Lecture on 锁骨骨折

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Clavicle fracture
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summary
one of the most common bony injuries
mechanism of injury to be consistent with a direct blow rather than a fall on the outstretched hand.
summary one of the most common bony injuries mechanism of injury to be consistent with a direct blow rather than a fall on the outstretched hand.
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Open or close???
Neer found nonunion only 0.1% in the clavicle treated closed
fractures treated by open reduction, nonunion occurred 4%. 
Do not be tempted to treat a fracture of the clavicle by open reduction merely because the patient or family objects to a bony prominence at the fracture.
Open or close??? Neer found nonunion only 0.1% in the clavicle treated closed fractures treated by open reduction, nonunion occurred 4%. Do not be tempted to treat a fracture of the clavicle by open reduction merely because the patient or family objects to a bony prominence at the fracture.
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Open or close???
Even if the ends of the fragments heal in an overlapped or bayonet position with a substantial bony prominence, this largely is resorbed with time and the mass decreases.
Even though displaced fractures of the clavicle often cannot be reduced and maintained in perfect position, cosmesis is acceptable, and functional results are uniformly excellent.
Open or close??? Even if the ends of the fragments heal in an overlapped or bayonet position with a substantial bony prominence, this largely is resorbed with time and the mass decreases. Even though displaced fractures of the clavicle often cannot be reduced and maintained in perfect position, cosmesis is acceptable, and functional results are uniformly excellent.
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Indication for open
Nonunion. This is the most frequent indication for open reduction. Internal fixation and bone grafting are required. 
Neurovascular involvement.
Fracture of the distal end with torn coracoclavicular ligaments in an adult.
A persistent wide separation of the fragments with interposition of soft tissue. 
Floating shoulder. Fractures of both the clavicle and the surgical neck of the scapula make the scapular fracture unstable.
Indication for open Nonunion. This is the most frequent indication for open reduction. Internal fixation and bone grafting are required. Neurovascular involvement. Fracture of the distal end with torn coracoclavicular ligaments in an adult. A persistent wide separation of the fragments with interposition of soft tissue. Floating shoulder. Fractures of both the clavicle and the surgical neck of the scapula make the scapular fracture unstable.
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ORIF
We prefer to use a small, semitubular AO plate rather than an intramedullary pin if the clavicular fracture requires internal fixation.
Expose the fracture through a curvilinear incision. Strip the periosteum sparingly but sufficiently to allow application of the plate. A four- or five-hole plate usually is sufficient. Apply it to the superior surface of the bone. Use extreme care in drilling and placing the screws to avoid injury to the subclavian vein and underlying thoracic contents. During the drilling place a protective instrument inferior to the clavicle to prevent the drill bit from inadvertently entering the thorax.
ORIF We prefer to use a small, semitubular AO plate rather than an intramedullary pin if the clavicular fracture requires internal fixation. Expose the fracture through a curvilinear incision. Strip the periosteum sparingly but sufficiently to allow application of the plate. A four- or five-hole plate usually is sufficient. Apply it to the superior surface of the bone. Use extreme care in drilling and placing the screws to avoid injury to the subclavian vein and underlying thoracic contents. During the drilling place a protective instrument inferior to the clavicle to prevent the drill bit from inadvertently entering the thorax.
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AFTERTREATMENT
The arm is supported in a sling for 1 to 2 weeks. 
Union should be solid in 8 to 10 weeks.
 Light activities of daily living are possible, but the arm should not be raised above the head until union.
AFTERTREATMENT The arm is supported in a sling for 1 to 2 weeks. Union should be solid in 8 to 10 weeks. Light activities of daily living are possible, but the arm should not be raised above the head until union.
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How to treat fracture of the distal end with torn coracoclavicular ligaments in an adult.
the fracture is held securely by two medullary pins from acromion into the proximal fragment ,Repair of the coracoclavicular ligaments is unnecessary .
Alternatively, coracoclavicular ligament disruption can be augmented with PDS-bands (Ethicon, Inc) that are used as a sling around the clavicle and coracoid process.
How to treat fracture of the distal end with torn coracoclavicular ligaments in an adult. the fracture is held securely by two medullary pins from acromion into the proximal fragment ,Repair of the coracoclavicular ligaments is unnecessary . Alternatively, coracoclavicular ligament disruption can be augmented with PDS-bands (Ethicon, Inc) that are used as a sling around the clavicle and coracoid process.