Failure of a new intramedullary device in fixation of clavicle fractures: a report of two cases and review of the literature

Abstract

Operative fixation is gaining popularity in the treatment of displaced midshaft clavicle fractures. Plates have traditionally been used in the surgical stabilization of these fractures. External fixators are rarely used, mainly being used in cases of open clavicular fracture or septic nonunion. Intramedullary devices behave as internal splints that maintain alignment of the fracture without rigid fixation. They are theoretically advantageous when compared with plate/screw devices because they entail minimal soft-tissue dissection and periosteal stripping, shorter hospital stays, cosmetic surgical exposure, and no skin prominence at the fracture site, and they avoid stress shielding. Intramedullary devices are now becoming streamlined to the anatomic specificities of the clavicle. The sigmoid shape of the clavicle dictates that intramedullary clavicle pins must be narrow and flexible enough to be installed through the curved medullary canal. The Sonoma CRx intramedullary clavicular pin (Sonoma Orthopedic Products, Santa Rosa, CA) is a new clavicle fixation pin that addresses the challenges of intramedullary fixation with a flexible head, grippers, and a buttressing screw. The flexible head contains grippers that extend within the medial fragment once the device is in place. Activation of the grippers transforms the flexible head into a rigid structure shaped according to the anatomic contours of the medullary canal. The locking screw is