Okuzuula n’okujjanjaba okumenya kw’omumwa gwa nnabaana

Okwanjula

Okumenya kw’ennyindo (clavicle fractures) kwa bulijjo era kutera kuva ku buvune obutereevu oba obutatereevu mu kitundu ky’ekibegabega. Okunoonyereza okwakolebwa ku ntandikwa y’emyaka gya 1960 kwalaga nti omuwendo gw’okumenya kw’ennywanto okutali kwa kugatta kwali wansi wa 1%, era obujjanjabi obw’okukuuma bwavaamu okumatizibwa kw’abalwadde okw’amaanyi; olw’okukulaakulanya eddagala gye buvuddeko, obujjanjabi obw’okulongoosa butuuse ku bulung’amu obw’amaanyi; n‟olwekyo, abasawo abakola mu kitongole ky‟abalwadde ab‟amangu oba mu ddwaaliro ly‟abalwadde abatali balwadde bonna balina okumanya ebitera okulabika n‟ebizibu ebiva mu buvune buno n‟enzirukanya yaabwo entongole.

Ebikwata ku ndwadde ezisaasaana

Okumenya kw’omumwa gwa nnabaana kukola ebitundu 2.6%-5% ku kumenya kwonna okw’abantu abakulu [1,2]. Okunoonyereza okwakolebwa mu Bulaaya okwalimu emisango 1,000 egy’okumenya ennyindo egy’omuddiring’anwa kwazuula [3,4] nti ebitundu ebisukka mu 66% eby’okumenya kw’ennyindo kwaliwo mu kitundu kya wakati ekya 1/3 eky’ennyindo, nga 25% byali bya kumenya kwa mabbali 1/3, ate 3% byali bya kumenya kwa makkati 1/3. Okumenya kw’omumwa gwa nnabaana kwalaga okusaasaana okw’engeri bbiri, okusinga okubeerawo mu basajja abali wansi w’emyaka 30, ne baddirira abo abasukka mu myaka 70.

Ensengeka y’omubiri mu bujjanjabi

Ekisooka mu magumba g’omuntu okutandika okukola amagumba ye clavicle, enkolagana yokka ey’amagumba wakati w’omukono ogwa waggulu n’omugongo, ekwatagana ewala ne acromion, acromioclavicular (AC) joint, ne proximally ne sternum, sternoclavicular (SC) joint. Ennyondo zino ziyitibwa atypical synovial joints kubanga ziriko layini ya fibrocartilage okusinga hyaline cartilage. Ensigo zinywezebwa ku scapula n’emisuwa gya acromioclavicular ne rostroclavicular era nga yeegattibwa ku sternum n’omusuwa gw’omugongo.

Ensigo (clavicle) eri mu ngeri ya 'S'. Ekitundu eky’okumpi (proximal half-arc) kifuluma mu maaso, ne kireka ekifo ky’ekibinja ky’emisuwa gy’obusimu eky’enkomerero eya waggulu. Ekitundu eky’ewala ekya arc kifuluma emabega (concave) n’oluvannyuma ne kyegatta ku scapula (rostral process ne acromion). Okumenya kw’ennyindo kutera kubaawo ku nkulungo y’ekisambi ebbiri (mid-arc), okusinga kiva ku butabeera na misuwa egyekwata ku magumba agaliraanye mu kitundu kino era olw’okuba kye kitundu ekisinga obunafu mu kifuba. Okumenya kw’omugongo bwe kusengulwa, ekitundu eky’okumpi kumpi bulijjo kisikibwa waggulu (cephalad) ekinywa kya sternocleidomastoid (ekikwatagana ku nkomerero y’omugongo ey’okumpi) ate ekitundu eky’ewala ne kisengulwa wansi (caudad) olw’obuzito bw’omukono ogwa waggulu, era ekitundu eky’okumpi kitera 'okumpi' (kwe kugamba, enkomerero z’okumenya zisalagana), . okusinga kiva ku kukonziba kw’ekitundu ekiyitibwa subscapularis ne pectoralis major (ekikyusa munda omukono ogwa waggulu). Kino kisinga kuva ku kukonziba kw’ebinywa ebinene ebya subscapularis ne pectoralis major (ebikyusa munda omukono ogwa waggulu ne gugusika nga gugenda mu kifuba).

