Ganewa da Maganin Karaya na Clavicle

Gabatarwa

Ƙunƙarar ƙwayar ƙwayar cuta ta zama ruwan dare gama gari kuma yawanci yana haifar da rauni kai tsaye ko kai tsaye zuwa yankin kafada. Nazarin a farkon shekarun 1960 ya ruwaito cewa rashin haɗin kai na clavicle fractures ya kasance ƙasa da 1%, kuma maganin ra'ayin mazan jiya ya haifar da gamsuwar haƙuri mai girma; tare da ci gaban magani na kwanan nan, maganin tiyata ya sami tasiri mai mahimmanci; sabili da haka, likitocin da ke aiki a cikin sashen gaggawa ko babban asibiti na asibiti ya kamata su saba da bayyanar cututtuka na yau da kullum da rikice-rikice na wannan rauni da kuma kula da shi.

Epidemiology

Clavicle fractures lissafin 2.6% -5% na duk manyan karaya [1,2]. Wani binciken na Turai wanda ya hada da 1,000 a jere clavicle fractures gano [3,4] cewa fiye da 66% na clavicle fractures ya faru a tsakiyar 1/3 na clavicle, kamar 25% sun kasance a gefen 1/3 fractures, kuma 3% sun kasance na tsakiya 1/3 fractures. Abubuwan da suka faru na clavicle fractures sun nuna rarraba bimodal, wanda ke faruwa da farko a cikin maza a ƙarƙashin shekaru 30, sannan waɗanda suka wuce shekaru 70.

Clinical Anatomy

Farkon kwarangwal na ɗan adam don fara ossification shine clavicle, kawai haɗin kasusuwa tsakanin hannun babba da gangar jikin, wanda ke bayyana nesa tare da acromion, haɗin gwiwa acromioclavicular (AC), kuma kusa da sternum, haɗin gwiwa na sternoclavicular (SC). Ana kiran waɗannan haɗin gwiwar haɗin gwiwa na synovial na yau da kullun saboda an yi musu layi tare da fibrocartilage maimakon guringuntsi na hyaline. Ƙwaƙwalwar ƙwayar cuta tana ƙunshe da scapula ta hanyar acromioclavicular da rostroclavicular ligaments kuma an haɗa shi da sternum ta hanyar ligament na sternoclavicular.

Ƙaƙwalwar ƙira mai siffar 'S'. Matsakaicin rabin-arc yana aiki a gaba, yana barin ɗaki don tarin ƙwayoyin jijiyoyin jini na babba. Rabin nesa na baka yana aiwatar da baya (concave) sannan ya shiga scapula (tsarin rostral da acromion). Karaya na clavicle yawanci yakan faru ne a mahaɗin baka biyu (tsakiyar baka), mai yuwuwa saboda rashin haɗin haɗin gwiwa da ke maƙwabtaka da ƙasusuwan maƙwabta a wannan yanki kuma saboda shine mafi rauni na clavicle. Lokacin da clavicle fracture ke gudun hijira, kusan kusan ko da yaushe yana jan sashin da ke kusa zuwa sama (cephalad) ta tsokar sternocleidomastoid (wanda aka haɗe zuwa ƙarshen ƙarshen clavicle) kuma ɓangaren nesa yana ƙaura zuwa ƙasa (caudad) ta nauyin hannun na sama, kuma clavicle yana kula da raguwa, da farko ya ƙare, kowane ɗayan ya ƙare, ya ƙare da 'ƙasa'. ƙanƙancewa na subscapularis da pectoralis babba (wanda a ciki ke juya hannun sama). Wannan ya samo asali ne saboda raguwar ƙananan ƙwayoyin cuta da manyan tsokoki na pectoralis (waɗanda a ciki suke juya hannu na sama kuma suna jan shi zuwa kirji).

Siffofin

Manufar maganin clavicle fracture shine don rage zafi da mayar da aikin haɗin gwiwa. Yawancin karaya har yanzu ana kula da su da farko ta hanyar ra'ayin mazan jiya (yawanci an rage shi da bai wuce 15 mm ba); jiyya masu ra'ayin mazan jiya kamar su bandeji-na takwas, majajjawa na gaba, bandages Sayre, Velpeau immobilization suits, da kuma hana motsi. Ana aiwatar da dakatarwar dakatarwa a cikin matsanancin lokaci, kuma farkon kewayon motsa jiki da motsa jiki na motsa jiki yawanci ana yin makonni 2-6 bayan fashewar lokacin da zafi ya ƙare. Ba a ba da shawarar yin amfani da adadi na bandages 8 ba saboda zai iya haifar da ciwon matsa lamba axillary da ƙarin rashin haɗuwa da karaya [5,6].

