Dɔléle si nye clavicle fractures didi kple edada .

Kpɔkplɔyiɖeme

Clavicle ƒe gbagbã bɔ ɖe abɔta ƒe akpa si le abɔta ƒe akpa si nye nuveviwɔame tẽ alo esi metso tẽ o gbɔ. Numekuku siwo wowɔ le ƒe 1960 ƒeawo ƒe gɔmedzedze ka nya ta be ne womexɔ clavicle ƒe gbagbã ƒe agbɔsɔsɔme si menye union o la, mede 1% o, eye atikewɔwɔ si me womezãa atike siwo wozãna le mɔ si sɔ nu o la na dɔnɔwo ƒe dzi dze eme ŋutɔ; Esi wova to atikewɔwɔ vɛ nyitsɔ laa la, amekoko ƒe atikewɔwɔ kpɔ ŋusẽ ɖe ame dzi ŋutɔ; Eyata ele be atikewɔla siwo le dɔ wɔm le dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ alo dɔnɔdzikpɔƒe si wokpɔa dɔnɔwo gbɔ le kɔdzi le kɔdzi bliboa me nanya nu tso abi sia kple eƒe dɔdzikpɔkpɔ veviwo ƒe ɖeɖefia kple kuxi siwo bɔ ŋu.

Dɔvɔ̃ŋutinunya .

Clavicle ƒe gbagbã nye 2.6%-5% le ame tsitsiwo ƒe gbagbãwo katã me [1,2]. Europa ƒe numekuku aɖe si me 1,000 siwo kplɔ wo nɔewo ɖo siwo nye clavicle fracture cases la ɖee fia [3,4] be clavicle ƒe gbagbã siwo wu 66% dzɔ le clavicle ƒe titina 1/3 me, si ade 25% nye axadzi 1/3 ƒe gbagbã, eye 3% nye medial 1/3 ƒe gbagbã. Klavi ƒe gbagbã ƒe dzɔdzɔ ɖee fia be mama le mɔ eve nu, si dzɔna le ŋutsu siwo mexɔ ƒe 30 haɖe o koŋ me, eye amesiwo xɔ wu ƒe 70 kplɔe ɖo.

Dɔdaƒe ƒe ŋutilã ƒe wɔwɔme .

Amegbetɔ ƒe ƒunukpeƒe gbãtɔ si adze ƒu ƒe ƒuƒu gɔmee nye abɔta, si nye ƒu ƒe kadodo ɖeka kolia si le abɔta kple akɔta dome, si ƒoa ƒu kple acromion, acromioclacular (AC) ƒunukpeƒe, eye wògogoa ƒunukpeƒea, si nye akɔtaƒu la. Woyɔa ƒunukpeƒe siawo be atypical synovial joints elabena fibrocartilage ye le wo ŋu tsɔ wu hyaline cartilage. Acromioclavicular kple rostroclaclacular ligaments ye tsɔa lãkusia ɖoa akɔta eye wotsɔa lãkusi si le lãkusi me kpena ɖe akɔta ŋu.

Klavi la nye 's' ƒe nɔnɔme. Aŋɔ afã si te ɖe eŋu la doa ŋgɔ, si wɔnɛ be teƒe si le etame ƒe akpa si le ahɔhɔ̃mekawo me la nɔa anyi. Arc la ƒe afã si le didiƒe la wɔa dɔ ɖe megbe (concave) eye emegbe wòwɔa ɖeka kple akɔta (rostral process kple acromion). Zi geɖe la, lãkusia ƒe gbagbã dzɔna le akasanu eveawo (mid-arc) ƒe ƒoƒo me, eye anɔ eme godoo be lãkusi siwo meku ɖe ƒu siwo te ɖe wo nɔewo ŋu le nuto sia me ƒe anyimanɔmanɔ kple le esi wònye lãkusia ƒe akpa si gbɔdzɔ wu ta. When a clavicle fracture is displaced, the proximal segment is almost always pulled upward (cephalad) by the sternocleidomastoid muscle (attached to the proximal end of the clavicle) and the distal segment is displaced downward (caudad) by the weight of the upper arm, and the clavicle tends to 'shorten' (ie, the fracture ends intersect each other), primarily due to the subscapularis kple pectoralis major (si trɔa abɔta ƒe akpa si le ememe) ƒe ʋuʋu. Esia tso subscapularis kple pectoralis ƒe lãmeka gãwo ƒe ʋuʋu koŋ gbɔ (si trɔa abɔta le ememe eye wòhenɛ yia akɔta).

