Gupima no kuvura imvune za Clavicle

Intangiriro

Ivunika rya Clavicle risanzwe risanzwe kandi mubisanzwe bituruka ku ihahamuka ritaziguye cyangwa ritaziguye ku rutugu. Ubushakashatsi bwakozwe mu ntangiriro ya za 1960 bwagaragaje ko igipimo cyo kudahuza imvune za clavicle kitari munsi ya 1%, kandi kuvura konservateur byatumye abarwayi banyurwa cyane; hamwe niterambere rya vuba ryubuvuzi, kuvura kubaga byageze kubikorwa byiza; kubwibyo, abaganga bakora mu ishami ryihutirwa cyangwa ivuriro rusange ry’ubuvuzi bagomba kuba bamenyereye kugaragara hamwe ningorane ziterwa niyi mvune nubuyobozi bwibanze.

Epidemiologiya

Ivunika rya Clavicle rifite 2,6% -5% by'imvune zose zikuze [1,2]. Ubushakashatsi bw’ibihugu by’i Burayi bwarimo 1.000 zikurikiranye zavunitse clavicle zagaragaje [3,4] ko ibice birenga 66% byavunitse clavicle byabaye hagati ya 1/3 cya clavicle, hafi 25% byavunitse 1/3, naho 3% byavunitse hagati ya 1/3. Ikibazo cyo kuvunika clavicle cyerekanaga ikwirakwizwa rya bimodal, igaragara cyane cyane kubagabo bari munsi yimyaka 30, ikurikirwa nabarengeje imyaka 70.

Clinical Anatomy

Kera cyane ya skeleti yumuntu gutangira ossifisiyasi ni clavicle, ihuza ryonyine ryamagufa hagati yukuboko hejuru nigitereko, kivuga kure na acromion, acromioclavicular (AC), kandi hafi ya sternum, sternoclavicular (SC). Izi ngingo zitwa guhuza udasanzwe twa synovial kuko zometse kuri fibrocartilage aho kuba karitsiye ya hyaline. Clavicle yometse kuri scapula na acromioclavicular na rostroclavicular ligaments kandi ifatanye na sternum na ligamenti ya sternoclavicular.

Clavicle ni 'S ' ifite ishusho. Hafi ya kimwe cya kabiri-arc umushinga imbere, usize umwanya wa neurovasculale bundle yo hejuru. Igice cya kabiri cya arc umushinga usubira inyuma (conave) hanyuma ugahuza na scapula (inzira ya rostral na acromion). Ivunika rya clavicle mubisanzwe ribera aho ihurira ryimpande zombi (hagati-arc), bishoboka cyane ko biterwa no kubura ligaments zifata amagufwa aturanye muri kano karere kandi kubera ko ari igice cyoroshye cya clavicle. Iyo kuvunika kwa clavicle kwimuwe, igice cyegeranye gikururwa hafi buri gihe hejuru (cephalad) n'imitsi ya sternocleidomastoid (ifatanye numusozo wa clavicle) kandi igice cya kure cyimurwa hepfo (caudad) nuburemere bwikiganza cyo hejuru, kandi clavicle ikunda cyane cyane guhuza ibice. pectoralis major (izenguruka imbere ukuboko hejuru). Ibi ahanini biterwa no kwikuramo imitsi minini ya subcapularis na pectoralis (izenguruka imbere ukuboko hejuru hanyuma ikayikurura mu gituza).

Ibiranga

Intego yo kuvura kuvunika clavicle nukugabanya ububabare no kugarura imikorere ihuriweho. Ibice byinshi byavunitse bya clavicle biracyavurwa cyane cyane muburyo bwo kubungabunga ibidukikije (mubisanzwe bigabanywa bitarenze mm 15); imiti igabanya ubukana nka shusho-ya-umunani, amaboko, amaboko ya Sayre, imyenda ya Velpeau, hamwe na immobilisation. Guhagarika ubudahangarwa bikorwa mucyiciro gikaze, kandi imyitozo yo hambere yimyitozo ngororamubiri hamwe nimyitozo yimbaraga ikorwa nyuma yibyumweru 2-6 nyuma yo kuvunika iyo ububabare bukemutse. Gukoresha ishusho ya bande 8 ntabwo byemewe kuko bishobora gutera ibisebe byingutu hamwe no kudahuza kuvunika [5,6].

