Clavicle Fractures a Wohu ne Nea Wɔsa

Nnianimu

Clavicle a ɛpaapae abu so kakra na mpɛn pii no efi apirakuru tẽẽ anaasɛ ɛnteɛ a ɛba mmati no fã hɔ. Nhwehwɛmu ahorow a wɔyɛe wɔ 1960 mfe no mfiase mu hɔ no bɔɔ amanneɛ sɛ dodow a ɛnyɛ nkabom a ɛma awotwaa mu paapae no nnu 1%, na ayaresa a wɔde di dwuma wɔ ɔkwan a ɛyɛ katee so no maa ayarefo nyaa abotɔyam kɛse; esiane nnuruyɛ a wɔayɛ nnansa yi nti, oprehyɛn a wɔde sa yare no ayɛ nea etu mpɔn kɛse; enti ɛsɛ sɛ ayaresabea adwumayɛfo a wɔyɛ adwuma wɔ dwumadibea a wɔhwɛ ntɛmpɛ so anaa ayaresabea a wɔhwɛ ayarefo a wɔda abɔnten nyinaa hu nea wɔtaa da adi ne nsɛnnennen a ɛba wɔ saa opira yi mu ne ne di titiriw no ho.

Nyarewa a ɛtrɛw ho adesua

Clavicle a ɛpaapae no yɛ 2.6%-5% wɔ mpanyimfo a ɛpaapae nyinaa mu [1,2]. Europa nhwehwɛmu bi a ɛfa nsɛm a ɛfa awotwaa a ɛpaapae a ɛtoatoa so 1,000 ho no hui [3,4] sɛ bɛboro 66% a ɛpaapae wɔ akyi berɛmo no mfinimfini 1/3, bɛyɛ 25% yɛ akyi 1/3 a ɛpaapae, na 3% yɛ mfinimfini 1/3 a ɛpaapae. Sɛnea awotwaa mu abubu no daa no adi sɛ wɔkyekyɛ wɔ akwan abien so, na ɛbaa mmarima a wonnii mfe 30 mu titiriw, na wɔn a wɔadi boro mfe 70 dii akyi.

Ayaresa mu Anatomy

Onipa nnompe a edi kan koraa a efi ase yɛ nnompe ne clavicle, nnompe biako pɛ a ɛda abasa a ɛwɔ soro ne dua no ntam, a ɛne acromion, acromioclavicular (AC) nkwaa no di nkitaho wɔ akyirikyiri, na ɛne sternum, sternoclavicular (SC) nkwaa no di nkitaho wɔ akyirikyiri. Wɔfrɛ saa nkwaa yi atypical synovial joints efisɛ wɔde fibrocartilage ahyɛ mu sen sɛ wɔde hyaline cartilage bɛhyɛ mu. Wɔde acromioclavicular ne rostroclavicular ntini no na ɛkyekyere clavicle no wɔ scapula no so na ɛnam sternoclavicular ligament no so bata sternum no ho.

Clavicle no yɛ 'S' nsusuwii. Proxim half-arc no pue kɔ anim, na ɛma baabi ma neurovascular bundle a ɛwɔ soro no. Arc no fã a ɛwɔ akyirikyiri no pue kɔ akyi (concave) na afei ɛka scapula no ho (rostral process ne acromion). Mpɛn pii no, akisikuru no mu paapae wɔ baabi a arc abien no hyia (mid-arc), a ɛda adi kɛse sɛ efi ntini a ɛbata nnompe a ɛbemmɛn no ho wɔ saa ɔmantam yi mu ne esiane sɛ ɛyɛ abon no fã a ɛyɛ mmerɛw sen biara nti. Sɛ wɔtu awotwaa a abubu a, ɛkame ayɛ sɛ bere nyinaa na sternocleidomastoid ntini (a ɛbata abɔso no awiei a ɛbɛn) no twe ɔfã a ɛbɛn no kɔ soro (cephalad) na ɔfã a ɛwɔ akyirikyiri no tu kɔ fam (caudad) denam basa a ɛwɔ soro no mu duru so, na abasa no taa 'yɛ tiaa' (kyerɛ sɛ, akisikuru no awiei no twa wɔn ho wɔn ho ntam), titiriw esiane subscapularis ne pectoralis major (a ɛdannan basa a ɛwɔ soro no mu) no twetwe nti. Eyi fi subscapularis ne pectoralis major ntini (a ɛdannan basa a ɛwɔ soro no mu na ɛtwe kɔ moma so) no twetwe titiriw.

