Clavicle Fractures hmuhchhuah leh enkawl dan

Inhmelhriattirna

Clavicle fracture hi a tam hle a, a tlangpuiin shoulder region-a direct emaw indirect emaw trauma avanga lo awm a ni. Kum 1960 chho tir lama zirchianna hrang hrangah chuan nonunion rate of clavicle fractures chu 1% aia tlem a ni tih an sawi a, conservative treatment hian damlote satisfaction sang tak a thlen a tun hnaia damdawi lam hmasawnna avang hian surgery hmanga enkawlna hian hlawhtlinna nasa tak a nei a; chuvangin, emergency department emaw general outpatient clinic-a thawk clinician-te chuan he hliam lan chhuahna leh harsatna awm fo leh a enkawl dan bulpui te hi an hriat chian a ngai a ni.

Epidemiology chungchang a ni

Puitling fracture zawng zawng zingah hian clavicle fracture hi 2.6%-5% a ni [1,2]. European zirchianna pakhatah chuan a zawnin clavicle fracture case 1,000 an tel a, [3,4] chuan clavicle fracture 66% aia tam chu clavicle 1/3 laiah a thleng a, 25% vel chu lateral 1/3 fracture a ni a, 3% chu medial 1/3 fracture a ni tih hmuhchhuah a ni. Clavicle fracture vei tamnaah hian bimodal distribution a awm a, mipa kum 30 hnuai lam zingah a thleng ber a, kum 70 chunglam zingah a dawttu a ni.

Clinical Anatomy hmanga thil tih a ni

Mihring ruhro zinga ossification tan hmasa ber chu clavicle a ni a, chu chu upper arm leh trunk inkar ruh inzawmna awmchhun a ni a, chu chu acromion, acromioclavicular (AC) joint nen distally-in a articulate a, sternum, sternoclavicular (SC) joint nen proximally-in a articulate bawk. Heng joint te hi hyaline cartilage aiin fibrocartilage hmanga lined a nih avangin atypical synovial joints an ti a ni. Clavicle hi acromioclavicular leh rostroclavicular ligament hmangin scapula-ah anchor a ni a, sternoclavicular ligament hmangin sternum-ah a inzawm bawk.

Clavicle hi 'S' ang deuh a ni. Proximal half-arc chu hmalam hawiin a project a, upper extremity-a neurovascular bundle tan hmun a awm ta a ni. Arc distal half chu hnunglam (concave) lamah a project a, chutah chuan scapula (rostral process leh acromion) nen a inzawm leh a ni. Clavicle fracture hi arc pahnih inzawmna hmunah (mid-arc) a thleng tlangpui a, hei hi he biala ruh kianga awm ligament inzawm loh vang leh clavicle chak lo ber a nih vang a nih a rinawm ber. Clavicle fracture a displace chuan proximal segment chu sternocleidomastoid muscle (clavicle proximal end-a inzawm) chuan chunglam (cephalad) lamah a hruai chhuak fo thin a, distal segment chu upper arm rit zawngin a hnuai lam (caudad) a inthlak a, clavicle chu 'shorten' (chu chu fracture tawp te chu a inzawm khawm tihna a ni), a chhan ber chu subscapularis leh pectoralis major (a chhungah chuan kut chunglam a inher kual) te inzawmkhawm vang a ni. Hei hi a chhan ber chu subscapularis leh pectoralis major muscles (a chhungah chuan kut chunglam chu a rotate a, a rilru lam hawiin a hruai) te a inzawm khawm vang a ni.

Nihphung

Clavicle fracture enkawlna tum ber chu natna tihziaawmna leh ruhkawr hnathawh that leh a ni. Clavicle fracture tam zawk hi chu a bik takin conservative-in an la enkawl reng a (a tlangpuiin 15 mm aia rei lova tih tawi a ni); conservative treatment te chu figure-of-eight bandage, forearm slings, Sayre bandage, Velpeau immobilization suit, leh immobilization te a ni. Suspension immobilization hi acute phase-ah tih a ni a, early range of motion training leh strength exercise te hi a natna a reh chuan fracture atanga kar 2-6 hnuah tih thin a ni. Figure 8 bandage hman hi a tha lo a, axillary pressure sores leh fracture non-union tam zawk a thlen theih avangin [5,6].