Ebintu eby'enjawulo

Ekigendererwa ky’obujjanjabi bw’okumenya ennyindo kwe kukendeeza ku bulumi n’okuzzaawo enkola y’ennyondo. Okumenya kw’ennyindo okusinga kukyajjanjabwa okusinga mu ngeri ey’okukuuma (ebiseera ebisinga kufunzibwa mm ezitasussa mm 15); obujjanjabi obukuuma obutonde nga bbandi eziriko ekifaananyi ky’omunaana, sling z’omukono ogw’omu maaso, bbandi za Sayre, essuuti za Velpeau ezitatambula, n’okuziyiza okutambula. Okuyimirizaawo okutambula kukolebwa mu mutendera ogw’amangu, era okutendekebwa mu kutambula nga bukyali n’okukola dduyiro w’amaanyi bitera okukolebwa nga wayise wiiki 2-6 oluvannyuma lw’okumenya ng’obulumi buweddewo. Okukozesa figure of 8 bandages tekiba kirungi kuba kiyinza okuvaako amabwa aga puleesa y’omugongo n’okusingawo obutakwatagana kw’okumenya [5,6].

Ebyafaayo n’okukebera omubiri

Okumenya ekibegabega kiva ku kukubwa butereevu ku kibegabega oluvannyuma lw’okugwa era kitera okulabibwa mu mizannyo egy’ebweru mu bavubuka ne mu kugwa mu butamanya mu bakadde. Kikulu okunnyonnyola enkola y’obuvune. Obuvune obw’amaanyi amangi buyinza okwegatta n’obuvune ku mutwe n’ekifuba, so ng’ate okumenya okuva mu buvune obutonotono kuyinza okuba okw’obulwadde. Obuvune obuwugulaza bwetaaga okutandika amangu n’okuggyako n’obwegendereza okwawula ekisenge ky’ekifuba eky’omugongo, obuvune bw’obusimu n’emisuwa. Mu bujjanjabi, wabaawo okuzimba n’okuzimba (ecchymosis) mu kifo we yamenyese, nga bigattiddwa wamu n’okulema n’okunyirira. Okufaayo kulina okussibwa ku bitundu ebigonvu okusobola okujack up, ekiyinza okuvaako olususu necrosis n’amabwa.

Okukuba ebifaananyi

Okumenya okusinga kuyinza okuzuulibwa nga bakozesa ebifaananyi ebyangu eby’omu maaso n’emabega. 20° head tilt radiographs zimalawo ekikolwa ky’ebituli by’ekifuba ebikwatagana. Abalwadde balina okukwatibwa ku leediyo mu mbeera ey’okweyimirizaawo okusobola okulaba obulungi okusengulwa kw’okumenya. Okusitula obuzito ku bifaananyi eby’oku leediyo kiyamba mu kwekenneenya obulungi bw’omusuwa gw’omugongo ogw’ewala mu buvune bw’ennyondo ey’ewala oba ey’omugongo.CT eyamba okulaba obuvune obw’amaanyi obw’omusipi gw’omugongo era etuwa okulaba obulungi obuvune obuyinza okubaawo mu kiwanga eky’okumpi ku kiwanga ky’omugongo. Okukwata ekifaananyi ky’ekifuba kiyamba okugaana obuvune bw’ekifuba obukwatagana nabyo, era okufunza kuyinza okukeberebwa nga kugeraageranya n’ennyindo ey’oku ludda olulala, awamu n’okugaana okwawukana kw’ekisenge ky’omu kifuba ekiyitibwa scapulothoracic.

