title: Does a minimal invasive approach reduce anterior chest wall numbness and postoperative pain in plate fixation of clavicle fractures?
abstract: BACKGROUND
  Fractures of the clavicle present very common injuries with a peak of incidence in young active patients. Recently published randomized clinical trials demonstrated an improved functional outcome and a lower rate of nonunions in comparison to non-operative treatment. Anterior chest wall numbness due to injury of the supraclavicular nerve and postoperative pain constitute common surgery related complications in plate fixation of displaced clavicle fractures. We recently developed a technique for mini open plating (MOP) of the clavicle to reduce postoperative numbness and pain. The purpose of this study was to analyze the size of anterior chest wall numbness and the intensity of postoperative pain in MOP in comparison to conventional open plating (COP) of clavicle fractures.
  
  
  METHODS
  24 patients (mean age 38.2 ± 14.2 yrs.) with a displaced fracture of the clavicle (Orthopaedic Trauma Association B1.2-C1.2) surgically treated using a locking compression plate (LCP) were enrolled. 12 patients underwent MOP and another 12 patients COP. Anterior chest wall numbness was measured with a transparency grid on the second postoperative day and at the six months follow-up. Postoperative pain was evaluated using the Visual Analog Scale (VAS).
  
  
  RESULTS
  Mean ratio of skin incision length to plate length was 0.61 ± 0.04 in the MOP group and 0.85 ± 0.06 in the COP group (p < 0.05). Mean ratio of the area of anterior chest wall numbness to plate length was postoperative 7.6 ± 5.9 (six months follow-up 4.7 ± 3.9) in the MOP group and 22.1 ± 19.1 (16.9 ± 14.1) in the COP group (p < 0.05). Mean VAS was 2.6 ± 1.4 points in the MOP group and 3.4 ± 1.6 points in the COP group (p = 0.20).
  
  
  CONCLUSIONS
  In our study, MOP significantly reduced anterior chest wall numbness in comparison to a conventional open approach postoperative as well as at the six months follow-up. Postoperative pain tended to be lower in the MOP group, however this difference was not statistically significant.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02247778 . Registered 21 September 2014.
authors.affiliation: Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. marc.beirer@mri.tum.de.
authors.forename: Marc
authors.initials: M
authors.lastname: Beirer
authors.affiliation: Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. lukas.postl@mri.tum.de.
authors.forename: Lukas
authors.initials: L
authors.lastname: Postl
authors.affiliation: Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. moritz.croenlein@mri.tum.de.
authors.forename: Moritz
authors.initials: M
authors.lastname: Crönlein
authors.affiliation: Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. sebastian.siebenlist@mri.tum.de.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Siebenlist
authors.affiliation: Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. wagner@mri.tum.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Huber-Wagner
authors.affiliation: Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. karl.braun@mri.tum.de.
authors.forename: Karl F
authors.initials: KF
authors.lastname: Braun
authors.affiliation: Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. peter.biberthaler@mri.tum.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Biberthaler
authors.affiliation: Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. chlodwig.kirchhoff@mri.tum.de.
authors.forename: Chlodwig
authors.initials: C
authors.lastname: Kirchhoff
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D050723:Fractures, Bone / Q000175:diagnosis / Q000601:surgery*; D005858:Germany; D006801:Humans; D006987:Hypesthesia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011859:Radiography; D035441:Thoracic Wall / Q000294:innervation*; D016896:Treatment Outcome; D055815:Young Adult