Amateka n'Ikizamini Cyumubiri

Ivunika rya Clavicle riterwa n'ingaruka zitaziguye ku rutugu nyuma yo kugwa kandi bikunze kugaragara muri siporo yo hanze mu rubyiruko no kugwa utabishaka. Ni ngombwa gusobanura uburyo bwo gukomeretsa. Gukomeretsa imbaraga nyinshi birashobora guhuzwa no gukomeretsa mu mutwe no mu gatuza, mu gihe kuvunika guturuka ku ihahamuka rito bishobora kuba indwara. Ibikomere byo kurangaza bisaba gutangira hakiri kare no gukumira witonze gutandukanya urukuta rwo mu gatuza, ibikomere byo mu mitsi no mu mitsi. Mubuvuzi, hariho kubyimba na ecchymose kumwanya wavunitse, ufatanije nubumuga nubwuzu. Hagomba kwitonderwa uduce tworoshye two guterura, bishobora gutera uruhu rwa nérosose hamwe n ibisebe.

Kwerekana

Ibice byinshi bishobora gupimwa na radiyo yoroshye ya anteroposterior. 20 ° umutwe uhengamye kumutwe ukuraho ingaruka zo gufunga thoracic cavites. Abarwayi bagomba gufotorwa mumwanya wo kwifasha kugirango barusheho kwiyumvisha kwimuka kuvunika. Kwipima ibiro bya radiografi bifasha mugusuzuma ubusugire bwimitsi ya rostral clavicular ligament ya clavicle ya kure cyangwa igikomere cya acromioclavicular.CT ifasha kwiyumvisha ibikomere bigoye byumukondo kandi bigatanga ishusho nziza yimvune zishobora kuba zifata clavicle zifatanije na sternoclavicular. Gufata radiografi yo mu gatuza bifasha kwirinda gukomeretsa kwa thoracic, kandi kugabanuka birashobora kugereranywa no kugereranya na clavicle itandukanijwe, ndetse no kwirinda gutandukanya urukuta rwa scapulothoracic.

Ubwoko

Kwandika kuvunika kwa AO / OTA: Kode ya clavicle yamenetse 15 igizwe nibice bitatu: 15.1 byegeranye (hagati), 15.2 diaphysis, na 15.3 kure (kuruhande). Ivunika ryegeranye (hagati) hamwe na kure (kuruhande) byashyizwe mubyiciro nkubwoko A (extra-articular), ubwoko B (igice cyimbere-articular), nubwoko C (intra-articular). Ivunika ry'imitsi ryashyizwe mu byiciro nk'ubwoko A (bworoshye), ubwoko bwa B (wedge), n'ubwoko bwa C (bwatangijwe) .Icyiciro cya AO / OTA cyo kuvunika no gutandukana ntikizirikana urugero rwo kwimura imvune, kandi kuri ubu kikaba gikoreshwa cyane mu kuvura imvune za clavicle no kumenya ibizamenyekana.

Kwandika kwa Allman bishingiye kumwanya wavunitse (I: hagati, cadent 1/3, II: kuruhande 1/3, III: hagati ya 1/3) (Ishusho 7.2.1).

Craig yongeye kunonosora ibyiciro ashingiye kuri Allman, hamwe ndi hagati ya 1/3 cya clavicle; ubwoko bwa II kuba hanze ya 1/3 cya clavicle, hanyuma igabanywa mubwoko 5 bushingiye ku kwimuka kuvunika no guhuza isano na rostral clavicular ligament; n'ubwoko bwa III kuba kuvunika imbere muri 1/3 cy'imbere ya clavicle, yagabanijwemo ubwoko 5 bushingiye ku ntera yo kwimuka kwavunitse kandi niba kuvunika kwari imbere.

Kwandika kwa Neer kuvunika kuruhande 1/3 bishimangira akamaro k'ururimi rwa rostral-clavicular: ubwoko bwa I buboneka kure cyane ya rostral-clavicular ligament, hamwe no kuvunika kwa mediya kwimuwe hejuru; ubwoko bwa II burimo rostral-clavicular ligament kandi bivamo guhagarika imvune yo hagati yimurwa hejuru; n'ubwoko bwa III bugera kuri acromioclavicular hamwe na rostral-clavicular ligament isigaye idahwitse.

