Comparison of Post-operative Numbness and Patient Satisfaction Using Minimally Invasive Plate Osteosynthesis or Open Plating for Acute Displaced Clavicular Shaft Fractures

Background: Anterior chest wall numbness after plate fixation of clavicular shaft fractures is a common complication. This is usually related to damage of the branches of the supraclavicular nerve in conventional open plating. We investigated whether the use of minimally invasive plate osteosynthesis could reduce the incidence of post-operative numbness and improve patients' satisfaction compared to open plating.

Methods: Between August 2012 and October 2015, 73 patients with acute clavicle shaft fracture (Robinson classification 2A2-2B2) were treated with plate fixation at our institution. Thirty-eight patients underwent minimally invasive plate osteosynthesis (MIPO), and the other 35 patients received conventional open reduction and internal fixation (ORIF). The incidence of anterior chest wall numbness, numbness area, and patient satisfaction were evaluated at 2 weeks, 3 months and 1 year after the operation by questionnaires. Shoulder joint function was evaluated using the Constant-Murley score and the Disability of the Arm, Shoulder and Hand (DASH) score, and pain was measured using a Visual Analogue Scale (VAS).

Results: The patients in the MIPO group had a lower incidence and smaller area of anterior chest wall numbness than the ORIF group at each follow-up interval. The patients who underwent MIPO reported higher satisfaction with the operation. There was no significant difference in the Constant-Murley score, DASH score and VAS of the 2 groups at 1-year follow-up.

Conclusion: The MIPO technique for clavicle shaft fractures is an effective way to reduce post-operative numbness and improve patients' satisfaction compare to conventional open plating. Surgeons could consider using this technique as an alternative procedure to prevent iatrogenic supraclavicular nerve damage and subsequent anterior chest wall numbness.