History leh Taksa enfiahna

Clavicle fracture hi tlu hnua a kekawrte direct-a a tlak vang a ni a, pawn lam infiamnaah naupangte leh tarte chu tum loh taka tluknaah hmuh tur a awm tlangpui. Hliam awm dan tur sawifiah a pawimawh. High-energy injuries chu lu leh rilru hliam nen a inzawm thei a, chutih laiin fracture tenau tenau avanga natna chu pathologic a ni thei thung. Distraction injuries hi a hmaa tan a ngai a, scapular chest wall separation, neurologic leh vascular injuries te hi uluk taka paih chhuah a ngai bawk. Clinically chuan fracture hmunah hian swelling leh ecchymosis a awm a, chu chu deformity leh tenderness nen a inzawm a ni. Jacking up atan soft tissue te ngaihven tur a ni a, hei hian vun necrosis leh ulceration a thlen thei a ni.

Imaging hmanga thil tih a ni

Fracture tam zawk hi anteroposterior radiograph awlsam tak hmanga hriat theih a ni. 20° head tilt radiographs hian thoracic cavities inzawmkhawm (overlapping thoracic cavities) te nghawng a ti bo thin. Damlote chu self-supporting position-ah radiographed an ni tur a ni a, chu chuan fracture displacement chu a hmu thei zawk ang. Radiographs atana weight-bearing hi distal clavicle emaw acromioclavicular joint injury-a rostral clavicular ligament integrity tehna atan a angkai hle.CT hian complex scapular girdle injuries te chu a hmuh theih nan a pui a, sternoclavicular joint-a proximal clavicle injury awm thei te pawh a hmu thei zawk bawk. Chest radiograph lak hian a kaihhnawih thoracic injury a awm loh nan a pui a, shortening chu contralateral clavicle nen khaikhin a, scapulothoracic wall separation pawh a awm loh nan a teh theih bawk.

Type hrang hrang

AO/OTA Fracture Dislocation Typing: Clavicle fracture code 15 hi hmun pathum a awm a, chungte chu 15.1 proximal (medial), 15.2 diaphysis, leh 15.3 distal (lateral) te an ni. Proximal (medial) leh distal (lateral) fracture te hi type A (extra-articular), type B (partially intra-articular), leh type C (completely intra-articular) tiin an thliar hrang a ni. Trunk fracture hi type A (simple), type B (wedge), leh type C (comminuted) tiin an thliar hrang a ni.AO/OTA classification of fracture and dislocations hian fracture a displacement degree a ngaihtuah lo va, tunah hian clavicle fracture enkawlnaah leh prognosis tehnaah hmanna a tlem hle.

Allman typing hi a ruh tliak awmna hmun (I: medial, cadent 1/3, II: lateral 1/3, III: medial 1/3) atanga siam a ni (Fig. 7.2.1).

Craig chuan Allman-a hmangin he classification hi a tithianghlim leh a, kei hi clavicle laihawl 1/3 ka ni a; type II chu clavicle pawn lam 1/3 a ni a, chu chu fracture displacement leh rostral clavicular ligament nena inzawmna a zirin chi 5-ah then a ni a leh type III chu clavicle chhung lam 1/3 fracture a ni a, chu chu fracture displacement degree leh fracture chu intra-articular a nih leh nih loh a zirin chi 5-ah then a ni.

Neer-a’n lateral 1/3 fractures a type dan hian rostral-clavicular ligament pawimawhzia a sawi uar hle a: type I hi rostral-clavicular ligament atanga hla takah a awm a, medial fracture block chu a chung lamah a inthlak a type II hian rostral-clavicular ligament a huam a, chu chuan medial fracture block chu a chung lamah a displace a; leh type III te hi acromioclavicular joint thlengin a inzar pharh a, rostral-clavicular ligament chu a awm reng a ni.