Ŋutinuwo

Taɖodzinu si le clavicle fracture dɔdamɔnu ŋue nye be woaɖe vevesese dzi akpɔtɔ eye wòana ƒunukpeƒewo nawɔ dɔ. Wogakpɔtɔ nyea clavicle fractures akpa gãtɔ ƒe atikewɔwɔ koŋ (zi geɖe la, woɖea wo kpuie wu milimeta 15); Atikewɔwɔ siwo me womezãa atikewo le o abe aŋenu enyi siwo wotsɔ blaa woe, abɔtaƒuƒu, Sayre ƒe aŋenuwo, Velpeau ƒe atike siwo me womeʋãna o, kple woƒe ʋuʋu ƒe ʋuʋu. Wowɔa ʋuʋudedi ƒe ʋuʋu le ʋuʋudedi ƒe akpa si nye acute, eye zi geɖe la, wowɔa ʋuʋu ƒe hehexɔxɔ ƒe didime kple ŋusẽdodo ƒe kamededewo le kwasiɖa 2-6 le gbagbã megbe ne vevesesea nu yi. Womekafui be woazã nɔnɔmetata si nye 8 bandages o elabena ate ŋu ahe axillary pressure sores kple non-union of the fracture [5,6].

Ŋutinya kple ŋutilã me dodokpɔ .

Clavicle ƒe gbagbã tsoa abɔta ƒe ŋusẽkpɔɖeamedzi tẽ le anyidzedze megbe eye wokpɔa wo zi geɖe le gota kamedefefewo me le sɔhɛwo kple ame tsitsiwo ƒe anyidzedze le manyamanya me. Ele vevie be woaɖe alesi nuveviwɔame wɔa dɔe me. Nuveviwɔame si me ŋusẽ geɖe le ate ŋu aƒo ƒu kple abi siwo woxɔ le ta kple akɔta, gake abi siwo dona tso abi suesuesuewo me ate ŋu anye dɔléle. Nuveviwɔame siwo hea susu ɖa le ame ŋu bia be woadze scapular akɔta ƒe gli ƒe mama gɔme kaba eye woaɖe abi siwo woxɔna le akɔta, ahɔhɔ̃mekawo kple ʋukawo me. Le atikewɔnyawo me la, ʋuʋudedi kple ecchymosis le gbagbãƒea, tsɔ kpe ɖe nɔnɔme madeamedzi kple vevesese ŋu. Ele be woalé ŋku ɖe lãkusi falɛfalɛawo ŋu hena jacking up, si ate ŋu ana ŋutigbalẽ naku eye wòagbã.

Nɔnɔmetatawo ɖeɖe .

Woate ŋu akpɔ ƒunukpeƒetetedɔ ƒe akpa gãtɔ to ŋkume ƒe keklẽŋusẽ bɔbɔewo dzi. 20° Ta ƒe ʋuʋu ƒe fotoɖeɖewo ɖea akɔta ƒe do siwo ƒo ƒu ɖe wo nɔewo dzi ƒe ŋusẽkpɔɖeamedzi ɖa. Ele be woaɖe dɔnɔwo ɖe radio dzi le nɔnɔme si me woate ŋu akpɔ wo ɖokui dzi le me be woakpɔ gbagbãƒe ƒe ʋuʋu le susu me nyuie wu. Kpekpeme-tsɔtsɔ na radiographs kpena ɖe ame ŋu le rostral clavicular ligament ƒe blibonyenye me dzodzro me le distal clavicle alo acromioclacular joint injuries.CT kpena ɖe ame ŋu le susu me be woakpɔ abi sesẽ siwo nye scapular girdle eye wònaa wokpɔa abi siwo ate ŋu anɔ proximal clavicle joint la nyuie wu. Akɔta ƒe foto ɖeɖe kpena ɖe ame ŋu be woaɖe akɔta ƒe abi si do ƒome kplii ɖa, eye woate ŋu ada eƒe kpuiƒe kpɔ to etsɔtsɔ sɔ kple akpa si le akpa si le ŋgɔgbe la me, eye wòadzudzɔ scaculothoracic gli ƒe mama.

ƒomeviwo .

