The Cutaneous Paresthesia Following Fixation Of Fracture Clavicle And Its Relevant Clinical Anatomy

Objectives:To analyze the follow up data of 135 cases of fracture cla vicle following internal fixation and report the incidence of cutaneous par esthesia and its relevant clinical anatomy.Methods: Retrospective analysis of fracture clavicle following internal fixation from The first and second affiliated hospitals of Guangxi Medic al University-complete follow up data of the 135 cases from May 2013 t o June 2015,the clinical symptoms of skin numbness around the scar,th e most peak numbness interval,when touch with cloth the severity of n umbness,pain around the scar and the changes of numbness after plate removal cases.In the dissecting room 7 cadaver specimens(1/7 bilateral),total eight supraclavicular neuroanatomy observed,understand the supra clavicular nerve,branches and its relationship with clinical.RESULTS: The incidence of altered sensation was 19.25%(n=26/135)of all,Of these,16.3%(n=22/135)reported hypoesthesia and 2.8%(n=4/135)report pain at scar site,majority of the patient reported no numbness.Amo ng the patient suffering from the numbness,most patients revealed that the firs t postoperated month was the worst.In the grading of numbness report,0.7%(n=1/135)case is severe,while 0.7%(n=1/135)was moderate and 14%(n=20/135)was mild.Two patients described increased awareness of numbness in contac t with objects such as clothing.The two patients were bordered by numbness d uring the numbness most peak time.None of the other bordered by the numbness.1.4%(n=2/135)report mild pain while 0.7%(n1/135)moderate and 0.7%(n=1/135)severe。Most of the patients,98.6%(n=133/135)re port numbness improved with time.1.4% report permanent numbness afte r 21.6 months follow up and only two cases still have numbness sensatio n.none of these two cases bordered by the numbness.Autopsy showed the supraclavicular nerves originating from cervical plexus C3C4 and passi ng through from lower half of the sternocleidomastoid muscle and divide into three branches,cut through the deep fascia and supply the posterior margin of sternocleidomastoid,manubrium,clavicle and the medial bord er of the acromion.The study revealed the three main branches of suprac lavicular nerve,lateral,intermediate and medial.The lateral branch about2.26 cm medial from acromion to clavicle and the medial branch about 2.03 cm from the lateral border of sternal notch to the clavicle.Conclusion : this report showed the loss of sensation of skin or hype ralgesia secondary to the nerve injury of supraclavicular nerve in fracture clavicle following plate internal fixation are seen.Most cases of numbne ss improve with time,Majority of the cases improve and a few may sust ain permanant life long.The supraclavicular nerve can be iatrogenically inj ured during either plate fixation or plate removal operation.The operation should be careful to separate,protect and try to avoid nerve damaging a nd excessive traction to the nerve.