Edinburgh typing hi diaphysis fracture te chu a displacement leh comminution degree a zirin classification system a ni.1 Type 1 fracture hian medial end a huam a, type 2 chu diaphysis fracture a ni a, type 3 chu lateral end fracture a ni. Diaphysis fracture te hi fracture fragment te inkara cortical contact awm leh awm loh a zirin type A leh B ah then a ni a, Type 2A fracture te chu nondisplaced (type 2A1) leh angulated (type 2A2) ah te then leh a ni a,2B fracture te hi simple emaw wedge-shaped (type 2B1) leh comminuted (type 2B2) ah te then a ni bawk.3 Type 1 fractures hian diaphysis medial end a huam a, type 3 hi diaphysis lateral end a ni. Medial leh lateral end fracture te hi a kianga joint a inrawlh leh tel loh a zirin subgroup 1 leh 2 ah then a ni.

Chutiang bawkin Rockwood typing, Jager type, leh Breitner typing te pawh a awm bawk.

Surgery tih dan tur

Fracture bik a awm

1, inhawng taka ruh tliak; 

2, a inthlak danglamna >2 cm; 

3, a tawi >2 cm; 

4, fracture fragment (>3) te tihchhiat; 

5, segment hrang hranga ruh tliak; 

6, underlying open fracture leh soft tissue hliam; 

7, deformity nasa tak (displacement leh shortening); 

8, scaphoid hliam tuar.

Compound hliam a awm

1, Ipsilateral upper extremity hliam inzawmkhawm;

2, Floating shoulder hliam;

3, hliam tam tak tuar;

4, fracture leh neurovascular injury inzawm;

5, ipsilateral multiple rib fractures leh chest wall deformity inzawmkhawm;

6, clavicle tawi a, thla nei shoulder siam;

7, Bilateral clavicle tihchhiat a ni.

Damlo Factors te

1, Hliam tam tak nei damlote chuan upper extremity weight bearing hmasa an mamawh a;

2, Damlo hnathawhna lama rang taka kir leh ngai (eg, elite leh competitive sports).

Surgery neih hun tur

Surgery neih theihna tur absolute indication a awm chuan surgery hi tihkhawtlai lohvin tih tur a ni.

Relative indication-a kar 2-3 aia rei surgery tihkhawtlai chuan fracture tihtlem harsatna a tipung thei a, a bik takin percutaneous technique hmanga closed reduction internal fixation atana inbuatsaih hunah.

Surgery hmanga tih theih a ni

Damlo chu beach chair position emaw semi-sitting position emaw-ah dah a ni. Surgery awlsam zawk nan clavicle tihsan nan a hnuaiah hian a nghawng shoulder chu padded a ni a, intraoperative mobilization neih theih nan arm chu towel hmanga vuah a ni bawk. Clavicle long axis-a transverse incision emaw, langer pattern nena inmil saber incision emaw chu thlan theih a ni.

Note: Transverse incision hian extension nasa zawk a pe a, longitudinal incision hian supraclavicular nerve injury hlauhawmna a ti tlem a, aesthetically pleasing zawk a ni.

Internal Fixation tih a ni

3.5 Clavicle fracture siam that nan hian systematic compression plate, reconstruction plate emaw plastic LCP emaw hman theih a ni. Plate te hi clavicle chungah emaw hma lamah emaw awlsam takin dah a ni. Plate te hi biomechanical injury-ah chuan chunglam atanga dah a nih chuan a chak zawk a, a bik takin a hnuaiah comminuted fracture a awm chuan a chak zawk a, hmuh theih a awlsam zawk bawk. Screw-te hi bicortical fixation a ngai a, a hnuai lam nerve leh thisen kalna kawngte hliam a awm theih avangin a zungte chu uluk takin drill tur a ni. A thatna: hmalam plate screw channel him taka drilling, plate apposition, contouring awlsam.

Note: A tir lamah chuan ruh grafting hi a ngai lo tlangpui a; internal fixation hnuah chuan plate khuh nan leh infection ven nan myofascial layer chu suture tha taka neih a pawimawh hle.