Kwandika kwa Edinburgh ni uburyo bwo gushyira mu byiciro kuvunika kwa diaphysis ukurikije urugero rwo kwimurwa no gutangira.1 Ivunika ryo mu bwoko bwa 1 ririmo impera yo hagati, ubwoko bwa 2 ni ibice bya diaphysis naho ubwoko bwa 3 ni imvune zanyuma. Ivunika rya diaphysis rishyirwa muburyo ukurikije kuboneka cyangwa kutabaho kwa cortical guhuza ibice byavunitse mubwoko bwa A na B. Ubwoko bwa 2A kuvunika byongeye gushyirwa mubice bidafite aho bihuriye (ubwoko bwa 2A1) kandi burakaye (ubwoko bwa 2A2), ibice 2B byashyizwe mubikorwa byoroheje cyangwa bifite imiterere (ubwoko bwa 2B1) kandi byavunitse (ubwoko bwa 2B2). diaphysis. Ivunika ryo hagati no kuruhande ryagabanijwemo amatsinda ya 1 na 2 ukurikije niba ingingo yegeranye irimo.

Muri ubwo buryo hariho kwandika Rockwood, kwandika Jager, no kwandika Breitner.

Ibimenyetso byo kubaga

Ivunika ryihariye

1, kuvunika; 

2, kwimura> cm 2; 

3, kugabanya> cm 2; 

4, gutangira ibice byavunitse (> 3); 

5, kuvunika ibice byinshi; 

6, munsi yo kuvunika gufunguye hamwe no gukomeretsa ingirangingo; 

7, ubumuga bukomeye (kwimura no kugabanya); 

8, igikomere cya scaphoid.

Gukomeretsa

1, Gukomeretsa impande zombi kuruhande rwo hejuru;

2, Gukomeretsa ku rutugu;

3, ibikomere byinshi;

4, kuvunika hamwe no gukomeretsa imitsi;

5, impande zombi zavunitse imbavu zifatanije nubumuga bwigituza;

6, clavicle igabanya gukora urutugu rufite amababa;

7, Kuvunika impande zombi.

Ibintu by'abarwayi

1, abarwayi bafite ibikomere byinshi bisaba uburemere bwo hejuru hejuru;

2, abarwayi bakeneye gusubira vuba mumikorere (urugero, siporo y'indobanure na siporo irushanwa).

Igihe cyo kubagwa

Kubaga bigomba gukorwa bidatinze mugihe ibimenyetso simusiga byo kubaga bihari.

Gutinda kubagwa birenze ibyumweru 2-3 mubyerekana ugereranije bishobora kongera ingorane zo kugabanya kuvunika, cyane cyane mugihe witegura kugabanya gufunga imbere gukosorwa hakoreshejwe tekinoroji.

Kubaga

Umurwayi ashyirwa kumwanya wintebe yinyanja cyangwa umwanya wicaye. Igitugu cyanduye cyometse munsi kugirango kizamure clavicle kugirango byoroherezwe kubagwa, kandi ukuboko gukururwa kugirango yemere gukorera hamwe. Ihinduranya ryambukiranya umurongo muremure wa clavicle cyangwa isabune ya saber ihwanye na langer ishusho irashobora guhitamo.

Icyitonderwa: Igice cyo guhinduranya gitanga kwaguka cyane, mugihe gutinda birebire bigabanya ibyago byo gukomeretsa imitsi ya supraclavicular kandi birashimishije cyane.

Gukosora Imbere

3.5 Isahani yo guhagarika sisitemu, ibyapa byo kwiyubaka, cyangwa LCP ya plastike irashobora gukoreshwa mugukosora ibice bya clavicle. Isahani ishyizwe neza hejuru cyangwa imbere ya clavicle. Isahani irakomeye mubikomere byibinyabuzima iyo bishyizwe hejuru, cyane cyane niba hari ibice byavunitse munsi, kandi byoroshye kubibona. Gukosora ibice bibiri birakenewe, kandi umwobo ugomba gucukurwa witonze, kuko hari ibyago byo gukomeretsa imitsi nimiyoboro yamaraso hepfo. Ibyiza: gucukura neza umuyoboro wimbere wimbere, gufata ibyapa, guhuza byoroshye.

Icyitonderwa: Gutera amagufwa mubisanzwe ntabwo bisabwa muburyo bwambere; nyuma yo gukosorwa imbere, nibyingenzi kudoda bihagije urwego rwa myofascial kugirango utwikire isahani kandi wirinde kwandura.

