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 chhoa zirchiannaah chuan nonunion rate chu clavicle fractures 1% aia tlem a ni tih an sawi a, conservative treatment-ah chuan damlo satisfaction sang tak a awm a Tun hnaia damdawi lam a lo chhuah takah chuan surgery hmanga enkawlna chuan a thawh hlawk hle a; Chuvangin, emergency department emaw general outpatient clinic-a thawk clinician-te chuan he hliam lan chhuahna leh harsatna awm fo leh a enkawlna bulpui te hi an hre chiang tur a ni.

Epidemiology 1.1.

Clavicle ruh tliak hian puitling hliam zawng zawng zinga 2.6%-5% a luah a ni [1,2]. European study-ah chuan a zawna clavicle fracture case 1,000 zet a awm a, chu chu clavicle fracture 66% aia tam chu clavicle laihawl 1/3-ah a awm tih hmuhchhuah a ni a, 25% vel chu lateral 1/3 fractures an ni a, 3% chu medial 1/3 fracture an ni. Clavicle fractures vei tamna hian bimodal distribution a nei a, mipa kum 30 hnuai lam a awm ber a, kum 70 chunglamte chu an dawt a ni.

Clinical anatomy .

Mihring ruhro ossification tan hmasa ber chu clavicle a ni a, chu chu kut chunglam leh trunk inzawmna awmchhun a ni a, chu chu acromion, acromioclavicular (AC) joint, leh sternum, sternoclavicular (SC) joint nen a inzawm tlat a ni. Heng joint te hi atypical synovial joint an ti a, a chhan chu hyaline cartilage aiin fibrocartilage hmanga lined an nih vang a ni. Clavicle hi scapula-ah acromioclavicular leh rostroclavicular ligament hmangin anchor a ni a, sternoclavicular ligament hmangin sternum-ah a inzawm a ni.

Clavicle chu 's' ang maia siam a ni. Proximal half-arc chuan hmalam lamah project a project a, a chung lam tawp lama neurovascular bundle awmna tur hmun a awm ta a ni. Arc-a distal half te hian backward (concave) an project a, chutah chuan scapula (rostral process leh acromion) te chu an zawm a ni. Clavicle-a ruh tliak hi arc pahnih (mid-arc) inzawmna hmunah a awm tlangpui a, a chhan ber chu he biala ruhro kianga awm ligament awm loh vang leh clavicle-a chak lo ber a nih vang a ni. Clavicle fracture chu a inthlak a nih chuan, proximal segment chu sternocleidomastoid muscle (clavicle proximal end-a dah) chuan a chung lam (cephalad) a chhuah (cephalad) a, distal segment chu upper arm rit takin a thlak danglam (caudad) a, clavicle chu a hruihrual a, a hruihrual chu a hrufai vek a ni (ie, the other contractement ends) a ni. of subscapularis leh pectoralis major (chu chu a chhungah chuan a kut chunglam a inher a ni). Hei hi a chhan ber chu subscapularis leh pectoralis major muscles (chu chuan a chhungah kut chunglam a inher a, a rilru lam hawiin a hruai a ni) a inzawm loh vang a ni.

Nihphung

Clavicle fracture hmanga enkawlna hian a tum ber chu natna tih tlem leh joint function siam that leh a ni. clavicle fracture tam zawk hi chu conservative-a enkawl ber an la ni ber (a tlangpuiin 15 mm aia tam loin an ti tawi a); Conservative treatment hrang hrang, figure-of-eight bandage, forearm slings, Sayre bandage, velpeau immobilization suit, leh immobilization te a awm a ni. Suspension immobilization hi acute phase-ah tih a ni a, early range of motion training leh strength exercise te hi natna a reh chuan a hliam hnu kar 2-6 hnuah tih a ni tlangpui. Bandage 8 figure 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 fractures hi a tlak hnua a ke ruh a direct a impact avanga lo awm a ni a, chu chu thalai te zingah pawn lam infiamnaah te leh tarte inadvertent falls-ah te hmuh tur a awm tlangpui. Hliam awm dan tur sawifiah a pawimawh. High-energy injury chu lu leh rilru hliam nen a inzawm thei a, chutih laiin trauma tenau avanga fracture awm chu pathologic a ni thei bawk. Distraction injury-ah hian scapular chest wall separation, neurologic leh vascular injury te uluk taka chhuah tir leh uluk taka paih chhuah a ngai a ni. Clinically chuan fracture na hmunah hian swelling leh ecchymosis a awm a, chu chu deformity leh tenderness nen a inzawm a ni. Soft tissue te hi jack up na atan ngaihven tur a ni a, chu chuan skin necrosis leh ulceration a thlen thei a ni.