Tarihi da Jarrabawar Jiki

Ƙunƙarar clavicle yana haifar da tasiri kai tsaye zuwa kafada bayan faɗuwa kuma ana yawan gani a cikin wasanni na waje a cikin matasa kuma a cikin faɗuwar da ba ta dace ba a cikin tsofaffi. Yana da mahimmanci don ayyana tsarin rauni. Raunin ƙarfi mai ƙarfi na iya haɗuwa tare da raunin kai da ƙirji, yayin da karaya da ke haifar da ƙananan rauni na iya zama cuta. Raunuka masu raɗaɗi suna buƙatar farawa da wuri da kuma cire hankali a hankali na rabuwar bangon kirji na scapular, raunin neurologic da jijiyoyin jini. A asibiti, akwai kumburi da ecchymosis a wurin karaya, hade da nakasa da taushi. Ya kamata a kula da kyallen takarda masu laushi don jacking up, wanda zai iya haifar da necrosis na fata da ulceration.

Hoto

Yawancin karaya ana iya gano su ta hanyar radiyo mai sauƙi na anteroposterior. 20° na karkatar da kai na rediyo yana kawar da tasirin cunkoson kogon thoracic. Ya kamata a yi hoton majiyyata a rediyo a matsayi mai goyan bayan kai don ganin mafi kyawun ƙaura. Nauyin nauyi don radiyo yana taimakawa wajen tantance amincin rostral clavicular ligament a distal clavicle ko acromioclavicular haɗin gwiwa raunin da ya faru.CT taimaka wajen hango ko hasashen hadaddun scapular girdle raunin da kuma samar da mafi kyau gani na yiwuwar kusanci clavicle raunin a sternoclavicular hadin gwiwa. Ɗaukar radiyon ƙirji yana taimakawa wajen kawar da wani rauni na thoracic da ke da alaƙa, kuma ana iya ƙididdige raguwa ta hanyar kwatanta shi da clavicle contralateral, da kuma yanke hukuncin rabuwar bangon scapulothoracic.

Nau'ukan

AO/OTA Tsagawar Rushewar Buga: Lambar clavicle fracture code 15 ta ƙunshi shafuka uku: 15.1 proximal (matsakaici), 15.2 diaphysis, da 15.3 distal (a gefe). Rarrabuwar kusanci (matsakaici) da nisa (na gefe) an rarraba su azaman nau'in A (karin-articular), nau'in B (ɓangare na intra-articular), da nau'in C (cikakkiyar intra-articular). An rarraba raunin gangar jikin a matsayin nau'in A (mai sauƙi), nau'in B (wedge), da kuma nau'in C (comminuted) . Ƙididdigar AO / OTA na raguwa da raguwa ba ya la'akari da matakin ƙaura na raguwa, kuma a halin yanzu yana da iyakacin amfani da shi wajen maganin clavicle fractures da kuma ƙayyade tsinkaya.

Buga Allman yana dogara ne akan wurin da aka yanke (I: medial, cadent 1/3, II: lateral 1/3, III: medial 1/3) (Fig. 7.2.1).

Craig ya sake sabunta wannan rarrabuwa bisa ga Allman, tare da kasancewa tsakiyar 1/3 na clavicle; nau'in II kasancewar 1/3 na waje na clavicle, wanda aka raba shi zuwa nau'ikan 5 dangane da ƙaurawar ɓarna da dangantaka da ligament na rostral clavicular; da kuma nau'in III kasancewa raguwa na 1/3 na ciki na clavicle, wanda aka raba zuwa nau'in 5 bisa ga girman ƙaura da kuma ko raunin ya kasance a cikin articular ko a'a.

Rubutun Neer na ɓarke ​​​​1/3 na gefe yana jaddada mahimmancin ligament na rostral-clavicular: nau'in I yana faruwa mai nisa zuwa ligament na rostral-clavicular, tare da shinge na tsakiya na tsakiya da aka raba da kyau; nau'in II ya ƙunshi ligament na rostral-clavicular kuma yana haifar da toshe fashewar tsaka-tsaki da aka yi gudun hijira da kyau; kuma nau'in III ya shimfiɗa zuwa haɗin gwiwar acromioclavicular tare da ligament na rostral-clavicular da ya rage.

