Analysis of neurovascular safety between superior and anterior plating techniques of clavicle fractures

Michael M. Hussey, Yumin Chen, Roberto A. Fajardo, Anil K Dutta

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

OBJECTIVES:: Clavicle fractures are commonly plated as a method of fixation, with superior and anterior techniques described. Although advantages and disadvantages have been attributed to both, it is unclear if one approach provides a lower risk of neurovascular injury. The aim of this study was to compare the potential for neurovascular injury between these 2 plate locations in a cadaveric model. METHODS:: Seventeen adult fresh frozen cadavers underwent bilateral dissections exposing the clavicle and underlying neurovasculature. After taking baseline anatomical measurements, a superior and anterior clavicle plate was applied, removed and measurements were taken from the nearest screw exit site to the underlying subclavian vein/artery and brachial plexus. The differences between superior and anterior measurements were compared based on proximity with the neurovasculature. RESULTS:: Distance to the vessels were unobtainable in 6 specimens (35%) plated with the anterior technique due to the trajectory of the screws projecting cephalad to the vessels. In the remaining specimens, there was no significant difference in the distance to the subclavian vein/artery and brachial plexus in the superior plate position (9.2 ± 4.6, 12.2 ± 5.8, and 9.8 ± 5.2 mm, respectively) compared with the anterior plate position (8.3 ± 3.5, 12.2 ± 6.5, and 9.7 ± 5.3 mm, respectively). In addition, no significant difference in potential neurovascular injury with regard to body size or gender was found. CONCLUSIONS:: The majority of our specimens showed no significant difference between superior and anterior plating in regard to potential risk for injury to the underlying neurovasculature. However, there appears to be a subset of the population with a more caudal position of the neurovascular structures in which anterior plating may be potentially safer.

Original languageEnglish (US)
Pages (from-to)627-632
Number of pages6
JournalJournal of Orthopaedic Trauma
Volume27
Issue number11
DOIs
StatePublished - Nov 2013

Fingerprint

Clavicle
Safety
Subclavian Vein
Subclavian Artery
Brachial Plexus
Wounds and Injuries
Body Size
Cadaver
Dissection
Population

Keywords

  • anterior plating
  • brachial plexus
  • cadaver
  • clavicle
  • fractures
  • neurovascular safety
  • neurovasculature
  • plating
  • study
  • subclavian
  • superior plating

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Analysis of neurovascular safety between superior and anterior plating techniques of clavicle fractures. / Hussey, Michael M.; Chen, Yumin; Fajardo, Roberto A.; Dutta, Anil K.

In: Journal of Orthopaedic Trauma, Vol. 27, No. 11, 11.2013, p. 627-632.

Research output: Contribution to journalArticle

Hussey, Michael M. ; Chen, Yumin ; Fajardo, Roberto A. ; Dutta, Anil K. / Analysis of neurovascular safety between superior and anterior plating techniques of clavicle fractures. In: Journal of Orthopaedic Trauma. 2013 ; Vol. 27, No. 11. pp. 627-632.
@article{896be5f04c4e4f159ec218055b9daa47,
title = "Analysis of neurovascular safety between superior and anterior plating techniques of clavicle fractures",
abstract = "OBJECTIVES:: Clavicle fractures are commonly plated as a method of fixation, with superior and anterior techniques described. Although advantages and disadvantages have been attributed to both, it is unclear if one approach provides a lower risk of neurovascular injury. The aim of this study was to compare the potential for neurovascular injury between these 2 plate locations in a cadaveric model. METHODS:: Seventeen adult fresh frozen cadavers underwent bilateral dissections exposing the clavicle and underlying neurovasculature. After taking baseline anatomical measurements, a superior and anterior clavicle plate was applied, removed and measurements were taken from the nearest screw exit site to the underlying subclavian vein/artery and brachial plexus. The differences between superior and anterior measurements were compared based on proximity with the neurovasculature. RESULTS:: Distance to the vessels were unobtainable in 6 specimens (35{\%}) plated with the anterior technique due to the trajectory of the screws projecting cephalad to the vessels. In the remaining specimens, there was no significant difference in the distance to the subclavian vein/artery and brachial plexus in the superior plate position (9.2 ± 4.6, 12.2 ± 5.8, and 9.8 ± 5.2 mm, respectively) compared with the anterior plate position (8.3 ± 3.5, 12.2 ± 6.5, and 9.7 ± 5.3 mm, respectively). In addition, no significant difference in potential neurovascular injury with regard to body size or gender was found. CONCLUSIONS:: The majority of our specimens showed no significant difference between superior and anterior plating in regard to potential risk for injury to the underlying neurovasculature. However, there appears to be a subset of the population with a more caudal position of the neurovascular structures in which anterior plating may be potentially safer.",
keywords = "anterior plating, brachial plexus, cadaver, clavicle, fractures, neurovascular safety, neurovasculature, plating, study, subclavian, superior plating",
author = "Hussey, {Michael M.} and Yumin Chen and Fajardo, {Roberto A.} and Dutta, {Anil K}",
year = "2013",
month = "11",
doi = "10.1097/BOT.0b013e31828c1e37",
language = "English (US)",
volume = "27",
pages = "627--632",
journal = "Journal of Orthopaedic Trauma",
issn = "0890-5339",
publisher = "Lippincott Williams and Wilkins",
number = "11",