Imaging hmanga siam a ni.

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

chi hrang hrang .

AO/OTA fracture dislocation Typing: Clavicle fracture code 15-ah hian 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) fractures te hi type A (extra-articular), type B (a then chu intra-articular), leh type C (completely intra-articular) ah then a ni. Trunk fractures hi type A (simple), type B (Wedge), leh Type C (commined) tiin an then a.AO/OTA classification of fractures and dislocations hian fracture a displacement degree a ngaihtuah lo va, tunah hian clavicle fracture enkawlnaah leh prognosis tihfelnaah hman a tlem hle.

Allman typing hi 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 he classification hi Allman-a innghatin a tithianghlim leh a, I chu clavicle-a middle 1/3 a nih avangin; Type II chu clavicle pawn lam 1/3 a nih avangin, chu chu fracture displacement leh rostral clavicular ligament nena inzawmna atanga chhutin chi 5 ah then a ni a leh Type III chu clavicle chhung lam 1/3-a 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 chuan rostral-clavicular ligament pawimawhzia a sawi uar hle: Type I hi rostral-clavicular ligament-ah distal a ni a, medial fracture block chu a chungnung zawk a Type II hian rostral-clavicular ligament a huam a, chu chuan medial fracture block chu a chungnung zawk a, a displaced a; leh Type III chu acromioclavicular joint-ah a inzar pharh a, rostral-clavicular ligament chu a la awm reng a ni.

Edinburgh typing hi diaphysis leh comminition degree a zirin diaphysis fractures classification system a ni.1 Type 1 fractures ah hian medial end a awm a, Type 2 hi diaphysis fracture a ni a, Type 3 hi lateral end fractures a ni. Diaphysis-a fractures te hi fracture fragments te chu type A leh B-a cortical contact awm leh awm loh a zirin an thliar hrang a, Type 2A fractures chu nondisplaced (type 2A1) leh angulated (type 2A2),2B fractures te chu simple or wedge-shaped involved media (type 2b1) leh comnuted ended (type 2b2) tiin an thliar hrang leh a. Diaphysis leh type 3 hi diaphysis lateral end a ni. Medial leh lateral end fracture te chu a kianga joint a inrawlh leh tel loh a zirin subgroup 1 leh 2 ah then a ni.

Chutiang bawkin Rockwood Typing, Jager Typing leh Breitner Typing te pawh an awm bawk.

Surgical lama hriattirna te .

Specific fractures .

1, hawn theih a ni a; 

2, hmun danga sawn chhuah >2 cm; 

3, tawi >2 cm; 

4, fracture fragments-a inhnamhnawih (>3); 

5, multi-segment fracture; 

6, a hnuaia open fracture chu soft tissue hliam a ni a; 

7, deformity nasa tak (displacement leh shortening); 

8, scaphoid hliam.

Compound hliam .

1, ipsilateral upper extremity hliam zawng zawng inzawmkhawm;

2, floating shoulder injury;

3, hliam tam tak a awm a;

4, fracture chu neurovascular injury nen a inzawm a;

5, ipsilateral multiple rib fractures te chu chest wall deformity nen a inzawm a;

6, clavicle shortening chu a ke ruh a siam a;

7, bilateral clavicle fractures.

