Kuongororwa uye Kurapa kweClavicle Fractures

Nhanganyaya

Clavicle fractures inowanzojairika uye kazhinji inokonzerwa nekushungurudzika kwakananga kana kusina kunanga kunzvimbo yefudzi. Zvidzidzo mukutanga kwe1960s zvakashuma kuti chiyero chisingaiti che clavicle fractures chakanga chiri pasi pe1%, uye kurapa kwekuchengetedza kwakaguma nekugutsikana kwevarwere; nekuvandudzwa kwemishonga ichangobva kuitika, kurapwa kwekuvhiya kwakawana kubudirira kukuru; saka, varapi vanoshanda mudhipatimendi rekukurumidzira kana kiriniki yevarwere vekunze vanofanirwa kunge vachiziva zvinowanzoitika uye matambudziko ekukuvara uku uye kutungamira kwayo.

Epidemiology

Clavicle fractures account ye 2.6% -5% yevose vakaputsika vanhu vakuru [1,2]. Ongororo yeEurope yaisanganisira 1,000 yakatevedzana clavicle fracture kesi yakawana [3,4] kuti inopfuura 66% yeclavicle fractures yakaitika pakati pe1 / 3 ye clavicle, inenge 25% yaiva lateral 1 / 3 fractures, uye 3% yaiva yepakati 1 / 3 fractures. Chiitiko chekutyoka kweclavicle kwakaratidza kupararira kwebimodal, kunoitika zvakanyanya muvarume vari pasi pemakore makumi matatu ezera, kuchiteverwa neavo vanopfuura makore makumi manomwe.

Clinical Anatomy

Chekutanga skeleton yemunhu kutanga ossification ndeye clavicle, iyo chete bony kubatana pakati pepamusoro ruoko uye hunde, iyo inotaura kure kure neacromion, iyo acromioclavicular (AC) joint, uye proximally ne sternum, sternoclavicular (SC) joint. Aya majoini anonzi atypical synovial joints nekuti akaiswa fibrocartilage pane hyaline cartilage. Iyo clavicle yakasungirirwa kune scapula neacromioclavicular uye rostroclavicular ligaments uye inosungirirwa kune sternum ne sternoclavicular ligament.

Iyo clavicle yakaumbwa 'S'. Iyo proximal hafu-arc mapurojekiti nechemberi, ichisiya nzvimbo yeurourovascular bundle yekumusoro kumucheto. Iyo distal hafu yearc mapurojekiti kumashure (concave) uye yozobatana ne scapula (rostral process uye acromion). Kutsemuka kwe clavicle kunowanzoitika panosangana ma arcs maviri (pakati-arc), zvinowanzoitika nekuda kwekushaikwa kwemarunda anonamatira kumabhonzo evavakidzani munharaunda ino uye nekuti ndiyo isina kusimba chikamu che clavicle. Kana clavicle fracture ichibviswa, chikamu chepamusoro chinenge nguva dzose chichikweverwa kumusoro (cephalad) ne sternocleidomastoid muscle (yakasungirirwa kumagumo ekupedzisira e clavicle) uye chikamu che distal chinodzingwa pasi (caudad) nehuremu hwepamusoro peruoko, uye clavicle inowanzosvika kune imwe neimwe, 'shoo' inopera, imwe neimwe. kunyanya nekuda kwekubatanidzwa kwe subscapularis uye pectoralis huru (iyo mukati inotenderera ruoko rwepamusoro). Izvi zvinonyanya kukonzerwa nekuputika kwe subscapularis uye pectoralis mikuru mikuru (iyo mukati inotenderera ruoko rwepamusoro uye ichikwevera kuchifuva).

Features

Chinangwa checlavicle fracture kurapwa ndechekuderedza marwadzo uye kudzorera kushanda kwemajoini. Mazhinji clavicle fractures achiri kurapwa zvakanyanya kuchengetedza (kazhinji akapfupikiswa neisingapfuuri 15 mm); kurapa kwekuchengetedza senge nhamba-ye-esere mabhandeji, forearm slings, Sayre mabhandeji, Velpeau immobilization masutu, uye immobilization. Suspension immobilization inoitwa muchikamu chakaoma, uye kutanga kwekutanga kwekudzidzira kufamba uye simba rekudzidzira kunowanzoitwa mavhiki e2-6 mushure mekuputsika apo kurwadziwa kunogadzirisa. Kushandiswa kwemufananidzo we8 mabhanji hazvikurudzirwi sezvo zvinogona kutungamirira kune axillary pressure maronda uye zvimwe zvisiri zvekubatana kwekuputsika [5,6].

