King Paul R, Ikram Ajmal, Lamberts Robert P
Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
J Shoulder Elbow Surg. 2015 Jan;24(1):e1-6. doi: 10.1016/j.jse.2014.04.018. Epub 2014 Jun 18.
Displaced and shortened clavicular shaft fractures can be treated by intramedullary fixation; however, hardware migration and soft tissue irritation at the insertion site have complicated its use. The aim of this study was to determine whether the new Sonoma CRx intramedullary device (Sonoma Orthopedic Products Inc, Santa Rosa, CA, USA) could be used successfully to treat displaced and shortened clavicular shaft fractures and restore the functional capacity of shoulder without the development of secondary complications.
Displaced and shortened clavicular shaft fractures in 47 consecutive patients were treated with the CRx device. Incision size was captured during the surgical procedure. The union rate was evaluated postoperatively. Shoulder function was assessed by Disabilities of the Arm, Shoulder and Hand (DASH) score, the Constant Shoulder Score, and a range of motion score. Patients were assessed after 3 to 6 months (group I), 6 to 9 months (group II), or 9 to 12 months (group III) postoperatively.
Union was achieved in all patients at the time of review, without any incidence of hardware migration. Postoperative complications developed in 3 patients, comprising infection in 1 and hardware failure in 2. No differences among the groups were found for the DASH score (P = .33), Constant Shoulder Score (P = .38), and range of motion score (P = .96). The DASH, Constant Shoulder, and range of motion scores were similar to other successful treatment options, such as plating.
The Sonoma CRx is a good alternative device to treat displaced and shortened clavicular shaft fractures and restore the functional capacity of the shoulder. Future research should focus on when nailing and plating should be used to treat clavicular shaft fractures most optimally.
移位和缩短的锁骨骨干骨折可采用髓内固定治疗；然而，内固定装置的移位及插入部位的软组织刺激使其应用变得复杂。本研究的目的是确定新型索诺玛CRx髓内装置（美国加利福尼亚州圣罗莎市索诺玛骨科产品公司）能否成功用于治疗移位和缩短的锁骨骨干骨折，并恢复肩部功能，且不发生继发性并发症。
连续47例移位和缩短的锁骨骨干骨折患者接受了CRx装置治疗。手术过程中记录切口大小。术后评估骨折愈合率。采用上肢、肩部和手部功能障碍（DASH）评分、Constant肩部评分及活动范围评分评估肩部功能。术后3至6个月（I组）、6至9个月（II组）或9至12个月（III组）对患者进行评估。
复查时所有患者均实现骨折愈合，无内固定装置移位发生。3例患者出现术后并发症，包括1例感染和2例内固定失败。DASH评分（P = 0.33）、Constant肩部评分（P = 0.38）及活动范围评分（P = 0.96）在各组间无差异。DASH、Constant肩部及活动范围评分与其他成功治疗方法（如钢板固定）相似。
索诺玛CRx是治疗移位和缩短的锁骨骨干骨折及恢复肩部功能的一种良好替代装置。未来研究应聚焦于何时采用髓内钉和钢板固定能最优化地治疗锁骨骨干骨折。