Su

Botae a ɛwɔ clavicle fracture ayaresa mu ne sɛ ɛbɛtew ɛyaw so na ama nkwaa no asan ayɛ adwuma. Wɔda so ara sa nsateaa a abubu dodow no ara wɔ ɔkwan a ɛnyɛ nea wɔkora so titiriw (mpɛn pii no, ɛyɛ tiaa ntra mm 15); ayaresa a wɔde di dwuma wɔ ɔkwan a ɛyɛ katee so te sɛ aduru a wɔde kyekyere nipadua no awotwe, nsateaa a wɔde kyekyere wɔn ho, Sayre aduru a wɔde kyekyere wɔn ho, Velpeau ntade a wɔde hyɛ nipadua no mu a wɔmfa nkɔ baabiara, ne ntade a wɔde kyekyere wɔn ho. Wɔyɛ suspension immobilization wɔ acute phase no mu, na wɔtaa yɛ ntɛm range of motion training ne ahoɔden apɔw-mu-teɛteɛ wɔ adapɛn 2-6 akyi wɔ abubuw no akyi bere a ɛyaw no ano abrɛ ase no. Wɔnkamfo nkyerɛ sɛ wɔmfa figure of 8 bandages nni dwuma efisɛ ebetumi ama axillary pressure sores ne akisikuru no a ɛnyɛ biako kɛse [5,6].

Abakɔsɛm ne Nipadua mu Nhwehwɛmu

Clavicle a ɛpaapae fi mmati no a ɛbɔ tẽẽ wɔ asehwe akyi na wɔtaa hu wɔ abɔnten agumadi mu wɔ mmerante ne mmabaa mu ne nkwakoraa ne mmerewa a wɔhwe ase a wɔanhyɛ da mu. Ɛho hia sɛ wɔkyerɛkyerɛ ɔkwan a wɔfa so pira no mu. Ebia opira a ahoɔden kɛse wom bɛka ti ne koko a opira ho, bere a akisikuru a efi ahodwiriw nketenkete mu ba no betumi ayɛ ɔyare. Apirakuru a ɛtwetwe adwene hwehwɛ sɛ wofi ase ntɛm na wɔde ahwɛyiye yi scapular chest wall separation, neurologic ne vascular opira ahorow fi mu. Wɔ ayaresabea no, ɔfe ne ecchymosis wɔ baabi a abubu no, na ɛka ho ne dɛmdi ne akisikuru. Ɛsɛ sɛ wɔhwɛ ntini a ɛyɛ mmerɛw no so ma ɛyɛ jacking up, a ebetumi ama honam ani ayɛ mmerɛw na ayɛ akuru.

Mfonini a wɔde yɛ mfonini

Wobetumi de anteroposterior radiographs a ɛnyɛ den ahu abubu dodow no ara. Radiographs a wɔde kyerɛ ti a ɛdannan 20° no yi nkɛntɛnso a ɛwɔ ahurututu mu a ɛka bom so no fi hɔ. Ɛsɛ sɛ wɔyɛ ayarefo no radiograph wɔ tebea a ɛboa wɔn ho no mu na ama wɔahu sɛnea akisikuru no tu no yiye. Weight-soaring for radiographs boa wɔ nhwehwɛmu a wɔyɛ wɔ rostral clavicular ligament no mudi mu kura mu wɔ distal clavicle anaa acromioclavicular joint injuries.CT boa ma wohu scapular girdle opira a ɛyɛ den na ɛma wotumi hu proximal clavicle opira a ebetumi aba wɔ sternoclavicular nkwaa no mu yiye. Sɛ wɔyɛ koko so mfonini a, ɛboa ma woyi ahurututu mu opira a ɛbata ho no fi hɔ, na wobetumi ahwɛ sɛnea ɛyɛ tiaa denam toto a wɔde bɛtoto akyi berɛmo a ɛwɔ akyi no ho, ne sɛnea wɔpow sɛ scapulothoracic fasu no mu apaapae no so.