Nhoroondo uye Kuongororwa Kwenyama

Clavicle fractures inokonzerwa nekukanganisa kwakananga kumapfudzi mushure mekudonha uye kunowanzoonekwa mumitambo yekunze kune vechidiki uye mukusaziva kunowira kune vakwegura. Zvakakosha kutsanangura nzira yekukuvara. Kukuvara kwepamusoro-simba kunogona kusanganiswa nekukuvara kwemusoro uye kwechipfuva, asi kuputsika kunokonzerwa nekushungurudzika kuduku kunogona kuva pathologic. Kukuvara kwekuvhiringidza kunoda kutanga kwekutanga uye kungwarira kusabatanidzwa kwescapular chest wall kuparadzaniswa, neurologic uye kukuvara kwevascular. Mukiriniki, kune kuzvimba uye ecchymosis panzvimbo yekutyoka, yakasanganiswa nekuremara uye unyoro. Kuchenjerera kunofanira kubhadharwa kune zvinyoro zvinyoro zvekusimudza, izvo zvinogona kukonzera ganda necrosis uye ulceration.

Imaging

Zvizhinji zvakaputsika zvinogona kuongororwa ne nyore anteroposterior radiographs. 20 ° musoro tilt radiographs inobvisa mhedzisiro yekupindirana kwe thoracic cavities. Varwere vanofanirwa kuve neradiographed munzvimbo yekuzvitsigira kuti vaone zvirinani kuparara kwekuputsika. Kurema-kurema kweradiographs kunobatsira pakuongorora kutendeseka kwe rostral clavicular ligament mu distal clavicle kana acromioclavicular jointkukuvara.CT inobatsira kuona kukuvara kwakaoma kwebhanhire re scapular uye inopa maonero ari nani ezvinogona kuitika proximal clavicle kukuvara pane sternoclavicular joint. Kutora chipfuva radiograph kunobatsira kubvisa kukuvara kwe thoracic yakabatana, uye kupfupisa kunogona kuongororwa nekuenzanisa ne contralateral clavicle, pamwe nekutonga kunze kwekuparadzanisa rusvingo rwe scapulothoracic.

Types

AO/OTA Fracture Dislocation Typing: The clavicle fracture code 15 ine nzvimbo nhatu: 15.1 proximal (medial), 15.2 diaphysis, uye 15.3 distal (lateral). Proximal (medial) uye distal (lateral) fractures inorongwa semhando A (extra-articular), rudzi B (chikamu intra-articular), uye rudzi C (zvakakwana intra-articular). Kuputsika kwetrunk kunorongwa semhando A (nyore), mhando B (wedge), uye rudzi C (yakaitwa) .Iyo AO / OTA kupatsanurwa kwekuputsika uye kuparadzaniswa hakufungi nezve dhigirii yekufambisa kwekutyoka, uye ikozvino kushandiswa kushoma mukurapa kweclavicle fractures uye pakusarudza kufungidzira.

Allman kutaipa kunobva panzvimbo yekutyoka (I: medial, cadent 1/3, II: lateral 1/3, III: medial 1/3) (Fig. 7.2.1).

Craig akakwenenzvera ichi zvakare pahwaro hwaAllman, ini ndiri pakati pe1/3 ye clavicle; mhando II iri yekunze 1/3 ye clavicle, iyo yakabva yakamurwa kuva 5 marudzi zvichienderana nekutyoka kwekuputsika uye hukama kune rostral clavicular ligament; uye mhando III kuve kutsemuka kwemukati 1/3 ye clavicle, iyo yakakamurwa kuita 5 mhando zvichienderana nedhigirii rekutyoka kwekuchinja uye kana kusaputsika kwacho kwaive intra-articular.

Neer's typing ye lateral 1/3 fractures inosimbisa kukosha kweiyo rostral-clavicular ligament: mhando I inoitika distal kune rostral-clavicular ligament, ine medial fracture block inotamiswa pamusoro; rudzi rwechipiri runosanganisira rostral-clavicular ligament uye rinoguma nepakati pekuputsika kwemukati kubviswa panzvimbo yepamusoro; uye rudzi rwechitatu runoenda kune acromioclavicular joint ne rostral-clavicular ligament yakasara yakasimba.