Gukosora

Ibikoresho bigezweho byo gukosora birimo pin ya Kirschner, pinwood ya Rockwood, pin ya Hagie, titanium elastic intramedullary pin, imiyoboro idahwitse, hamwe no gufunga imisumari ya elastique; urugero, imisumari ya titanium ntabwo yemerera gufunga static, ntukemere kugenzura uburebure no kuzunguruka, kandi bishobora kuvamo kugabanuka kwa kabiri mugihe byakoreshejwe kuvunika. Tekinike yimisumari irashobora gukoreshwa gusa kumeneka yoroheje, ihindagurika cyangwa ihindagurika.

Ibyiza

gutemagura bito, byinshi byiza, kwiyambura ingirabuzimafatizo zoroshye, ibyago byo kugabanuka kwa endofite, hamwe no gutuza bijyana no kurwara ibisebe.

Ibibi

kurwara uruhu cyangwa inenge aho winjirira.

Icyitonderwa: Kugabanya gufunga kuvunika kwa clavicle rimwe na rimwe biragoye kandi kurenza urugero ukuboko kwumukoresha kumirasire biririndwa mugihe cyo kubaga.

Nibisanzwe byibasiye isahani

Isahani ntoya yibasira osteosynthesis ya clavicle yatekereje gutanga imbaraga za biomehanike mugihe wirinze ibibi byo gukosora isahani ifunguye cyangwa gukosorwa.

Gushyira mubikorwa bya sisitemu 3.5 ya LCP imbere ya clavicle, byaba byiza imbere yimbere ya clavicle, itanga ibisobanuro kuri clavicle nzima, byoroshye gukora isahani mbere no kubona aperture ndende.

Gukoresha hakiri kare isahani yibasiwe na osteosynthesis irashobora kuba ifitanye isano no gukomeretsa imitsi ya supraclavicular, kudahuza neza cyangwa kugabanya insinga zibiri bigira ingaruka kumikorere, no kunama kw'isahani cyangwa kuvunika.

Isahani yo gukosora ibice byavunitse kuruhande rwa clavicle

Guhitamo ibisahani biterwa nubunini bwuruhande rwamagufwa. Nibura byibuze imigozi 3 ya bicortical irakenewe kugirango igufwa ryuruhande ruruhande. Byiza, imiyoboro ya tension igomba gukoreshwa kumeneka ya oblique. Niba igufwa ryamagufwa ari rito cyane kugirango rikosorwe, hashobora gukoreshwa isahani ya clavicle.

Kuvura acromioclavicular gufatanya gutandukana

Ibikomere bya Acromioclavicular bingana na 12% byimvune zo mu mukandara kandi bikunze kugaragara mubakinnyi buzuye.

Sisitemu ikoreshwa cyane muburyo bwo gutunganya ni Rockwood. Ubwoko bwa I ni sprain ya acromioclavicular ligament hamwe na rostroclavicular ligament idahwitse; ubwoko bwa II ni amarira ya acromioclavicular ligament hamwe na rostroclavicular ligament idahwitse; ubwoko bwa III ni amarira yombi ya acromioclavicular ligament na rostroclavicular ligament; ubwoko bwa IV ni kwimura inyuma ya clavicle ya kure imanika trapezius; ubwoko bwa V ni amarira yuzuye yingingo ya acromioclavicular hamwe na rostroclavicular ligament, hamwe no kwimura ibice birenga 100 ku ijana; n'ubwoko bwa VI ibikomere ni gake cyane, hamwe na clavicle ya kure yimuwe hepfo munsi ya rostral.

Ubuvuzi bwa conservateur hamwe na feri yigihe gito hamwe na kantilever irasabwa kubwoko bwa I nubwoko bwa II. Imicungire yimvune zo mu bwoko bwa III ntivugwaho rumwe, hamwe nubuvanganzo bumwe buvuga ko ubuvuzi bwita ku barwayi bugaragara ku rubyiruko rukuze rukora. Gusubirana imikorere nibyiza nubwo hashobora kubaho impamyabumenyi zitandukanye muburyo bugaragara. Ubwoko bwa IV - VI ibikomere birakomeye kandi birasabwa gutabara.

Kugeza ubu, uburyo bwo kubaga bukunze gukoreshwa ni: Bosworth rostral yo gufunga tekinike ya tekinike hamwe no gusana icyiciro kimwe cyangwa kudasana ligament; Tightrope ya tab ya plaque ikosorwa cyangwa inanga yerekana suture ikoresheje arthroscope cyangwa agace gato; na rostral gufunga ligament suture cyangwa guhagarikwa gushimangirwa, hamwe nibikoresho bya artile cyangwa tendon hagati ya rostral eminence na clavicle.