AO/OTA ƒe gbagbã ƒe ʋuʋu ƒe nuŋɔŋlɔ: Klavicle ƒe gbagbã ƒe nuŋɔŋlɔ 15 nye teƒe etɔ̃: 15.1 proximal (medial), 15.2 diaphysis, kple 15.3 distal (afã). Woda ƒu siwo te ɖe wo nɔewo ŋu (siwo le titina) kple esiwo le didiƒe (le axadzi) ɖe hatsotsowo me be wonye A (Arty-articular), Type B (si ƒe akpa aɖe nye ƒunukpeƒea ƒe akpa aɖe), kple ƒomevi C (si nye ƒunukpeƒea ƒe akpa si le ƒunukpeƒea me). Woma trunk fractures ɖe hatsotsowo me abe Type A (simple), Type B (Wedge), kple Type C (Commimed).Ao/OTA ƒe hatsotso si nye gbagbãƒewo kple ʋuʋu mebu alesi gbegbe woadzo le lãme na ame ƒe ʋuʋu kple esi me womezãa clavicle fractures le o ŋu o.

Wotu Allman ƒe nuŋɔŋlɔ ɖe afisi gbagbãƒea le dzi (I: Medial, Cadent 1/3, II: lateral 1/3, III: medial 1/3) (Fig. 7.2.1).

Craig gagbugbɔ trɔ asi le hatsotso sia ŋu le Allman dzi, eye nyee nye clavicle ƒe titina 1/3; ƒomevi II nye klavia ƒe gotagome 1/3, si woma emegbe ɖe ƒomevi 5 siwo wotu ɖe gbagbãƒe ƒe ʋuʋu kple ƒomedodo kple rostral clavicular ligament dzi; eye ƒomevi III nye lãkusi ƒe ememe 1/3 ƒe gbagbã, si woma ɖe ƒomevi 5 me le alesi gbegbe gbagbãƒea ʋuʋu kple nenye be ƒunukpeƒea ƒe akpa si le ƒunukpeƒea nye le ƒunukpeƒea me alo menyee o ta.

Neer ƒe nuŋɔŋlɔ ɖe axadzi 1/3 ƒe gbagbã dzi te gbe ɖe rostral-clavicular ligament ƒe vevienyenye dzi: Ƒomevi I dzɔna le didiƒe tso rostral-clavicular ligament gbɔ, eye medial fracture block displaced; Type II lɔ rostral-clavicular ligament ɖe eme eye wònana be medial fracture block la ʋuʋuna ɖe dzi wu; eye Type III keke ta ɖo acromioclavicular joint la gbɔ eye rostral-clavicular ligament gakpɔtɔ li.

Edinburgh typing nye diaphysis ƒe gbagbã ƒe hatsotsowo ƒe ɖoɖo si le alesi gbegbe woɖe woe kple alesi wobla woe nu.1 Ƒomevi 1 ƒe gbagbã lɔ titina ƒe nuwuwu ɖe eme, ƒomevi 2 nye diaphysis ƒe gbagbã eye ƒomevi 3 nye axadzinuwuwu ƒe gbagbã. Woma diaphysis ƒe gbagbãƒewo ɖe hatsotsowo me le alesi cortical contact ƒe anyinɔnɔ alo manɔmanɔ dome le fracture fragments dome ɖe ƒomevi A kple B. Wogade ƒomevi 2A gbagbãwo hatsotso me be womeʋu o (ƒomevi 2A1) kple esiwo wotsɔ ƒo ƒu (Type 2A2), 2B ƒe akpa 2B2. Diaphysis kple Type 3 nye diaphysis ƒe axadzinuwuwu. Womaa titina kple axadzi ƒe nuwuwu ƒe gbagbãƒewo ɖe hatsotso sue 1 kple 2 me le nenye be ƒunukpeƒe si te ɖe wo nɔewo ŋu la le eme ta.

Nenema ke Rockwood ƒe nuŋɔŋlɔ, Jager ƒe nuŋɔŋlɔ, kple Breitner ƒe nuŋɔŋlɔ hã le afima.

Amekoko ƒe dzesiwo .

gbagbãƒe tɔxɛwo .

1, gbagbã le gaglãgbe; 

2, ʋuʋu >2 cm; 

3, kpuiƒe >2 cm; 

4, gbagbã ƒe kakɛwo ƒe comminution (>3); 

5, akpa vovovowo ƒe gbagbã; 

6, si le ete le ʋuʋu si le ʋuʋu ɖi me kple abi si le lãkusi falɛfalɛwo ŋu; 

7, nɔnɔme madeamedzi ɖedzesiwo (ʋuʋudedi kple kpuiƒe); 

8, Scaphoid ƒe abixɔxɔ.

