Clavicle tihchhiat a ni

Clavicle fracture hi mi 100,000 zingah 30-60 vel a ni a, mipa leh hmeichhia ratio chu 2:1 vel a ni a, fracture zawng zawng 5% atanga 10% leh shoulder joint hliam 44% a ni. Clavicle hi mihring taksaa ruh (ossification) hmasa ber a ni a, a ruh (ossification) hi embryonic dam chhung kar nga-naah a intan a, intramembranous osteogenesis hmanga ruh sei tak, tubular ruh sei awmchhun a ni. Primitive ossification center hi clavicle lai takah a awm a, kum 5 thlenga clavicle thanna tur a ni. Clavicle chhung leh pawn lam tawp tinah epiphyseal plate lian zel a awm a, mahse a tam zawkah chuan medial ossification center chauh x-ray hmangin hmuh theih a ni. Medial epiphyseal plate hian clavicle sei zawng 80% a tipung a, a ossification center hi kum 13 atanga kum 19 thlengin a lang tan lo tlangpui a, kum 22 atanga 25 inkar thlengin clavicle nen a fuse lo. Chuvangin, damlo naupangte sternoclavicular dislocation hmuhchhuah hunah medial clavicular epiphyseal injury nen thliar hran a pawimawh hle.

Functional Anatomy a ni

Clavicle hi hmalam atanga thlir chuan a dinglam vel a ni a, mahse chunglam atanga thlir chuan S-shaped a ni a, dorsally leh medial lamah ventral side-ah a inher a ni. A cross-section chu long axis-ah a inthlak a, a pawn lam 1/3 chu muscle leh ligament pulling awm thei turin a flatten a; a lai 1/3 chu tubular a lo ni ta a, a diameter a tlahniam a, a dang zawng aiin a cortex a thuk zawk a, ruh a denser bawk a, axial pressure leh tension awm theihna tur leh a hnuaia vascular nerve awmte humhim turin a chhung lam 1/3 chu rhombic a ni a, sternum leh first rib nen hian ligamentous tissue chak tak hmangin a inzawm a ni (Figure 1). Anatomical study-ah chuan hetah hian clavicle hi a chak lo ber a, hei hi middle leh outer 1/3-a morphological variation vang a ni. Chu bakah, subclavian muscle stop lateral-ah a awm a, muscular ligaments venhimna a tlachham a, hei vang hian fracture awmna hmun hlauhawm ber a ni tih clinical observation-ah a lang.

Hliam awm dan (mechanism) a ni

Puitlingah chuan clavicle fracture-ah chuan clavicle fracture-a hliam tuar tam ber chu a hmain kut hyperextended position-a tlu avanga tlu niin an ngai a, mahse Stanley et al. hmuhchhuah dan chuan he hliam mechanism hian mid-clavicle fracture 6.3% leh distal clavicle fracture 5.9% chauh a huam a, damlo zawng zawngah chuan hliam awm dan tlangpui chu direct forces acting on the shoulder joint atanga lo chhuak a ni Damlo zawng zawnga hliam awm dan tlangpui chu direct force on the shoulder joint a ni a, a tlangpuiin significant displacement awm lo emaw, mild displacement chauh nei emaw a ni.

Hyperextended position-a kutphah awma tlu a nih chuan, tlak hnua pawn lam chakna secondary-in a nghawng vang a ni fo thin. Indirect violence avanga fracture chi dang chu pawn lam chaknain shoulder-ah hna a thawk a, chu chuan clavicle chu rib hmasa ber nen a inhnawh a, chu chuan clavicle lai 1/3-ah spiral fracture a siam a ni. Chu bakah, tun hnaia traffic accident a thlen fo avangin, car accident-a a nghawng nasat avangin seat belt hian shoulder-ah fulcrum of force a siam a, chu chuan clavicle lai takah transverse emaw oblique emaw fracture a thlen fo thin a, chu chu miten seat belt fracture an ti thin. Trauma-a tharum thawhna a tam zawk vang pawh a ni mai thei, he fracture chi hi clavicle fracture pangngai aiin non-union a awm duh zawk.

Tihdamna

Middle clavicle a tliak: .