Bugawa na Edinburgh shine tsarin rarraba diaphysis fractures bisa ga matakin ƙaura da ƙaddamarwa.1 Nau'in nau'in nau'in 1 ya haɗa da ƙarshen tsakiya, nau'in 2 shine diaphysis fractures da nau'in 3 sune raunin ƙarshe na gefe. An rarraba ɓarna na diaphysis bisa ga kasancewar ko rashi na haɗin gwiwar cortical tsakanin ɓawon burodi a cikin nau'in A da B. Nau'in nau'in 2A an kara rarraba su azaman nau'in nau'in 2A1 (nau'in 2A1) da angulated (nau'in 2A2), 2B fractures an rarraba su azaman mai sauƙi ko nau'i-nau'i (nau'in 2Bnuted 1) da nau'in 3 (nau'in 2Bnuted). ya ƙunshi ƙarshen tsakiya na diaphysis kuma nau'in 3 shine ƙarshen diaphysis. An raba karaya na tsakiya da na gefe zuwa rukuni na 1 da 2 bisa ga ko haɗin haɗin gwiwa yana da hannu.

Hakazalika akwai rubutun Rockwood, buga Jager, da kuma bugun Breitner.

Alamun tiyata

Takamaiman karaya

1, karaya a bude; 

2, ƙaura> 2 cm; 

3, ragewa> 2 cm; 

4, comminument of fracture fragments (> 3); 

5, karaya mai yawa; 

6, ƙananan karaya mai buɗewa tare da rauni mai laushi; 

7, nakasa mai mahimmanci (matsuwa da raguwa); 

8, rauni mai rauni.

Raunin mahalli

1, Haɗaɗɗen raunin ipsilateral babba;

2, Raunin kafada mai iyo;

3, raunuka masu yawa;

4, karaya tare da raunin neurovascular;

5, raunin haƙarƙari da yawa na ipsilateral haɗe tare da nakasar bangon ƙirji;

6, clavicle gajarta don samar da kafada mai fuka-fuki;

7, Karaya mai kaifi biyu.

Abubuwan Haƙuri

1, Marasa lafiya tare da raunuka da yawa suna buƙatar ɗaukar nauyin nauyin nauyin farko na farko;

2, Marasa lafiya da ke buƙatar dawowa aiki cikin sauri (misali, fitattu da wasanni masu gasa).

Lokacin tiyata

Ya kamata a yi tiyata ba tare da bata lokaci ba lokacin da cikakkun alamun tiyata sun kasance.

Jinkirta a cikin tiyata fiye da makonni 2-3 a cikin alamun dangi na iya ƙara wahalar raguwar karaya, musamman lokacin da ake shirya rufaffiyar raguwa na cikin gida ta hanyar dabaru masu ɓarna.

Samun damar tiyata

An sanya majiyyaci a cikin kujerar kujerar bakin teku ko matsayi na rabin zama. An lulluɓe kafadar da abin ya shafa a ƙasa don ɗaga ƙwanƙwasa don sauƙi na tiyata, kuma ana tawul ɗin hannu don ba da damar motsa jiki. Za'a iya zaɓar juzu'i mai jujjuyawa tare da dogayen gaɓoɓin clavicle ko ɓangarorin saber mai layi ɗaya da tsarin langer.

Lura: Ƙarƙashin ɓarna yana ba da ƙarin tsawo, yayin da tsinkayar tsayin daka yana rage haɗarin raunin jijiya na supraclavicular kuma yana da kyau sosai.

Gyaran Cikin Gida

3.5 Za a iya amfani da faranti na matsawa na tsari, faranti na sake ginawa, ko LCPs na filastik don gyara karaya. Ana sanya faranti a sama ko a gaba zuwa ga clavicle. Faranti sun fi ƙarfi a cikin raunin ƙwayoyin halitta lokacin da aka sanya su da kyau, musamman idan akwai karaya a ƙasa, kuma sun fi sauƙin gani. Daidaitawar bicortical na screws ya zama dole, kuma ya kamata a zubar da ramuka tare da kulawa sosai, saboda akwai haɗarin rauni ga jijiyoyi da jini a ƙasa. Abũbuwan amfãni: aminci hakowa na gaban farantin dunƙule tashar, farantin appposition, sauki contouring.

