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Case Reflection : Left
CLAVICLE Fracture - group Oleh : lili Widianto & dwi endra !p!
"e#$i#$ing : dr! s%aiful #uhtar' sp!$ $d
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introduction
( Cla)icle is the #ost fre*uentl% fractured $one in thechildhood' accounting for +,-+. of all fractures in group!
( Cla)icular inuries affect + in +,,, people per %ear! incidence occurs in #en %ounger than 01 %ears and olde%ears!
(2iddle third 3group I4 5-60. of all fractures of thewhereas distal third 3group II4 +0.' and #edial third 3g. of cases!
( Cla)icular inuries occur 0!1 ti#es #ore co##onl% 7fe#ales!
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Identit%
( 8a#e : 2r! AW9
( Age : + %o
( Address : ua#au treet' R; 1
( <ospitali=ed : >rd April 0,+
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Ana#nesis
( Chief co#plaint :
Right ar#s cannot $e #o)ed
( <istor% of co#plaint :
Right ar#s of the pasien cannot $e #o)ed after ind
#otorc%cle accident 0 da%s ago' the patient use hel#et! other co#plaint is pain in the left shoulde
nausea 3-4' )o##it 3-4' headache 3-4!
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( "ast illnes histor%: 3-4
( Fa#il% illnes histor%: 3-4
( Alergi : 3-4
( 2edical histor% : 3-4
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"h%sic E?a#ination
( Conciousness : Co#pos#entis' E@V12
( Vital sign
/" : ++,6, ##<g
<R : 6, ?i' reguler
RR : 0, ?i' reguler ;o : >B'0oC
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( <ead and nec :
ane#is 3--4' iteri 3--4' pupil isoor >##>##' light perception 34' sign of trau#a 3-4!
( ;hora? :
inspesi: retraction 3-4' si#etris
palpasi : $reathing #o)e#ent and )ocal fre#itus 9 si#etris
perusi : sonor in all of lung fieldausultasi: )esiuler 34' rh 3--4' wh= 3--4' s+s0 reguler
( A$do#en :
inspesi : flat' sign of trau#a 3-4
palpasi : soefl' tenderness 3-4
perusi : t%#phani' acites 3-4
ausultasi : /D 34' nor#al
( Estre#itas :
war# acral' in the left shoulder' ede#a 34' hipere#is 34' CR; 0 deti
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Local tatus
Regio houlder inistra
( Loo
ede#a 34' hipere#is 34
( Feel
"ain 34' AV8 clear' CR; 0 sec( 2o)e
RO2 restricted
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La$orator% Finding
( La$oratoriu# @ april 0,+
W/C : +5!6 +,>ul
<G/ : +@'1 gdl<C; : @6'6.
/; : 0H
C; : 5H
G9 : +50 #gdl
Dreu# : 0@'0 #gdl
Creatinin : ,'1 #gdl
8atriu# : +>5 ##olL
aliu# : 1'+ ##olL
Chloride : +,B ##olL
<$sag :non reatif
A$<i) : non reatif
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Case
MRS 3/4/16
PRO ORIF4/4/16 – 7/4/16ARM SLING (-)
KELUARGAPIKIR-PIKIR
KELUARGAMENOLAK
PASIEN MEKONSERVA
A V N D
A L A M
B A T A S N O
R M A L
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Interpretation :- Middle third left clavicle fracture wit
displacement
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discussion
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clasification
( Group I 3#iddle third fractures4'( Group II 3lateral third fractures4'
J 3a4 those with the coracocla)icular liga#ents intact' J 3/4 those where the coracocla)icular liga#ents are
detached fro# the #edial seg#ent $ut the trape=oid
re#ains intact to the distal seg#ent' J 3C4 factures which are intra-articular!
( Group III 32edial third fractures4! Lateral third fractu$e further su$-classified into
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Group I
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Group II
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Group iii
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#echanis#
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igns & s%#pto#s
;he patient #a% cradle the inured e?tre#it% with the uninured ar#
;he shoulder #a% appear shortened relati)e to the opposite side and #a% droop
welling' ecch%#osis' and tenderness #a% $e noted o)er the cla)icle
A$rasion o)er the cla)icle #a% $e noted' suggesting that the fracture was fro# a direct #echa
Crepitus fro# the fracture ends ru$$ing against each other #a% $e noted with gentle #anipula
9ifficult% $reathing or di#inished $reath sounds on the affected side #a% indicate a pul#onar%a pneu#othora?
"alpation of the scapula and ri$s #a% re)eal a conco#itant inur%
;enting and $lanching of the sin at the fracture site #a% indicate an i#pending open fracture'
often re*uires surgical sta$ili=ation 3see the i#age $elow4
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treat#ent
(Group I J si#ple ar# sling
J Figure of eight
J Internal fi?ation
(Group ii
J i#ple ar# sling J Internal fi?ation
(Group iii J i#ple ar# sling
( E!"#$%&'
( %"
( P#%' %"#$%&'
( F&**&+-!
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"rognosis
( 2ost cla)icle fractures treated nonoperati)e
although with )aria$le a#ounts of cos#etic de
Kounger children generall% re*uire shorter pe
i##o$ili=ation 30-@ w4 than do adolescen
adults 3@-6 w4!
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co#plication
(Neurovascular injuries
(Intrathoracic injuries
(Non-union
(Malunion
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;han %ou