Ebika

AO/OTA Fracture Dislocation Typing: Koodi y’okumenya kw’omugongo 15 erimu ebifo bisatu: 15.1 proximal (medial), 15.2 diaphysis, ne 15.3 distal (lateral). Okumenya okw’okumpi (okw’omu makkati) n’okw’ewala (okw’ebbali) kugabanyizibwamu ekika kya A (eky’ebweru w’ennyindo), ekika kya B (ekitundu ekimu eky’omu kifuba), n’ekika kya C (eky’omu kifuba ekijjuvu). Okumenya kw’omugongo kugabanyizibwamu ekika kya A (ekyangu), ekika kya B (wedge), n’ekika kya C (comminuted).Okugabanya kwa AO/OTA okw’okumenya n’okusengulwa tekulowooza ku ddaala ly’okusengulwa kw’okumenya, era mu kiseera kino kwa mugaso mutono mu kujjanjaba okumenya kw’omugongo ne mu kusalawo okuteebereza.

Okuwandiika kwa Allman kwesigamiziddwa ku kifo ekimenyese we kiri (I: wakati, cadent 1/3, II: lateral 1/3, III: wakati 1/3) (Fig. 7.2.1).

Craig yaddamu okulongoosa ensengeka eno ng’asinziira ku Allman, nga nze ndi kitundu kya wakati ekya 1/3 eky’omugongo; ekika kya II nga kitundu kya 1/3 eky’ebweru eky’ekisambi, oluvannyuma ekyagabanyizibwamu ebika 5 okusinziira ku kusengulwa kw’okumenya n’enkolagana n’omusuwa gw’ennyindo ogw’omugongo (rostral clavicular ligament); n’ekika kya III nga kumenya kwa kitundu kya 1/3 eky’omunda eky’ekisambi, ekyagabanyizibwamu ebika 5 okusinziira ku ddaala ly’okusengulwa kw’okumenya n’okumanya oba okumenya kwali kwa mu bitundu by’omubiri oba nedda.

Neer’s typing of lateral 1/3 fractures eggumiza obukulu bw’omusuwa gw’omugongo (rostral-clavicular ligament): ekika kya I kibeera wala nnyo n’omusuwa gw’omugongo, nga ekitundu ky’okumenya eky’omu makkati kisenguddwa waggulu; ekika kya II kizingiramu omusuwa gwa rostral-clavicular ligament era kivaamu ekitundu ky’okumenya wakati okusengulwa waggulu; era ekika kya III kituuka ku kiyungo kya acromioclavicular nga rostral-clavicular ligament esigala nga bweri.

Edinburgh typing nkola ya kugabanya kumenyamenya kwa diaphysis okusinziira ku ddaala ly’okusengulwa n’okusaanuuka.1 Okumenya okw’ekika kya 1 kuzingiramu enkomerero y’omu makkati, ekika eky’okubiri kumenyamenya kwa diaphysis ate ekika eky’okusatu kumenya ku nkomerero y’ebbali. Emenyese z’ekisenge ky’omubiri (diaphysis) zigabanyizibwa okusinziira ku kubeerawo oba obutabaawo kwa kukwatagana kwa cortical wakati w’ebitundutundu by’okumenya mu bika A ne B. Okumenya okw’ekika kya 2A kwongera okugabanyizibwamu nga okutasengulwa (ekika 2A1) n’okulina enkoona (ekika 2A2),2B okumenyaamenya (2B-shaped) (ekika 2B1) n’okusala (ekika 2B2).3 Ekika 1 okumenya kuzingiramu enkomerero ya wakati eya diaphysis ate ekika eky’okusatu ye nkomerero y’ebbali eya diaphysis. Okumenya enkomerero z’omu makkati n’ez’ebbali zaawulwamu ebibinja 1 ne 2 okusinziira ku oba ekiyungo ekiriraanye kye kikwatibwako.

Mu ngeri y’emu waliwo okuwandiika kwa Rockwood, okuwandiika kwa Jager, n’okuwandiika kwa Breitner.

