Reduction of the Douleur Neuropathique 4 (DN4) Score in the Supraclavicular Nerve Separation and Disability of the Arm Shoulder and Hand (DASH) Score Third Month and Sixth Month Post Open Reduction Internal Fixation of Clavicular Fracture
Authors: Dwi Yudistira I Made Arditya , Kawiyana I Ketut Siki , Wiratnaya I Gede Eka 
Published: December 2024

Introduction: Clavicle fractures are common injuries to the scapular girdle, with fractures in the middle third of the clavicle being the most prevalent. Non-operative treatment is often used but can lead to unsatisfactory outcomes, including pain, malunion, and thoracic outlet syndrome. As a result, operative fixation using Open Reduction and Internal Fixation (ORIF) Plate and Screw (ORIF PS) has gained popularity. Postoperative complications such as numbness around the surgical incision are frequently observed. This study aims to evaluate the differences in functional outcomes in patients with clavicle fractures post ORIF PS using the preserved supraclavicular nerve and non-preserved supraclavicular nerve methods, assessed by the Disability of the Arm Shoulder and Hand (DASH) score and Douleur Neuropathique 4 (DN4) score at 3 and 6 months post-operation.
Methods: This cohort study used medical records data from patients with middle third clavicle fractures at RSUP Prof. Dr. IGNG Ngoerah. Patients were divided into two groups: preserved supraclavicular nerve and non-preserved supraclavicular nerve. Data were collected at 3 and 6 months post-operation to evaluate DASH and DN4 scores. Statistical analysis was performed using SPSS version 25.0, with the Kolmogorov-Smirnov test for normality and appropriate hypothesis tests based on data distribution.
Results: This study involved 51 patients with clavicle fractures undergoing ORIF PS surgery. There were no significant differences in baseline characteristics between the two groups. At three months, the difference in DN4 scores between the preserved and non-preserved groups was not statistically significant (p=0.347). However, at six months, the preserved group showed significantly lower DN4 scores (p=0.012). The DASH scores at three months showed a significant difference between the two groups (p<0.001), with the preserved group showing better scores. At six months, the difference in DASH scores was not significant (p=0.210). Longitudinal analysis showed significant reductions in DASH and DN4 scores between three and six months in both groups.
Discussion: This study demonstrates that preserving the supraclavicular nerve during ORIF clavicle surgery provides significant benefits in reducing neuropathic pain and improving arm function in the long term. These findings support the importance of this approach in clavicle fracture surgeries to reduce complications and enhance functional outcomes.
Conclusion: Preserving the supraclavicular nerve during ORIF clavicle surgery can significantly reduce neuropathic pain and improve arm function in the long term. These findings emphasize the importance of this approach in clinical practice to improve patient outcomes following clavicle fracture surgery.

Keywords: Clavicular fracture, Douleur Neuropathique 4 score, supraclavicular nerve separation, DN4 score, DASH score, ORIF.