JBJS essential surgical techniques · 2016
A Novel Intramedullary Locked Fixation Device for Treatment of Clavicle Shaft Fractures.
СтатьяНазвание и аннотация: Перевод в очереди
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King Paul R, Basamania Carl J, Lamberts Robert P
Аннотация
INTRODUCTION: An intramedullary nail (the Sonoma CRx) with a unique flexible anatomical design and locking system is a viable alternative for treatment of displaced and shortened clavicle shaft fractures.
STEP 1 POSITIONING: Place the patient in the beach-chair position and drape the arm free so that you can obtain an exaggerated anteroposterior and an axial fluoroscopic view of the clavicle by manipulating the position of the arm.
STEP 2 SKIN INCISION: The surgical technique necessitates opening the fracture site in order to implant the device.
STEP 3 PREPARING THE MEDIAL FRAGMENT: The preparation of the medial fragment is of utmost importance as the intramedullary Sonoma CRx nail should be placed as far as possible into the medial fragment of the clavicle, to provide the highest level of stability and the lowest risk of device failure.
STEP 4 PREPARING THE LATERAL FRAGMENT: Preparation of the lateral fragment is more challenging than preparation of the medial fragment because of its relative immobility and shorter medullary canal.
STEP 5 PLACEMENT OF THE INTRAMEDULLARY NAIL: Use the longest possible intramedullary nail that the clavicle can accommodate and insert the nail as far medially as possible into the medullary canal of the clavicle bone.
STEP 6 ACTIVATION OF THE LOCKING DEVICE: Lock the device at its medial end with distally deployed grippers and laterally with a locking screw placed through a jig.
STEP 7 MANAGEMENT OF COMMINUTED FRACTURE FRAGMENTS: Comminuted fractures are not a contraindication to the use of the intramedullary device as they can be reduced by the nail and secured by using cerclage sutures.
STEP 8 POSTOPERATIVE MANAGEMENT: Protect the affected shoulder in a shoulder immobilizer for six weeks.
RESULTS: In our original study, forty-seven consecutive patients with a displaced and shortened clavicle shaft fracture were treated with open reduction and internal fixation using the Sonoma CRx device.
STEP 1 POSITIONING: Place the patient in the beach-chair position and drape the arm free so that you can obtain an exaggerated anteroposterior and an axial fluoroscopic view of the clavicle by manipulating the position of the arm.
STEP 2 SKIN INCISION: The surgical technique necessitates opening the fracture site in order to implant the device.
STEP 3 PREPARING THE MEDIAL FRAGMENT: The preparation of the medial fragment is of utmost importance as the intramedullary Sonoma CRx nail should be placed as far as possible into the medial fragment of the clavicle, to provide the highest level of stability and the lowest risk of device failure.
STEP 4 PREPARING THE LATERAL FRAGMENT: Preparation of the lateral fragment is more challenging than preparation of the medial fragment because of its relative immobility and shorter medullary canal.
STEP 5 PLACEMENT OF THE INTRAMEDULLARY NAIL: Use the longest possible intramedullary nail that the clavicle can accommodate and insert the nail as far medially as possible into the medullary canal of the clavicle bone.
STEP 6 ACTIVATION OF THE LOCKING DEVICE: Lock the device at its medial end with distally deployed grippers and laterally with a locking screw placed through a jig.
STEP 7 MANAGEMENT OF COMMINUTED FRACTURE FRAGMENTS: Comminuted fractures are not a contraindication to the use of the intramedullary device as they can be reduced by the nail and secured by using cerclage sutures.
STEP 8 POSTOPERATIVE MANAGEMENT: Protect the affected shoulder in a shoulder immobilizer for six weeks.
RESULTS: In our original study, forty-seven consecutive patients with a displaced and shortened clavicle shaft fracture were treated with open reduction and internal fixation using the Sonoma CRx device.