Nneɛma ahorow

AO/OTA Fracture Dislocation Typing: Clavicle fracture code 15 no wɔ mmeae abiɛsa: 15.1 proximal (mfinimfini), 15.2 diaphysis, ne 15.3 distal (afã). Wɔakyekyɛ akisikuru a ɛbɛn (mfinimfini) ne akyirikyiri (akyi) mu sɛ ɔkwan A (akyi ntini), ɔkwan B (a ne fã bi yɛ ntini mu), ne ɔkwan C (a ɛwɔ ntini mu koraa). Wɔkyekyɛ dua a ɛpaapae mu sɛ type A (simple), type B (wedge), ne type C (comminuted).AO/OTA nkyekyɛmu a ɛfa fractures ne dislocations ho no nsusuw sɛnea abubu no tu kɔ baabi foforo no ho, na mprempren wɔmfa nni dwuma kakraa bi wɔ clavicle fractures ayaresa ne nkɔmhyɛ a wɔkyerɛ mu.

Allman typing gyina beaeɛ a abubuo no wɔ (I: medial, cadent 1/3, II: lateral 1/3, III: medial 1/3) (Mfonini 7.2.1).

Craig gyinaa Allman so siesiee saa nkyekyɛmu yi bio, na me na meyɛ akisikuru no mfinimfini 1/3; type II yɛ clavicle no akyi 1/3, a afei wɔkyekyɛɛ mu yɛɛ no ​​ahorow 5 a egyina abubuw a ɛkɔ baabi foforo ne abusuabɔ a ɛda rostral clavicular ligament no ntam so; na type III yɛ clavicle no mu 1/3 a ɛpaapae, a wɔkyekyɛɛ mu ahorow 5 a egyina sɛnea abubu no tu ne sɛ ebia na abubu no wɔ intra-articular anaasɛ ɛnte saa so.

Neer typing of lateral 1/3 fractures si hia a rostral-clavicular ligament no ho hia so dua: type I ba wɔ akyirikyiri wɔ rostral-clavicular ligament no ho, na medial fracture block no tu kɔ soro; type II no fa rostral-clavicular ligament no ho na ɛde medial fracture block no tu kɔ soro; ne type III trɛw kɔ acromioclavicular nkwaa no mu a rostral-clavicular ligament no da so ara yɛ nea enni dɛm.

Edinburgh typing y nhyehye a wde kyerkyer diaphysis a abubu no mu sde sde wde twetwe ne s s wde bhy mu.1 Type 1 fractures fa mfimfini awiei ho, type 2 y diaphysis fractures na type 3 y lateral end fractures. Wɔkyekyɛ diaphysis no mu abubuw no mu sɛnea cortical contact a ɛwɔ abubuw no asinasin no ntam wɔ hɔ anaasɛ enni hɔ no mu ayɛ no type A ne B. Wɔsan kyekyɛ type 2A fractures no mu sɛ nondisplaced (type 2A1) ne angulated (type 2A2),2B fractures no wɔkyekyɛ mu sɛ simple anaasɛ wedge-shaped (type 2B1) ne comminuted (type 2B2).3 Type 1 abubuw no fa diaphysis no mfinimfini awiei ho na type 3 yɛ diaphysis no akyi awiei. Wɔakyekyɛ mfinimfini ne akyi awiei a ɛpaapae no mu akuw nketewa 1 ne 2 sɛnea sɛ ebia nkwaa a ɛbɛn no ka ho anaa.

Saa ara nso na Rockwood a ɔkyerɛw, Jager a ɔkyerɛw, ne Breitner a ɔkyerɛw nsɛm nso wɔ hɔ.

Oprehyɛn ho nsɛnkyerɛnne

Abubuw pɔtee bi

1, akisikuru a wɔabue mu; 

2, nea ɛkɔ baabi foforo >2 cm; 

3, ɛyɛ tiaa >2 cm; 

4, abubu asinasin a wɔabubu (>3); 

5, afã horow pii a ɛpaapae; 

6, ase a ɛpaapae a ɛbue a ntini a ɛyɛ mmerɛw apira; 

7, deformity a ɛho hia (displacement ne tiawa); 

8, scaphoid a opira.

