Mini-open intramedullary fixation with attempted supraclavicular nerve preservation versus plate fixation for
Kesai Yang1, Jiaxing Sun2, Yongtao Li1
1Department of General Surgery, Affiliated Hospital of NCO School, Army Medical University, Shijiazhuang, China.
Abstract:
PurposeTo compare mini-open intramedullary fixation and plate fixation for Robinson type II midshaft clavicle fractures, with supraclavicular nerve preservation attempted in both approaches, regarding postoperative numbness, pain, shoulder function, perioperative outcomes, and fracture healing.MethodsThis retrospective study included 75 adults with Robinson type II midshaft clavicle fractures treated between September 2019 and January 2025. Group A (n=35) underwent mini-open intramedullary fixation with a 2.0-2.5-mm titanium Kirschner wire, and Group B (n=40) underwent plate fixation; supraclavicular nerve preservation was attempted in both groups. Incision length, blood loss, operation time, postoperative numbness, visual analogue scale pain scores, Constant-Murley scores, nonunion, and implant-related events were assessed, using generalized estimating equations and linear mixed-effects models.ResultsBaseline characteristics were comparable. Group A had a shorter incision (mean difference, -8.99 cm), less blood loss (-38.42 mL), and a shorter operation time (-24.96 min; all P<0.001). Numbness rates were lower in Group A at 2 weeks, 3 months, and 6 months; at 12 months, 5.7% versus 22.5% (P=0.053). Group B had higher overall odds of postoperative numbness (OR=3.98, 95% CI 1.58-9.98; P=0.003). Pain scores decreased in both groups (group-by-time interaction, P<0.001), with no significant between-group difference at 12 months (P=0.163). Constant-Murley scores were lower in Group A at 3 months (89.4±4.4 vs 93.0±4.9; P=0.001) but similar at 6 and 12 months; the group-by-time interaction was significant (P=0.003). Nonunion rates were similar. Implant irritation occurred in 2/35 Group A patients (5.7%).ConclusionMini-open intramedullary fixation with attempted supraclavicular nerve preservation was associated with less surgical trauma, lower early postoperative pain, and lower overall odds of numbness than plate fixation. The 3-month Constant-Murley advantage of plating was not sustained at 6 or 12 months, and fracture healing was comparable. Implant irritation occurred in 5.7% of Group A patients.
