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FRACTURES  OF THE CLAVICLE  Le Kim Trong MD., Le Nghi Thanh Nhan MD.
General Information ,[object Object],[object Object],[object Object],[object Object],[object Object]
Current Debate in Treatment ,[object Object]
Ossification ,[object Object],[object Object],[object Object],[object Object]
Anatomy ,[object Object],[object Object],[object Object],[object Object]
Anatomy Left Clavicle:  Superior & Inferior Views Middle Third Weak to axial load Medial Third Protects brachial plexus, subclavian vessels, & superior lung Convex ventral on medial half Concave ventral on lateral half
Anatomy Weakest region of bone
Anatomy Subcutaneous along entire length  Supraclavicular nerves are only structures to cross anterior to clavicle Scapula and clavicle bound securely by the AC & CC ligaments Main nutrient artery enters just medial to CC ligaments
Clavicle Function ,[object Object],[object Object],[object Object],[object Object],Facilitates the placement of the shoulder in a more lateral position, so the hand can be more effectively positioned to deal with a 3-D environment
[object Object],[object Object],[object Object],[object Object]
Mechanism of Injury ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
VI.Classifications & Treatments   Group I - Middle third  (80-85%) Nondisplaced ,[object Object],nonoperative        Displaced ,[object Object],[object Object],operative 
Group II - Lateral third (10-15%) Type I ,[object Object],[object Object],[object Object],nonoperation                       Type I Group II
Group II - Lateral third (10-15%) Type IIA ,[object Object],[object Object],[object Object],operative                      Type IIA G II
Group II - Lateral third (10-15%) Type IIB ,[object Object],[object Object],[object Object],operative         Type IIB G II
Group II - Lateral third (10-15%) Type III ,[object Object],[object Object],[object Object],nonoperative Type IV ,[object Object],[object Object],[object Object],[object Object],nonoperative Type V ,[object Object],[object Object],[object Object],operative
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classifications
Goals of Treatment ,[object Object],[object Object],[object Object]
Nonoperative Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Closed Reduction Techniques
Immobilisation
Researchs ,[object Object],[object Object]
Researchs   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Researchs ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Indications of operative treatment   (con.)     ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Researchs   ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
Close treatment ,[object Object],[object Object],[object Object]
Plate fixation: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Researchs ,[object Object],[object Object],[object Object]
LC-DCP  ,[object Object],[object Object],[object Object],[object Object]
a) Reconstruction plate fixation at the top. b) DCP fixation at the anterior surface .
Researchs   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Researchs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intramedullary fixation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],Intramedullary fixation
McKeever intramedullary fixation of clavicle
Rockwood  intramedullary pin  of clavicle
Researchs ,[object Object],[object Object],[object Object]
Research ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Research ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DISTAL CLAVICULAR FRACTURES The literature is more controversial for this fracture type than for the midclavicle
Undisplaced Lateral-End Fractures  (Neer Type I ) ,[object Object],[object Object],[object Object]
Displaced Lateral-End Fractures  (Neer Type II ) ,[object Object],[object Object],[object Object],[object Object],[object Object]
RESEARCHS ,[object Object],[object Object]
RESEARCHS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RESEARCHS ,[object Object],[object Object],[object Object],[object Object]
[object Object]
[object Object],[object Object],1. Direct fixation of the fracture site without coracoclavicular stabilization
RESEARCHS ,[object Object],[object Object],[object Object]
Researchs   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
The clavicular hook plate:     +The distal fragment is too small .    +The plate has an offset lateral hook, designed to engage distal to the posterior aspect of the acromion.   + Most surgeons advise routine plate removal at three months after implantation
[object Object],[object Object],[object Object],[object Object]
RESEARCHS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
2. Direct Fixation of the Fracture with Coracoclavicular Stabilization ,[object Object],[object Object],[object Object]
Clinical case
RESEARCHS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RESEARCHS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
3. Coracoclavicular Stabilization With or Without Excision of the Lateral Clavicular Segment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object]
TREATMENT ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Fractures of the clavicle