title: The treatment of clavicular shaft fractures with an innovative locked intramedullary device.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors.forename: Paul R
authors.initials: PR
authors.lastname: King
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors.forename: Ajmal
authors.initials: A
authors.lastname: Ikram
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa. Electronic address: rplam@hotmail.com.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Lamberts
mesh_terms: D000293:Adolescent; D000328:Adult; D002968:Clavicle / Q000293:injuries / Q000601:surgery*; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D050723:Fractures, Bone / Q000601:surgery*; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D020127:Recovery of Function; D012782:Shoulder; D055815:Young Adult
keywords: CRx; Clavicle; collarbone; fixation; fracture; intramedullary nail