Supraclavicular Nerve During Clavicle ORIF

NCT ID: NCT06050473

Last Updated: 2023-09-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

45 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-11-02

Study Completion Date

2023-08-10

Brief Summary

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Clavicle fractures are a common orthopedic injury and make up 2.6%-5% of all fractures. Despite the benefits of operative management, post-operative chest wall paresthesia is a well-known complication among surgeons and is well described in the literature. Studies reporting on the natural history of post-operative paresthesia report an incidence of chest wall numbness anywhere from 10-80% and this is attributed to iatrogenic injury of the branches of the supraclavicular nerve that provide sensation over the clavicle, anteromedial shoulder and proximal chest. While this may seem like an easy complication to avoid, anatomic studies give insight into the complex and unpredictable branching of the supraclavicular nerve. The aim of this study was to compare the area (cm2) and change in size over time of post-operative paresthesia (includes hypesthesia and dysesthesia) following ORIF of displaced clavicle fractures between nerve-sacrificing and nerve-preserving procedures.

Detailed Description

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This is a prospective, partially-blinded, single center, randomized controlled trial to compare the post-operative outcomes of paresthesias and morbidity between nerve-preserving and nerve-sacrificing procedures after surgical fixation of clavicle fractures. Although prior studies explore different incision orientation, most fail to specify whether or not the supraclavicular nerve branches were identified and protected and also lack a patient questionnaire that focuses on paresthesia characteristics and patient quality of life as it relates to the measured area of postoperative numbness. In this proposed study, the investigators will be able to fill this gap in knowledge and give insight into whether or not a nerve-sparing technique should be used to decrease the morbidity of postoperative chest wall paresthesia following operative fixation of clavicle fractures. This research will be important to the scientific community because it will help guide a physician's pre-operative counseling and establish realistic expectations for their patients. It could also guide a physician's surgical technique in a manner to decrease post-operative morbidity for patient's undergoing surgical fixation of clavicle fractures.

1. Group 1 - Operative treatment utilizing a supraclavicular nerve-sacrificing procedure
2. Group 2 - Operative treatment utilizing a supraclavicular nerve-preserving procedure

Conditions

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Clavicle Fracture

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants
Participants blinded to the cohort they are randomized to (i.e., nerve-sparing group vs nerve-sacrificing group). Care providers were blinded to the randomization and made aware of the patient's cohort just prior to surgery.

Study Groups

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Supraclavicular nerve-sacrificing procedure

Surgeon will not attempt to identify the supraclavicular nerve branches.

Group Type ACTIVE_COMPARATOR

Nerve-sacrificing procedure

Intervention Type PROCEDURE

Surgical fixation of the clavicle fracture will be performed through a horizontal incision over the clavicle. During the incision and soft tissue dissection, the surgeon will not attempt to identify the supraclavicular nerve branches. Instead, the surgeon will cut the nerve branches during the dissection.

Supraclavicular nerve-preserving procedure

Surgeon will attempt to dissect out, identify and preserve all branches of the supraclavicular nerve throughout the fracture reduction, fixation and closure.

Group Type ACTIVE_COMPARATOR

Nerve preserving procedure

Intervention Type PROCEDURE

Surgical fixation of the clavicle fracture will be performed through the same horizontal incision over the clavicle. The surgeon will attempt to dissect out, identify and preserve all branches of the supraclavicular nerve throughout the fracture reduction, fixation and closure.

Interventions

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Nerve-sacrificing procedure

Surgical fixation of the clavicle fracture will be performed through a horizontal incision over the clavicle. During the incision and soft tissue dissection, the surgeon will not attempt to identify the supraclavicular nerve branches. Instead, the surgeon will cut the nerve branches during the dissection.

Intervention Type PROCEDURE

Nerve preserving procedure

Surgical fixation of the clavicle fracture will be performed through the same horizontal incision over the clavicle. The surgeon will attempt to dissect out, identify and preserve all branches of the supraclavicular nerve throughout the fracture reduction, fixation and closure.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patients \>17 years old with a displaced, midshaft clavicle fracture
* Closed injury
* No skin compromise

Exclusion Criteria

* Clavicle non-union/malunion
* Far proximal (medial) or far distal (lateral) clavicle fractures
* Open injury
* Skin compromise
* Prior surgery of the anterior chest wall or affected clavicle
* Pre-existing chest wall numbness, cervical root symptoms, neurologic or sensory deficits, signs of neuropathy
* We will not exclude patients on membrane stabilizing medications for nerve paresthesia (GABA agonists, tricyclic anti-depressants) but will include this on patient intake form and document it
* Traumatic brain injury
* Patients who had prior deltopectoral approach to glenoid
Minimum Eligible Age

17 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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HealthPartners Institute

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Peter A Cole, MD

Role: PRINCIPAL_INVESTIGATOR

HealthPartners Institute

References

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Ahrens PM, Garlick NI, Barber J, Tims EM; Clavicle Trial Collaborative Group. The Clavicle Trial: A Multicenter Randomized Controlled Trial Comparing Operative with Nonoperative Treatment of Displaced Midshaft Clavicle Fractures. J Bone Joint Surg Am. 2017 Aug 16;99(16):1345-1354. doi: 10.2106/JBJS.16.01112.

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Reference Type BACKGROUND
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Reference Type BACKGROUND
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Reference Type BACKGROUND
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Reference Type BACKGROUND
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Reference Type BACKGROUND
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Reference Type BACKGROUND
PMID: 33966101 (View on PubMed)

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Ban I, Nowak J, Virtanen K, Troelsen A. Overtreatment of displaced midshaft clavicle fractures. Acta Orthop. 2016 Dec;87(6):541-545. doi: 10.1080/17453674.2016.1191275. Epub 2016 May 26.

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O'Neill K, Stutz C, Duvernay M, Schoenecker J. Supraclavicular nerve entrapment and clavicular fracture. J Orthop Trauma. 2012 Jun;26(6):e63-5. doi: 10.1097/BOT.0b013e31822c0796.

Reference Type BACKGROUND
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Other Identifiers

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A16-535

Identifier Type: -

Identifier Source: org_study_id

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