FRACTURES & DISLOCATIONS- DR.AKIF A.B

ROTATOR CUFF

TIP: Remember muscle locations, it can be asked as a question for identification

Q. Lift off test is done for??

Ans. SUBSCAPULARIS MUSCLE

B

Q.Rotator Interval ??

Ans. Rotator interval is interval between subscapularis and suprascapularis. Coracohumeral ligament passes through this interval

SHOULDER DISLOCATION

1) Most common type of shoulder dislocation = Anterior type (subcoracoid> preglenoid)

2) Mechanism of injury for anterior dislocation = abduction and external rotation

3) Position of arm in anterior dislocation = abduction and external rotation

4) Position of arm in posterior dislocation = adduction and internal rotation

5) Most common joint to dislocate = shoulder

6) Least common joint to dislocate = Ankle

7) Tests for anterior shoulder dislocation = Bryant’s test

Callaway’s Test

Dugas test

Hamilton ruler test

NORMAL SHOULDER X-RAY

Q. Identify type of shoulder dislocation?

A B

Ans. ‘A’ is anterior dislocation and ‘B’ is Posterior dislocation

Explanation: In anterior dislocation of shoulder, position of shoulder is abducted and externally rotated and you can see that in xray i.e humerus will be at an angle to scapula i.e abducted position.

In posterior dislocation, position of shoulder is adducted and internally rotated, so u can see clearly in xray that humerus is straight (adducted) and not making any angle.

Anterior dislocation

Line is straight…..so

Posterior dislocation

Bankart’s lesionA Bankart lesion is an injury of the anterior (inferior) glenoid labrum of the shoulder due to anterior shoulder dislocation. When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it.

Hill sach’s lesionHill–Sachs fracture, is a cortical depression in the posterolateral head of the humerus. It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly.

Q. What is Reverse Hill sach’s Lesion??

Ans. It is defect in Antero medial part aspect of humerus head in posterior dislocation of shoulder

Mnemonic: R – Reverse hill sachs A – Anterior part of humeral head M – Medial part of humeral head P – Posterior dislocation

Q. Muscle crossing shoulder joint = Long head of Biceps

Q. Weakest portion of shoulder joint capsule = Inferior

Shoulder is weakest inferiorly but dislocations are more common anteriorly since it is the direction of force which decides dislocation but Never the anatomical weakness

Q. Most common early complication of = Nerve Injury shoulder dislocation

Q. Most common Nerve Injury in = Axillary N. shoulder dislocation

MANAGEMENTTreatment of choice : Reduction techniques : Kocher’s method :best

Stimson’s gravity method

Hippocratic method :old

Neglected shoulder dislocation is always managed Surgically

Kocher’s Method

HIPPOCRATIC METHOD

STIMSON’S GRAVITY METHOD

LUXATIO ERECTA-Also known as Inferior dislocation of Shoulder.

- caused by severe hyperabduction of force.

- MC Nerve injury associated is : Axillary N.

Tests for evaluation of glenohumeral joint instability

Anterior Instability : F- Fulcrum test

o

C – Crank test

u

S- surprise test (Most Accurate)

Posterior Instability : Jerk Test Posterior apprehension test Posterior clunk test Push-pull test

Inferior Instability : Sulcus test

Very Important

S.No. Injury Nerve Involved1. Shoulder dislocation Axillary2. Fracture surgical neck humerus Axillary

3. Fracture shaft of humerus Radial4. Supracondylar fracture AIN>Median>Radia

l>Ulnar (AMRU)5. Medial condyle humerus # Ulnar N.6. Monteggia # Post. Interosseus N.7. Volkman ischemic contracture Ant. Interosseus N.8. Lunate dialocation Median N.9. Hip dislocation Sciatic N.10. Knee dislocation Common peroneal

N.11. Post. Dislocation of shoulder Ulnar N.

CLAVICLE-Most common bone to fracture in body.