Damlote thil .

1, hliam tam tak nei damlote chuan early upper extremity weight bearing an mamawh a;

2, damlo hnathawh leh hnathawh chak taka kir leh ngai (eg, elite leh competitive sports).

Surgery neih hun tur .

Surgery atana absolute indication a awm chuan surgery tih tur a ni.

Kar 2-3 chhunga relative indication-a surgery neih hun sawn chuan ruh tliak tihtlem harsatna a tipung thei a, a bik takin percutaneous technique hmanga closed reduction internal fixation atana inbuatsaih hunah.

Surgical hmanga kal theihna .

Damlo chu beach chair position emaw semi-sitting position emaw-ah dah a ni. A kekawr ipte chu a hnuaiah an padded a, clavicle chu operation awlsam zawk nan an chawisang a, arm chu toweled a ni a, chu chuan intraoperative mobilization a phalsak a ni. Clavicle axis sei tak zawh zawnga transverse incision emaw, Langer pattern parallel saber incision emaw chu thlan theih a ni.

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

A chhunga fixation .

3.5 Clavicle ruh tliakte siam that nan hian compression plate, reconstruction plate, emaw plastic LCP te chu systematic takin hman theih a ni. Plate te chu clavicle chungah emaw, anterior emaw chungah emaw a tha zawngin an dah a. Plate te hi biomechanical injury sang zawka dah a nih chuan an chak zawk a, a bik takin a hnuaia comminuted fracture a awm chuan, hmuh theiha siam a awlsam zawk. Screw-te bicortical fixation neih a ngai a, a hnuaia nerve leh thisen kalna kawngte hliam a awm theih avangin uluk taka khur tur a ni. A thatna: Anterior plate screw channel him taka drilling, plate apposition, contouring awlsam tak.

Note: A tir lama tih tur atan chuan ruh grafting hi a ngai lo tlangpui; Internal fixation hnuah chuan plate khuh nan leh infection ven nan myofascial layer chu a tling tawka suture a pawimawh hle.

Intramedullary fixation .

Tuna intramedullary fixation device-ah hian Kirschner pin, rockwood pin, hagie pin, titanium elastic intramedullary pin, hollow screw, leh elastic locking intramedullary nails te a awm a eg, titanium elastic nails hian static locking a phal lo va, a sei leh a inher dan control a phal lo va, comminuted fracture-a hman a nih chuan secondary shortening a thlen thei bawk. Intramedullary nailing technique hi simple, transverse emaw oblique clavicle fracture-ah chauh hman theih a ni.

A thatna te .

Incision tlem zawk, aesthetic tam zawk, soft tissue stripping tlem zawk, endophyte protrusion hlauhawmna hniam zawk, leh scab siamna nena inzawm stability te.

A that lohna .

Skin irritation emaw point of entry-a chhiat emaw.

Note:Clavicle fractures tihtlem hi a chang chuan a harsa a, surgical maneuvers neih lai hian operator kut chu radiation-ah overexposure a awm lo.

Minimally invasive plate fixation a awm bawk.

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

Intraoperative placement of the 3.5 system LCP anterior to the clavicle, a tha ber chu clavicle hnuai lam a nih chuan, clavicle hrisel tak chu a reference thei a, chu chuan plate chu a hmain a siam awlsam a, screw aperture sei zawk a hmu thei bawk.

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

Clavicle lateral end a fractures te plate fixation .

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

Acromioclavicular joint dislocation enkawlna .

Acromioclavicular joint injury hian scapular girdle injury 12% a nei a, filled contact athletes-ah a awm fo bawk.

