Transcript of Re-written by: Daniel Habashi Upper Extremity Fractures And Dislocations.
- Slide 1
- Re-written by: Daniel Habashi Upper Extremity Fractures And
Dislocations
- Slide 2
- Shoulder Girdle Clavicle Scapula Humerus
- Slide 3
- Clavicle- Mechanism of Injury There is no correlation between
the fracture location and the mechanism of injury Falls onto the
affected shoulder 87% Direct impact 7% Falls onto an outstretched
hand 6%
- Slide 4
- Clavicle clinical evaluation Arm adducted across the chest and
supported by the contra lateral hand Neurovascular examination
Tenting the skin Crepitus X-ray
- Slide 5
- Clavicle non operative treatment Reduction if needed Closed
treatment is successful in most cases Dessaulte cast
Figure-of-eight cast 4-6 weeks
- Slide 6
- Clavicle operative treatment Open fractures Fractures with
associated neurovascular injury Fractures with severe associated
injuries (flail chest with multiple rib fractures) Cosmetic
reasons
- Slide 7
- Clavicle fixation Plate Intramedullary devices (pins) Cerclage
suturing or wiring External fixation
- Slide 8
- Acromioclavicular joint mechanism of injury Most often in the
Spring Fall onto the shoulder with the arm adducted Fall onto an
outstretched hand with force transmission up the arm
- Slide 9
- AC joint clinical evaluation Step-off deformity Possible
tenting of the skin overlying the distal clavicle Limited range of
motion Tenderness X-ray
- Slide 10
- AC joint classification Type I sprain of the AC ligament Type
II tear of the AC ligament and sprain of the caracoclavicular
ligament Type III AC and coracoclavicular ligaments torn with AV
joint dislocation
- Slide 11
- AC joint non-operative treatment Type I - Rest 10 days, ice
packs and sling Type II Sling for 2 weeks, gentle range of motion,
refrain from heavy activity for 6 weeks Type III Sling, early range
of motion, acceptance of deformity
- Slide 12
- AC joint operative treatment Controversial patients Heavy
laborers, patients 20-25 years of age Open reduction and
suturing
- Slide 13
- Sternoclavicular joint mechanism of injury Direct hit Indirect
force applied from antero-lateral or postero-lateral aspects of the
shoulder
- Slide 14
- SC joint classification Anterior dislocation more common
Posterior dislocation
- Slide 15
- SC joint clinical evaluation Patient supports the affected
extremity across the trunk with the contra-lateral arm Swelling,
tenderness, painful range of motion X-ray
- Slide 16
- SC joint treatment Mild sprain ice packs, sling for 7 days
Moderate sprain or subluxation ice packs and sling for 4-6
weeks
- Slide 17
- Scapula mechanism of injury Relatively uncommon injury Result
of high energy trauma Suspicion of associated injuries Fractured
ribs Clavicle Sternum Pneumothorax Pulmonary contusion Spinal
column fractures
- Slide 18
- Scapula Clinical Evaluation Full trauma evaluation Upper
extremity supported by the contra-lateral hand Swelling of the
posterior thorax X-ray
- Slide 19
- Scapula treatment Most scapula fractures are treated
non-operatively Sling and early range of motion
- Slide 20
- Proximal humerus mechanism of injury A fall onto an
outstretched upper extremity from standing height (typically seen
in an elderly osteoporotic woman) High energy trauma (motor vehicle
accident) Direct trauma Pathologic processes
- Slide 21
- proximal humerus - clinical evaluation Upper extremity
supported by the contralateral hand Pain, swelling, tenderness,
painful range of motion Crepitus, instability, ecchymosis
X-ray
- Slide 22
- Proximal humerus clinical evaluation A careful neurovascular
evaluation is required
- Slide 23
- Proximal humerus treatment Open reduction and internal fixation
(plates, screws, K- wires, pins, flexible nails with tension band)
Prosthetic replacement
- Slide 24
- Humeral shaft mechanism of injury Direct trauma (most common)
Indirect: fall on an outstretched arm
- Slide 25
- Humeral shaft radial nerve injury Radial nerve injury is
something we must take care of Symptoms of a radial nerve injury
is: dropped hand since its responsible for the innervations of all
the extensors
- Slide 26
- Humeral shaft clinical evaluation Pain, swelling, deformity,
shortening of the affected arm Instability with crepitus A careful
neurovascular exam with special attention to the radial nerve
function X-ray
- Slide 27
- Humeral shaft non operative treatment Most humeral shaft
fractures will heal with nonsurgical treatment A hanging cast A
co-aptation splint Thoracobrachial immobilization (Dessaulte,
Velpau dressing)
- Slide 28
- Humeral shaft operative treatment Open reduction and internal
fixation (plates, screws, intramedullar nails) External fixation
quite quite quite rare
- Slide 29
- Humeral shaft radial nerve injury Most common with middle third
fractures Generally neuropraxia or axonotmesis (function returns
within 3-4 months) Laceration most common in gunshot injuries
etc
- Slide 30
- Distal humerus classification Supracondylar Transcondylar
Intercondylar (most common) Condylar Capitellum Etc
- Slide 31
- Distal humerus mechanism of injury Fall on outstretched hand
with or without an abduction or adduction force (supra and
transcondylar fractures) Force directed against the posterior
aspect of an elbox flexed more than 90 degrees
- Slide 32
- Distal humerus clinical evaluation Swelling, painful range of
motion, crepitus, instability Elbow held in the flexed position A
careful neurovascular evaluation is essential because the sharp
fractured end.
- Slide 33
- Distal humerus treatment Open reduction and internal fixation
(screws, plates) Total elbow arthroplasty
- Slide 34
- Glenohumeral dislocation The shoulder is the most commonly
dislocated joint of the body (45% of dislocations)
- Slide 35
- Glenohumeral dislocation classification Anterior (most common
84%) Posterior ( the second most common - 10%) Inferior (rare)
Superior (rare)
- Slide 36
- Glenohumeral dislocation mechanism of injury
- Slide 37
- Glenohumeral dislocation clinical evaluation Determine the
nature of the trauma Position of the affected extremity Painful
shoulder, muscular spasm Neurovascular examination X-ray