Intramedullary fixation hmanga tih a ni

Tuna intramedullary fixation device hman mekte chu Kirschner pin, Rockwood pin, Hagie pin, titanium elastic intramedullary pin, hollow screw, leh elastic locking intramedullary nail te an ni a eg, titanium elastic nails hian static locking a phal lo va, a sei zawng leh rotation control a phal lo va, comminuted fractures atana hman a nih chuan secondary shortening a awm thei bawk. Intramedullary nailing technique hi simple, transverse emaw oblique clavicle fracture-ah chauh hman theih a ni.

A thatna te

incision te zawk, aesthetic zawk, soft tissue stripping tlem zawk, endophyte protrusion risk hniam zawk, leh scab formation nena inzawm stability te.

A that lohna te

vun natna emaw, a luhna hmuna chhiatna emaw a awm.

Note:Closed reduction of clavicle fractures hi a harsa fo thin a, surgical maneuver laiin operator kut chu radiation laka overexposure a awm lo.

Plate fixation hi a tlem berah invasive a ni

Minimally invasive plate osteosynthesis of the clavicle hian biomechanical strength nasa zawk a pe thei niin an ngai a, chutih rualin open plate fixation emaw intramedullary fixation emaw a chhiatna a pumpelh bawk.

Intraoperative placement of the 3.5 system LCP anterior to the clavicle, a tha ber chu anteriorly below the clavicle, a hrisel clavicle reference theih a ni a, hei hian plate chu a hmaa siam a awlsam phah a, screw aperture sei zawk a hmu thei bawk.

Minimally invasive plate osteosynthesis hman hmasak hi supraclavicular nerve injury, wire pahnih alignment tha lo emaw shortening emaw hian function a nghawng thei a, plate bending emaw fracture emaw nen a inzawm thei bawk.

Clavicle lateral end-a fracture awmte chu plate fixation a ni

Plate implant thlan dan tur chu lateral bone block lian leh te a zirin a ni. Lateral bone block atan hian bicortical screw 3 aia tlem lo a ngai a ni. A tha ber chu oblique fracture tan chuan tension screw hman tur a ni. Bone block hi fixation theih loh khawpa te a nih chuan clavicle hook plate hman theih a ni.

Acromioclavicular joint dislocation enkawl dan

Scapular girdle hliam zinga 12% chu acromioclavicular joint injury a ni a, filled contact athlete-ah a thleng fo bawk.

Staging system hman tlanglawn ber chu Rockwood staging a ni. Type I chu acromioclavicular ligament-a rostroclavicular ligament awm reng chunga hliam (sprain) a ni a; type II chu acromioclavicular ligament te chu rostroclavicular ligament a awm reng a; type III hi acromioclavicular ligament leh rostroclavicular ligament pahnih te a ni a; type IV chu trapezius impaling distal clavicle hnunglam atanga inthlak danglamna a ni a; type V chu acromioclavicular joint leh rostroclavicular ligament pahnih tear vek a ni a, joint za zela 100 aia tam a inthlak danglam a; leh type VI hliam hi a tlem hle a, distal clavicle chu rostral process hnuaiah hnuai lam hawiin a inthlak a ni.

Type I leh type II hliam tan chuan cantilever sling hmanga hun rei lote chhunga braking hmanga conservative treatment pek a tha. Type III hliam enkawl dan hi sawisel a hlawh hle a, literature thenkhatah chuan active young adult tan chuan conservative treatment hi a tha hle niin an sawi. Functional recovery hi a tha a, a lan danah chuan deformity degree hrang hrang awm thei mahse. Type IV - VI hliam hi a na zawk a, surgical intervention neih a tha.

Tunah hian surgery hman tlanglawn tak takte chu: Bosworth rostral locking screw technique hmanga ligament chu stage khata siamthat emaw siamthat loh emaw;, clavicle hook plate fixation, clavicle fracture lateral end ang chi Tightrope-a tab plate fixation emaw anchor pinning suture emaw chu arthroscope emaw, incision te tak te hmanga siam emaw; leh rostral locking ligament suture emaw reinforced suspension emaw, rostral eminence leh clavicle inkarah artificial material emaw tendon emaw dah a ni.