Ebiraga nti omuntu alongooseddwa

Okumenya ebitongole ebitongole

1, okumenya okuggule; 

2, okusengulwa >2 cm; 

3, okufunza >2 cm; 

4, okusaanyawo ebitundutundu by’okumenya (>3); 

5, okumenya ebitundu ebingi; 

6, wansi okumenya okuggule n’obuvune mu bitundu ebigonvu; 

7, obulema obw’amaanyi (okusengulwa n’okufunza); 

8, obuvune mu scalphoid.

Obuvune obw’amaanyi

1, Okugatta ipsilateral obuvune ku nkomerero ya waggulu;

2, Obuvune ku kibegabega nga kitengejja;

3, obuvune obw’enjawulo;

4, okumenya nga kugatta wamu n’obuvune bw’emisuwa gy’obusimu;

5, ipsilateral multiple rib fractures nga zigatta wamu n’okulema kw’ekisenge ky’ekifuba;

6, okukendeera kw’ekibegabega (clavicle shortening) okukola ekibegabega ekirimu ebiwaawaatiro;

7, Okumenya kw’ennyindo ku njuyi zombi.

Ensonga z’Omulwadde

1, Abalwadde abalina obuvune obuwera beetaaga okusitula obuzito bw’enkomerero eya waggulu nga bukyali;

2, Abalwadde abeetaaga okudda amangu mu mirimu (okugeza, emizannyo egy’ekika ekya waggulu n’egy’okuvuganya).

Ebiseera by’okulongoosebwa

Okulongoosa kulina okukolebwa awatali kulwa nga waliwo ebiraga ebituufu eby’okulongoosebwa.

Okulwawo mu kulongoosa okusukka wiiki 2-3 mu biraga ebikwatagana kiyinza okwongera ku buzibu bw’okukendeeza ku kumenya, naddala nga weetegekera okunyweza munda mu kukendeeza okuggaddwa nga bakozesa obukodyo obw’okuyita mu lususu.

Okulongoosa okutuuka ku bantu

Omulwadde ateekebwa mu mbeera y’entebe ya bbiici oba mu mbeera y’okutuula ekitundu. Ekibegabega ekikosebwa kiteekebwako padd wansi okusitula clavicle okusobola okwanguyirwa okulongoosa, ate omukono ne guteekebwako akatambaala okusobozesa okutambula mu kulongoosa. Okusala okuwanvuwa okuyita ku kisenge ekiwanvu eky’omugongo oba okusala kwa saber okukwatagana n’enkola ya langer kuyinza okulondebwa.

Weetegereze: Okusala okuwanvuwa kuwa okugaziwa okusingawo, ate okusala okuwanvu kukendeeza ku bulabe bw’okulumwa obusimu obuyitibwa supraclavicular nerve era nga kinyuma nnyo mu by’obulungi.

Okunyweza munda

3.5 Ebipande ebinyigiriza ebitegekeddwa, ebipande ebiddamu okuzimba, oba LCP ez’obuveera bisobola okukozesebwa okutereeza okukutuka kw’ennyindo. Ebipande biteekebwa bulungi waggulu oba mu maaso g’enkwaso. Ebipande biba bya maanyi mu buvune bw’ebiramu (biomechanical injuries) nga biteekeddwa waggulu naddala nga waliwo okumenya okusaliddwa wansi, era nga nnyangu okulaba mu birowoozo. Okunyweza sikulaapu mu bicortical kyetaagisa, era ebituli birina okusimibwa n’obwegendereza bungi, kubanga waliwo akabi k’okulumwa obusimu n’emisuwa wansi. Ebirungi: okusima okutali kwa bulabe okwa anterior plate screw channel, plate apposition, contouring ennyangu.

Weetegereze: Okusimba amagumba ebiseera ebisinga tekikwetaagisa ku nkola esooka; oluvannyuma lw’okunyweza munda, kikulu nnyo okutunga obulungi oluwuzi lw’omubiri (myofascial layer) okubikka ku pulati n’okuziyiza okukwatibwa obuwuka.

Okunyweza mu nnyindo (intramedullary fixation).

