[Ortho] Re: Ортопедический квест: «допустимое» смещение отломков ключицы

[Dr. A. Liberson]

I agree in 101% with dr Chelnokov- He was overtreated and I do not understant who gains.
We tret p-nts- not X-rays
AL
  ----- Original Message ----- 
  From: Alexander Chelnokov 
  To: Orthoforum 
  Sent: Tuesday, August 21, 2007 9:25 PM
  Subject: Re: [Ortho] п·я─я┌п╬п©п╣п╢п╦я┤п╣я│п╨п╦п╧ п╨п╡п╣я│я┌: б╚п╢п╬п©я┐я│я┌п╦п╪п╬п╣б╩ я│п╪п╣я┴п╣п╫п╦п╣ п╬я┌п╩п╬п╪п╨п╬п╡ п╨п╩я▌я┤п╦я├я▀


  Dear п⌠п╣п╬я─пЁп╦п╧ п╗п╬я┌п╟п╡п╦я┤,

  Tuesday, August 21, 2007, 11:51:45 PM, you wrote:

  п⌠п⌠п╗> п╟п╢п╪п╦п╫п╦я│я┌я─п╟я┌п╦п╡п╫п╬-п╨п╩п╦п╫п╦я┤п╣я│п╨п╟я▐ п╢п╦я│п╨я┐я│я│п╦я▐ п©п╬ п©п╬п╡п╬п╢я┐ я─п╣п╥я┐п╩я▄я┌п╟я┌п╬п╡ п╩п╣я┤п╣п╫п╦я▐
  п⌠п⌠п╗> п©п╣я─п╣п╩п╬п╪п╟ п╨п╩я▌я┤п╦я├я▀ п╡ п╬п╢п╫п╬п╪ п╦п╥ я┌я─п╟п╡п╪п╟я┌п╬п╩п╬пЁп╦я┤п╣я│п╨п╦я┘ п╬я┌п╢п╣п╩п╣п╫п╦п╧.

  п░ п╫п╣п╩я▄п╥я▐ п╩п╦ п©я─п╦п©п╬п╢п╫я▐я┌я▄ п╥п╟п╡п╣я│я┐ - я┤я┌п╬ п©п╬я│п╩я┐п╤п╦п╩п╬ 1)п©я─п╦я┤п╦п╫п╬п╧ п╦ 2)п©п╬п╡п╬п╢п╬п╪
  я█я┌п╬п╧ п╢п╦я│п╨я┐я│я│п╦п╦? п║я┌я─п╟я┘п╬п╡п╟я▐ п╨п╬п╪п©п╟п╫п╦я▐ п╡я▀я│п╨п╟п╥п╟п╩п╟ п╫п╣п╢п╬я┐п╪п╣п╫п╦п╣? п≤п╩п╦ п©п╟я├п╦п╣п╫я┌
  п©п╬п╤п╟п╩п╬п╡п╟п╩я│я▐?

  п⌠п⌠п╗> п╡я▀п©п╬п╩п╫п╣п╫п╦я▐ п╫п╬п╡п╬п╨п╟п╦п╫п╬п╡п╬п╧ п╠п╩п╬п╨п╟п╢я▀ п╢п╣п╤я┐я─п╫п╬п╧ п╠я─п╦пЁп╟п╢п╬п╧ п╡я▀п©п╬п╩п╫п╣п╫п╟ п╥п╟п╨я─я▀я┌п╟я▐
  п⌠п⌠п╗> я─п╣п©п╬п╥п╦я├п╦я▐, п╫п╟п╩п╬п╤п╣п╫я▀ п╨п╬п╩я▄я├п╟ п■п╣п╩я▄п╠п╣. п═п╣п╥я┐п╩я▄я┌п╟я┌я▀ я─п╣п©п╬п╥п╦я├п╦п╦ п©п╬п╨п╟п╥п╟п╫я▀ п╫п╟

  п÷п╬я┤п╣п╪я┐ п©п╟я├п╦п╣п╫я┌ п╬п╨п╟п╥п╟п╩я│я▐ п╡ п©я─п╦п╣п╪п╫п╬п╪ п©п╬п╨п╬п╣, п╟ п╫п╣ п╡ я┌я─п╟п╡п╪п©я┐п╫п╨я┌п╣?

  п⌠п⌠п╗> п÷п╟я├п╦п╣п╫я┌ пЁп╬я│п©п╦я┌п╟п╩п╦п╥п╦я─п╬п╡п╟п╫ п╡ я┌я─п╟п╡п╪п╟я┌п╬п╩п╬пЁп╦я┤п╣я│п╨п╬п╣ п╬я┌п╢п╣п╩п╣п╫п╦п╣,

  п≈п╟я┤п╣п╪? п≤п╩п╦ п©п╬п╡я─п╣п╤п╢п╣п╫п╦я▐ п╫п╣ п╦я│я┤п╣я─п©я▀п╡п╟п╩п╦я│я▄ п╦п╥п╬п╩п╦я─п╬п╡п╟п╫п╫я▀п╪ п©п╣я─п╣п╩п╬п╪п╬п╪
  п╨п╩я▌я┤п╦я├я▀?

