fractures and dislocations of the shoulder girdle and elbow and fractures of the humerus

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Fractures and dislocations of the shoulder girdle and elbow and fractures of the humerus. H. Sithebe. Anterior shoulder dislocation. Two Views. AP. Lateral. REDUCTION. POST REDUCTION. CONTROL X-RAY SLING 2-3 WEEKS AVOID EXTERNAL ROTATION AND ABDUCTION. COMPLICATIONS. - PowerPoint PPT Presentation

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  • Fractures and dislocations of the shoulder girdle and elbow and fractures of the humerusH. Sithebe

  • Anterior shoulder dislocation

  • Two Views.APLateral

  • REDUCTION

  • POST REDUCTIONCONTROL X-RAYSLING 2-3 WEEKSAVOID EXTERNAL ROTATION AND ABDUCTION

  • COMPLICATIONSAXILLARY NERVE INJURYVASCULAR INJURYFRACTURE DISLOCATIONRECURRENT DISLOCATIONBRACHIAL PLEXUS INJURY

  • Posterior shoulder dislocationAPLateral

  • REDUCTIONARM PULLED AND EXTERNALLY ROTATEDHUMERAL HEAD IS PUSHED FOREWARDARMSLING 3 WEEKSAVOID ADDUCTION,FOREWARD FLEXION AND INTERNAL ROTATION

  • COMPLICATIONSAXILLARY NERVE INJURYVASCULAR INJURYFRACTURE DISLOCATIONRECURRENT DISLOCATIONBRACHIAL PLEXUS INJURY

  • AC joint injuries - MechanismDirect fall on point of shoulder with arm aductedIndirect upward force on outstretched arm is transmitted up the arm (rare) Indirect downward force pull with heavy weight (rare)

  • AC DISLOCATION

  • Fractures of the Clavicle.

  • Fractures of the clavicle

  • Fractures of the clavicleTreatment- conservative.Sling or collar and cuff.

    Surgery.Open fractures.Neurovascular injuries.21st Century.

  • Complications of clavicle #sNeurovascularNon-union 1.9%Mal-union > 20 mm shortening leads to pain Post-traumatic arthritis

  • SCAPULA FRACTURES

  • SCAPULAR FRACTURESASSOCIATED INJURIES 35-98%10-15% MORTALITYSEVERELY INJURED PATIENTC-Spine injury!ARTERIAL INJURYBRACHIAL PLEXUS INJURYPNEUMOTHORAXFRACTURED RIBSPULMONARY CONTUSION

  • Humeral Shaft Fractures Non-Operative TreatmentModified U slabHanging castFunctional bracing (Sarmiento)

  • Hanging Arm CastMid-shaft fractures with shorteningOblique or spiral patternShould extend 2 cm proximal to fractureNOT transverse fractures96% union

  • Modified U splintFractures with minimal shorteningCan be exchanged for functional brace 2 weeks after injuryDisadvantages: lost shoulder movement, axillary irritation, patient discomfort and bulkiness

  • Functional BracingFracture reduction through soft tissue compressionPrefabricated anterior shell and posterior shellVelcro strapsContraindications: massive soft tissue injury or bone loss, unreliable patient, and inability to maintain alignment

  • Indications surgery (radial nerve palsy)Open fracturesHolstein-Lewis distal 1/3 fracturesSecondary palsies developing after closed reduction

  • ELBOW DISLOCATIONA FALL ON THE ELBOWMOST COMMON POST LATERALDEFORMITY OBVIOUSNEURO VASCULAR EXAMX-RAY

  • ELBOW DISLOCATION

  • ELBOW FRACTURE DISLOCATION

  • COMPLICATIONSASSOCIATED FRACTURES RADIAL HEAD CORONOID OLECRANON MEDIAL EPICONDYLEHETEROTOPIC BONE FORMATIONNEUROVASCULARRECURRENT DISLOCATIONSTIFF ELBOW

  • TREATMENTGENTLE TRACTION WITH COUNTERTRACTIONCORRECT MEDIAL/ LATERAL DISPLACEMENTELBOW FLEXED WHILE GUIDING OLECRANON REDUCTON

  • CLOSED REDUCTION ELBOW

  • THE ENDTHANK YOU