Nuveviwɔame ƒokpli .

1, ƒo ƒu ipsilateral tame ƒe abixɔxɔ;

2, abɔta ƒe abi si le tsia dzi;

3, Nuveviwɔame geɖe;

4, ƒu gbagbã kple ahɔhɔ̃mekawo ƒe abixɔxɔ;

5, ipsilateral multiple rib fractures ƒo ƒu kple akɔta gli ƒe nɔnɔme madeamedzi;

6, clavicle shortening be woawɔ abɔta si ŋu aʋala le;

7, akpa eve ƒe klavia ƒe gbagbã.

Dɔnɔwo ƒe Nɔnɔmewo .

1, dɔnɔ siwo xɔ abi zi geɖe la hiã be woatsɔ kpekpeme si le etame ƒe akpa si le etame la ƒe kaba;

2, dɔnɔ siwo hiã be woatrɔ ayi dɔwɔwɔ me kabakaba (le kpɔɖeŋu me, ame ŋkutawo kple kamedefefe siwo me hoʋiʋli le).

Ɣeyiɣi si woawɔ dɔ na ame .

Ele be woawɔ dɔ na ame heheɖemegbe manɔmee ne amekoko ƒe dzesi blibowo li.

Amekoko ƒe megbetsitsi wu kwasiɖa 2-3 le dzesi siwo sɔ gbɔ me ate ŋu ana wòadzi ɖe edzi sesẽ be woaɖe akɔta ƒe gbagbã dzi akpɔtɔ, vevietɔ ne wole dzadzram ɖo ɖe nusiwo wotu ɖe wo nɔewo ŋu le ememe ƒe fixation to percutaneous techniques dzi.

Amekoko ƒe mɔɖeɖe .

Wotsɔa dɔnɔa dana ɖe ƒutazikpui ƒe nɔnɔme me alo eƒe nɔƒe afã. Woblaa abɔta si ŋu dɔlélea le la ɖe ete be wòado abɔtawua ɖe dzi be woawɔ dɔ nɛ bɔbɔe, eye woklɔa alɔa be wòana woate ŋu awɔ dɔ le dɔwɔwɔ nɛ me. Woate ŋu atia fli si le axadzi le abɔta ƒe akpa didi alo saber ƒe ʋuʋudedi si sɔ kple Langer ƒe nɔnɔmetata la ŋu.

MIDE DZESII: Afɔdzidede si le tsia dzi naa kekeɖenudɔwɔwɔ geɖe wu, esime lãkusi didi aɖe ɖea afɔku si le lãmeka siwo le lãkusi me ƒe abixɔxɔ ŋu dzi kpɔtɔna eye wòdzea atsyɔ̃ɖoɖo ŋu wu.

Ememe Fixation .

3.5 Woate ŋu azã ɖoɖo ƒe nutete ƒe agbalẽviwo, gbugbɔgatu gbadzɛwo, alo plastic LCPwo atsɔ aɖɔ clavicle ƒe gbagbãwo ɖo. Wotsɔa agbawo dana ɖe akpa si le lãkusia dzi la tame nyuie alo doa ŋgɔ nɛ. Plɛtiwo sesẽ wu le biomechanical abiwo me ne woda wo ɖe dzi wu, vevietɔ ne comminud fracture le ete, eye wole bɔbɔe wu be woakpɔe le susu me. Ehiã be woatsɔ gaviawo aɖo bicortical fixation, eye ele be woaku doawo kple beléle gã aɖe, elabena afɔku li be woaxɔ abi le lãmekawo kple ʋuka siwo le ete ŋu. Viɖewo: Anterior plate screw channel, plate apposition, contouring bɔbɔe ƒe kuɖiɖi dedie.

MIDE DZESII: Zi geɖe la, womehiãa ƒu ƒe dodo ɖe lãme na ame hafi wowɔa dɔ le gɔmedzedzea me o; Le ememe fixation megbe la, ele vevie ŋutɔ be woatsɔ abla myofascial layer la nyuie be wòatsyɔ agbaa dzi ahaxe mɔ ɖe dɔlékuiwo xɔxɔ nu.

Intramedullary fixation .

