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

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.