Ebyuma ebinyweza ennyindo mu kiseera kino mulimu ppini za Kirschner, ppini za Rockwood, ppini za Hagie, ppini za titanium elastic intramedullary pins, sikulaapu eziriko ebituli, n’emisumaali egy’okusiba elastic; okugeza, emisumaali egya titanium elastic tegikkiriza kusiba mu ngeri ya static, tegikkiriza kufuga buwanvu na kuzimbulukuka, era giyinza okuvaamu okufunza okw’okubiri nga gikozesebwa ku kumenyamenya okusaliddwa. Enkola y’okukuba emisumaali mu nnyindo (intramedullary nailing technique) esobola okukozesebwa ku kumenya kw’ennyindo okwangu, okuwanvu oba okuserengese.

Ebirungi ebirimu

okusala okutono, okulabika obulungi, okuggyibwako ebitundu ebigonvu okutono, akabi akatono ak’okufuluma kw’endophyte, n’okutebenkera okukwatagana n’okutondebwa kw’ebisusunku.

Ebizibu ebivaamu

okunyiiga kw’olususu oba obulema mu kifo we bayingira.

Note:Okukendeeza ku kumenya kw’ennyindo mu ngeri ey’okuggalawo oluusi kizibu era okusukkirizibwa kw’omukono gw’omukozi ku masanyalaze kwewalibwa mu kiseera ky’okulongoosa.

Okunyweza ebbaati nga tekuyingirira nnyo

Minimally invasive plate osteosynthesis of the clavicle kirowoozebwa nti ekuwa amaanyi amangi ag’ebiramu ate nga yeewala ebizibu by’okunyweza plate enzigule oba okunyweza mu misuwa.

Okuteekebwa mu kulongoosa enkola ya 3.5 LCP mu maaso g’ennyindo, okusinga mu maaso wansi w’ennyindo, kisobozesa okujuliza ennyindo ennungi, ekyanguyira okubumba ebbaati nga bukyali n’okufuna omukutu gwa sikulaapu omuwanvu.

Okukozesa amangu enkola y’okusengejja amagumba g’epulati etali ya maanyi nnyo kuyinza okukwatagana n’obuvune bw’obusimu obuyitibwa supraclavicular nerve, okukwatagana obubi oba okufunza waya bbiri ezikosa enkola, n’okubeebalama oba okumenya epulati.

Okunyweza epulati (plate fixation) kw’okumenya kw’enkomerero y’omugongo ey’ebbali

Okulonda ebiteekebwa mu pulati kisinziira ku bunene bwa bbulooka y’amagumba ag’ebbali. Ebikulu bya bicortical ebitakka wansi wa 3 byetaagibwa ku bbulooka y’amagumba ag’ebbali. Ekisinga obulungi, sikulaapu ezisika (tension screws) zirina okukozesebwa ku kumenya okuserengese. Singa bbulooka y’amagumba eba ntono nnyo okusobola okuginyweza, oyinza okukozesebwa ekipande ekiyitibwa clavicle hook plate.

Obujjanjabi bw’okusannyalala kw’ekiwanga kya acromioclavicular

Obuvune bw’ennyondo za acromioclavicular bukola ebitundu 12% ku buvune bw’omusipi gw’omugongo era butera okubaawo mu bannabyamizannyo abajjudde okukwatagana.

Enkola y’okuteeka siteegi esinga okukozesebwa ye Rockwood staging. Ekika I kwe kunyiga kw’omusuwa gwa acromioclavicular nga omusuwa gwa rostroclavicular tegufudde; ekika kya II kwe kukutuka kw’omusuwa gwa acromioclavicular nga omusuwa gwa rostroclavicular tegufudde; ekika kya III kwe kukutuka kw’omusuwa gwombi ogwa acromioclavicular ligament ne rostroclavicular ligament; ekika kya IV kwe kusengulwa okw’emabega okw’ekisambi eky’ewala nga kikomerera ekitundu ky’omubiri ekiyitibwa trapezius; ekika kya V kwekutula okujjuvu kw’ekiwanga kyombi ekya acromioclavicular joint ne rostroclavicular ligament, nga ekiwanga kisengulwa ebitundu ebisukka mu 100 ku buli 100; n’obuvune obw’ekika kya VI tebutera nnyo, nga ekitundu eky’ewala eky’omugongo (distal clavicle) kisenguddwa wansi wansi w’enkola ya rostral.

