title: Analysis of neurovascular safety between superior and anterior plating techniques of clavicle fractures.
abstract: OBJECTIVE
  Clavicle fractures are commonly plated as a method of fixation, with superior and anterior techniques described. Although advantages and disadvantages have been attributed to both, it is unclear if one approach provides a lower risk of neurovascular injury. The aim of this study was to compare the potential for neurovascular injury between these 2 plate locations in a cadaveric model.
  
  
  METHODS
  Seventeen adult fresh frozen cadavers underwent bilateral dissections exposing the clavicle and underlying neurovasculature. After taking baseline anatomical measurements, a superior and anterior clavicle plate was applied, removed and measurements were taken from the nearest screw exit site to the underlying subclavian vein/artery and brachial plexus. The differences between superior and anterior measurements were compared based on proximity with the neurovasculature.
  
  
  RESULTS
  Distance to the vessels were unobtainable in 6 specimens (35%) plated with the anterior technique due to the trajectory of the screws projecting cephalad to the vessels. In the remaining specimens, there was no significant difference in the distance to the subclavian vein/artery and brachial plexus in the superior plate position (9.2 ± 4.6, 12.2 ± 5.8, and 9.8 ± 5.2 mm, respectively) compared with the anterior plate position (8.3 ± 3.5, 12.2 ± 6.5, and 9.7 ± 5.3 mm, respectively). In addition, no significant difference in potential neurovascular injury with regard to body size or gender was found.
  
  
  CONCLUSIONS
  The majority of our specimens showed no significant difference between superior and anterior plating in regard to potential risk for injury to the underlying neurovasculature. However, there appears to be a subset of the population with a more caudal position of the neurovascular structures in which anterior plating may be potentially safer.
authors: Departments of *Orthopaedic Surgery, †Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX.
authors: Michael M
authors: MM
authors: Hussey
authors: Yumin
authors: Y
authors: Chen
authors: Roberto A
authors: RA
authors: Fajardo
authors: Anil K
authors: AK
authors: Dutta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates / Q000009:adverse effects*; D001863:Bone Screws; D002102:Cadaver; D002968:Clavicle / Q000293:injuries* / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020196:Trauma, Nervous System / Q000453:epidemiology*; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000453:epidemiology*