Lura: Ba a buƙatar gyaran kashi don tsarin farko; bayan gyaran ciki, yana da mahimmanci don daidaitaccen suturar myofascial Layer don rufe farantin da hana kamuwa da cuta.

Intramedullary gyarawa

Na'urorin gyara intramedullary na yanzu sun haɗa da fil ɗin Kirschner, fil na Rockwood, fil ɗin Hagie, fil ɗin intramedullary na roba na titanium, screws mara kyau, da kusoshi na roba na intramedullary; misali, ƙusoshi na roba na titanium baya bada izinin kulle tsaye, kar a ba da izinin sarrafa tsayi da juyi, kuma yana iya haifar da raguwa na biyu lokacin amfani da karaya. Za a iya amfani da dabarar ƙusa ta intramedullary zuwa ga karaya mai sauƙi, mai juzu'i ko ɓarna.

Amfani

ƙarami juzu'i, ƙarin ƙaya, ƙarancin cirewar nama mai laushi, ƙananan haɗarin fitowar endophyte, da kwanciyar hankali mai alaƙa da samuwar scab.

Rashin amfani

ciwon fata ko lahani a wurin shiga.

Lura: Rufe raguwar karaya yana da wahala wani lokaci kuma ana kaucewa wuce gona da iri na hannun mai aiki zuwa radiation yayin aikin tiyata.

Ƙarƙashin gyaran farantin karfe

Ana tsammanin ƙaramin ɓarna osteosynthesis na clavicle zai samar da ƙarin ƙarfin biomechanical yayin guje wa rashin lahani na gyaran farantin buɗaɗɗen ko gyaran intramedullary.

Sanya intraoperative tsarin 3.5 LCP na gaba zuwa clavicle, zai fi dacewa a gaba a ƙasa da clavicle, yana ba da damar yin la'akari da clavicle mai lafiya, yana sauƙaƙa siffata farantin a gaba kuma don samun buɗewar dunƙule mai tsayi.

Farkon aikace-aikacen farantin ƙaramin osteosynthesis na iya haɗawa da raunin jijiya na supraclavicular, daidaitawa mara kyau ko rage nau'i-nau'i na wayoyi da ke shafar aiki, da lankwasa farantin ko karaya.

Gyaran farantin karfe na karaya na gefen ƙarshen clavicle

Zaɓin kayan da aka saka farantin ya dogara da girman shingen kashi na gefe. Ana buƙatar mafi ƙanƙancin skru 3 don toshe kashi na gefe. Da kyau, yakamata a yi amfani da sukurori don karaya. Idan katangar kashi ya yi ƙanƙanta don gyarawa, ana iya amfani da farantin ƙugiya.

Jiyya na acromioclavicular haɗin gwiwa dislocation

Raunin haɗin gwiwa na Acromioclavicular yana da kashi 12% na raunin scapular girdle kuma sau da yawa yana faruwa a cikin 'yan wasan da suka cika.

Mafi yawan tsarin da aka fi amfani da shi shine tsarin Rockwood. Nau'in I shi ne sprain na acromioclavicular ligament tare da rostroclavicular ligament m; nau'in II shine hawaye na ligament acromioclavicular tare da ligament rostroclavicular m; nau'in III shine tsagewar duka ligament acromioclavicular da ligament rostroclavicular; Nau'in IV shine ƙaura na baya na ƙwanƙwasa mai nisa yana rataye trapezius; nau'in V shine cikakken hawaye na duka haɗin gwiwa na acromioclavicular da haɗin gwiwar rostroclavicular, tare da fiye da kashi 100 na maye gurbin haɗin gwiwa; kuma nau'in raunin VI ba kasafai ba ne, tare da ɓangarorin nesa da aka kora ƙasa ƙasa da tsarin rostral.

Ana ba da shawarar jiyya mai ra'ayin mazan jiya tare da birki na ɗan gajeren lokaci tare da majajjawa cantilever don raunin nau'in I da nau'in II. Gudanar da raunin nau'in nau'in III yana da rikici, tare da wasu wallafe-wallafen da ke nuna cewa ana nuna magungunan ra'ayin mazan jiya ga matasa masu aiki. Farfadowa na aiki yana da kyau ko da yake ana iya samun nau'ikan nakasu daban-daban a bayyanar. Nau'in IV - VI raunin ya fi tsanani kuma ana ba da shawarar yin aikin tiyata.