Obujjanjabi obw’okukuuma ng’okozesa buleeki ey’ekiseera ekitono ng’okozesa ‘cantilever sling’ kirungi ku buvune obw’ekika kya I n’eky’ekika kya II. Enzirukanya y‟obuvune obw‟ekika kya III eriko okusika omuguwa, ng‟ebiwandiiko ebimu biraga nti obujjanjabi obw‟obukuumi bulagibwa eri abavubuka abakulu abakola. Okudda engulu mu nkola kirungi wadde nga wayinza okubaawo diguli ez’enjawulo ez’obulema mu ndabika. Obuvune obw’ekika kya IV - VI buba bwa maanyi nnyo era kirungi okulongoosebwa.

Mu kiseera kino, enkola z’okulongoosa ezisinga okukozesebwa ze zino: Enkola ya Bosworth rostral locking screw nga eddaabiriza omutendera gumu oba nga tewali kuddaabiriza ligament;, clavicle hook plate fixation, okufaananako n’enkomerero y’ebbali ey’okumenya kw’omusuwa; Tightrope’s tab plate fixation oba anchor pinning suture okuyita mu arthroscope oba akasala akatono; ne rostral locking ligament suture oba reinforced suspension, nga waliwo ekintu ekikoleddwa oba tendon wakati wa rostral eminence ne clavicle.

Tekinnamanyika nkola ki ey’okulongoosa esinga okuba ey’omugaso, era wadde nga wayinza okubaawo ekigero ekimu eky’okufiirwa okuddamu okukola, obulungi obw’enkomerero obw’obukodyo buno bwonna bumatiza.

Obujjanjabi bw’okumenya kw’ennyindo (medial end clavicle fractures) n’okukutuka kw’ennyondo z’omugongo (sternoclavicular joint dislocations).

Obuvune buno tebutera kubaawo, era nate waliwo obutaba na ndagiriro z’obujjanjabi ezesigamiziddwa ku ddagala eryesigamiziddwa ku bujulizi.

Medial clavicle fractures zitera okuba extra-articular fractures nga tezirina kusengulwa era zisobola okujjanjabibwa mu ngeri ey’okukuuma. Epiphysis y’enkomerero y’omumwa gwa nnabaana ey’omu makkati etera okuggalawo ku myaka 23-25 ​​era ye epiphysis esembayo okuggalawo mu mubiri. N’olwekyo, obuvune bungi obw’omu makkati mu butuufu buba bumenyamenya bwa epiphyseal plate obwa Salter-Harris ekika kya I oba II. X-ray eza bulijjo nzibu okuzuula, n’enkizo nti 40° head tilt radiograph n’okugeraageranya ku ludda olulamu kiyinza okulaga okusengulwa kw’enkomerero y’omu makkati ey’enkwaso, era CT egaba ebifaananyi ebisinga obulungi okuzuula.

Okumenya oba okusengulwa okusengulwa mu maaso ebiseera ebisinga kuyinza okuggalwa ne kuddamu okuteekebwa mu kifo, naye emirundi mingi tebinywevu era nga bifuuse lobotomized okusobola okuddamu okusengulwa. Obulabirizi obukkakkanya obulumi busemba ku kusengulwa oba okusengulwa okutambula obutasalako kubanga emirundi mingi tebivaamu kulemererwa kukola. Okusengulwa kw’enkomerero y’omugongo ogw’omu makkati emabega tekitera kuvaamu buvune mu kitundu eky’omu makkati ekya waggulu, omuli okulumwa emisuwa oba n’okuzibikira kw’omukka n’okunyigirizibwa kw’emikutu gy’empewo. Ku kuseeseetula n’okumenya awali akatundu ak’omu makkati akatono ennyo, obupande busobola okusibwako omutala okubuna ekiwanga okusobola okunyweza ku mugongo.