Staging system hman tlanglawn ber chu Rockwood staging a ni. Type I hi acromioclavicular ligament a ni a, rostroclavicular ligament chu a awm reng a; Type II chu acromioclavicular ligament a ni a, rostroclavicular ligament chu a awm reng a; Type III hi acromioclavicular ligament leh rostroclavicular ligament pahnih tear a ni a; Type IV hi trapezius-a impaling distal clavicle hnunglam atanga inthlak danglamna a ni a; Type V hi acromioclavicular joint leh rostroclavicular ligament pahnih a tear tluantling a ni a, za zela 100 chuang chu joint atanga displacement a ni a Tin, 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 hliamte tan cantilever sling hmanga hun rei lote chhunga braking hmanga conservative treatment neih a tha. Type III hliam enkawl dan hi sawisel a hlawh hle a, literature thenkhatah chuan active young adults tan conservative treatment hi hman a nih thu an sawi. Functional recovery hi a tha a, mahse a lan danah chuan deformity degree hrang hrang a awm thei. Type IV - VI hliam hi a na zawk a, surgical intervention neih a tha.

Tunah hian surgical procedure hman tlanglawn ber chu: Bosworth rostral locking screw technique hmanga ligament siam that emaw, siam that loh emaw;, clavicle hook plate fixation, lateral end of clavicle fracture ang chi Tightrope-a tab plate fixation emaw anchor pinning suture chu arthroscope emaw, incision te tak te emaw hmanga tih a ni a; leh rostral locking ligament suture emaw reinforced suspension emaw, rostral eminence leh clavicle inkarah artificial material emaw tendon emaw a awm bawk.

Eng surgical technique nge a hlawk zawk tih erawh a chiang lo va, resurfacing hloh engemaw zat awm thei mah se, heng technique zawng zawngte hian a thawh hlawk ber chu a satisfactory hle.

Medial end clavicle fractures leh sternoclavicular joint dislocations te enkawlna .

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

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

Fractures emaw dislocations anteriorly displaced te chu a tlangpuiin khar leh repositioned theih a ni a, mahse re-displacement atan chuan unstable leh lobotomized an ni fo thin. Palliative care hi persistent dislocations emaw displacement emaw tan chuan a tha hle a, a chhan chu functional impairment a thlen loh fo avangin. Clavicle-a medial end dislocation chuan posteriorly-in upper mediastinal injury a thlen tam lo hle a, chutah chuan vascular injury emaw tracheal obstruction leh airway compression emaw pawh a tel. Medial fragment a tlem lutukna dislocations leh fracture te tan chuan plate te chu joint atanga sternum thlenga fixation atan bridge theih a ni.

Fixation hman dan dang .

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

Operation hunlai enkawl dan tur .

Sling-ah chuan arm chunglam chu immobilized tur a ni a, shoulder pendulum training chu tan nghal tur a ni. Kar 2 hnuah chuan damlo chu a hliam enfiah leh x-ray enfiah turin enkawl zui tur a ni a, chutih laiin forearm sling chu lakchhuah theih a ni a, unrestricted joint mobility training chu tan theih a ni a, mahse damlo chu a ke ruh natna nen rit phur lo turin hrilh tur a ni. Strength training hi operation hnu kar 6-ah tan theih a ni a, chutah chuan ruh damna chhinchhiahna a lo lang ang. Contact sports emaw extreme sports emaw hi operation hnu thla 3 chhung atan a tlakbuak vek hma chuan tih loh tur a ni.

Complication te pawh a awm thei.

A hmaa harsatna awmte .

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 chuan he symptom nei zinga 83% vel chu hun kal zelah a tlahniam a, dysfunction nasa tak a thlen lo a, mahse, operation hnu kum 2 thleng a awm thei a

endophyte protrusion leh vun agitation, voluminous plate emaw nail tails emaw hmanga soft tissue coverage tha lo hman thin

re-fracture, chu chu surgical leh conservative treatment hnua lo awm thei; Post-surgical re-injury chuan endoprosthesis chu a ben emaw, a tikehsawm emaw thei a, a nih loh leh endoprosthesis vel a tikehsawm thei bawk;

nonunion, conservative treatment nei 15% nonunion rate leh diaphyseal fractures displaced tak tak surgical treatment nei 2% nonunion rate A ruh tliak vek, cm 2 aia rei lo, meizuk, kum upat, chakna sang tak nei, re-fracture (mechanical instability), recalcitrant diaphyseal dislocations, ruh quality tha lo, leh ruh hloh tam lutuk te.

