Klavikula cisim kırığı

Özet

Travma BT'sinde klavikula cismindeki kırık ve fragman deplasmanı gösterilebilir. Çok düzlemli BT rekonstrüksiyonları kırık örüntüsünü tanımlamaya ve cerrahi planlamaya katkı sağlayabilir. Orta cisim kırıklarında distal fragmanın anatomik ilişkiler nedeniyle genellikle öne rotasyonu görülebilir. Klavikula kırıklarına kaburga kırıkları ve pnömotoraks eşlik edebilir; nadiren brakiyal pleksus veya damar yaralanması da görülebilir.

Faz ve pencere

Kontrastsız tanısal

BT'de klavikula kırığı ve fragman deplasmanı gösterilebilir.

Kemik algoritması tanısal

İnce aksiyel kesitlerden koronal ve sagittal rekonstrüksiyonlar kırık yönünü, angülasyonu, parçalanmayı ve sternoklaviküler-akromiyoklaviküler uçlara uzanımı gösterir.

Önerilen pencereler: Kemik (G 1800 / M 400), Akciğer (G 1500 / M -600), Yumuşak doku (G 400 / M 40).

BT bulguları

• BT'nin farklı görünümlerinde klavikula cismi kırığı gösterilebilir.
• Orta cisim kırıklarında distal fragmanın anatomik ilişkiler nedeniyle genellikle öne rotasyonu görülebilir.
• Klavikula kısalması, kırıklı ve sağlam tarafın uzunlukları arasındaki fark olarak ölçülebilir; BT bu ölçüm için referans yöntem olarak kullanılmıştır.
• Angülasyon — fragmanların uzun eksenleri arasındaki yön değişikliği koronal ve sagittal rekonstrüksiyonlarda tarif edilir.
• Klavikula cisim kırıklarında kelebek fragmanlı bir örüntü tanımlanmıştır.
• Klavikula kırığına komşu ilk ve ikinci kaburgalarda keskin kortikal basamak veya kırık hattı aranır.
• Apikal plevra ve yumuşak doku — plevral hava/sıvı, hematom veya kemik fragmanının akciğer tepesine yakınlığı değerlendirilir.
• Allman sınıflamasında orta cisim kırıkları Tip I olarak adlandırılır.

Ölçütler ve sınıflamalar

Robinson sınıflaması

Kaynakta, orta cisim kırığı Robinson Tip 2B1 olarak sınıflandırılmıştır. Deplase orta cisim kırıklarında 15–20 mm'den fazla kısalma cerrahinin sık önerildiği bir eşik olarak bildirilmiştir; karar başka etmenleri de içerir.

Normalde

Klavikula kısalmasını değerlendirirken kırıklı tarafın uzunluğunu sağlam karşı tarafla karşılaştırın; BT, klavikula uzunluğunu ölçmek için referans yöntem olarak kabul edilir.

Ayırıcı tanı

Eski kaynamış kırık

düzgünleşmiş kallus ve kortikal yeniden şekillenme akut keskin kırık hattından ayrılır.

Kostoklaviküler bağ tutunma izi

verilen kaynaklar bu izin BT görünümünü veya kırık hattından ayırt ettirici özelliklerini açıklamaz.

Tuzaklar

• Tek aksiyel kesitte örtüşen fragmanları tek kemik konturu sanma; klavikulayı koronal ve sagittal planda baştan sona takip et.
• Kısalmayı hasta rotasyonuna bağlı asimetriyle karıştırma; karşı tarafı aynı rekonstrüksiyon ve omuz pozisyonunda kıyasla.
• Klavikula kırığına odaklanırken ilk kaburga ve akciğer apeksini kadraj dışında bırakma; plevral hava veya komşu kırık eşlik edebilir.

Kendini dene

1. Orta klavikula kırığında düşey deplasmanın radyografik projeksiyondan etkilenmesiyle ilgili hangi ifade doğrudur?

   • Mutlak ve göreli düşey deplasman, incelenen projeksiyonlardan anlamlı biçimde etkilenmemiştir
   • Düşey deplasman yalnız ayakta çekimde ölçülebilir
   • Düşey deplasman projeksiyon değiştikçe her zaman artar
   • Düşey deplasman yalnız BT'de değerlendirilebilir
   Cevabı göster

   Mutlak ve göreli düşey deplasman, incelenen projeksiyonlardan anlamlı biçimde etkilenmemiştir. Standartlaştırılmış ölçümlerde orta cisim kırığındaki mutlak ve göreli düşey deplasman, incelenen radyografik projeksiyonlardan anlamlı biçimde etkilenmemiştir.

2. Klavikula kırığı görülmüş bir travma BT'sinde hangi komşu alan, eşlik eden yaralanma açısından özellikle taranmalıdır?

   • Akciğer apeksi
   • Sella turcica
   • Renal hilus
   • Sakroiliak eklem
   Cevabı göster

   Akciğer apeksi. Klavikula cismi plevra tepesi ve ilk kaburgalara komşudur; plevral hava veya komşu kırık aynı toraks incelemesinde görülebilir. Diğer anatomik bölgeler bu kırığın doğrudan komşuluğunda değildir.

İlgili konular

• Skapula boyun kırığı
• Yüzen omuz (floating shoulder)

Kaynaklar

Bu sayfadaki 33 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 11 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.