Enkola endala ez’okunyweza

okugeza okunyweza ebweru ne stent, okunyweza ebweru ne clavicle plate, n’ebirala.

Enzirukanya y’emirimu oluvannyuma lw’okulongoosebwa

Omukono ogwa waggulu gulina okutambulira mu sling era okutendekebwa mu pendulum y’ebibegabega kulina okutandika amangu ddala. Nga wayise wiiki 2, omulwadde alina okugobererwa okukebera ekiwundu n’okuddamu okwetegereza X-rays, ate nga n’omuggo gw’omukono ogw’omu maaso gusobola okuggyibwamu n’okutandika okutendekebwa mu kutambula kw’ennyondo awatali kuziyizibwa, naye omulwadde alina okutegeezebwa obutasitula buzito n’ekitundu ky’omubiri ekikoseddwa. Okutendekebwa mu maanyi kuyinza okutandika ku wiiki 6 oluvannyuma lw’okulongoosebwa ng’obubonero bw’okuwona kw’amagumba bulabika. Emizannyo gy’okukwatagana oba egy’amaanyi girina okwewalibwa okumala emyezi 3 oluvannyuma lw’okulongoosebwa okutuusa ng’okumenya kuwonye ddala.

Ebizibu ebivaamu.

Ebizibu ebisooka

Yinfekisoni z’ebiwundu oluvannyuma lw’okulongoosebwa zisobola okubaawo mu bitundu 4.8%;

Okuziyira mu kitundu kya subclavian kye kizibu ekisinga okutawaanya, nga okunoonyereza ku byafaayo by’obutonde ku balwadde abawera 83% abalina akabonero kano, nga kino kikendeera okumala ekiseera era tekivaako buzibu bwa maanyi, wadde nga kiyinza okuwangaala okutuuka ku myaka 2 oluvannyuma lw’okulongoosebwa;

Endophyte protrusion n’okutabuka kw’olususu, ekitera okubaawo nga bakozesa voluminous plates oba nail tails nga tezirina kubikka bulungi bitundu bigonvu;

okuddamu okumenya, ekiyinza okubaawo oluvannyuma lw’okulongoosebwa n’obujjanjabi obw’okukuuma; okuddamu okulumwa oluvannyuma lw’okulongoosebwa kuyinza okuvaamu okufukamira oba okumenya endoprosthesis, oba okumenya okwetoloola endoprosthesis;

nonunion, nga 15% nonunion rate n’obujjanjabi conservative ate 2% nonunion rate n’okulongoosa obujjanjabi ku diaphyseal fractures ezisenguddwa ddala; okusengulwa okujjuvu kw’okumenya, okukendeera okusukka sentimita 2, okunywa sigala, okweyongera kw’emyaka, obuvune obw’amaanyi amangi, okuddamu okumenya (obutabeera mu ntebenkevu mu byuma), okusenguka kw’omusuwa mu ngeri etali ya bwesimbu, omutindo gw’amagumba ogubi, n’okufiirwa amagumba okuyitiridde.

Ebizibu ebibaawo ekikeerezi

Obulwadde bw’amagumba mu kiwanga kya acromioclavicular butera kubaawo n’okumenya kw’amagumba mu bitundu by’omubiri (Edinburgh type 3B2); obujjanjabi obulaga obubonero n’okukuuma bwe butakola, ekitundu eky’ewala ekiyitibwa distal clavicle kiyinza okusalibwako mu ngeri y’okukebera ebinywa oba okulongoosebwa mu lujjudde;

