Upper extremity fractures

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Upper extremity fractures. By Mohammad Hassan Lecturer of Orthopedic Surgery & Traumatology Faculty of Medicine University of Alexandria . INJURIES ABOUT THE SHOULDER. ANATOMICAL CONSIDERATIONS Bony Anatomy. ANATOMICAL CONSIDERATIONS Bony Anatomy. ANATOMICAL CONSIDERATIONS Articulations.
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Upper extremity fracturesByMohammad HassanLecturer of Orthopedic Surgery & TraumatologyFaculty of MedicineUniversity of Alexandria INJURIES ABOUT THE SHOULDERANATOMICAL CONSIDERATIONSBony AnatomyANATOMICAL CONSIDERATIONSBony AnatomyANATOMICAL CONSIDERATIONSArticulationsANATOMICAL CONSIDERATIONSMuscular AnatomyANATOMICAL CONSIDERATIONSMuscular AnatomyANATOMICAL CONSIDERATIONSMuscular AnatomyANATOMICAL CONSIDERATIONSNeuro-Vascular AnatomyRadiologic AnatomySTERNOCLAVICULARJOINT DISLOCATION
  • Injuries to the SC joint are rare
  • Types; Mechanism
  • STERNOCLAVICULARJOINT DISLOCATION
  • Complaints
  • Pain,
  • Deformity,
  • Limited range of motion,
  • Dyspnea
  • Dysphagia
  • STERNO-CLAVICULARJOINT DISLOCATION
  • Examination
  • Respiratory, Heart rates, Trachea, Stridor, Breath sounds, Pulses
  • Pain on Palpating the clavicle, Loss of fullness of proximal clavicle, Skin tenting
  • Neurological examination
  • STERNO-CLAVICULARJOINT DISLOCATION
  • Radiological Examination
  • Always be Doubtful
  • Plain X-ray
  • C.T. Scan
  • STERNO-CLAVICULARJOINT DISLOCATION
  • COMPLICATIONS
  • Anterior
  • SC joint Arthritis
  • Cosmetic appearance – Persistent Prominence
  • Chronic Pain
  • STERNO-CLAVICULARJOINT DISLOCATION
  • COMPLICATIONS
  • Posterior
  • Pneumothorax
  • Compression or Laceration of Trachea, Oesophagous, Vessels
  • Brachial Plexus injury
  • Thoracic Outlet Obstruction
  • STERNO-CLAVICULARJOINT DISLOCATION
  • Treatment: Closed Reduction
  • Anterior SC Dislocation
  • Controversial
  • Majority unstable following reduction
  • Sling immobilization for 6 weeks
  • STERNO-CLAVICULARJOINT DISLOCATION
  • Treatment: Closed Reduction
  • Posterior SC Dislocation
  • Closed reduction – 2- 3 days of injury
  • Sling or figure-of-eight
  • If unstable or complications, then open
  • STERNO-CLAVICULARJOINT DISLOCATION
  • Operative Treatment include:
  • Fixation of the medial clavicle to the sternum using fascia lata, tendon, or suture,
  • Resection of the medial clavicle.
  • The use of Kirschner wires or Steinmann pins is discouraged, because migration of hardware may occur.
  • FRACTURES OF THE CLAVICLE
  • FUNCTION
  • Serves as a protector of the Brachial Plexus
  • Acts as a strut which provides the only bony connection between upper limb and the trunk.
  • FRACTURES OF THE CLAVICLE
  • Fractures are common especially in children and elderly
  • Mechanism of injury
  • Associated Injuries
  • Brachial Plexus Injuries;
  • Rib Fractures,
  • Scapula Fracture,
  • Vascular Injury
  • Pneumothorax
  • FRACTURES OF THE CLAVICLE Clinical Evaluation
  • Deformity/abnormal motion
  • Thorough distal neurovascular exam
  • Auscultation for the possibility ofpneumothorax
  • FRACTURES OF THE CLAVICLE Radiographic Exam FRACTURES OF THE CLAVICLE AllmanClassification FRACTURES OF THE CLAVICLE 80%5%15%TREATMENT
  • Nonoperative Treatment
  • Figure-of-eight bandage fixation
  • Sling immobilization for usually 3-4 weeks
  • Despite deformity, healing usually proceeds rapidly.