Eng surgical technique nge a hlawk zawk tih erawh a chiang lo va, resurfacing hlohna engemaw chen awm thei mah se, heng technique zawng zawngte hlawhtlinna tawp ber chu a lungawithlak hle.

Medial end clavicle fracture leh sternoclavicular joint dislocations te enkawl dan

Heng hliamte hi a tlem hle a, hetah pawh hian evidence-based medicine hmanga enkawl dan tur kaihhruaina a awm lo.

Medial clavicle fracture hi extra-articular fracture a ni fo a, displacement pawimawh lo tak a awm a, conservative takin enkawl theih a ni. Clavicle medial end epiphysis hi kum 23-25 ​​inkarah a khar tlangpui a, taksaa epiphysis khar hnuhnung ber a ni. Chuvangin, medial injury tam tak hi a takah chuan Salter-Harris type I emaw II emaw epiphyseal plate fracture a ni. X-ray pangngai hi hriat a harsa a, a thatna chu 40° head tilt radiograph leh hrisel lam nena khaikhin chuan clavicle medial end displacement a awm thei a, CT hian diagnostic imaging tha ber a pe thei bawk.

Fracture emaw dislocations hmalam atanga inthlak danglam te chu khar leh dah leh theih a ni tlangpui a, mahse a nghet lo fo a, a inthlak danglam theih nan lobotomized a ni fo thin. Persistent dislocations emaw displacement emaw tan chuan palliative care hi a tha ber a, a chhan chu functional impairment a thlen loh vang a ni. Clavicle hnunglam medial end dislocation hian upper mediastinal injury a thlen tam lo hle a, vascular injury emaw tracheal obstruction leh airway compression pawh a awm thei. Medial fragment a te lutukna hmuna dislocation leh fracture tan chuan plate te chu sternum-a fixation atan joint atanga bridge theih a ni.

Fixation hman dan dangte

eg pawn lam stent hmanga fixation, pawn lam clavicle plate hmanga fixation, etc.

Operation hnua enkawl dan tur

Upper arm chu sling-ah immobilized tur a ni a, shoulder pendulum training tan nghal tur a ni. Kar 2 hnuah damlo chu enkawl zui a, hliam enfiah a, X-ray te enfiah leh tur a ni a, chutih laiin forearm sling chu lakchhuah theih a ni a, unrestricted joint mobility training tan theih a ni a, mahse damlo chu a kut leh ke natna nen rit phur lo turin hrilh tur a ni. Strength training hi operation hnu kar 6-ah ruh damna chhinchhiahna a lan chuan tan theih a ni. Operation hnu thla 3 chhung chu a ruh a dam vek hma chuan contact sports emaw extreme sports emaw tih loh tur a ni.

Harsatna awm thei.

Harsatna hmasa ber

Postoperative wound infection hi 4.8% thleng a awm thei a;

Subclavian region-a numbness hi complication awm tam ber a ni a, natural history study-ah hian he symptom nei damlo 83% thleng an awm a, hun kal zelah a tlahniam a, dysfunction lian tham a thlen lo a, mahse operation hnuah kum 2 thleng a awm thei a

Endophyte protrusion leh skin agitation, soft tissue coverage tha tak nei lo voluminous plate emaw nail tail emaw hman fo thin;

re-fracture, chu chu surgical leh conservative treatment pahnih hnuah pawh a awm thei; post-surgical re-injury hian endoprosthesis chu a ben emaw, a chhe emaw a, endoprosthesis vel a ti chhe thei bawk;

nonunion, 15% nonunion rate chu conservative treatment-ah leh 2% nonunion rate-in surgical treatment-ah completely displaced diaphyseal fractures a awm a a ruh chu a inthlak vek a, cm 2 aia a tawi a, meizuk a, kum a pung a, chakna sang takin a hliam a, a tliak leh (mechanical instability), recalcitrant diaphyseal dislocations, ruh quality tha lo, leh ruh hloh lutuk.