Mɔ̃ siwo wotsɔna léa nu ɖe ​​lãme na ame fifia dometɔ aɖewoe nye kirschner pins, rockwood pins, hagie pins, titanium elastic intramedullary pins, hollow screws, kple elastic locking intramedullary nails; Le kpɔɖeŋu me, titanium elastic nails meɖea mɔ ɖe static locking ŋu o, meɖea mɔ ɖe didime kple tɔtrɔ ŋu o, eye ate ŋu ana woawɔ evelia kpuie ne wozãe na comminud fractures. Woate ŋu azã atike si nye intramedullary nailing technique la ɖe clavicle fractures bɔbɔe siwo le tsia dzi alo esiwo le tsia dzi ko ŋu.

Viɖewo .

Lãɖeɖe le sue wu, atsyɔ̃ɖoɖo si sɔ gbɔ wu, lãkusi siwo me fa miamiamia, si me woɖea nu le bɔbɔe, afɔku si le endophyte ƒe dodo ɖe ŋgɔ me dzi ɖena kpɔtɔna, kple liƒo si do ƒome kple ʋuʋudedi ƒe wɔwɔme.

Nusiwo gblẽ le eŋu .

ŋutigbalẽ ƒe dzikudodo alo nusiwo gblẽ le afisi woge ɖo.

MIDE DZESII:Woƒoa asa na clavicle ƒe gbagbã dzi ɖeɖe kpɔtɔ si wotu ɖe edzi ɣeaɖewoɣi eye woƒoa asa na dɔwɔla ƒe asi si sɔ gbɔ akpa ɖe keklẽŋusẽ ŋu le amekoko ƒe afɔɖeɖewo me.

Nuwo ƒe tsɔtsɔ ɖe nu dzi si me nu boo aɖeke mele o .

Wosusu be klatsa ƒe ƒumeŋuɖui si me nu boo aɖeke mele o la naa ŋusẽ si lolo wu le biomechanical me esime wòƒoa asa na nusiwo gblẽ le plate fixation alo intramedullary fixation ŋu.

3.5 system LCP anterior la ɖoɖo ɖe dɔwɔwɔ me ɖe clavicle la ŋu, si nyo wu ne ele ŋgɔgbekpa dzi le clavicle te, ɖea mɔ be woaƒo nu tso klavi si le lãmesẽ me ŋu, si wɔnɛ be wònɔa bɔbɔe be woatrɔ asi le agbalẽa ŋu do ŋgɔ eye be woakpɔ ʋuƒo si didi wu.

Ne wozã ƒumeŋuɖui si me nu boo aɖeke mele o si me womezãa nu boo aɖeke le o la, ate ŋu ado ƒome kple lãmeka ƒe abixɔxɔ si le supraclavicular, ka siwo kpɔa ŋusẽ ɖe dɔwɔwɔ dzi, kple plate bending alo fracture ƒe akpa eve ƒe ƒoƒo ɖe wo nɔewo ŋu nyuie alo kpuie.

Plate fixation of fractures of the lateral end of the clavicle .

Plɛti siwo wotsɔ dea nu me ƒe tiatia nɔ te ɖe axadziƒu ƒe lolome dzi. Wohiã bicortical screw 3 ya teti na axadzi ƒu ƒe ƒuƒoƒo. Le mɔ nyuitɔ nu la, ele be woazã tension screws na oblique fractures. Ne ƒu ƒe ƒuƒoƒoa le sue akpa be woate ŋu aɖoe la, woate ŋu azã clavicle hook plate.

Atikewɔwɔ na Acromioclavicular ƒunukpeƒe ƒe ʋuʋu .

Acromioclavicular ƒunukpeƒe ƒe abixɔxɔ nye 12% le scapular girdle ƒe abixɔxɔ me eye zi geɖe la, edzɔna le kamedefefewɔla siwo yɔ fũ kple wo nɔewo me.

Nusi wozãna wu le fefewɔƒeae nye Rockwood fefewɔƒea. Type I nye acromioclavicular ligament ƒe vuvu si me rostroclacular ligament la me gblẽ o; Type II nye acromioclavicular ligament ƒe aɖatsi si me rostroclacular ligament la me gblẽ o; Type III nye akɔta ƒe lãkusi kple rostroclavicular ligament siaa ƒe aɖatsi; Type IV nye megbe ƒe ʋuʋu le didiƒe ʋĩ ƒe afɔkpodzi si le trapezius la ƒom; Type V nye acromioclavicular joint kple rostroclacular ligament siaa ƒe aɖabɛ keŋkeŋ, eye ƒunukpeƒea ƒe ʋuʋu wu 100 le alafa me; eye ƒomevi VI ƒe abixɔxɔwo mebɔ kura o, kple distal clavicle si woɖe ɖa yi anyime le rostral ƒe ɖoɖoa te.