Edinburgh typing ndiyo hurongwa hwekugadzirisa diaphysis fractures maererano nehuwandu hwekufamba uye comminution.1 Rudzi rwe 1 fractures rinosanganisira kupera kwepakati, rudzi rwechipiri ndiro diaphysis fractures uye rudzi rwe 3 ndeye lateral end fractures. Kuputsika kwe diaphysis kunorongwa maererano nekuvapo kana kusavapo kwekortical contact pakati pezvimedu zvekuputsika mumhando A uye B. Rudzi rwe2A fractures rinowedzera kurongerwa se-nondisplaced (rudzi 2A1) uye angulated (rudzi 2A2), 2B fractures inorondedzerwa sezviri nyore kana kuti wedge-shaped (type 2B1) mhando (rudzi 2B1). kuputsika kunosanganisira kuguma kwepakati pe diaphysis uye rudzi rwe 3 ndiyo kuguma kwekupedzisira kwe diaphysis. Medical and lateral end fractures yakakamurwa kuita subgroups 1 uye 2 zvichienderana nekuti mubatanidzwa wepedyo unobatanidzwa.

Saizvozvo kune Rockwood kutaipa, Jager kutaipa, uye Breitner kutaipa.

Kuvhiya zviratidzo

Kutyoka chaiko

1, kuvhurika kutyoka; 

2, kutamiswa> 2 cm; 

3, kupfupisa>2cm; 

4, kuendeswa kwezvimedu zvekuputsika (> 3); 

5, kutsemuka kwezvikamu zvakawanda; 

6, kuvhurika kwakavhurika nekukuvara kwenyama yakapfava; 

7, kuremara kwakakosha (kutamisa uye kupfupisa); 

8, kukuvara kwescaphoid.

Kukuvara kwakawanda

1, Yakasanganiswa ipsilateral kukuvara kwepamusoro;

2, kukuvara kwepfudzi kunoyangarara;

3, kukuvara kwakawanda;

4, kuputsika kunosanganiswa neurovascular kukuvara;

5, ipsilateral mbabvu dzakawanda dzakatsemuka dzakasanganiswa nekuremara kwechipfuva;

6, kupfupisa clavicle kuita bendekete rine mapapiro;

7, Bilateral clavicle fractures.

Mwoyo murefu

1, Varwere vane kukuvara kwakawanda vanoda kutanga kwepamusoro kurema kubereka;

2, Varwere vanoda kukurumidza kudzoka kubasa (semuenzaniso, elite uye mitambo yemakwikwi).

Nguva yekuvhiya

Kuvhiya kunofanira kuitwa pasina kunonoka kana zviratidzo zvakakwana zvekuvhiyiwa zviripo.

Kunonoka pakuvhiyiwa kunopfuura mavhiki e2-3 mune zviratidzo zvehukama zvinogona kuwedzera kuoma kwekuputsika kwekuputsika, kunyanya pakugadzirira kuvharwa kuderedzwa kwemukati kugadzirisa kuburikidza ne percutaneous techniques.

Kuvhiya kuwana

Murwere anoiswa munzvimbo yebhenji chair kana semi-yakagara. Badzi rakabatwa rakaputirwa pasi kuti risimudze clavicle kuti ive nyore kuvhiyiwa, uye ruoko rwakasungirirwa kubvumira intraoperative mobilization. Kucheka kwakachinjika pamwe neakisi refu ye clavicle kana saber incision inofambirana nelanger pateni inogona kusarudzwa.

Cherechedza: A transverse incision inopa kuwedzera kukuru, nepo longitudinal incision inoderedza njodzi yekukuvara kwetsinga ye supraclavicular uye inonyanya kufadza.

Internal Fixation

3.5 Yakarongeka yekumanikidza mahwendefa, mahwendefa ekuvakazve, kana mapurasitiki LCP anogona kushandiswa kugadzirisa clavicle fractures. Mahwendefa akaiswa zvakanaka pamusoro kana anterior kune clavicle. Maplates akasimba mukukuvara kwebiomechanical kana akaiswa pamusoro, kunyanya kana pane comminuted fracture pazasi, uye zviri nyore kuona. Bicortical fixation ye screws inofanirwa, uye maburi anofanira kudonhedzwa nekuchenjerera kukuru, sezvo kune ngozi yekukuvara kune mitsipa neropa pasi apa. Zvakanakira: kuchera kwakachengeteka kweanterior plate screw channel, plate apposition, nyore contouring.