}

TY - JOUR

T1 - Analysis of neurovascular safety between superior and anterior plating techniques of clavicle fractures

AU - Hussey, Michael M.

AU - Chen, Yumin

AU - Fajardo, Roberto A.

AU - Dutta, Anil K

PY - 2013/11

Y1 - 2013/11

N2 - OBJECTIVES:: Clavicle fractures are commonly plated as a method of fixation, with superior and anterior techniques described. Although advantages and disadvantages have been attributed to both, it is unclear if one approach provides a lower risk of neurovascular injury. The aim of this study was to compare the potential for neurovascular injury between these 2 plate locations in a cadaveric model. METHODS:: Seventeen adult fresh frozen cadavers underwent bilateral dissections exposing the clavicle and underlying neurovasculature. After taking baseline anatomical measurements, a superior and anterior clavicle plate was applied, removed and measurements were taken from the nearest screw exit site to the underlying subclavian vein/artery and brachial plexus. The differences between superior and anterior measurements were compared based on proximity with the neurovasculature. RESULTS:: Distance to the vessels were unobtainable in 6 specimens (35%) plated with the anterior technique due to the trajectory of the screws projecting cephalad to the vessels. In the remaining specimens, there was no significant difference in the distance to the subclavian vein/artery and brachial plexus in the superior plate position (9.2 ± 4.6, 12.2 ± 5.8, and 9.8 ± 5.2 mm, respectively) compared with the anterior plate position (8.3 ± 3.5, 12.2 ± 6.5, and 9.7 ± 5.3 mm, respectively). In addition, no significant difference in potential neurovascular injury with regard to body size or gender was found. CONCLUSIONS:: The majority of our specimens showed no significant difference between superior and anterior plating in regard to potential risk for injury to the underlying neurovasculature. However, there appears to be a subset of the population with a more caudal position of the neurovascular structures in which anterior plating may be potentially safer.

AB - OBJECTIVES:: Clavicle fractures are commonly plated as a method of fixation, with superior and anterior techniques described. Although advantages and disadvantages have been attributed to both, it is unclear if one approach provides a lower risk of neurovascular injury. The aim of this study was to compare the potential for neurovascular injury between these 2 plate locations in a cadaveric model. METHODS:: Seventeen adult fresh frozen cadavers underwent bilateral dissections exposing the clavicle and underlying neurovasculature. After taking baseline anatomical measurements, a superior and anterior clavicle plate was applied, removed and measurements were taken from the nearest screw exit site to the underlying subclavian vein/artery and brachial plexus. The differences between superior and anterior measurements were compared based on proximity with the neurovasculature. RESULTS:: Distance to the vessels were unobtainable in 6 specimens (35%) plated with the anterior technique due to the trajectory of the screws projecting cephalad to the vessels. In the remaining specimens, there was no significant difference in the distance to the subclavian vein/artery and brachial plexus in the superior plate position (9.2 ± 4.6, 12.2 ± 5.8, and 9.8 ± 5.2 mm, respectively) compared with the anterior plate position (8.3 ± 3.5, 12.2 ± 6.5, and 9.7 ± 5.3 mm, respectively). In addition, no significant difference in potential neurovascular injury with regard to body size or gender was found. CONCLUSIONS:: The majority of our specimens showed no significant difference between superior and anterior plating in regard to potential risk for injury to the underlying neurovasculature. However, there appears to be a subset of the population with a more caudal position of the neurovascular structures in which anterior plating may be potentially safer.

KW - anterior plating

KW - brachial plexus

KW - cadaver

KW - clavicle

KW - fractures

KW - neurovascular safety

KW - neurovasculature

KW - plating

KW - study

KW - subclavian

KW - superior plating

UR - http://www.scopus.com/inward/record.url?scp=84887410949&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84887410949&partnerID=8YFLogxK

U2 - 10.1097/BOT.0b013e31828c1e37

DO - 10.1097/BOT.0b013e31828c1e37

M3 - Article

C2 - 23443051

AN - SCOPUS:84887410949

VL - 27

SP - 627

EP - 632

JO - Journal of Orthopaedic Trauma

JF - Journal of Orthopaedic Trauma

SN - 0890-5339

IS - 11

ER -