Okuwona obulema, okubaawo ku diguli ez’enjawulo mu kumenya kwonna okusenguddwa okujjanjabiddwa mu ngeri ey’okukuuma; okufunza omusipi gw’omugongo nga kuwerekerwako okukyusakyusa ekitundu ky’okumenya eky’ewala kiyinza okuvaamu okukendeeza ku maanyi g’ebibegabega ag’enkomerero n’okugumiikiriza naddala mu kuwamba ebibegabega; okufunda kw’omukutu ogufuluma mu kifuba kuyinza okuvaamu obubonero bw’okunyigirizibwa kw’omugongo; n’obutakwatagana bulungi bw’ennyondo z’ekisenge ky’omugongo (scapulothoracic wall joints) kiyinza okuleeta okulengejja mu maaso kw’ekibegabega n’okuleeta obulumi mu bibegabega n’okulumwa emisuwa, singa kiba kyeyoleka bulungi nti obubonero buva mu kulema Bwe wabaawo okuwona, okutereeza amagumba n’okunyweza ebbaati kisoboka okusinziira ku byetaago by’omulwadde.

Okuteebereza n’ebivaamu

Okunoonyereza okukwatagana nabyo mu Bulaaya kwalaga nti obujjanjabi obw’okulongoosa obw’okumenya kw’omumwa gwa midclavicular okusengulwa kwali kwa maanyi, era meta-analysis yaayo yalaga nti emirundi gy’obutakwatagana obuvaako okumenya obutakwatagana n’obuzibu obuleeta obubonero bwali wansi nnyo mu kibinja ekyalongoosebwa okusinga mu kibinja ekyajjanjabwa mu ngeri ey’okukuuma ng’okulongoosa kugeraageranyizibwa n’obujjanjabi obw’okukuuma; okugatta ku ekyo, ekibinja ky’abalongoosa kyali kikendeezezza ku bulumi nga bukyali, era okulongoosa mu bubonero bw’emirimu gya Constant ne DASH kwali kweyolekera nnyo.

Mu bufunze

Okumenya kw’ennyindo okusinga kuva ku butabanguko obutereevu oba obutatereevu, era obujjanjabi buno buyinza okugabanyizibwamu obujjanjabi obw’okukuuma oba obw’okulongoosa. Mu nsonga z’obujjanjabi, wadde ng’okumenya kw’ennywanto okusinga obungi okutaliimu kusengulwa kwa maanyi kuyinza okujjanjabibwa mu ngeri ey’okukuuma, enkola y’okulongoosa ey’obujjanjabi ku kumenya okulina okusengulwa okunene eriko okusika omuguwa. Ku kumenya amagumba agasenguddwa, obujjanjabi obw’okulongoosa bulina omuwendo omunene ogw’okuwona amagumba n’ebiva mu kukola amangu bw’ogeraageranya n’obujjanjabi obw’okukuuma.

Ebiwandiiko ebikozesebwa

[1] Postacchini F, Gumina S, De Santis P, Albo F. Endwadde z’obulwadde bw’okumenya kw’ennywanto. J Okulongoosa enkokola z’oku kibegabega 2002; 11:452.

[2] Eiff, MP, Hatch, n’abalala. Okumenya ennyindo n’ennyindo (clavicle). Mu: Enzirukanya y’okumenya mu bujjanjabi obusookerwako, 2nd ed, W. B. Saunders, Philadelphia 2002. p.198.

[3] Robinson C. M., era nga bano. Okumenya kw’omugongo mu muntu omukulu. Epidemiology n’okugabanya. J Okulongoosa ebinywa by’amagumba Br 1998; 80:476.

[4] Neer CS ow’okubiri. Okumenya ekitundu eky’okusatu eky’ewala eky’omugongo. Clin Orthop Relat Res 1968, Omuwandiisi w’ebitabo. 58:43.

[5] Andersen K, Jensen PO, Lauritzen J. Obujjanjabi bw’okumenya kw’ennyindo. Figure-of-eight bandage okusinziira ku sling ennyangu. Omusomo gwa Acta Orthop 1987; 58:71.

[6] Ersen A, Atalar A. C., Birisik F, n’abalala. Okugerageranya sling y’omukono ennyangu n’ekifaananyi kya bbandi ya clavicular munaana ku midshaft clavicular fractures: okunoonyereza okufugibwa mu ngeri ey’ekifuulannenge. Ekiwanga ky’amagumba J 2015; 97-B:1562.