Skip to main content
OTA 2023 Annual Meeting Main banner
Back

Upper Extremity

Session: Annual Meeting Podium Session VII: Upper Extremity

Preservation Versus Sacrifice of the Supraclavicular Nerves During Clavicle Open Reduction and Internal Fixation

Saturday, October 21, 2023
10:08 AM – 10:14 AM PST
Location: 4B

    Presenting Author(s)

  • Indraneel Brahme, MD (he/him/his)

    Research Fellow
    University of Minnesota, Regions Hospital
    Maplewood, Minnesota, United States

    Disclosure(s): No financial relationships to disclose

    • Corresponding Author(s)

  • PC

    Peter A. Cole, MD

    University of Minnesota/Regions Hospital
    St. Paul, Minnesota, United States

    Disclosure(s): AO Trauma: Speakers Bureau (Ongoing); AONA: Other Financial or Material Support (Ongoing); BoneFoams Inc, LLC: Stock Shareholder (excluding mutual funds) (Ongoing); Depuy Synthes: Other Financial or Material Support (Ongoing); Exactech, Inc.: Consultant (Ongoing); Geriatric Orthopaedic Surgery and Rehabilitation: Other Financial or Material Support (Ongoing); Journal of Orthopaedic Trauma: Other Financial or Material Support (Ongoing); KLS Martin: Grant or Research Support, or I am listed as the PI (Ongoing), Other Financial or Material Support (Ongoing), Speakers Bureau (Ongoing); OMEGA: Other Financial or Material Support (Ongoing); Siemens Health Care: Other Financial or Material Support (Ongoing); Stryker: Grant or Research Support, or I am listed as the PI (Ongoing), Other Financial or Material Support (Ongoing); Synthes: Consultant (Ongoing), Grant or Research Support, or I am listed as the PI (Ongoing), Speakers Bureau (Ongoing); UTMB-DOSR Univ of Tx Medical Branch - Dept of Ortho Surgery & Rehab: Speakers Bureau (Ongoing)

    • Co-Author(s)

  • GT

    Geneva Tranchida, MD
  • GM

    Gaonhia Y. Moua, BS
  • PH

    Patrick Horrigan, MD

  • Brian Cunningham, MD
Purpose: Clavicle fractures make up 2.6% to 5% of all fractures. Despite the benefits of surgery, postoperative chest wall symptoms are well-known complications with reported incidence from 10% to 80% of the time due to iatrogenic injury of branches of the supraclavicular nerve that provide sensation over the anteromedial shoulder and proximal chest. The purpose of our study is to discover differences between nerve-sparing and nerve-sacrificing techniques during open reduction and internal fixation (ORIF) of clavicle fractures.

Methods: This is a prospective, partially blinded, single center, randomized controlled trial. Patients who presented to our hospital after sustaining a closed, isolated, displaced, midshaft clavicle fracture and underwent operative fixation were consented and randomized to either the “nerve-sacrificing” or “nerve-sparing” group. During postoperative follow-up, Semmes-Weinstein monofilament testing of the supraclavicular area was performed by a trained research assistant. Measurements were mapped onto a standardized grid to determine the area of anesthesia. Patien- reported outcomes (PROs) including symptom severity, and single assessment numerical evaluation (SANE) scores were obtained at follow up visits.


Results: 39 patients were included in the final study cohort. 21 were randomized to “nerve-sacrificed”, and 18 to the “nerve-spared” group. There were no statistically significant differences in age (41.5 vs 46.6 years, P = 0.18) or gender ratio (28.6% female vs 16.7% female, P = 0.46). 71.8% of patients had greater than 6 months of follow-up and 100% achieved union. The area of anesthesia in the “nerve-sparing group” decreased from 62.1 ± 61.1 cm² at 2 weeks to 10.9 ± 14.5cm² at 1 year. In the “nerve-sacrificing group” the area decreased from 73.9 ± 45.2 cm² to 20.3 ± 24.2 cm². This represented a statistically significant difference at all time points (2, 12, 24, and 52 weeks). Unadjusted SANE scores increased from 50.4 ± 17.7 at 2 weeks to 95.6 ± 8.0 at 1 year in the nerve-sparing group. The nerve-sacrificing group increased from 57.9 ± 20.1 to 90.2 ± 9.9. This did not represent a statistically significant difference between groups. Additionally, symptom severity scores showed similar improvements in both cohorts with no statistically significant differences.


Conclusions: Our study demonstrates that sparing the supraclavicular nerve during ORIF of clavicle fracture results in decreased chest-wall numbness which persists through the 1-year postoperative period but may not provide clinically significant improvements in function compared to sacrificing the nerve.

Graphic