Apirakuru a emu yɛ den

1, ipsilateral atifi fam opira a wɔaka abom;

2, Mmati so opira a ɛsensɛn nsu so;

3, apirakuru pii;

4, akisikuru a wɔde neurovascular opira ka ho;

5, ipsilateral multiple rib fractures a wɔaka abom ne koko fasu mu dɛmdi;

6, clavicle a ɛyɛ tiaa ma ɛyɛ mmati a ntaban wom;

7, Afã abien a ɛwɔ akyi berɛmo mu a ɛpaapae.

Nneɛma a Ɛma Ɔyarefo

1, Ayarefo a wɔapirapira pii no hwehwɛ sɛ wɔsoa wɔn atifi fam mu duru ntɛm;

2, Ayarefo a wɔhwehwɛ sɛ wɔsan kɔ wɔn dwumadi mu ntɛmntɛm (sɛ nhwɛso no, agumadi a ɛyɛ atitiriw ne akansi).

Bere a wɔde bɛyɛ oprehyɛn

Ɛsɛ sɛ wɔyɛ oprehyɛn a wɔntwentwɛn wɔn nan ase bere a nsɛnkyerɛnne a edi mũ a ɛkyerɛ sɛ wɔbɛyɛ oprehyɛn wɔ hɔ no.

Oprehyɛn a ɛkyɛ boro adapɛn 2-3 wɔ nsɛnkyerɛnne a ɛfa ho mu no betumi ama ɛyɛ den sɛ wɔbɛtew akisikuru so, titiriw bere a wɔresiesie wɔn ho ama closed reduction internal fixation denam percutaneous techniques so no.

Oprehyɛn a wɔde yɛ adwuma

Wɔde ɔyarefo no si mpoano nkongua gyinabea anaasɛ ɔfã a ɔtra ase. Wɔde ntama ahyɛ mmati a ayɛ basaa no ase ma ama asen no akɔ soro na ama oprehyɛn no ayɛ mmerɛw, na wɔde mpopaho gu abasa no so na ama wɔatumi akanyan wɔn ho wɔ oprehyɛn no mu. Wobetumi apaw ntwitwiridii a ɛtrɛw wɔ clavicle no axis tenten no so anaasɛ saber ntwitwiridii a ɛne langer nhyehyɛe no hyia.

Hyɛ no nsow: Ntwitwiridii a ɛtrɛw ma ɛtrɛw kɛse, bere a twitwa a ɛkɔ akyiri no brɛ asiane a ɛwɔ hɔ sɛ ntini a ɛwɔ soro no bepira no so tew na ɛyɛ fɛ kɛse wɔ afɛfɛde mu.

Nneɛma a Wɔde Siesie Nneɛma a Ɛwɔ Mu

3.5 Wobetumi de compression plates a wɔahyehyɛ, reconstruction plates, anaa plastic LCPs adi dwuma de asiesie clavicle a abubu. Wɔde mprɛte gu awotwaa no atifi anaa n’anim mmerɛw. Mprɛte mu yɛ den wɔ biomechanical opira mu bere a wɔde si soro no, titiriw sɛ abubuw a abubu wɔ ase hɔ a, na ɛnyɛ den sɛ wobetumi ayɛ ho mfonini wɔ w’adwenem. Ɛho hia sɛ wɔde nkɔnsɔnkɔnsɔn no si cortical fixation mu, na ɛsɛ sɛ wɔde ahwɛyiye kɛse to ntokuru no, efisɛ asiane wɔ hɔ sɛ ntini ne mogya ntini a ɛwɔ ase hɔ no bepira. Mfaso: ahobammɔ drilling a anterior mprɛte skru kwan, mprɛte apposition, mmerɛw contouring.

Hyɛ no nsow: Mpɛn pii no, ɛho nhia sɛ wɔde nnompe hyɛ nipadua mu wɔ oprehyɛn a edi kan no mu; bere a wɔde ahyɛ mu akyi no, ɛho hia sɛ wɔpam myofascial layer no yiye de kata prɛte no so na wɔasiw ɔyare mmoawa ano.

Intramedullary a wɔde hyɛ nipadua no mu

Mprempren mfiri a wɔde si medullary mu no bi ne Kirschner pin, Rockwood pin, Hagie pin, titanium elastic intramedullary pin, nkɔnsɔnkɔnsɔn a ɛyɛ tokuru, ne nnadewa a ɛyɛ den a ɛto mu; sɛ. Wobetumi de intramedullary nailing kwan no adi dwuma wɔ clavicle a ɛyɛ mmerɛw, transverse anaa oblique clavicle fractures nkutoo ho.

