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Natural history of anterior chest wall numbness after plating of clavicle fractures: educating patients.

Abstract：

OBJECTIVES: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. DESIGN:Prospective observational cohort. SETTING:Level 1 trauma center. PATIENTS/PARTICIPANTS:Adult patients undergoing plating of a displaced middle third diaphyseal clavicle fracture. INTERVENTION:Open reduction and internal fixation with superior clavicle plating. MAIN OUTCOME MEASUREMENTS: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. LEVEL OF EVIDENCE:Prognostic level IV. See instructions for authors for a complete description of levels of evidence.

journal_name

J Orthop Trauma

journal_title

Journal of orthopaedic trauma

authors

Christensen TJ,Horwitz DS,Kubiak EN

doi

10.1097/BOT.0000000000000095

subject

Has Abstract

pub_date

2014-11-01 00:00:00

pages

642-7

issue

eissn

0890-5339

issn

1531-2291

journal_volume

pub_type

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Natural history of anterior chest wall numbness after plating of clavicle fractures: educating patients.