Wokafu atikewɔwɔ si me wozãa brek ɣeyiɣi kpui aɖe le kple cantilever sling na abi ƒomevi I kple ƒomevi II. Woʋlia nya le abi ƒomevi III ƒe dɔlélewo gbɔ kpɔkpɔ ŋu, eye agbalẽ aɖewo ɖee fia be woɖe atikewɔwɔ si me womezãa atike aɖeke le o fia sɔhɛ tsitsi siwo le dɔ dzi vevie. Dɔwɔwɔ ƒe hayahaya nyo togbɔ be ate ŋu anye be nɔnɔme madeamedziwo le vovovo le dzedzeme nu hã. Nuveviwɔame ƒomevi IV - VI sesẽ wu eye wokafu amekoko ƒe nudede eme.

Fifia la, amekokomɔnu siwo wozãna zi geɖee nye: Bosworth Rostral Locking Screw mɔnu si me wodzraa lãkusia ɖo le afɔɖeɖe ɖeka me alo womedzrae ɖo o;, clavicle hook plate fixation, si sɔ kple lateral end of clavicle fracture; Tightrope ƒe tab gbadzɛ alo seke ƒe pinning suture to arthroscope alo lãkusi sue aɖe me; kple rostral locking ligament suture alo reinforced suspension, kple nuwɔwɔ alo lãkusi le rostral eminence kple clavicle dome.

Womenya amekokomɔnu si ɖea vi wu o, eye togbɔ be ate ŋu anye be womagagbugbɔe awɔ o vaseɖe afi aɖe hã la, mɔnu siawo katã ƒe dɔwɔwɔ nyuie wu nye nusi naa dzidzeme ame.

Atikewɔwɔ na medial end clavicle fractures kple sternoclavicular joint dislocations .

Nuveviwɔame siawo mebɔ kura o, eye le afisia hã la, atikewɔwɔ ŋuti mɔfiame siwo wotu ɖe atike siwo ŋu kpeɖodzi le dzi la meli o.

Zi geɖe la, medial clavicle fractures nyea ƒunukpeƒetetedɔ siwo to vovo na wo nɔewo kple ʋuʋu si mele vevie o eye woate ŋu awɔ nu ɖe ​​wo ŋu le mɔ si me woɖea mɔ ɖe nu ŋu le. Zi geɖe la, clavicle ƒe titina ƒe nuwuƒe ƒe epiphysis wua enu ne woxɔ ƒe 23-25 ​​eye eyae nye epiphysis mamlɛtɔ si wotu ɖe ŋutilã me. Eyata le nyateƒe me la, abi geɖe siwo woxɔ le titina le titina la nye epiphyseal plate fractures of Salter-Harris Type I alo II. X-ray siwo wozãna ɖaa la didi sesẽ, kple viɖe si nye be 40° ta ƒe ʋuʋu ƒe radiograph kple tsɔtsɔ sɔ kple akpa si le lãmesẽ me ate ŋu aɖe lãkusia ƒe titina ƒe nuwuwu afia, eye CT naa dɔlélewo didi ƒe nɔnɔmetata nyuitɔ kekeake.

Zi geɖe la, woate ŋu axe gbagbã alo ʋuʋu siwo woɖe ɖa le ŋgɔgbe gome eye woatrɔ wo ɖe teƒe bubuwo, gake zi geɖe la, womeli ke o eye wowɔa wo ɖe teƒeteƒewo hena ʋuʋu ake. Wokafu beléle na ame ƒe lãmetutudɔ na ʋuʋu alo ʋuʋu si nɔa anyi ɖaa elabena zi geɖe la, womewɔa dɔwɔwɔ ƒe gbɔdzɔgbɔdzɔ o. Ƒã hafi ʋua ƒe akpa si le megbe ƒe titina ƒe akpa si le megbe la ƒe megbe ƒe akpa si le megbe la hea abi si le etame mediastinal, si me ʋukawo me abi alo yagbɔgbɔ ƒe mɔxexe kple yaƒoƒo ƒe nutete gɔ̃ hã le. Le ʋuʋu kple gbagbãƒe siwo titina ƒe kakɛa le sue akpa ta la, woate ŋu atsɔ platewo aƒo ƒu ɖe ƒunukpeƒea be woatsɔ aɖo akɔta.