  п⌠п⌠п╗>  пЁп╢п╣ п╡ я┌п╣я┤п╣п╫п╦п╣ 6 п╢п╫п╣п╧ п©я─п╬п╡п╬п╢п╦п╩п╬я│я▄ Lп╫п╟п╠п╩я▌п╢п╣п╫п╦п╣б╕ п╥п╟ я│п╬я│я┌п╬я▐п╫п╦п╣п╪
  п⌠п⌠п╗> п╨п╬п╩п╣я├ п■п╣п╩я▄п╠п╣ п╦ я│п╢п╣п╩п╟п╫п╟ п╬п╢п╫п╬п╨я─п╟я┌п╫п╟я▐ п©п╬п©я▀я┌п╨п╟ Lп╦п╥п╪п╣п╫п╣п╫п╦я▐ п©п╬п╩п╬п╤п╣п╫п╦я▐

  п▒п╣я│я│п╪я▀я│п╩п╣п╫п╫п╟я▐ п╪п╟п╫п╦п©я┐п╩я▐я├п╦я▐.

  п⌠п⌠п╗> п²п╟ 7-п╣ я│я┐я┌п╨п╦ п╡я▀п©п╦я│п╟п╫ п╦п╥ я│я┌п╟я├п╦п╬п╫п╟я─п╟ я│ я─п╣п╨п╬п╪п╣п╫п╢п╟я├п╦п╣п╧ п╩п╣я┤п╣п╫п╦я▐ п╡ я┐я│п╩п╬п╡п╦я▐я┘

  п≈п╢я─п╟п╡я▀п╧ я│п╪я▀я│п╩ п╡я│п╣-я┌п╟п╨п╦ п╡п╬п╥п╬п╠п╩п╟п╢п╟п╩ ;-)

  п⌠п⌠п╗> пЁп╬я│п©п╦я┌п╟п╩п╦п╥п╟я├п╦п╦ я┤п╣я─п╣п╥ я┌я─п╦ п╫п╣п╢п╣п╩п╦ п╢п╩я▐ я─п╣п╫я┌пЁп╣п╫п╬п╩п╬пЁп╦я┤п╣я│п╨п╬пЁп╬ п╨п╬п╫я┌я─п╬п╩я▐.

  п■п╩я▐ я─п╣п╫я┌пЁп╣п╫п╟ - пЁп╬я│п©п╦я┌п╟п╩п╦п╥п╟я├п╦я▐???

  п⌠п⌠п╗> п═п╣п╥я┐п╩я▄я┌п╟я┌ я│я┌п╟я├п╦п╬п╫п╟я─п╫п╬пЁп╬ п╩п╣я┤п╣п╫п╦я▐ п©я─п╦п╡п╣п╢п╣п╫ п╫п╟ я─п╣п╫я┌пЁп╣п╫п╬пЁя─п╟п╪п╪п╣ (Xray_3).

  п╜я┌п╬ п╨п╟я─я┌п╦п╫п╨п╟ я┌п╬ п╣я│я┌я▄ я┤п╣я─п╣п╥ п╫п╣п╢п╣п╩я▌ п©п╬я│п╩п╣ я┌я─п╟п╡п╪я▀, п©я─п╦ п╡я▀п©п╦я│п╨п╣?
  п▒п╬п╩п╣п╣ я┤п╣п╪ п©я─п╦п╣п╪п╩п╣п╪п╬.

  п⌠п⌠п╗> п÷я─п╬я┬я┐ п╬я┌п╡п╣я┌п╦я┌я▄ п╫п╟ п╡п╬п©я─п╬я│: я│я┤п╦я┌п╟п╣я┌п╣ п╩п╦ п▓я▀, я┤я┌п╬ Lп©п╬я│п╩п╣ я─п╣п©п╬п╥п╦я├п╦п╦ я│я┌п╬я▐п╫п╦п╣
  п⌠п⌠п╗> п╨п╬я│я┌п╫я▀я┘ я└я─п╟пЁп╪п╣п╫я┌п╬п╡ я┐п╢п╬п╡п╩п╣я┌п╡п╬я─п╦я┌п╣п╩я▄п╫п╬п╣, я│п╪п╣я┴п╣п╫п╦п╣ п©п╬ п╢п╩п╦п╫п╣ п╦ я┬п╦я─п╦п╫п╣
  п⌠п⌠п╗> п╢п╬п©я┐я│я┌п╦п╪п╬п╣б╕? п■п░. п²п∙п╒.

  п■п╟, п╢п╟, п╢п╟-п╢п╟-п╢п╟! п·я│п╬п╠п╣п╫п╫п╬ п╡ 15 п╩п╣я┌.