Mfaso a ɛwɔ so

ntwitwiridii nketenkete, ɛyɛ fɛ kɛse, ntini a ɛyɛ mmerɛw a wɔayi afi hɔ pii, asiane a ɛwɔ hɔ sɛ endophyte bɛpue no sua, na ɛyɛ den a ɛbata akisikuru a ɛba ho.

Mfomso ahorow a ɛwom

honam ani a ɛyɛ hyew anaasɛ sintɔ ahorow wɔ baabi a ɛhyɛn mu no.

Hyɛ no nsow:Ɛtɔ mmere bi a ɛyɛ den sɛ wɔbɛtew clavicle fractures so a wɔatoto mu na wɔkwati sɛ wɔbɛma nea ɔyɛ oprehyɛn no nsa no anya mframa a ɛboro so bere a wɔreyɛ oprehyɛn no.

Mprɛte a wɔde si hɔ a ɛnyɛ den koraa

Wosusuw sɛ mprɛte osteosynthesis a ɛnyɛ den pii a ɛwɔ clavicle no mu no ma biomechanical ahoɔden kɛse bere a wɔkwati ɔhaw ahorow a ɛwɔ mprɛte a wɔabue mu a wɔde si hɔ anaasɛ intramedullary fixation mu no.

Intraoperative placement of the 3.5 system LCP anterior to the clavicle, sɛ ɛbɛyɛ yiye a, anteriorly ase clavicle, ma kwan ma wɔtwe adwene si clavicle a ɛte apɔw no so, na ɛma ɛyɛ mmerɛw sɛ wobedi kan ayɛ mprɛte no na wɔanya screw aperture tenten.

Ebia mprɛte nnompe a ɛnyɛ den pii a wɔde bedi dwuma ntɛm no ne supraclavicular nerve opira, nhama abien a ɛnhyia yiye anaasɛ ɛnyɛ tiaa a ɛka dwumadi, ne mprɛte a ɛkotow anaasɛ ɛbubu.

Mprɛte a wɔde si hɔ a ɛma abubuw a ɛwɔ akyi berɛmo no akyi no

Mprɛte a wɔde bɛhyɛ nipadua mu a wɔpaw no gyina sɛnea nnompe a ɛwɔ akyi no kɛse te so. Anyɛ yiye koraa no, ɛho hia sɛ wɔde bicortical screws 3 na ɛyɛ lateral bone block no. Sɛnea ɛbɛyɛ yiye no, ɛsɛ sɛ wɔde tension screws di dwuma ma oblique fractures. Sɛ nnompe no sua dodo sɛ wɔde besi hɔ a, wobetumi de clavicle hook plate adi dwuma.

Acromioclavicular nkwaa a ɛpaapae ho ayaresa

Acromioclavicular nkwaa mu opira yɛ 12% wɔ scapular girdle opira mu na ɛtaa ba wɔ agumadifo a wɔde wɔn ho ahyɛ mu ma mu.

Asɛnka agua so nhyehyɛe a wɔtaa de di dwuma ne Rockwood agoprama so dwumadi. Type I yɛ acromioclavicular ligament no a ɛpaapae a rostroclavicular ligament no nni dɛm; type II yɛ acromioclavicular ligament no mu tetew a rostroclavicular ligament no nni dɛm; type III yɛ acromioclavicular ligament ne rostroclavicular ligament no nyinaa mu tetew; type IV yɛ akyi a ɛkɔ akyirikyiri a ɛtwetwe trapezius no; type V yɛ acromioclavicular nkwaa ne rostroclavicular ligament nyinaa a ɛtetew koraa, na nkwaa no bɛboro ɔha biara mu nkyem 100 tu kɔ baabi foforo; na type VI opira ho yɛ na koraa, na distal clavicle no tu kɔ fam wɔ rostral process no ase.

