title: Natural history of anterior chest wall numbness after plating of clavicle fractures: educating patients.
abstract: OBJECTIVE
  Improved patient outcomes after plating of displaced clavicle fractures have been demonstrated by recent clinical studies. Many of these patients, however, complain of anterior chest wall numbness after this procedure; we hypothesize that numbness likely persists long term for many patients, but without effect on shoulder function.
  
  
  METHODS
  Prospective observational cohort.
  
  
  METHODS
  Level 1 trauma center.
  
  
  METHODS
  Adult patients undergoing plating of a displaced middle third diaphyseal clavicle fracture.
  
  
  METHODS
  Open reduction and internal fixation with superior clavicle plating.
  
  
  METHODS
  The primary outcome is anterior chest wall numbness size (in square centimeters) and location as measured with a numbness transparency grid. Secondary outcomes include Visual Analog scale, Disabilities of the Arm, Shoulder, and Hand, and Constant scores 1 year postoperatively.
  
  
  RESULTS
  Twenty-five of 27 consecutive patients met inclusion/exclusion criteria, with 92% 1-year follow-up. Numbness at 2 weeks is very common, involving 83% of patients, with a mean area of 44 cm. Numbness at 1 year remains relatively common, involving 52% of patients, with a mean area of 15 cm (66% decrease in area from 2 weeks, P = 0.009). Numbness at 2 weeks predicted a 63% chance of continued 1-year numbness (37% resolved); Constant, Disabilities of the Arm, Shoulder, and Hand, and Visual Analog scale pain scores remained excellent in all patients at final follow-up, without correlation between numbness and outcome measures (r < 0.170).
  
  
  CONCLUSIONS
  Anterior chest wall numbness after open reduction internal fixation of displaced clavicle fractures is very common in the early postoperative period and may remain high 1 year postoperatively. Numbness 1 year after surgery is not associated with poor clinical outcome measures.
  
  
  METHODS
  Prognostic level IV. See instructions for authors for a complete description of levels of evidence.
authors.affiliation: *University of Utah, Salt Lake City, UT; and †Geisinger Medical Center, Dansville, PA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Christensen
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Horwitz
authors.forename: Erik N
authors.initials: EN
authors.lastname: Kubiak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates / Q000009:adverse effects*; D002968:Clavicle / Q000293:injuries* / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D006987:Hypesthesia / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011446:Prospective Studies; D020127:Recovery of Function; D035441:Thoracic Wall; D016896:Treatment Outcome; D055815:Young Adult