Mɔnu bubu siwo wozãna tsɔ léa ŋku ɖe nu ŋu .

eg gotagome fixation kple stent, gotagome fixation kple clavicle plate, kple bubuawo.

Dɔwɔwɔ vɔ megbe dzikpɔkpɔ .

Ele be woaʋã abɔta ƒe abɔta le aŋetu me eye woadze abɔta ƒe pendulum hehexɔxɔ gɔme enumake. Kwasiɖa 2 megbe la, ele be woakplɔ dɔnɔa ɖo be wòalé ŋku ɖe abi la ŋu ahalé ŋku ɖe X-ray la ŋu, gake woate ŋu aɖe abɔta ƒe aŋea ɖa eye woate ŋu adze ƒunukpeƒetetedɔ ƒe hehexɔxɔ si ŋu seɖoƒe mele o gɔme, gake ele be woagblɔ na dɔnɔa be wòagakɔ kpekpemewo kple abɔ si ŋu dɔlélea le la o. Woate ŋu adze ŋusẽdodo ame ƒe hehexɔxɔ gɔme le kwasiɖa 6 le dɔwɔwɔ nɛ vɔ megbe ne ƒu ƒe dɔyɔyɔ ƒe dzesiwo dze. Ele be woaƒo asa na kadodo kple kamedefefe siwo gbɔ eme hena ɣleti 3 le amekokoa megbe vaseɖe esime ƒu gbagbãa nahaya keŋkeŋ.

kuxiwo.

Kuxi siwo dona tso eme kaba .

abi ƒe dɔléle siwo woxɔna le dɔwɔwɔ vɔ megbe ate ŋu adzɔ le dɔléle siwo ade 4.8% me;

Numbness le subclavian nutoa me nye kuxi si bɔ wu, kple dzɔdzɔme ŋutinya me numekuku si wowɔ le dɔnɔ siwo ƒe dzesi sia le 83% ŋu, si dzi ɖena kpɔtɔna le ɣeyiɣi aɖe megbe eye mehea dɔmawɔmawɔ nyuie vɛ o, togbɔ be ate ŋu anɔ anyi ƒe 2 le dɔwɔwɔ nɛ vɔ megbe hã;

endophyte protrusion kple skin agitation, si bɔ ɖe voluminous plates alo nail tails zazã me evɔ lãkusi falɛfalɛwo metsyɔ nu edzi nyuie o;

Gbugbɔgadzɔ, si ate ŋu adzɔ le amekoko kple atikewɔwɔ si me womezãa atikewo le o siaa megbe; Amekoko le amekoko megbe ate ŋu ana endoprosthesis la nabɔbɔ alo agbã, alo woagbãe le endoprosthesis la ŋu;

Nonunion, kple 15% nonunion rate kple conservative dɔdamɔnu kple 2% nounion rate kple amekoko atikewɔwɔ na keŋkeŋ displaced diaphyseal fractures; Ƒutsotsoe la ƒe ʋuʋu keŋkeŋ, eƒe didime wu sentimeta 2, atamanono, ƒe si woxɔna ɖe edzi, abi siwo ŋu ŋusẽ le ŋutɔ, gbugbɔgadzɔ (mɔ̃ɖaŋununya ƒe malikenyenye), diaphyseal ƒe ʋuʋu si gbugbɔna, ƒu ƒe nyonyome madeamedzi, kple ƒu ƒe gbagbã fũ.

Kuxi siwo tsi megbe .

Acromioclavicular joint ƒe ƒumeŋuɖui dzɔna zi geɖe wu le ƒunukpeƒetetedɔ me (Edinburgh ƒomevi 3B2); Ne atikewɔwɔ si me dzesiwo le kple esi me womezãa atike aɖeke le o mewɔa dɔ o la, woate ŋu aɖe lãkusi si le didiƒe la ɖa le lãkusi me alo to amekoko si woawɔ le gaglãgbe me;