Wɔkamfo ayaresa a wɔmfa nni dwuma yiye a wɔde bere tiaa bi breki a wɔde cantilever sling di dwuma kyerɛ ma opira a ɛyɛ ɔkwan I ne nea ɛto so abien. Akyinnyegye wɔ sɛnea wodi opira a ɛto so III ho dwuma ho, na nhoma ahorow bi kyerɛ sɛ wɔkyerɛ sɛ wɔmfa nnuru a wɔmfa nni dwuma yiye mma mmerante ne mmabaa a wɔadu mpanyin afe so a wɔyɛ nnam. Dwumadi mu ahoɔden ye ɛwom sɛ ebia dɛmdi ahorow bɛba wɔ sɛnea ɛte no mu de. Type IV - VI opira no mu yɛ den kɛse na wɔkamfo kyerɛ sɛ wɔnyɛ oprehyɛn.

Mprempren, oprehyɛn akwan a wɔtaa de di dwuma ne: Bosworth rostral locking screw kwan a wɔfa so siesie ɔfã biako anaasɛ wonsiesie ligament no;, clavicle hook plate fixation, a ɛte sɛ lateral end of clavicle fracture Tightrope’s tab plate fixation anaasɛ anchor pinning suture denam arthroscope anaa ntwitwiridii ketewaa bi so; ne rostral locking ligament suture anaasɛ reinforced suspension, a wɔde nneɛma a wɔde ayɛ anaa ntini a ɛwɔ rostral eminence ne clavicle ntam.

Ɛnyɛ nea ɛda adi pefee sɛ oprehyɛn kwan bɛn na mfaso wɔ so kɛse, na ɛwom sɛ ebia ɛbɛhwere ɔkwan bi a wɔfa so san yɛ nneɛma foforo de, nanso sɛnea saa akwan yi nyinaa yɛ adwuma yiye koraa no yɛ nea abotɔyam wom.

Ayaresa a wɔde sa medial end clavicle fractures ne sternoclavicular nkwaa a ɛpaapae

Saa opira ahorow yi ho yɛ na, na bio nso, ayaresa ho akwankyerɛ a egyina nnuru a egyina adanse so nni hɔ.

Mpɛn pii no, medial clavicle fractures yɛ extra-articular fractures a ɛnyɛ nea ɛkɔ baabi foforo na wobetumi ayɛ ho adwuma wɔ ɔkwan a ɛnyɛ nea wɔahyɛ da ayɛ so. Mpɛn pii no, epiphysis a ɛwɔ clavicle no mfinimfini awiei no to mu bere a wadi mfe 23-25 ​​na ɛyɛ epiphysis a etwa to a ɛto mu wɔ nipadua no mu. Enti, mfinimfini apirakuru pii yɛ Salter-Harris type I anaa II epiphyseal plate a ɛpaapae ankasa. Ɛyɛ den sɛ wobehu X-ray a wɔtaa de di dwuma, a mfaso wɔ so sɛ radiograph a wɔde kyerɛ ti a ɛdannan no 40° na wɔde toto ɔfã a ɛwɔ apɔwmuden no ho no betumi ada no adi sɛ akisikuru no mfinimfini awiei no atu akɔ baabi foforo, na CT ma wonya mfonini a eye sen biara a wɔde hu yare.

Mpɛn pii no, wobetumi atoto mmeae a abubu anaasɛ wɔatu akɔ anim no mu na wɔasan de asi baabi foforo, nanso ɛtaa yɛ nea entumi nnyina na wɔyɛ no lobotomized ma ɛsan tu. Wɔkamfo ɔhwɛ a ɛma obi ho dwo no kyerɛ wɔ akisikuru a ɛkɔ so tu anaasɛ nea ɛkɔ baabi foforo no ho efisɛ mpɛn pii no ɛmma ontumi nyɛ adwuma yiye. Clavicle no mfinimfini awiei a ɛpue wɔ akyi no ntaa mma mediastinal no atifi pira, a ntini a epira anaasɛ mpo ahurututu mu a ɛsiw ne mframa kwan a ɛtwetwe ka ho. Wɔ mmeae a ɛpaapae ne nea ɛpaapae wɔ baabi a mfinimfini asinasin no sua dodo ho no, wobetumi de mprɛte no abɔ nkwaa no so de ahyɛ akyi berɛmo no mu.

Akwan afoforo a wɔfa so fixation

s.e. abɔnten so a wɔde stent hyɛ mu, abɔnten a wɔde clavicle plate si hɔ, ne nea ɛkeka ho.

