Preservation Versus Sacrifice of the Supraclavicular Nerves During Clavicle ORIF: A Randomized Controlled Trial

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Abstract
OBJECTIVES: To discover postoperative symptom differences between nerve-sparing and nerve-sacrificing techniques during ORIF of clavicle fractures. METHODS: Design: Prospective, partially blinded randomized controlled trial. Setting: Single academic level I trauma center. Patient Selection Criteria: Patients with closed, isolated, displaced, midshaft clavicle fractures (OTA/AO 15-2A, -2B, -2C) underwent ORIF and were consented and randomized to a “nerve-sacrificing” or “nerve-sparing” group. Outcome Measures and Comparisons: Semmes-Weinstein monofilament used to test for sensation changes around the supraclavicular area, single assessment numerical evaluation scores, and symptom severity level providing patient self-reported changes, and patient morbidity questionnaires were issued at follow-up. One trained research fellow measured and mapped area of anesthesia. Outcomes between “nerve-sacrificing” and “nerve-sparing” groups were compared. RESULTS: In total, 21 patients (median age 41.5 years, 28.6% women) were randomized to “nerve-sacrificed” and 16 patients (median age 45.6 years, 18.8% women) to the “nerve-spared” group. There were no statistical differences in age or sex ratio (P = 0.304 and 0.702, respectively). Longitudinal models including an interaction between group and time showed cohort differences being driven by 12 weeks (49.3 (95% CLM 7.68–90.92)) and 24 weeks (23.92 (95% CLM 1.70–46.14)). Although point estimates for the spare group were still lower at 2 and 52 weeks, they were not significantly different between groups. Single assessment numerical evaluation scores and symptom severity level data showed improvements in both cohorts over time; however, there were no statistically significant differences between the groups (P = 0.176 and 0.155, respectively). CONCLUSIONS: Sparing the supraclavicular nerve during open reduction and internal fixation of clavicle fractures significantly decreased chest-wall area of anesthesia at 12 and 24 weeks postoperatively. However, nerve sparing did not provide clinically significant differences in other symptoms compared with sacrificing the nerve. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

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