  п⌠п⌠п╗> п║п╡п╬п╠п╬п╢п╫п╬п╣ п╡я▀я│п╨п╟п╥я▀п╡п╟п╫п╦п╣ я┌п╟п╨п╤п╣ п©я─п╦п╡п╣я┌я│я┌п╡я┐п╣я┌я│я▐.

  п∙я│п╩п╦ п©п╟я├п╣п╫я┌ я│ п╡я▀я│п╬п╨п╦п╪п╦ п©п╬я┌я─п╣п╠п╫п╬я│я┌я▐п╪п╦ (п©я─п╬я└п╣я│я│п╦п╬п╫п╟п╩я▄п╫я▀п╧ я│п©п╬я─я┌я│п╪п╣п╫?
  п╬п╩п╦пЁп╟я─я┘?), я┘п╬я┤п╣я┌ я│я█п╨п╬п╫п╬п╪п╦я┌я▄ п╡я─п╣п╪я▐, п╫п╣ я┌п╟я│п╨п╟я┌я▄я│я▐ п╡п╬ п╡я│я▐п╨п╬пЁп╬ я─п╬п╢п╟
  п╨п╬п╩я▄я├п╟я┘ п╦ п╡п╬я│я▄п╪п╣я─п╨п╟я┘, я┌п╬ я┐п╤ я│я┌п╬п╦п╩п╬ п©я─п╬я│я┌п╬ я│п╢п╣п╩п╟я┌я▄ п╬я│я┌п╣п╬я│п╦п╫я┌п╣п╥. п╜я┌п╬
  п╣п╢п╦п╫я│я┌п╡п╣п╫п╫п╬п╣, я┤я┌п╬ я│п╢п╣п╩п╟п╩п╬ п╠я▀ пЁп╬я│п©п╦я┌п╟п╩п╦п╥п╟я├п╦я▌ п╬п©я─п╟п╡п╢п╟п╫п╫п╬п╧. п▓ п╬я│я┌п╟п╩я▄п╫п╬п╪ - 
  я┌я─п╟п╡п╪п╟ п╟п╪п╠я┐п╩п╟я┌п╬я─п╫п╟я▐. п∙я│п╩п╦ п╫п╣ п╢п╣п╩п╟я┌я▄ п╨п╟п╤п╢я▀п╧ п╢п╣п╫я▄ п©п╬п©я▀я┌п╨п╦ я─п╣п©п╬п╥п╦я├п╦п╦, я┌п╬
  я┐ п©п╟я├п╦п╣п╫я┌п╟ 15 п╩п╣я┌ я│я─п╟я┴п╣п╫п╦я▐ п╪п╬п╤п╫п╬ п╬п╤п╦п╢п╟я┌я▄ п╡ 101% я│п╩я┐я┤п╟п╣п╡.

  п⌠п⌠п╗> п╩п╦я┌п╣я─п╟я┌я┐я─п╫я▀п╣ я│я│я▀п╩п╨п╦ п╫п╟ п╦я│я┌п╬я┤п╫п╦п╨п╦, п©п╬я│п╡я▐я┴п╣п╫п╫я▀п╣ п╩п╣я┤п╣п╫п╦я▌
  п⌠п⌠п╗> п©п╬п╢п╬п╠п╫я▀я┘ п©п╣я─п╣п╩п╬п╪п╬п╡

  п▓ я█п╩п╣п╨я┌я─п╬п╫п╫п╬п╧ п╡п╣я─я│п╦п╦ Rockwood & Green "Fractures in Adults" п╣я│я┌я▄
  я│п╬п╬я┌п╡п╣я┌я│я┌п╡я┐я▌я┴п╟я▐ пЁп╩п╟п╡п╟.

  "Clearly, there is no need for a recommendation for nonoperative
  management of most midshaft clavicle fractures. Anyone who has treated
  this injury intuitively knows that most of these patients do extremely 
  well, even when patient compliance may not be optimal. There are even
  several authors who proposed that, in the initial 3 months after
  injury, treatment by an orthopaedic surgeon is not necessary
  (53,54,76). Yet for most of us, the patients who have an excellent 
  result after closed treatment of a midshaft clavicle fracture are
  usually children. Although results in adults are also good, certain
  injuries remain difficult.         

  Most authors who have reported nonoperative treatment of clavicular
  fractures have found superb union rates. Neer (126) evaluated 2,235
  patients with midshaft fractures and determined that the nonunion rate
  was 0.13%. Rowe (167) found a nonunion rate of 0.8% in his series of
  566 fractures. Analysis of these data is confusing because of the
  addition of pediatric patients. However, other studies have confirmed
  excellent rates of healing even in an isolated adult population 
  (6,57,138)" 


  -- 
  Best regards,
  Alexander N. Chelnokov
  Ural Scientific Research Institute 
  of Traumatology and Orthopaedics
  7, Bankovsky str. Ekaterinburg 620014 Russia 


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