Late complication 1000 a awm.

Acromioclavicular joint-a osteoarthritis hi intra-articular fracture (Edinburgh Type 3B2) nen a awm tam zawk a; Symptomatic leh conservative treatment a hlawk loh chuan distal clavicle chu arthroscopically emaw open surgery hmangin resected a ni thei a;

deformity healing, chu chu conservative taka enkawl displaced fracture zawng zawngah degree hrang hrangin a thleng a; Distal fracture block rotation nena inzawm scapular girdle tih tawi hian ultimate shoulder strength leh endurance tlahniam a thlen thei a, a bik takin shoulder abduction-ah Thoracic outlet tihtlem chuan brachial plexus compression symptoms a awm thei a; Tin, scapulothoracic wall joint-a malalignment chuan scapula anterior tilting a thlen thei a, shoulder pain leh myalgias a siam thei bawk a, chu chu damna a thlen hunah symptoms a awm tih a chiang a nih chuan, osteotomy correction leh plate fixation chu damlo mamawh dan azirin a awm thei a ni.

Prognosis leh a rah chhuah .

Europe-a zirchianna inzawm pakhat chuan, displaced midclavicular fractures surgical treatment chu a hlawkpui hle tih a tarlang a, a meta-analysis-ah chuan malunion a thlen chuan fracture nonunion leh symptom-producing malunion thlentu chu conservative treated group-a surgery group-ah chuan conservative treatment nena khaikhin chuan surgical group aiin a hniam zawk tih a lang a Chu bakah, surgical group-ah chuan a tir lamah natna a tlahniam a, constant leh dash functional score-ah pawh hmasawnna a langsar zawk bawk.

Summarize rawh .

Clavicle fracture tam zawk hi direct emaw indirect emaw violence avanga lo awm a ni a, chu enkawlna chu conservative emaw surgical treatment emaw anga then theih a ni. Enkawlna lamah chuan, clavicle fracture tam zawk displacement awm lo tam zawk chu conservative-a enkawl theih ni mah se, fractures displacement nasa tak nei tan surgical treatment option chu sawisel a hlawh hle. Displaced clavicle fractures tan chuan surgical treatment hian ruh damna a nei sang zawk a, conservative treatment nen khaikhin chuan early functional outcome a nei sang zawk bawk.

Thuhriltute .

[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 a ni a; 11:452 a ni.

[2] Eiff, MP, Hatch, leh a thawhpuiten an zirchiannaah chuan, “Ka rilru a buai em em a ni. clavicle leh scapula te chu a chhe thei hle. In: Primary Care atana ruh tliak enkawlna, 2nd ED, WB Saunders, Philadelphia 2002. P.198.

[3] Robinson CM chuan a rawn ti a. Puitlingah chuan clavicle-a ruh tliak (fractures) a awm. Epidemiology leh classification tih te a ni. j ruh ruhro ruhro a ni a, BR 1998 a ni a; 80:476 a ni.

[4] NEER CS 2nd a ni. Clavicle-a distal third-a fractures. Clin Orthop Relat Res 1968-ah a rawn lang a; 58:43 a ni.

[5] Andersen K, Jensen PO, Lauritzen J. A rilru a hah lutuk chuan a rilru a buai em em a. FIGURE-OF-Eight Bandage leh sling awlsam tak. Acta Orthop chuan kum 1987 khan Scand-ah a lo chang tawh a; 58:71 a ni.

[6] Ersen A, Atalar AC, Birisik F, leh a dangte chuan an ziak a. Midshaft clavicular fractures atana clavicular bandage pariat simple arm sling leh figure tehkhin dan: randomized controlled study. ruh inzawmna J 2015; 97-B:1562-ah a awm.