Background:
Clavicle fractures, frequently associated with sports and trauma, are prevalent injuries in the upper extremity. Surgical repair, a common intervention, aims to restore skeletal stability and facilitate functional recovery. The role of neural protection, particularly concerning the supraclavicular nerve, in clavicle fracture surgery remains an area of interest. The purpose of this study was to compare operative time, bleeding, postoperative hospitalization, postoperative pain, numbness, and upper extremity function between clavicle plastic surgery patients using supraclavicular nerve preservation and supraclavicular nerve sacrifice techniques.
Methods:
A retrospective cohort study spanning January 2021 to January 2023 involved patients with midshaft clavicle fractures treated with dynamic compression plates or locking plates at Xi'an People's Hospital (Xi'an Fourth Hospital). Patient data were extracted, and surgical outcomes were meticulously recorded. Parameters such as operative time, estimated blood loss, post-operative hospitalization duration, Visual Analog Scale (VAS) scores, Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score, and the occurrence of numbness were among the comprehensive outcomes analyzed.
Results:
Among the 241 eligible patients, the study categorized them into Supraclavicular Nerve Preservation (SNP) and Supraclavicular Nerve Sacrificing (SNS) groups. Baseline analysis revealed comparable demographic and injury-related characteristics. Surgical outcomes analysis demonstrated no significant difference in operative time between the SNP and SNS groups (64.28 ± 16.07 vs. 67.50 ± 17.53, p = 0.19). Strikingly, the SNP group exhibited significantly lower blood loss during surgery compared to the SNS group (28.43 ± 13.35 vs. 36.51 ± 16.54, p < 0.01). No substantial difference in post-operative hospitalization duration was noted between the two groups (3.07 ± 1.07 vs. 3.23 ± 41.06, p = 0.32). Evaluation of postoperative numbness consistently favored the SNP group at 1 month (94.1% vs. 8.1%, p < 0.01), 3 months (95.6% vs. 10.4%, p < 0.01), 6 months (98.5% vs. 11.6%, p < 0.01), and 1 year postoperatively (98.5% vs. 13.3%, p < 0.01).
Conclusion:
This study suggests that the Supraclavicular Nerve Preservation approach, while equivalent in operative efficiency, offers advantages in reducing blood loss (p < 0.01) and minimizing postoperative numbness (all p < 0.01). These findings contribute valuable evidence to the discourse on optimal clavicle fracture management, emphasizing the importance of nerve preservation in surgical interventions. Further research is warranted to validate and extend these findings for broader clinical implications.