Ntabwo byumvikana tekiniki yo kubaga ifite akamaro kanini, kandi nubwo hashobora kubaho urwego runaka rwo gutakaza reurfacing, ingaruka zanyuma zubuhanga bwose zirashimishije.

Kuvura imvune zo hagati ya clavicle hamwe no gutandukana kwa sternoclavicular

Izi nkomere ni gake, kandi na none hariho kubura amabwiriza yo kuvura ashingiye ku buvuzi bushingiye ku bimenyetso.

Ivunika rya clavicle yo hagati ni akenshi ivunika ridasanzwe hamwe no kwimurwa ridafite akamaro kandi birashobora kuvurwa muburyo bwiza. Epiphysis yimpera yo hagati ya clavicle mubisanzwe ifunga kumyaka 23-25 ​​kandi niyo epiphysis yanyuma ifunga mumubiri. Kubwibyo, ibikomere byinshi byo hagati ni ibice bya epiphyseal plaque ya Salter-Harris ubwoko bwa I cyangwa II. X-imirasire isanzwe biragoye kuyisuzuma, hamwe nibyiza ko 40 ° yumutwe wa radiyo ugereranya no kugereranya kuruhande rwiza bishobora kwerekana kwimura impera yimpera ya clavicle, kandi CT itanga amashusho meza yo gusuzuma.

Kuvunika cyangwa kwimurwa byimuwe imbere birashobora gufungwa no kwimurwa, ariko akenshi bidahinduka kandi bigahinduka kugirango bimurwe. Ubuvuzi bwa Palliative burasabwa kwimurwa cyangwa kwimurwa bidasubirwaho kuko akenshi bidatera imikorere mibi. Kwimura impera yo hagati ya clavicle inyuma ntibikunze kuviramo gukomeretsa hagati, harimo gukomeretsa kw'imitsi cyangwa no guhagarika tracheal no guhagarika inzira. Kubijyanye no gutandukana no kuvunika aho igice cyo hagati ari gito cyane, amasahani arashobora guhuzwa hakurya kugirango akosore kuri sternum.

Ubundi buryo bwo gukosora

urugero gukosora hanze hamwe na stent, gukosora hanze hamwe na plaque clavicle, nibindi.

Ubuyobozi nyuma yubuvuzi

Ukuboko hejuru kurashobora guhagarikwa mumaguru kandi imyitozo ya pendulum yigitugu igomba gutangira ako kanya. Nyuma y'ibyumweru 2, umurwayi agomba gukurikiranwa kugirango asuzume igikomere kandi asuzume X-ray, mugihe umugozi wamaboko ushobora gukurwaho kandi imyitozo yo kugendana imipaka ntigabanijwe irashobora gutangira, ariko umurwayi agomba kubwirwa kudaterura ibiro hamwe ningingo zanduye. Imyitozo yimbaraga irashobora gutangira mubyumweru 6 nyuma yo kubagwa mugihe hagaragaye ibimenyetso byo gukira amagufwa. Menyesha siporo cyangwa siporo ikabije bigomba kwirindwa amezi 3 nyuma yo kubagwa kugeza igihe kuvunika gukize.

Ingorane.

Ingorane zo hambere

Indwara zanduye nyuma yo kubagwa zishobora kugaragara kugeza kuri 4.8%;

Kunanirwa mu karere ka subclavian nicyo kibazo gikunze kugaragara, hamwe n’ubushakashatsi bwakozwe ku mateka karemano y’abarwayi bagera kuri 83% bafite iki kimenyetso, kikagabanuka uko igihe kigenda kandi ntigitera imikorere mibi, nubwo gishobora kumara imyaka 2 nyuma yo kubagwa;

Endophyte protrusion hamwe no guhindagurika k'uruhu, bisanzwe hamwe no gukoresha amasahani manini cyangwa umurizo wimisumari udafite ingirabuzimafatizo nziza;

kongera kuvunika, bishobora kubaho nyuma yubuvuzi bwo kubaga no kubungabunga ibidukikije; nyuma yo kubagwa nyuma yo kubagwa bishobora kuviramo kunama cyangwa kumena endoprosthesis, cyangwa kuvunika hafi ya endoprosthesis;

kudahuza, hamwe na 15% yo kudahuza hamwe no kuvura abagumyabanga hamwe na 2% yo kudahuza hamwe no kubaga kubuvuzi bwa diaphyseal yimuwe burundu; kwimura burundu kuvunika, kugabanya kurenza cm 2, kunywa itabi, kongera imyaka, gukomeretsa ingufu nyinshi, kongera kuvunika (guhungabana kwa mashini), kwimura diaphyseal recalcitrant, kutagira amagufwa mabi, no gutakaza amagufwa menshi.

