title: Post-operative numbness and patient satisfaction following plate fixation of clavicular fractures.
abstract: OBJECTIVE
  Numbness across the shoulder and upper chest wall is a frequent complication following plate fixation of clavicular shaft fractures. This is usually attributed to damage to branches of the supraclavicular nerve caused by the surgical approach. We investigate whether the use of an incision perpendicular to the long axis of the clavicle (vertical incision) rather than one parallel to it (horizontal incision) is associated with reduced post-operative numbness and improved patient satisfaction.
  
  
  METHODS
  We retrospectively assessed a group of patients who underwent plate fixation of a fractured clavicle at our institution. Using a patient-completed questionnaire, we compared differences in numbness, scar satisfaction, pain, and overall satisfaction with the operation, between those who received a horizontal incision (n=21) versus those treated using a vertical incision (n=14).
  
  
  RESULTS
  The likelihood of experiencing post-operative numbness was less in the vertical incision group. Those who had undergone vertical incisions also reported a significantly reduced degree of numbness and significantly less awareness of the numbness with clothing and shoulder straps. There was no statistically significant difference between the groups in terms of pain and scar satisfaction. Patients who reported being most bothered by their numbness also tended to report the highest dissatisfaction with the operation.
  
  
  CONCLUSIONS
  Vertical incisions for plate fixation of clavicular shaft fractures may be associated with reduced post-operative numbness and avoid some cases of patient dissatisfaction. Surgeons should consider using this approach in plate fixation of clavicle fractures.
authors.affiliation: Department of Orthopaedic Surgery, Alfred Hospital, Melbourne, Victoria, Australia. kemble.wang@gmail.com
authors.forename: Kemble
authors.initials: K
authors.lastname: Wang
authors.forename: Adam
authors.initials: A
authors.lastname: Dowrick
authors.forename: John
authors.initials: J
authors.lastname: Choi
authors.forename: Reza
authors.initials: R
authors.lastname: Rahim
authors.forename: Elton
authors.initials: E
authors.lastname: Edwards
mesh_terms: D001860:Bone Plates; D002968:Clavicle / Q000293:injuries* / Q000294:innervation; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D006987:Hypesthesia / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D008297:Male; D017060:Patient Satisfaction; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D016896:Treatment Outcome