Sérgio Queiroz [email protected].
Transcript of Sérgio Queiroz [email protected].
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S.Y., MASC., 22 ANOS, ESTUDANTE, ACIDENTE MOTO HAVIA 3 DIAS, DOR OMBRO ESQ, IMPOTÊNCIA FUNCIONAL. VEIO DE OUTRO SERVIÇO COM FAIXA EM 8.
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MECANISMO TRAUMA?
TRAÇÕES ?
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LESÕES ASSOCIADAS:
ESQUELÉTICAS (LUXAÇÃO ESTERNO E ACROMIO CLAVICULAR, DISSOCIAÇÃO ESCÁPULO TORÁCICA, # COSTELAS)
PULMÃO E PLEURA: 3% PNEUMOTÓRAX
PLEXO BRAQUIAL VASCULARES
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FUNÇÕES DA CLAVÍCULA
FORÇA E ESTABILIDADE DO BRAÇO MOVIMENTAÇÃO CINTURA ESCAPULAR INSERÇÕES MUSCULARES (TRAPÉZIO /
DELTÓIDE / PEITORAL MAIOR / ECM) PROTEÇÃO ESTRUTURAS
NEUROVASCULARES FUNÇÃO RESPIRATÓRIA ESTÉTICA
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CLASSIFICAÇÃO:
GRUPO I : 1/3 MÉDIO – 80%
GRUPO II : 1/3 DISTAL – 12%
GRUPO III : 1/3 PROXIMAL – 8%
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INDICAÇÕES P/ CIRURGIA
DESVIOS IMPORTANTES PERFURAÇÃO EM POTENCIAL DA PELE ENCURTAMENTO > 2 CM LESÃO NEUROVASCULAR OMBRO FLUTUANTE # EXPOSTAS POLITRAUMA INCAPACIDADE EM TOLERAR IMOBILIZAÇÃO
(PARKINSON / EPILEPSIA) MAU APARÊNCIA COSMÉTICA
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COMPLICAÇÕES: PSEUDARTROSE: 0,9 / 4%• IMOBILIZAÇÃO INADEQUADA• GRAVIDADE DO TRAUMA• REFRATURA• DESVIO ACENTUADO• # DO 1/3 DISTAL• REDUÇÃO CRUENTA PRIMÁRIA: MÁ FIXAÇÃO INTERNA
CONSOLIDAÇÃO VICIOSA
NEUROVASCULARES: CALO ÓSSEO
INFECÇÃO
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PSEUDARTROSE INFECTADA
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TRATAMENTO?
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P.O.I.
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3 MESES PO
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PLACA PONTE
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TEN – TITANIUM ELASTIC NAIL
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Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. Surgical techniqueJ Bone Joint Surg Am, 2008:(90 Suppl 2):1-8 Class of Evidence: II
AUTHOR'S CONCLUSION:
“Operative fixation of a displaced fracture of the clavicular shaft resulted in improved functional outcome and a lower rate of malunion and nonunion compared with nonoperative treatment at one year follow-up.”
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Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial Class of Evidence: I-II Canadian Orthopaedic Trauma SocietyJ Bone Joint Surg Am, 2007:(89):1-10
AUTHOR'S CONCLUSION:
“Operative fixation of a displaced fracture of the clavicular shaft results in improved functional outcome and a lower rate of malunion and nonunion compared with nonoperative treatment at one year of follow-up. “
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Elastic intramedullary nailing of midclavicular fracturesHartmann E., Hessmann M. H., Gercek E., Rommens P. M.Acta Chir Belg, 2008:(108):428-32 Class of Evidence: IV
AUTHOR'S CONCLUSION:
“Elastic stable intramedullary nailing of displaced midclavicular fractures is a minimally invasive technique with excellent functional results and early pain relief. “