Minimally invasive implantation of a novel flexible intramedullary nail in patients with displaced midshaft clavicle fractures

Abstract

Purpose: We report our initial experiences with use of a new technique we developed for implantation of Sonoma Crx intramedullary rod in patients with displaced clavicle fractures. Methods: A total of 35 patients (mean age 41.82 ± 13.65, male:female ratio = 21:14) having Robinson Types 1b, 2b and 3b displaced midshaft fractures with >2 cm clavicle shortening were included into the study. A single small incision (~1 cm) was made over the anteromedial aspect of the involved clavicle and an appropriate sized intramedullary nail was inserted in reverse (mirror) configuration of that has been suggested by the manufacturer. Functional assessment was made using Constant shoulder and disability of the arm shoulder and hand scoring. Results: Mean time of operation was 51.20 ± 10.56 min and mean time of fluoroscopy was 2.33 ± 1.12 min. One patient had implant failure 2 months after the operation and was revised to a new implant. Superficial or deep wound infection, hematoma, neurovascular complication, substance irritation or implant failure did not occur. Follow-up ranged from 12 to 45 months (mean 28.5 ± 9.95 months). At the latest follow-up, mean Constant shoulder score was 93.14 ± 4.06 (ranging from 84.00 to 100.00) and mean disability of the arm shoulder and hand score was 3.68 ± 1.73 (ranging from 0.0 to 6.80). Conclusion: The technique we described herein provided successful procedural outcomes, eliminated the need for deep dissection of the fracture site and reduced the operation time. Further study on larger populations is warranted to confirm these findings. © 2015, Springer-Verlag Berlin Heidelberg.