Ibibazo bitinze

Osteoarthritis yo mu bwoko bwa acromioclavicular ibaho kenshi hamwe no kuvunika imbere (ubwoko bwa Edinburgh 3B2); iyo kuvura ibimenyetso no kubungabunga ibidukikije ntacyo bivuze, clavicle ya kure irashobora guterwa arthroscopique cyangwa kubagwa kumugaragaro;

Gukiza ubumuga, bibaho ku buryo butandukanye mu kuvunika kwimuwe kwimuwe; kugabanya umukandara wa scapular uherekejwe no kuzenguruka kumeneka ya kure bishobora kuvamo kugabanuka kwingufu zintugu no kwihangana, cyane cyane gushimuta ibitugu; kugabanuka kwa thoracic gusohoka bishobora kuvamo ibimenyetso byo kwikuramo brachial plexus; hamwe no kudahuza ingingo ya scapulothoracic urukuta rushobora gutera imbere ya scapula kandi bigatera ububabare bwigitugu na myalgiya, niba bigaragara ko ibimenyetso bituruka kumubiri Iyo gukira bibaye, gukosora osteotomy no gukosora amasahani birashoboka ukurikije ibyo umurwayi akeneye.

Kumenyekanisha n'ibizagerwaho

Ubushakashatsi bujyanye n’uburayi bwatangaje ko kubaga ubuvuzi bwavunitse bwa midclavicular bwimuwe bwagize akamaro, kandi isesengura ryakozwe na meta ryerekanye ko indwara ya malunion itera kuvunika no kutavura ibimenyetso byaragabanutse cyane mu itsinda ry’abaganga ugereranije no mu itsinda ryavuwe neza igihe kubaga byagereranywaga no kuvura abaganga; hiyongereyeho, itsinda ryo kubaga ryagabanije ububabare hakiri kare, kandi iterambere ryamanota ya Constant na DASH ryagaragaye cyane.

Vuga muri make

Ivunika ryinshi rya clavicle riterwa n’urugomo rutaziguye cyangwa rutaziguye, kandi ubuvuzi bushobora gushyirwa mu rwego rwo kuvura indwara zo kubaga cyangwa kubaga. Kubijyanye no kuvura, nubwo kuvunika kwa clavicle kutagira kwimurwa gukomeye gushobora kuvurwa muburyo bwitondewe, uburyo bwo kubaga uburyo bwo kubaga kuvunika hamwe no kwimurwa gukomeye ntibivugwaho rumwe. Kuvunika kwa clavicle kwimuwe, ubuvuzi bwo kubaga bufite umuvuduko mwinshi wo gukiza amagufwa hamwe ningaruka zikorwa hakiri kare ugereranije no kuvura indwara.

Reba

[1] Postacchini F, Gumina S, De Santis P, Albo F. Epidemiologiya yo kuvunika clavicle. J Urutugu Elbow Surg 2002; 11: 452.

[2] Eiff, Depite, Hatch, n'abandi. Ivunika rya Clavicle na scapula. Muri: Gucunga kuvunika kubuvuzi bwibanze, icya 2, WB Saunders, Philadelphia 2002. P.198.

[3] Robinson CM. Ibice bya clavicle mubantu bakuru. Epidemiologiya no gushyira mu byiciro. J Amagufwa Yungurije Surg Br 1998; 80: 476.

[4] Neer CS ya 2. Ibice bya gatatu bya kure ya clavicle. Clin Orthop Relat Res 1968; 58:43.

[5] Andersen K, Jensen PO, Lauritzen J. Kuvura kuvunika clavicular. Igishushanyo-cya-umunani bande na shitingi yoroshye. Acta Orthop Scand 1987; 58:71.

[6] Ersen A, Atalar AC, Birisik F, n'abandi. Kugereranya amaboko yoroshye yo gushushanya nigishushanyo cyumunani wa clavicular bandage ya midshaft clavicular ivunika: ubushakashatsi bwateganijwe. Amagufwa ahuriweho J 2015; 97-B: 1562.