Oprehyɛn akyi ayaresa

Ɛsɛ sɛ wɔma basa a ɛwɔ soro no ntumi nkɔ baabiara wɔ sling mu na ɛsɛ sɛ wofi ase tete mmati so pendulum ntɛm ara. Adapɛn 2 akyi no, ɛsɛ sɛ wodi ɔyarefo no akyi hwɛ kuru no na wɔsan hwɛ X-ray ahorow no mu, bere a wobetumi ayi anim nsateaa no na wɔafi ase tete nkwaa a wɔde tu mmirika a anohyeto biara nni ho, nanso ɛsɛ sɛ wɔka kyerɛ ɔyarefo no sɛ ɔmfa ɔhonam akwaa a ɛka no no mma nneɛma a emu yɛ duru so. Wobetumi afi ahoɔden ntetee ase wɔ adapɛn 6 wɔ oprehyɛn no akyi bere a nnompe ayaresa ho sɛnkyerɛnne ahorow da adi no. Ɛsɛ sɛ wɔkwati agumadi a wɔde wɔn ho hyɛ mu anaa agumadi a emu yɛ den asram 3 wɔ oprehyɛn no akyi kosi sɛ akisikuru no bɛsa koraa.

Nsɛnnennen a ɛba.

Nsɛnnennen a ɛba ntɛm

Oprehyɛn akyi kuru mu nyarewa betumi aba wɔ nsɛm no mu bɛyɛ 4.8% mu;

Nsuo a ɛyɛ mmerɛw wɔ subclavian mpɔtam hɔ ne ɔhaw a ɛtaa ba, a abɔdeɛ mu abakɔsɛm mu nhwehwɛmu a ɛfa ayarefoɔ a wɔwɔ saa sɛnkyerɛnne yi mu bɛyɛ 83% ho, a ɛso tew bere kɔ so na ɛmma wɔnyɛ adwuma a ɛnyɛ adwuma yiye kɛse, ɛwom sɛ ebetumi akɔ so akosi mfe 2 wɔ oprehyɛn no akyi de

Endophyte a ɛpuepue ne honam ani a ɛyɛ basaa, a ɛtaa ba bere a wɔde mprɛte a ɛyɛ kɛse anaa nnadewa dua a ntini a ɛyɛ mmerɛw nkata so yiye di dwuma no;

re-fracture, a ebetumi aba bere a wɔayɛ oprehyɛn ne ayaresa a wɔmfa nnuru nhyɛ mu nyinaa akyi; oprehyɛn akyi a wɔsan pira bio no betumi ama endoprosthesis no akotow anaasɛ abubu, anaasɛ abubu atwa endoprosthesis no ho ahyia;

nonunion, a 15% nonunion rate ne conservative treatment ne 2% nonunion rate a oprehyɛn sa diaphyseal fractures a wɔatu koraa; abubuw no a ɛtwetwe koraa, ɛyɛ tiaa bɛboro sɛntimita 2, sigaretnom, mfe a obi nyin kɔ soro, ahoɔden kɛse a epirapira, ɛsan bubu (mfiri a entumi nnyina), diaphyseal a ɛtwetwe a ɛnyɛ hwee, nnompe a ɛnyɛ papa, ne nnompe a ɛyera dodo.

Nsɛnnennen a ɛba akyiri yi

Nnompe mu yare a ɛwɔ acromioclavicular nkwaa no mu no taa ba bere a ntini no mu abubu (Edinburgh type 3B2); sɛ ayaresa a ɛkyerɛ yare no ho sɛnkyerɛnne ne nea wɔde siw ano no ntumi nyɛ adwuma yiye a, wobetumi de ntini mu nhwehwɛmu anaasɛ oprehyɛn a wɔabue mu atwa akyi berɛmo a ɛwɔ akyirikyiri no;

Deformity healing, a ɛba wɔ ɔkwan soronko so wɔ akisikuru a wɔatu a wɔasan ayɛ ho adwuma wɔ ɔkwan a ɛyɛ katee so nyinaa mu; scapular girdle a ɛyɛ tiaa a distal fracture block no a wɔdannan ka ho no betumi ama mmati ahoɔden ne boasetɔ a etwa to no so atew, titiriw wɔ mmati a wɔkyere sie mu; ahurututu no kwan a ɛyɛ teateaa no betumi ama woanya brachial plexus compression ho sɛnkyerɛnne; na scapulothoracic ɔfasu nkwaa no a ɛnkɔ pɛpɛɛpɛ no betumi ama scapula no akɔ anim na ama mmati mu ayɛ yaw na ayɛ myalgias, sɛ ɛda adi pefee sɛ sɛnkyerɛnne ahorow no fi dɛmdi Sɛ ayaresa ba a, osteotomy nteɛso ne mprɛte a wɔde si hɔ no betumi ayɛ yiye a egyina ɔyarefo no ahiade so.