Cherechedza: Bone grafting kazhinji haidikanwi kune yekutanga maitiro; mushure mekugadzirisa mukati, zvakakosha kuti unyatso suture myofascial layer kuvhara ndiro uye kudzivirira utachiona.

Intramedullary fixation

Ikozvino intramedullary fixation zvishandiso zvinosanganisira Kirschner pini, Rockwood pini, Hagie pini, titanium elastic intramedullary pini, hollow screws, uye elastic locking intramedullary zvipikiri; semuenzaniso, titanium elastic zvipikiri haibvumire kuvharika kwakamira, haibvumire kutonga kwehurefu uye kutenderera, uye inogona kukonzera kupfupikiswa kwechipiri kana ichishandiswa kune comminuted fractures. Iyo intramedullary nailing tekinoroji inogona kungoshandiswa kune yakapusa, yakachinjika kana oblique clavicle fractures.

Zvakanakira

diki incision, aesthetics yakawanda, kushomeka kwematishu akapfava, njodzi yakaderera ye endophyte protrusion, uye kugadzikana kunoenderana nekuumbwa kwegwenga.

Zvakaipa

kutsamwa kweganda kana kukanganisa panzvimbo yekupinda.

Ongorora:Kuvharwa kuderedzwa kweclavicle fractures dzimwe nguva kwakaoma uye kuratidzwa kweruoko rwemushandisi kune radiation kunodzivirirwa panguva yekuvhiya.

Minimally invasive plate fixation

Minimally invasive plate osteosynthesis ye clavicle inofungidzirwa kuti inopa yakakura biomechanical simba uku ichidzivirira zvakaipira zvakavhurika plate fixation kana intramedullary fixation.

Intraoperative placement ye3.5 system LCP anterior kune clavicle, zviri nani nechemberi pasi pe clavicle, inobvumira kutaurwa kune ine hutano clavicle, zvichiita kuti zvive nyore kugadzira ndiro pamberi uye kuwana yakareba screw aperture.

Kutanga kushandiswa kweishoma invasive plate osteosynthesis inogona kunge yakabatana nekukuvara kwetsinga ye supraclavicular, kurongeka kwakashata kana kupfupika kwemaviri ewaya anokanganisa basa, uye kubhenda kwendiro kana kuputsika.

Plate fixation yekuputsika kwekupedzisira kwekupedzisira kwe clavicle

Kusarudzwa kweplate implants kunoenderana nehukuru hwe lateral bone block. Zvishoma zve 3 bicortical screws zvinodiwa kune lateral bone block. Nenzira yakanaka, tension screws inofanira kushandiswa kune oblique fractures. Kana chivharo chepfupa chakanyanya kudiki kuti chigadziriswe, clavicle hook plate inogona kushandiswa.

Kurapa kwe acromioclavicular joint dislocation

Kukuvara kweAcromioclavicular joint account ye12% yekukuvara kwebhanhire re scapular uye inowanzoitika mune vakazadzwa vanosangana vatambi.

Iyo inonyanya kushandiswa staging system ndeye Rockwood staging. Type I is a sprain of the acromioclavicular ligament ine rostroclavicular ligament intact; mhando II kubvarura kweacromioclavicular ligament ine rostroclavicular ligament intact; mhando III kubvarura kwezvose zviri zviviri acromioclavicular ligament uye rostroclavicular ligament; mhando IV ndeyekusimuka kwemashure kweiyo distal clavicle inorovera trapezius; mhando V izere kubvarura kwezvose zviri zviviri acromioclavicular joint uye rostroclavicular ligament, ine inopfuura 100 muzana yekusimuka kwejoini; uye mhando yekukuvara kweVI haiwanzo, uye distal clavicle yakadzingwa ichidzika pasi pasi pe rostral process.

Kuchengetedza kurapa nekupfupika mabhureki ane cantilever sling inokurudzirwa kune mhando I uye mhando II kukuvara. Kutungamirirwa kwekukuvara kwerudzi rwechitatu kune kukakavara, nemamwe mabhuku anoratidza kuti kurapwa kwekuchengetedza kunoratidzwa kune vechidiki vanoshingaira. Kushanda kupora kwakanaka kunyangwe panogona kunge paine madhigirii akasiyana ekuremara muchitarisiko. Rudzi rweIV - VI kukuvara kwakanyanya uye kupindira kwekuvhiya kunokurudzirwa.

