Supraclavicular Nerves Protection During Open Reduction And Internal Fixation

Our study was to verify whether the approach of protecting supraclavicular nerve could effectively reduce the discomfort caused by iatrogenic injury to the supraclavicular nerve. A total of 37 patients with unilateral midclavicular fractures were enrolled and randomly assigned into the experimental group (patients received meticulous dissection by specially preservation of supraclavicular nerves with diameter > 0.5 mm during open reduction and internal fixation (ORIF)) and control group (patients received conventional ORIF). One year follow-up was performed after operation. Clinical outcomes including intraoperative and postoperative parameters were compared between groups. For the intraoperative parameters, no significant difference was found between groups in operative time (P = 0.074). However, the blood loss (P = 0.004) was significantly decreased and incision length (P = 0.008) was significantly longerin experimental group compared with control group. For postoperative parameters, the time of bone healing was similar between groups (P = 0.856). However, the degree and range of skin numbness were significantly decreased by specially preservation of supraclavicular nerves during ORIF compared with conventional ORIF at two weeks and one year after operation (P < 0.05). In addition, although no statistical significance (P = 0.090), the results also indicated a trend that experimental group had fewer patients with complications related to the supraclavicular nerve injury than control group, including hyperesthesia, Tinel's sign, tenderness, afraid of cold or feel discomfort beneath the incision. The results of this study supported the application of preservation of supraclavicular nerves during ORIF in treatment of midclavicular fractures.