Nkɔmhyɛ ne nea ebefi mu aba

Nhwehwɛmu bi a ɛfa ho a wɔyɛe wɔ Europa bɔɔ amanneɛ sɛ oprehyɛn a wɔde sa mfinimfini akisikuru a wɔatu afi baabi foforo no tu mpɔn, na ne meta-nhwehwɛmu kyerɛe sɛ nkabom bɔne a ɛde mpaapaemu a ɛnyɛ nkabom ne nkabom bɔne a ɛde sɛnkyerɛnne ba no sua koraa wɔ oprehyɛn kuw no mu sen kuw a wɔde aduruyɛ a ɛyɛ katee saa no mu bere a wɔde oprehyɛn totoo ayaresa a wɔde di dwuma ɔkwammɔne so ho no; afei nso, na kuw a wɔyɛɛ oprehyɛn no so atew ɛyaw so ntɛm ara, na na nkɔso a ɛbae wɔ Constant ne DASH dwumadi mu nkontaahyɛde mu no da adi kɛse.

Bobɔ no mua

Basabasayɛ tẽẽ anaasɛ ɛnteɛ na ɛde asen mu a ɛpaapae dodow no ara ba, na wobetumi akyekyɛ ayaresa no mu sɛ ayaresa a wɔde di dwuma ɔkwammɔne so anaasɛ oprehyɛn. Wɔ ayaresa ho no, ɛwom sɛ wobetumi asa akisikuru dodow no ara a enni baabiara kɛse de, nanso oprehyɛn a wɔde sa akisikuru a ɛtwetwe kɛse no yɛ nea akyinnyegye wɔ ho. Wɔ akisikuru a wɔatu afi baabi foforo ho no, oprehyɛn a wɔde sa yare no ma nnompe no sa yare kɛse na ɛma ɛyɛ adwuma ntɛm bere a wɔde toto ayaresa a wɔde di dwuma ɔkwammɔne so ho no.

Nsɛm a wɔde gyinaa so

[1] Postacchini F, Gumina S, De Santis P, Albo F. Nyarewa a ɛba wɔ awotwaa mu a ɛpaapae ho. J Mmati mu Nsateaa Surg 2002; 11:452 na ɛwɔ hɔ.

[2] Eiff, M. P., Hatch, ne afoforo. Clavicle ne scapula a ɛpaapae. Wɔ: Akisikuru Ho Dwumadie ma Mfitiaseɛ Ayarehwɛ, 2nd ed, W. B. Saunders, Philadelphia 2002. p.198.

[3] Robinson C. M., ne ne mfɛfo. Clavicle a ɛpaapae wɔ ɔpanyin no mu. Nyarewa ho nimdeɛ ne nkyekyɛmu. J Nnompe Ntini mu Oprehyɛn Br 1998; 80:476 na ɛwɔ hɔ.

[4] Neer CS 2 nea ɛto so abien. Akisikuru a ɛwɔ akyi no fã a ɛto so abiɛsa a ɛwɔ akyirikyiri no. Clin Orthop Relat Nhwehwɛmu 1968; 58:43 na ɛwɔ hɔ.

[5] Andersen K, Jensen PO, Lauritzen J. Aduru a wɔde sa akisikuru a ɛma akisikuru. Figure-of-eight aduru a wɔde kyekyere aduru a wɔde kyekyere aduru a ɛnyɛ den. Acta Orthop Scand a wɔyɛe wɔ 1987 mu; 58:71 na ɛwɔ hɔ.

[6] Ersen A, Atalar A. C., Birisik F, ne afoforo. Ntotoe a wɔde toto nsa sling a ɛnyɛ den ne figure a ɛyɛ awotwe clavicular bandage ma midshaft clavicular fractures: nhwehwɛmu a wɔanhyɛ da a wɔhwɛ so. Nnompe Ntini J 2015; 97-B:1562 na ɛwɔ hɔ.