  • Significantly displaced mid-shaft and distal-third injuries have a higher incidence of nonunion.
  • FRACTURES OF THE CLAVICLE TREATMENT
  • Operative Treatment
  • Fractures with neurovascular injury
  • Fractures with severe associated chest injuries
  • Open fractures
  • Displaced distal third fractures
  • Cosmetic reasons, uncontrolled deformity
  • Painful Nonunion
  • Floating Shoulder; Fractures of both the clavicle and neck of the scapula
  • FRACTURES OF THE CLAVICLE ACROMIO-CLAVICULARJOINT DISLOCATION
  • Horizontal stability from superior / inferior AC ligaments
  • Vertical stability from CC ligaments
  • ACROMIO-CLAVICULARJOINT DISLOCATION
  • Mechanism of Injury
  • Direct: The most common mechanism, fall onto the shoulder with the arm adducted.
  • Indirect: fall onto an outstretched hand
  • ACROMIO-CLAVICULARJOINT DISLOCATIONClinical evaluationACROMIO-CLAVICULARJOINT DISLOCATION
  • Radiographic Evaluation
  • Initial Views:
  • Anteroposterior view
  • Zanca view (15 degree cephalic tilt)
  • Other views:
  • Axillary: demonstrates AP displacement
  • Stress views: weight lift.
  • ACROMIO-CLAVICULARJOINT DISLOCATIONClassificationType I
  • Sprain of AC ligament
  • AC joint intact
  • CC ligaments intact
  • Deltoid and trapezius muscles intact
  • ACROMIO-CLAVICULARJOINT DISLOCATIONClassificationType II
  • AC ligaments are disrupted
  • < 50% Vertical displacement
  • Sprain of the CC ligaments
  • Deltoid and trapezius muscles intact
  • ACROMIO-CLAVICULARJOINT DISLOCATIONClassificationType III
  • AC and CC ligaments are all disrupted
  • AC joint dislocated
  • CC inter space greater than the normal shoulder (25-100%)
  • Deltoid and trapezius muscles usually detached from the distal clavicle
  • ACROMIO-CLAVICULARJOINT DISLOCATIONClassificationType IV
  • AC and CC ligaments disrupted
  • AC joint dislocated and clavicle displaced posteriorly
  • Deltoid and trapezius muscles detached from the distal clavicle
  • ACROMIO-CLAVICULARJOINT DISLOCATIONClassificationType V
  • AC and CC ligaments disrupted
  • CC inter space greater than the normal shoulder (100-300%)
  • Deltoid and trapezius muscles detached from the distal clavicle
  • ACROMIO-CLAVICULARJOINT DISLOCATIONClassificationType VI
  • AC joint dislocated and clavicle displaced inferiorly
  • AC and CC ligaments disrupted
  • Deltoid and trapezius muscles detached from the distal clavicle
  • ACROMIO-CLAVICULARJOINT DISLOCATION
  • Treatment Options for Types I - II
  • Nonoperative:ice packs, sling. Refrain from full activity until painless, full range of motion (2 weeks).
  • ACROMIO-CLAVICULARJOINT DISLOCATION
  • Treatment Options for Types III
  • For inactive, especially for the non dominant arm, nonoperative treatment is indicated: sling, early range of motion, strengthening, and acceptance of deformity.
  • For younger, more active patients with more severe degrees of displacement may benefit from operative stabilization.
  • ACROMIO-CLAVICULARJOINT DISLOCATION
  • Treatment Options for Types III injuries in highly active patients, Type IV, V, and VI injuries
  • Open reduction and surgical repair of the CC ligaments
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