- MC site of fracture = junction of medial 2/3rd and lateral 1/3rd

- Most common bone fractured during birth

- Treatment: Figure of 8 bandage

Q. Highest bony landmark in shoulder x-ray ??

a) clavicle b) acromion c) coracoid d) head of humerus

Ans. Acromion

Q. Velpeau bandage and sling and swathe splint are used in ??

Ans. Acromioclavicular dislocation

HUMERAL SHAFT #-A spiral fracture of lower 3rd of humerus is k/a Holstein Lewis fracture

- MC nerve injury is : Radial N.

- Treatment : Hanging cast

ELBOWOssification centres :

CRITOE

Capitullum = 2years

Internal(medial) epicondyle = 6years

Radius Head = 4years

Trochlea = 8years

External(Lateral) epicondyle = 12years

Olecranon = 10years

SUPRACONDYLAR #MC elbow injury in children

(MC elbow injury in adults is : Physeal Injury)

MC type : Extension type(98%)

MC type of distal fragment displacement in Extension type: Postero-medial with internal rotation

Medial(Internal) Rotation/ Medial Tilt/Medial shift

Impaction (proximal shift)Dorsal displacement/ dorsal tilt

Characteristic displacements

-GARTLAND Classification is used for it

- Treatment : Close Reduction and K wire fixation

- MC complication : Malunion = Cubitus varus or gunstock deformity

- MC Nerve Injury : Anterior Interosseus Nerve ( A>M>R>U )

- 3 point bony relationship is maintained i.e tips of medial and lateral epicondyle and olecranon

-MC Cause of Volkmann Ischemic Contracture

SUPRACONDYLAR #

Lateral Condyle #1) MILCH Classification is used

2) MC complication : Non union – leads to Cubitus Valgus

3) Treatment : Open reduction

4) Treatment of cubitus varus : Modified French Osteotomy

5) Late complication : Tardy Ulnar N. Palsy

6) 3point bony landmark is disturbed

FRACTURE of NECESSITY( Requiring Surgery)

Mnemonic: Lets Go For OPeration At Medical college

Lateral condyle #

Galeazi #Femur neck#

Olecranon #

Patella#

Articular#( Involving joint)

Monteggia #

- Calf pressure during walking is = 200-300mmHg

-In compartment Sx, pain on passive stretch ( distal most joint of extremity) is the first sign

-Peripheral pulses can be normal in compartment syndrome

- MC muscle involved in volkmann ischemic contracture :

Flexor digitorum profundus> flexor pollicis longus

PULLED ELBOWA pulled elbow is a common injury amongst children under the age of five.

It is a result of the lower arm (radius bone) slipping out of its normal position at the elbow joint or more accurately subluxation of annular ligament

from the head of radius

Treatment: Reduced by flexing the elbow to 90degrees and rapidly and firming rotating the forearm into full supination on OP basis without anaesthesia

Chid holds elbow in slight flexion with elbow normal

ESSEX- LOPRESTI #

Q. Treatment for Olecranon # ??

A. Tension Band wiring

MONTEGGIA#-Monteggia fracture is a fracture of the proximal third of the ulna with dislocation of the proximal radio-ulnar joint

- Bado’s classification

The Galeazzi fracture is a fracture of the radius with dislocation of the distal radioulnar joint.

GALEAZZI#

AColles' fracture is a fracture of the distal radius in the forearm with dorsal (posterior) and radial displacement of the wrist and hand.

COLLES#Displacement : S: Supination

L : lateral displacementI : Impaction(proximal shift)P: Posterior displacement

Cast : below elbow Position: Reverse to displacement

pronation ulnar deviation Palmar angulation

Common in elderly menopausal females

COLLES#

Complications : 1) Joint Stiffness : Most common

2) malunion : 2nd most common

3) sudeck’s osteodystrophy

4) carpal tunnel Sx

SMITH#Reverse of colles

Cast : Above elbow

BARTON#

SCAPHOID#-Pain in anatomical snuff box

- MC complication : Non union

- Cast : Glass holding cast

CARPAL BONESMnemonic: Some Lovers Try Positions That They Can’t Handle

Proximal row lateral to medial

Distal row lateral to medial

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