A halin yanzu, hanyoyin fida da aka saba amfani da su sune: Bosworth rostral locking screw dabaran tare da gyara mataki daya ko babu gyaran jijiya; Gyaran farantin ƙugiya ta Tightrope ko ƙwanƙwasa suture ta hanyar arthroscope ko ƙarami; da suture na ligament na kullewa ko ƙarfafa dakatarwa, tare da kayan wucin gadi ko tendon tsakanin ficewar rostral da clavicle.

Ba a fayyace wace dabarar tiyata ce ta fi fa'ida ba, kuma ko da yake za a iya samun wasu nau'ikan asarar haɓakawa, ingantaccen ingancin duk waɗannan fasahohin yana da gamsarwa.

Jiyya na tsaka-tsakin ƙarshen clavicle fractures da sternoclavicular hadin gwiwa dislocations

Waɗannan raunukan ba su da yawa, kuma kuma akwai ƙarancin jagororin jiyya bisa tushen shaidar shaida.

Karaya na tsaka-tsakin tsaka-tsaki sau da yawa ƙananan karaya ne tare da ƙaura mara mahimmanci kuma ana iya kula da su ta hanyar kiyayewa. Epiphysis na tsakiyar ƙarshen clavicle yawanci yana rufewa a cikin shekaru 23-25 ​​kuma shine epiphysis na ƙarshe don rufewa a cikin jiki. Saboda haka, yawancin raunin da ya faru na tsaka-tsaki shine ainihin raunin farantin epiphyseal na nau'in Salter-Harris I ko II. Rayukan X-ray na al'ada suna da wahalar ganowa, tare da fa'idar cewa 40 ° kai karkatar da radiyo da kwatancen gefen lafiya na iya bayyana ƙaura daga tsakiyar ƙarshen clavicle, kuma CT yana ba da mafi kyawun hoto na bincike.

Karye ko tarwatsewar da aka yi gudun hijira a gaba ana iya rufe su kuma a mayar da su wuri, amma galibi ba su da kwanciyar hankali kuma suna lobotomized don sake ƙaura. Ana ba da shawarar kula da jin daɗi don ci gaba da tarwatsewa ko ƙaura saboda sau da yawa ba sa haifar da lahani na aiki. Ragewar tsakiyar ƙarshen clavicle na baya baya da wuya ya haifar da rauni na tsakiya na sama, gami da raunin jijiyoyin jini ko ma toshewar tracheal da matsawar iska. Don rarrabuwa da karyewa inda guntuwar tsakiya ya yi ƙanƙanta, ana iya haɗa faranti a kan haɗin gwiwa don daidaitawa zuwa sternum.

Sauran hanyoyin gyarawa

misali gyarawa na waje tare da stent, gyaran waje tare da farantin clavicle, da dai sauransu.

Gudanar da aikin bayan tiyata

Ya kamata a yi motsi na sama a cikin majajjawa kuma a fara horar da pendulum na kafada nan da nan. Makonni 2 bayan haka, ya kamata a bi majiyyaci don duba raunin da kuma duba radiyon X-ray, yayin da za a iya cire majajjawar gaba kuma za a iya fara horar da motsi na haɗin gwiwa ba tare da ƙuntatawa ba, amma ya kamata a gaya wa mara lafiya kada ya ɗaga nauyi tare da abin da ya shafa. Ana iya fara horar da ƙarfi a makonni 6 bayan tiyata lokacin da alamun waraka na ƙashi ya bayyana. Wasannin tuntuɓar wasanni ko matsananciyar wasanni yakamata a guji su na tsawon watanni 3 bayan tiyata har sai raunin ya warke gaba ɗaya.

Matsaloli.

