Background: Operative management of clavicle fractures indicated for open reduction internal fixation poses significant risk to critical anatomic structures. The associated risks to the underlying neurovascular structures during clavicle fixation as a result of plunge depth for patients in the supine position in comparison to patients in the beach-chair position is currently unknown. The purpose of this study was to compare plunge depth measurements between the supine and beach-chair positions during plate fixation of clavicle fractures. Methods: The participant population at this single institution was comprised of residents, fellows, and fellowship-trained, attending orthopaedic surgeons. The participants drilled three bicortical holes into the bone model. The arm was then adjusted and positioned at 45° to simulate beach-chair positioning. The participant drilled three additional holes into the bone model. After allowing each clay mold to harden, the clay was removed, and the plunge depth was measured with a depth gauge by two independent researchers with a standard depth gauge. Results: A total of 9 attending surgeons, 9 fellows, and 12 residents participated in this study. Including all levels of training, it was found that the beach-chair position had an average plunge depth of 2.9 mm, which was lower than the average supine position plunge depth of 3.2 mm. This difference was not found to be significant (P = 0.116). Conclusions: We found no significant difference in plunge depth measurements during clavicle fixation in the supine versus beach-chair position. However, the importance of safely executing clavicle fracture fixation is critical to prevent avoidable morbidity and potential mortality of orthopaedic patients. The plunge depths recorded, if produced from a larger sample, should motivate deep refection of the current liberal indications of clavicle fracture fixation.
Mullane, Aaron; Layla A. Haidar; Adam Kozemchak; and Colton Wayne. "Effect of Patient-Surgeon Orientation on Plunge Depth During Plate Fixation of Clavicle Fractures." Western Journal of Orthopaedics 10, 1 (2021). https://digitalrepository.unm.edu/wjo/vol10/iss1/6