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Updated: May 14, 2025
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Published on: September 13, 2020
Preservation versus Sacrifice of the Supraclavicular Nerves during Clavicle ORIF: A Randomized Controlled Trial
Indraneel S Brahme1,2, Geneva Tranchida1,2, Jeffrey D Winter1,2
1Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota.
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 (SANE) scores and symptom severity level (SSL) 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:
21 patients (median age 41.5, 28.6% female) were randomized to "nerve-sacrificed" and 16 (median age 45.6, 18.8% female) to the "nerve-spared" group. There were no statistical differences in age or gender 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)). While point estimates for the spare group were still lower at 2- and 52-weeks, they were not significantly different between groups. SANE scores and SSL 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 to sacrificing the nerve.
Level Of Evidence:
Level I, Therapeutic.
