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International Orthopaedics

, Volume 43, Issue 8, pp 1977–1982 | Cite as

Surgical approach for open reduction and internal fixation of clavicle fractures: a comparison of vertical and horizontal incisions

  • Ofir Chechik
  • Ron Batash
  • Yariv Goldstein
  • Nimrod Snir
  • Eyal Amar
  • Michael Drexler
  • Eran Maman
  • Oleg DolkartEmail author
Original Paper
  • 137 Downloads

Abstract

Purpose

This study was designed to compare the results of clavicle fracture open reduction internal fixation (ORIF) with standard horizontal incision versus vertical incision.

Methods

ORIF surgery performed between October 2012 and August 2016 was included. The surgical approach was chosen according to surgeon preference as vertical or horizontal. Functional outcomes, fracture union, complications, scar appearance, skin irritation, and denervation around the scar were assessed at a minimum follow-up of three months.

Results

Thirty-eight patients, age 39 ± 12 years, were operated upon, 22 through vertical incisions and 16 through horizontal incisions. There were no significant group differences in functional scores, fracture union, or complications. Two patients in the vertical incision group had a post-operative haematoma. The scar length was significantly shorter when a vertical incision was used (6.75 ± 1.25 cm vs 8.9 ± 2.3 cm, P = 0.001). The typical distribution of hypoesthetic skin area distal and lateral to the scar represented iatrogenic damage to the supraclavicular nerves and was found in 66% of patients. The mean hypoesthetic surface area was smaller in the vertical incision group (38 ± 29 cm2 vs 48 ± 28 cm2, P = non-significant).

Conclusion

Vertical incision results in shorter scars but may be associated with increased incidence of haematomas. Meticulous closure of the subcutaneous tissue is recommended.

Keywords

Clavicle fractures Open reduction and internal fixation Vertical and horizontal incisions 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This retrospective study was approved by the Institutional Review Board.

References

  1. 1.
    Chen W, Zhu Y, Liu S, Hou Z, Zhang X, Lv H, Zhang Y (2018) Demographic and socioeconomic factors influencing the incidence of clavicle fractures, a national population-based survey of five hundred and twelve thousand, one hundred and eighty seven individuals. Int Orthop 42(3):651–658.  https://doi.org/10.1007/s00264-018-3815-0 CrossRefPubMedGoogle Scholar
  2. 2.
    Alshameeri ZA, Katam K, Alsamaq M, Sonsale P (2012) The outcome of surgical fixation of mid shaft clavicle fractures; looking at patient satisfaction and comparing surgical approaches. Int J Shoulder Surg 6(3):76–81.  https://doi.org/10.4103/0973-6042.102556 CrossRefPubMedGoogle Scholar
  3. 3.
    Coupe BD, Wimhurst JA, Indar R, Calder DA, Patel AD (2005) A new approach for plate fixation of midshaft clavicular fractures. Injury 36(10):1166–1171.  https://doi.org/10.1016/j.injury.2005.03.007 CrossRefPubMedGoogle Scholar
  4. 4.
    Nathe T, Tseng S, Yoo B (2011) The anatomy of the supraclavicular nerve during surgical approach to the clavicular shaft. Clin Orthop Relat Res 469(3):890–894.  https://doi.org/10.1007/s11999-010-1608-x CrossRefPubMedGoogle Scholar
  5. 5.
    Wang K, Dowrick A, Choi J, Rahim R, Edwards E (2010) Post-operative numbness and patient satisfaction following plate fixation of clavicular fractures. Injury 41(10):1002–1005.  https://doi.org/10.1016/j.injury.2010.02.028 CrossRefPubMedGoogle Scholar
  6. 6.
    Zhang T, Chen W, Sun J, Zhang Q, Zhang Y (2017) Minimally invasive plate osteosynthesis technique for displaced midshaft clavicular fracture using the clavicle reductor. Int Orthop 41(8):1679–1683.  https://doi.org/10.1007/s00264-016-3392-z CrossRefPubMedGoogle Scholar
  7. 7.
    Sullivan T, Smith J, Kermode J, McIver E, Courtemanche DJ (1990) Rating the burn scar. J Burn Care Rehabil 11(3):256–260CrossRefPubMedGoogle Scholar
  8. 8.
    Vercelli S, Ferriero G, Sartorio F, Stissi V, Franchignoni F (2009) How to assess postsurgical scars: a review of outcome measures. Disabil Rehabil 25(31):2055–2063.  https://doi.org/10.3109/09638280902874196 CrossRefGoogle Scholar
  9. 9.
    Hulsmans MH, van Heijl M, Houwert RM, Hammacher ER, Meylaerts SA, Verhofstad MH, Dijkgraaf MG, Verleisdonk EJ (2017) High irritation and removal rates after plate or nail fixation in patients with displaced midshaft clavicle fractures. Clin Orthop Relat Res 475(2):532–539.  https://doi.org/10.1007/s11999-016-5113-8 CrossRefPubMedGoogle Scholar
  10. 10.
    Beirer M, Postl L, Cronlein M, Siebenlist S, Huber-Wagner S, Braun KF, Biberthaler P, Kirchhoff C (2015) Does a minimal invasive approach reduce anterior chest wall numbness and postoperative pain in plate fixation of clavicle fractures? BMC Musculoskelet Disord 16:128.  https://doi.org/10.1186/s12891-015-0592-4 CrossRefPubMedGoogle Scholar
  11. 11.
    Calbiyik M, Ipek D, Taskoparan M (2017) Prospective randomized study comparing results of fixation for clavicular shaft fractures with intramedullary nail or locking compression plate. Int Orthop 41(1):173–179.  https://doi.org/10.1007/s00264-016-3192-5 CrossRefPubMedGoogle Scholar
  12. 12.
    Ban I, Troelsen A (2016) Risk profile of patients developing nonunion of the clavicle and outcome of treatment--analysis of fifty five nonunions in seven hundred and twenty nine consecutive fractures. Int Orthop 40(3):587–593.  https://doi.org/10.1007/s00264-016-3120-8 CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Ofir Chechik
    • 1
  • Ron Batash
    • 1
  • Yariv Goldstein
    • 1
  • Nimrod Snir
    • 1
  • Eyal Amar
    • 1
  • Michael Drexler
    • 1
  • Eran Maman
    • 1
  • Oleg Dolkart
    • 1
    Email author
  1. 1.Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael

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