Parizvino, maitiro ekuvhiya anowanzoshandiswa ndeaya: Bosworth rostral locking screw technique ne-one-stage repair kana kusagadziriswa kwe ligament;, clavicle hook plate fixation, yakafanana ne lateral end of clavicle fracture; Tightrope's tab plate fixation kana anchor pinning suture kuburikidza nearthroscope kana diki incision; uye rostral locking ligament suture kana yakasimbiswa kumiswa, ine zvinhu zvekugadzira kana tendon pakati pe rostral eminence uye clavicle.

Hazvisi pachena kuti ndeipi nzira yekuvhiya inonyanya kubatsira, uye kunyange zvazvo panogona kunge kune imwe dhigirii yekurasikirwa kwekugadzirisazve, kushanda kwekupedzisira kwemaitiro ose aya kunogutsa.

Kurapa kwepakati pekupedzisira clavicle fractures uye sternoclavicular joint dislocations

Izvi zvinokuvadza zvishoma, uye zvakare pane kushayikwa kwemitemo yekurapa inobva pauchapupu-hwakavakirwa mushonga.

Medial clavicle fractures inowanzowedzera-articular fractures ine kusakosha kusimuka uye inogona kurapwa nekuchengetedza. Iyo epiphysis yepakati pekupedzisira ye clavicle inowanzovhara pamakore 23-25 ​​yemakore uye ndiyo yekupedzisira epiphysis kuvhara mumuviri. Nokudaro, kukuvadzwa kwakawanda kwepakati ndeye epiphyseal plate fractures yeSalter-Harris mhando I kana II. Yakajairika X-rays yakaoma kuongorora, nekunakirwa kweiyo 40 ° musoro inorereka radiograph uye kuenzanisa kune ine hutano divi inogona kuratidza kutama kwepakati pekupedzisira kwe clavicle, uye CT inopa yakanakisa diagnostic imaging.

Kutsemuka kana kutsemuka kunotamiswa pamberi kazhinji kunogona kuvharwa uye kuiswa patsva, asi kazhinji kusagadzikana uye lobotomized yekutamisazve. Palliative care inokurudzirwa kuramba ichibviswa kana kutamiswa nekuti kazhinji haikonzeri kukanganisa kushanda. Kubviswa kwepakati pekupedzisira kwe clavicle shure hakuwanzokonzera kukuvara kwepamusoro kwepakati, kusanganisira kukuvara kwevascular kana kunyange kuvharwa kwetracheal uye kudzvinyirira kwemhepo. Pakutsemuka uye kutsemuka uko chikamu chemukati chiri chidiki zvakanyanya, mahwendefa anogona kuvharwa pajoinhi kuti agadziriswe kune sternum.

Dzimwe nzira dzekugadzirisa

semuenzaniso gadziriso yekunze ine stent, yekunze gadziriso ine clavicle plate, nezvimwe.

Postoperative management

Ruoko rwepamusoro runofanira kuvharika muchipfuramabwe uye kudzidziswa kwepfudzi pendulum kunofanira kutanga nekukurumidza. Mavhiki e2 gare gare, murwere anofanira kuteverwa kuti aongorore ronda uye kuongorora ma-X-rays, nepo sling yepamberi inogona kubviswa uye kusingabvumirwi kudzidziswa kwekufamba kwemajoini kunogona kutangwa, asi murwere anofanira kuudzwa kuti asasimudza masimbi nemakumbo akabatwa. Kudzidziswa kwesimba kunogona kutangwa pamasvondo e6 mushure mekuvhiyiwa apo zviratidzo zvekupora kwebhonzo zvinoonekwa. Kubata mitambo kana mitambo yakanyanyisa inofanira kudziviswa kwemwedzi ye3 mushure mekuvhiyiwa kusvikira kuputsika kwapora zvachose.

Matambudziko.