Splint fixation:Clavicle fracture-a splint fixation hi 'gold standard' a la ni reng. Plate-ah hian 3.5mm LC-DCP, 3.5mm reconstruction plate, LCP locking plate, leh plate chi hrang hrang thenkhat te a tel a ni. Splint hman thatna chu: transverse fracture compression; oblique emaw butterfly emaw fracture te chu tension screw hmanga neutralizing splints nena inzawm fixation; rotation control tha tak; damlo nitin hnathawhna atan fracture chu secure fixation; leh splint te hi a tlangpuiin lakchhuah a ngai lo tih te (operation hnu thla 12 atanga thla 18 thleng lak chhuah a ngai a nih chuan).

Distal clavicle tihchhiatna: 1.1.

Clavicle hook splint hi indirect fixation method a ni a, a thatna chu internal fixation dah awlsam, repositioning dik zawka enkawl, acromioclavicular joint tihbuai loh, leh traditional kyphotic pin ang bawkin a chhehvel tissue-a slip lovin internal fixation chu relative stability a ni.

Proximal clavicle tihchhiatna: 1.1.

Literature-ah chuan hetiang fracture chi hrang hrangah hian nonoperative treatment hi duh zawk a ni a, cervical-wrist sling braking hmanga enkawl a ni. Vascular nerve hliam a awm a nih chuan, emaw, a ruh chu hnunglam atanga a inthlak a, damlo thawk emaw, ei emaw a harsat a nih chuan, emaw, chutiang symptoms a awm lo a nih pawhin, mahse imaging atanga a lan dan chuan displaced fracture hian vital posterior structure a tichhe tih leh repositioning a hlawhtling lo tih a hriat chuan incisional internal fixation ngaihtuah theih a ni. Fixation theih loh chuan a tul chuan proximal clavicle chu lakchhuah theih a ni.

Harsatna awm thei

• No healing:Tun hmaa literature-ah chuan clavicle fracture-ah hian non-healing rate 0.9% atanga 4% vel a awm tih an sawi a, tun hnaia bulk case survey an neihah chuan actual non-healing rate chu beisei aia sang zawk a ni tih hmuhchhuah a ni.

• Deformity healing: Traditional ngaihdan chuan clavicle deformity healing hi aesthetic problem chauh a ni a, operation hnua dam lohna a awm chuan deformity awm phalsak ai chuan a rah chhuah a tha zawk tih hi a ni. Mahse, tun hnaia thil hmuhchhuahte chuan clavicle cm 15 aia tawi a nih chuan a tawp lamah natna leh chetna a tikhawtlai fo tih hmuhchhuah a ni. Chu bakah, mithiam thenkhat chuan deformity healing enkawlnaah 'clavicle shaping' awlsam tak an rawt a, mahse he hman dan hi a tha lo. Scab chhuak chauh lak chhuah hian clavicle chu a ti thim thei a, a tikehsawm theihna pawh nasa takin a tipung thei a, clavicle deformity chu dimension thum-ah a lan avangin horizontal plane-a clavicle 'smoothing' ringawt chuan deformity chu a siam tha kim vek dawn lo. Chuvangin, rintlak zawk chu nonunion enkawlna nen a inang a, chu chu incision hnua ruh hnim tam lutuk chu a theih ang anga lak chhuah, internal fixation stabilization leh one-stage bone grafting te hi a ni. Dik tak chuan damlo chu operation hmain non-union hlauhawmzia hriattir a ngai a ni.

• Vascular nerve injury:Clavicle fracture hnua vascular nerve injury awm theihna hi a tir lamah a hniam a, secondary injury hi a fracture hnua vascular nerve space a san avangin a displacement vang a ni tlangpui lo a, a tawp lamah erawh chuan ruh scarbs lo thang lian hian entrapment symptoms a thlen thei thung. Chutiang a nih chuan surgical decompression a ngai fo thin.

• Traumatic arthritis:Clavicle fracture hnua traumatic arthritis hi clavicle pawn lam 1/3 a tliak hnuah acromioclavicular joint-ah a awm fo thin a, a chhan ber chu trauma a thlen lai hian tharum thawhna hmanga he joint hi a tihchhiat vang a ni a, a then chu articular surface inrawlhna fracture vang a ni. Closure a hlawhtlin loh chuan clavicle distal 1 cm chu resect tur a ni a, intraoperative care-ah rostral-clavicular ligament venhim tur a ni.

  
  

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