Deformity Healing, si dzɔna le agbɔsɔsɔ vovovowo me le ƒu gbagbã siwo katã ŋu wowɔ atike ɖo le mɔ si me womezãa atikewo le o nu; Akɔtaɖonu ƒe akɔtaɖonu ƒe kpuiƒe si kpe ɖe distal fracture block ƒe tɔtrɔ ŋu ate ŋu ana abɔta ƒe ŋusẽ mamlɛtɔ kple dzidodo naɖiɖi, vevietɔ le abɔta ƒe ʋuʋu me; Akɔta ƒe dodo ƒe akpa si le kpuie ate ŋu ana akɔta ƒe lãkusi ƒe nutete ƒe dzesiwo nadze; Eye akɔtaƒuwo ƒe ƒunukpeƒewo ƒe gbegblẽ ate ŋu ana akɔta ƒe ŋgɔgbe naʋuʋu eye wòana abɔta nase veve kple myalgias, ne edze ƒã be dzesiawo tso deformity me ne dɔyɔyɔ dzɔ la, ƒumeŋuɖui ɖɔɖɔɖo kple plate fixation nye nusi woate ŋu awɔ le dɔnɔa ƒe nuhiahiãwo nu.

Nyagblɔɖi kple emetsonu .

Numekuku aɖe si do ƒome kplii le Europa ka nya ta be amekoko ƒe atikewɔwɔ na titina ƒe gbagbã siwo woɖe ɖa la wɔ dɔ nyuie, eye eƒe meta-kuxiwo me dzodzro ɖee fia be malunion ƒe dzɔdzɔ si na be fracture nonunion kple symptom-producing malunion dzi ɖe kpɔtɔ ŋutɔ le amekoko ƒe ƒuƒoƒoa me wu le ƒuƒoƒo si me womewɔ atike na o me ne wotsɔ amekoko si me womezãa atike siwo wozãna le mɔ gbegblẽ nu o la sɔ kple atikewɔwɔ si me womezãa atike siwo wozãna le mɔ gbegblẽ nu o; Tsɔ kpe ɖe eŋu la, amekoko ƒe ƒuƒoƒoa ɖe vevesese dzi kpɔtɔ le gɔmedzedzea me, eye dɔwɔwɔ ƒe dzesi siwo nɔa anyi ɖaa kple esiwo me wowɔa dɔ le ɣesiaɣi ƒe ŋgɔyiyi dze ƒã wu.

Gblɔe kpuie .

Ŋutasẽnuwɔwɔ tẽ alo esi metso tẽ o gbɔe clavicle ƒe gbagbã akpa gãtɔ tsona, eye woate ŋu ama atikewɔwɔa ɖe hatsotsowo me be enye atikewɔwɔ si me woakpɔ egbɔ le alo woawɔ dɔ nɛ. Le atikewɔwɔ gome la, togbɔ be woate ŋu ada lãkusi ƒe gbagbã akpa gãtɔ evɔ womaɖe wo le wo ɖokui si boo o hã la, nyaʋiʋli le amekoko ƒe atikewɔmɔnu si woazã na gbagbãƒe siwo me ʋuʋu le vevie ŋu. Le clavicle fractures siwo woɖe ɖa gome la, amekoko ƒe atikewɔwɔ ƒe ƒuwo ƒe dɔyɔyɔ kple dɔwɔwɔ kaba ƒe agbɔsɔsɔ si sɔ gbɔ wu ne wotsɔe sɔ kple atikewɔwɔ si me womezãa atikewo le o.

Nusiwo woŋlɔ ɖe eme .

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[2] EIFF, MP, Hatch, kple ame bubuwo. clavicle kple akɔtaƒuwo ƒe gbagbã. Le: Fracture Management for Primary Care, 2nd ED, WB Saunders, Philadelphia 2002. P.198.

[3] Robinson CM. Fractures of the clavicle le ame tsitsia me. Dɔvɔ̃ŋutinunya kple hatsotsowo me toto. J Ƒu ƒe ƒunukpeƒe ƒe dɔwɔwɔ BR 1998; 80:476.

[4] Neer CS 2 lia. Akpa si le didiƒe ƒe akpa etɔ̃lia ƒe gbagbã. Clin Orthop Relat Res ƒe 1968; 58:43.

[5] Andersen K, Jensen PO, Lauritzen J. Atikewɔwɔ na clavicular fractures. Figure-of-eight bandage tsɔtsɔ sɔ kple aŋekotoku bɔbɔe aɖe. Acta Orthop Scand 1987; 58:71.

[6] Ersen A, Atalar AC, Birisik F, kple ame bubuwo. Abɔti bɔbɔe kple nɔnɔmetata si nye clavicular bandage enyi tsɔtsɔ sɔ kple wo nɔewo na midshaft clavicular fractures: numekuku si wowɔ le vome. Ƒu ƒe ƒunukpeƒe J 2015; 97-B:1562.