Does a skin incision following Langers Lines reduce complications following fixation of displaced middle third clavicle fractures

Background

Internal fixation of displaced mid-third clavicle fractures reduces the rate of non-union and offers a faster return of functioncomparedtonon-operative management. Several studies have reported a significant rate of complications with this procedure however. The aim of this study is to investigate whether or not using a skin incision following Langer’s lines, as opposed to a traditional transverse incision, reduces the rate of complications.

Methods

In this retrospective cohort study, data on 108 patients who underwent open reduction and internal fixation of mid-shaft clavicle fractures between 2014 and 2018 was reviewed. Either a standard transverse incision or an oblique incision along skin Langer’s lines was used according to surgeon’s preference. A pre-contoured diaphyseal locking plate was used in all cases. We collected data on fracture classification, minor complications (irritation from prominent plate, chest wall numbness, superficial wound infection) and major complications (irritation from plate necessitating metalwork removal, periprosthetic fracture, deep infection, neurovascular injury and non-union). Statistical analysis was performed using Chi squared tests.

Results

57 patients underwent fixation using the oblique incision and 51 via the transverse incision. Age, gender and fracture pattern in the two groups were comparable. There were 15 minor and 6 major complications in the oblique group. In the transverse group there were 18 minor and 5 major complications. The major complication rate was 10.5% in the oblique group and 9.8% in the transverse group. The overall major complication rate was 10.2%. No statistically significant difference in the rate of complications between the two groups was identified.

Conclusions

Based on our data, neither incision is superior to the other meaning that selection of incision should follow surgeon’s usual practice. Of note the overall rate of major complications was lower than reported elsewhere in the literature.

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