Matambudziko ekutanga

Zvirwere zvemaronda epashure zvinogona kuitika kusvika ku4.8% yezviitiko;

Numbness munharaunda ye subclavia ndiyo inonyanya kuoma, nekuongorora kwezvakaitika kare kusvika ku83% yevarwere vane chiratidzo ichi, iyo inopera nekufamba kwenguva uye haitungamiri kune kusakosha kwakanyanya, kunyange zvazvo inogona kuramba ichienderera kusvika kumakore maviri mushure mekushanda;

Endophyte protrusion uye kubvongodzwa kweganda, zvakajairika nekushandiswa kwemaplateti ane simba kana miswe yezvipikiri pasina kufukidzwa kwakanaka kwenyama yakapfava;

zvakare-kutsemuka, izvo zvinogona kuitika mushure mekuvhiya uye kuchengetedza kurapwa; mushure mekuvhiyiwa kukuvara zvakare kunogona kukonzera kukotama kana kuputsika kweiyo endoprosthesis, kana kuputsika kwakatenderedza endoprosthesis;

nonunion, ine 15% yezvisingabvumirwe chiyero neanochengetedza kurapa uye 2% yeanonunion chiyero nekuvhiya kurapwa kweakabva zvachose diaphyseal fractures; kutama kwakakwana kwekuputsika, kupfupisa kukuru kupfuura 2 cm, kusvuta, kuwedzera zera, kukuvara kwepamusoro-simba, kuparara zvakare (mechanical instability), recalcitrant diaphyseal dislocations, hurombo husina kunaka hwemapfupa, uye kunyanya kurasikirwa kwepfupa.

Kunonoka matambudziko

Osteoarthritis yejojo ​​ye acromioclavicular inowanzoitika kakawanda ne intra-articular fractures (Edinburgh rudzi 3B2); kana kurapa kwechiratidzo uye kuchengetedza kusingashande, iyo distal clavicle inogona kudzokororwa arthroscopically kana nekuvhiya pachena;

Kuporeswa kwekuremara, kunoitika kune madhigirii akasiyana-siyana mune zvese zvakachengetedzeka zvakarapwa zvakatyoka; kupfupisa kwebhanhire re scapular rinoperekedzwa nekutenderera kwe distal fracture block kunogona kukonzera kuderera kwekupedzisira kwesimba remafudzi uye kutsungirira, kunyanya mukubviswa kwefudzi; kupfupika kweiyo thoracic kubuda kunogona kukonzera zviratidzo zvebrachial plexus compression; uye kusarongeka kwe scapulothoracic wall joints kunogona kukonzera anterior tilting ye scapula uye kubudisa marwadzo epafudzi uye myalgias, kana zviri pachena kuti zviratidzo zvinobva pakuremara Kana kuporesa kunoitika, kururamisa osteotomy uye kugadzirwa kweplate kunokwanisika zvichienderana nezvinodiwa nemurwere.

Prognosis uye mhedzisiro

Chimwe chidzidzo chakabatana muEurope chakashuma kuti kurapwa kwekuvhiyiwa kwekuputsika kwepakati pepakati kwakabudirira, uye meta-analysis yakaratidza kuti chiitiko che malunion chinotungamirira pakuputsika nonunion uye zviratidzo zvinobudisa malunion zvakanyanya kuderera muboka rekuvhiya kupfuura muboka rekuchengetedza rakachengetwa apo kuvhiyiwa kwakafananidzwa nekurapa kwekuchengetedza; kuwedzera, boka rekuvhiya rakanga raderedza marwadzo kare kare, uye kuvandudzwa kweConstant uye DASH maitiro ekushanda ainyanya kutaurwa.

Pfupisa

Mazhinji clavicle fractures anokonzerwa nechisimba chakananga kana chisina kunanga, uye kurapwa kunogona kuiswa muchikamu sekuchengetedza kana kuvhiya kurapwa. Panyaya yekurapa, kunyangwe akawanda clavicle fractures pasina kuchinjika kwakakosha anogona kurapwa zvine hungwaru, yekuvhiya kurapwa sarudzo yekutyoka nekutamisa kwakakosha kune nharo. Kune vakadzingwa clavicle fractures, kurapwa kwekuvhiya kune mwero wepamusoro wekupora kwemapfupa uye yekutanga kushanda kwemhedzisiro kana ichienzaniswa neinochengetedza kurapwa.

References

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[3] Robinson CM. Kuputsika kwe clavicle mumunhu mukuru. Epidemiology uye kupatsanura. J Bone Joint Surg Br 1998; 80:476.

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