Late complication a awm thin

Acromioclavicular joint-a osteoarthritis hi intra-articular fracture (Edinburgh type 3B2)-ah a awm tam zawk a; symptomatic leh conservative treatment a hlawhtlin loh chuan distal clavicle chu arthroscopically emaw open surgery emaw hmangin resect theih a ni a;

Deformity healing, conservative taka enkawl displaced fracture zawng zawngah degree hrang hranga thleng thin; distal fracture block rotation nena inzawm scapular girdle tawi chuan ultimate shoulder strength leh endurance a tlahniam thei a, a bik takin shoulder abduction-ah thoracic outlet a tawi chuan brachial plexus compression symptom a awm thei a; leh scapulothoracic wall joints malalignment hian scapula hmalam tilting a thlen thei a, shoulder pain leh myalgias a thlen thei a, a symptoms chu deformity atanga lo chhuak tih a chiang a nih chuan Damna a awm chuan osteotomy correction leh plate fixation chu damlo mamawh dan azirin tih theih a ni.

Prognosis leh a chhuah dan tur

Europe rama zirchianna nena inzawm chuan displaced midclavicular fracture-te surgical treatment chu a hlawk hle tih a tarlang a, a meta-analysis chuan fracture nonunion leh symptom-producing malunion thlentu malunion chu surgery group-ah chuan conservative treatment nena khaikhin chuan conservative-a enkawl group-te aiin a tlem zawk tih a tarlang a chu bakah, surgical group-te chuan a tir lamah natna an tihziaawm a, Constant leh DASH functional score-ah pawh hmasawnna a langsar zawk bawk.

A tawi zawngin sawi rawh

Clavicle fracture tam zawk hi direct emaw indirect emawa tharum thawhna avanga lo awm a ni a, a enkawlna chu conservative emaw surgical treatment emaw anga then theih a ni. Enkawlna lam hawi chuan, clavicle fracture tam zawk hi displacement lian tham nei lo chu conservative takin enkawl theih ni mahse, fracture displacement nasa tak nei tan chuan surgical treatment option chu sawisel a hlawh hle. Displaced clavicle fracture tan chuan surgical treatment hian conservative treatment nena khaikhin chuan ruh dam leh early functional outcome rate a sang zawk a ni.

Thuhmahruai

[1] Postacchini F, Gumina S, De Santis P, Albo F. A rilru a hah lutuk chuan a rilru a buai em em a, a rilru a hah lutuk chuan a rilru a buai em em bawk a. J Shoulder Elbow Surg 2002 khan a rawn chhuak a; 11:452 ah a awm.

[2] Eiff, MP, Hatch leh a dangte chuan an ziak a. Clavicle leh scapula a tliak. A rilru a hah lutuk chuan a rilru a buai em em a, a rilru a hah lutuk chuan a rilru a buai em em bawk a. 2nd ed, WB Saunders, Philadelphia 2002. p.198.

[3] Robinson CM chuan a rawn ti a. Puitlingah chuan clavicle a tliak. Epidemiology leh a thliar hranna. J Ruh ruh Surg Br 1998-ah a awm a; 80:476 ah a awm.

[4] Neer CS 2-na a ni. Clavicle distal third-a fracture awm. Clin Orthop Relat Res 1968-ah chuan a ziak a; 58:43 ah a awm.

[5] Andersen K, Jensen PO, Lauritzen J. Kawngpui ruh tliak enkawlna. Figure-of-eight bandage leh sling awlsam tak. Acta Orthop Scand 1987-a siam a ni a; 58:71 ah a awm.

[6] Ersen A, Atalar AC, Birisik F, leh a dangte chuan an ziak a. Midshaft clavicular fracture avanga simple arm sling leh figure of eight clavicular bandage tehkhin dan: randomized controlled study. Bone Joint J 2015 khan a rawn lang leh a; 97-B:1562-ah a tarlang bawk.