Rikicin farko

Ciwon raunuka bayan tiyata na iya faruwa a cikin kashi 4.8% na lokuta;

Ƙunƙasa a cikin yankin subclavian shine mafi yawan rikice-rikice, tare da nazarin tarihin tarihi na har zuwa 83% na marasa lafiya tare da wannan alamar, wanda ke raguwa a tsawon lokaci kuma baya haifar da rashin aiki mai mahimmanci, ko da yake yana iya ci gaba har zuwa shekaru 2 bayan aiki;

Ƙaddamarwar Endophyte da tashin hankali na fata, na kowa tare da yin amfani da faranti masu girma ko ƙusa wutsiya ba tare da kyakkyawar murfin nama mai laushi ba;

sake karaya, wanda zai iya faruwa bayan duka biyu na tiyata da na mazan jiya; sake raunin da aka yi bayan tiyata zai iya haifar da lanƙwasa ko karyawar endoprosthesis, ko karaya a kusa da endoprosthesis;

rashin haɗin kai, tare da kashi 15% na rashin haɗin kai tare da magani mai ra'ayin mazan jiya da kuma kashi 2% na rashin haɗin kai tare da maganin tiyata don gaba ɗaya da aka yi hijira zuwa diaphyseal fractures; cikakken matsawa na karaya, ragewa fiye da 2 cm, shan taba, ƙara yawan shekaru, raunin da ya faru na makamashi mai karfi, sake karaya (rashin lafiya na injiniya), raguwa na diaphyseal recalcitrant, rashin ingancin kashi, da asarar kashi mai yawa.

Maƙarƙashiya rikitarwa

Osteoarthritis na haɗin gwiwa na acromioclavicular yana faruwa akai-akai tare da raunin intra-articular (nau'in Edinburgh 3B2); lokacin da alamun bayyanar cututtuka da masu ra'ayin mazan jiya ba su da tasiri, za'a iya sake gyara clavicle mai nisa ta hanyar arthroscopically ko ta hanyar tiyata ta budewa;

Warkar da nakasu, wanda ke faruwa zuwa nau'i daban-daban a cikin duk karayar da aka yi wa matsugunin da aka yi wa matsuguni; rage girman ƙugiya tare da jujjuyawar toshewar ɓarna na iya haifar da raguwar ƙarfin kafaɗa na ƙarshe da jimiri, musamman a cikin satar kafada; kunkuntar hanyar thoracic na iya haifar da bayyanar cututtuka na matsi na plexus na brachial; da rashin daidaituwa na bangon bango na scapulothoracic na iya haifar da karkatar da baya na scapula kuma ya haifar da ciwon kafada da myalgias, idan ya bayyana a fili cewa alamun bayyanar cututtuka sun fito ne daga nakasa Lokacin da warkaswa ya faru, gyaran osteotomy da gyaran farantin karfe yana yiwuwa dangane da bukatun mai haƙuri.

Hasashen da sakamako

Wani bincike mai alaka a Turai ya ba da rahoton cewa aikin tiyata na ɓarkewar tsakiyar clavicular da aka yi hijira yana da tasiri, kuma bincikensa na meta-bincike ya nuna cewa abin da ya faru na malunion da ke haifar da karaya ba tare da haɗin gwiwa ba da kuma bayyanar da alamun bayyanar cututtuka ya ragu sosai a cikin ƙungiyar tiyata fiye da a cikin ƙungiyar masu ra'ayin mazan jiya lokacin da aka kwatanta aikin tiyata tare da magani na mazan jiya; Bugu da ƙari, ƙungiyar tiyata ta rage jin zafi da wuri, kuma ingantawa a cikin ayyukan Constant da DASH sun fi bayyana.

Takaita

Yawancin karayar da ake samu ta hanyar tashin hankali kai tsaye ko kai tsaye, kuma ana iya rarraba maganin a matsayin magani na mazan jiya ko na tiyata. Dangane da jiyya, kodayake yawancin ɓarkewar ɓarna ba tare da ƙaura mai mahimmanci ba ana iya bi da su ta hanyar ra'ayin mazan jiya, zaɓin jiyya na tiyata don karaya tare da ƙaura mai mahimmanci yana da rikici. Don karyewar ɓarna da aka yi gudun hijira, jiyya na fiɗa yana da mafi girman adadin warkar da kashi da sakamakon aikin farko idan aka kwatanta da jiyya na mazan jiya.

Magana

[1] Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J kafada Elbow Surg 2002; 11:452.

[2] Eiff, MP, Hatch, et al. Clavicle da scapula karaya. A cikin: Sarrafa Karya don Kulawa na Farko, ed na biyu, WB Saunders, Philadelphia 2002. p.198.

[3] Robinson CM. Karaya na clavicle a cikin manya. Epidemiology da rarrabawa. J Bone Joint Surg Br 1998; 80:476.

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