Natural History of Anterior Chest Wall Numbness After Plating of Clavicle Fractures: Educating Patients

作者：Christensen Thomas J; Horwitz Daniel S; Kubiak Erik N^*

来源：Journal of Orthopaedic Trauma, 2014, 28(11): 642-647.

• clavicle fracture
• numbness
• Constant score
• DASH score

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(2). Numbness at 1 year remains relatively common, involving 52% of patients, with a mean area of 15 cm(2) (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(2)<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.

• 出版日期2014-11