Fraktur Clavicula Ppt

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Fraktur clavicula DM Bedah RSU Haji

Text of Fraktur Clavicula Ppt

Fracture & Dislocation of Clavicula

Fracture & Dislocation of Claviculadr Erwien Isparnadi Sp.OT

IntroductionFractures of the clavicle are common injuries accounting for between 2.6 and 4% of adult fractures and 35% of injuries to the shoulder girdle Hippocrateswho noted that when a fractured clavicle is fairly broken across it is more easily treated, but when broken obliquely it is more difficult to manageClavicular fractures are most common in younger patients with incidence greatest in the second and third decadesThe aetiology of clavicle injuries in young adults and children is most commonly an RTA, sports injury and, to a lesser extent, a fallfalls represent their most frequent cause among the elderlyClasification Allman divided clavicle fractures by anatomical site into 3 groups; Group 1 being fractures to the middle thirdGroup 2 being fractures distal to the coraco-clavicular ligamentGroup 3 relating to fractures of the proximal third of the clavicleNeer went further and subdivided lateral third fractures into three groups; undisplaced, displaced, and intra-articular.The displaced types were then divided into 2a or 2b, depending on the presence of injury to the coraco-clavicular (CC) ligaments [6].Thus a type 2a injury represents a fracture medial to both conoid and trapzezoid elements of the CC ligaments, with the shaft displacing superior relative to the lateral endA type 2b injury represents a fracture of the lateral end of the clavicle, with disruption of the conoid portion of the CC ligamenType 1, Middle third

Type 2, lateral third

Type 3, Proximal third

AssesmentAnamnesis : presenting complaint, including mechanisme of injuryPhysic diagnostic : examination on both shoulder and arm, differing limb blood pressures may be present if theres a vascular injuryRadiography :Patients should also have a plain antero-posterior (AP) X-ray performed in the emergency department. Other projections of the clavicle may be performed after liaising with a radiographer, such an apical oblique view of the clavicle with the patient standing at 45 degrees toward the beam and the beam angled 20-30 degrees TreatmentThe majority of clavicle fractures are treated non-operatively with good outcomes. Measures such as an arm sling, analgesia and, in the case of mid shaft fractures, figure of eight bandage across the shoulders, often provide ample treatment. Mid Shaft Clavicular FractureUndisplaced mid-shaft fractures are generally managed non-operatively. displaced mid shaft fracture can be manage by non-operatively,Operatively use platting such as Knowles pins, Rockwood pins, Hagie Pins or titanium elastic nailsLateral end fractureUndisplaced mid-shaft fractures are generally managed non-operatively. Displaced lateral clavicle fractures are often treated operatively with conservative measures being associated with high rates of non-unionNon-operative treatment is generally used in those patients who are low demand, elderly or frailIn the case of a standard distal clavicle plate, three screws (a minimum of two) should be placed in the distal fragment to provide sufficient stabilityMedial end FractureBecause of the close proximity of the mediastinal structures, formal fixation is considered only in the event of marked displacement of the clavicle, with a risk to underlying structuresDislocationDislocation of Sternoclavicular joinDislocation of acromioklavikular (AC) joint

Sternoclavicular jointThe patient complained of mild to moderate pain, especially with movement of the upper limb. Together with a little swelling and pain during palpation, but instability was not found. In moderate sprains occur sternoclavicular joint subluxation. Ligaments can be partially disrupted. There is swelling and pain, especially with movement of the arm. Anterior or posterior sternoclavicular subluxation was evident when the joint is injured compared with normal join

Sternoclavicular joint describe on 2 type, there is:Sternoclavicular joint anteriorSternoclavicular joint posterior

Sternoclavicular joint dislocation (posterior)clavicle will appear less prominent on palpation. Affected shoulder will appear shortened and pushed forward when compared with the normal shoulder. Head can be tilted toward the side of the joint is dislocated. Discomfort increased when the patient is placed in supine position, the shoulder is not affected in a horizontal position compared with healthy shoulders

Some treatment options include open reduction for retrosternal dislocation. However, closed reduction is considered the treatment of choice, especially if the patient presents within 24 hours. A sack of sand or other cushioning placed between the shoulder then pulled shoulder lateral and ipsilateral arm in abduction position. Traction lateral and medial end of the clavicle done is terelevasi forward and laterally. Sling figure of eight used after reduction for 4-6 weeks to help the healing ligament

sternoklavikular (SC) joint anteriordilocationPatients with anterior dislocation usually complain of pain in the SC joint, which increases with movement of the arm; atraumatic cases have only mild symptoms

Acromioclavicular dislocation AC Joint Injuries often occur as a result of a direct blow to the tip of the shoulder, such as a fall or a collision with another player during exercise. This forces the acromion process of the down, beneath the clavicle. In addition, the AC Joint injury can occur as a result of the upward force on the long axis of the humerus in the fall with direct impact when the wrist in a straight position. Usually the shoulders are in a position of adduction and flexion

Rockwood classification

Surgical options for joint instability acromioklavikular including (1) coracoklavikular ligament reconstruction with or without excision of the distal clavicle or (2) stabilization coracoklavikular with ligament reconstruction coracoklavikularHandling directly on soft tissue injury consists of a ricer protocol - rest, ice, compression, elevation and referral. RICE protocol should be followed for 48-72 hours. The goal is to reduce bleeding and damage in the joints. Shoulder must rest in a position of elevation with an ice pack for 20 minutes every two hours (avoid direct contact of ice on the skin). Arm immobilized in a sling at least two days for minor injuries or six weeks for more severe cases. No HARM protocol should also be applied - no heat, no alcohol, no running or activity, and no massage. This will reduce swelling and bleeding in the injured area