fractures and dislocations of the shoulder girdle and elbow and fractures of the humerus h. sithebe
TRANSCRIPT
Fractures and dislocations of the Fractures and dislocations of the shoulder girdle and elbow and shoulder girdle and elbow and
fractures of the humerusfractures of the humerus
H. SithebeH. Sithebe
Anterior shoulder dislocationAnterior shoulder dislocation
Two Views.Two Views.
APAP LateralLateral
REDUCTIONREDUCTION
POST REDUCTIONPOST REDUCTION
CONTROL X-RAYCONTROL X-RAY SLING 2-3 WEEKSSLING 2-3 WEEKS AVOID EXTERNAL ROTATION AND AVOID EXTERNAL ROTATION AND
ABDUCTIONABDUCTION
COMPLICATIONSCOMPLICATIONS
AXILLARY NERVE INJURYAXILLARY NERVE INJURY VASCULAR INJURYVASCULAR INJURY FRACTURE DISLOCATIONFRACTURE DISLOCATION RECURRENT DISLOCATIONRECURRENT DISLOCATION BRACHIAL PLEXUS INJURYBRACHIAL PLEXUS INJURY
Posterior shoulder dislocationPosterior shoulder dislocation
APAP LateralLateral
REDUCTIONREDUCTION
ARM PULLED AND EXTERNALLY ARM PULLED AND EXTERNALLY ROTATEDROTATED
HUMERAL HEAD IS PUSHED HUMERAL HEAD IS PUSHED FOREWARDFOREWARD
ARMSLING 3 WEEKSARMSLING 3 WEEKS AVOID ADDUCTION,FOREWARD AVOID ADDUCTION,FOREWARD
FLEXION AND INTERNAL ROTATIONFLEXION AND INTERNAL ROTATION
COMPLICATIONSCOMPLICATIONS
AXILLARY NERVE INJURYAXILLARY NERVE INJURY VASCULAR INJURYVASCULAR INJURY FRACTURE DISLOCATIONFRACTURE DISLOCATION RECURRENT DISLOCATIONRECURRENT DISLOCATION BRACHIAL PLEXUS INJURYBRACHIAL PLEXUS INJURY
AC joint injuries - MechanismAC joint injuries - Mechanism
Direct – fall on point of shoulder with arm Direct – fall on point of shoulder with arm aductedaducted
Indirect – upward force on outstretched arm Indirect – upward force on outstretched arm is transmitted up the arm (rare) is transmitted up the arm (rare)
Indirect – downward force pull with heavy Indirect – downward force pull with heavy weight (rare)weight (rare)
AC DISLOCATIONAC DISLOCATION
Fractures of the Clavicle.Fractures of the Clavicle.
Fractures of the clavicleFractures of the clavicle
Fractures of the clavicleFractures of the clavicle Treatment- conservative.Treatment- conservative.
– Sling or collar and cuff.Sling or collar and cuff.
Surgery.Surgery.– Open fractures.Open fractures.– Neurovascular injuries.Neurovascular injuries.– 2121stst Century. Century.
Complications of clavicle #’sComplications of clavicle #’s
NeurovascularNeurovascular Non-union 1.9%Non-union 1.9% Mal-union > 20 mm shortening leads to Mal-union > 20 mm shortening leads to
pain pain Post-traumatic arthritisPost-traumatic arthritis
SCAPULA FRACTURESSCAPULA FRACTURES
SCAPULAR FRACTURESSCAPULAR FRACTURES
ASSOCIATED INJURIES ASSOCIATED INJURIES 35-98%35-98%
10-15% MORTALITY10-15% MORTALITY SEVERELY INJURED SEVERELY INJURED
PATIENTPATIENT C-Spine injury!C-Spine injury! ARTERIAL INJURYARTERIAL INJURY BRACHIAL PLEXUS BRACHIAL PLEXUS
INJURYINJURY PNEUMOTHORAXPNEUMOTHORAX FRACTURED RIBSFRACTURED RIBS PULMONARY PULMONARY
CONTUSIONCONTUSION
Humeral Shaft Fractures Humeral Shaft Fractures Non-Operative TreatmentNon-Operative Treatment
Modified U slabModified U slab Hanging castHanging cast Functional bracing Functional bracing
(Sarmiento)(Sarmiento)
Hanging Arm CastHanging Arm Cast
Mid-shaft fractures Mid-shaft fractures with shorteningwith shortening
Oblique or spiral Oblique or spiral patternpattern
Should extend 2 cm Should extend 2 cm proximal to fractureproximal to fracture
NOT transverse NOT transverse fracturesfractures
96% union96% union
Modified U splintModified U splint
Fractures with minimal shorteningFractures with minimal shortening Can be exchanged for functional brace 2 Can be exchanged for functional brace 2
weeks after injuryweeks after injury Disadvantages: lost shoulder movement, Disadvantages: lost shoulder movement,
axillary irritation, patient discomfort and axillary irritation, patient discomfort and bulkinessbulkiness
Functional BracingFunctional Bracing
Fracture reduction through soft tissue Fracture reduction through soft tissue compressioncompression
Prefabricated anterior shell and posterior Prefabricated anterior shell and posterior shellshell
Velcro strapsVelcro straps Contraindications: massive soft tissue Contraindications: massive soft tissue
injury or bone loss, unreliable patient, and injury or bone loss, unreliable patient, and inability to maintain alignmentinability to maintain alignment
Indications – surgery (radial Indications – surgery (radial nerve palsy)nerve palsy)
Open fracturesOpen fractures Holstein-Lewis distal 1/3 fracturesHolstein-Lewis distal 1/3 fractures Secondary palsies developing after closed Secondary palsies developing after closed
reductionreduction
ELBOW DISLOCATIONELBOW DISLOCATION
A FALL ON THE ELBOWA FALL ON THE ELBOW MOST COMMON POST LATERALMOST COMMON POST LATERAL DEFORMITY OBVIOUSDEFORMITY OBVIOUS NEURO VASCULAR EXAMNEURO VASCULAR EXAM X-RAYX-RAY
ELBOW DISLOCATIONELBOW DISLOCATION
ELBOW FRACTURE ELBOW FRACTURE DISLOCATIONDISLOCATION
COMPLICATIONSCOMPLICATIONS
ASSOCIATED FRACTURESASSOCIATED FRACTURES RADIAL HEADRADIAL HEAD CORONOIDCORONOID OLECRANONOLECRANON MEDIAL EPICONDYLEMEDIAL EPICONDYLE HETEROTOPIC BONE FORMATIONHETEROTOPIC BONE FORMATION NEUROVASCULARNEUROVASCULAR RECURRENT DISLOCATIONRECURRENT DISLOCATION STIFF ELBOWSTIFF ELBOW
TREATMENTTREATMENT
GENTLE TRACTION WITH GENTLE TRACTION WITH COUNTERTRACTIONCOUNTERTRACTION
CORRECT MEDIAL/ LATERAL CORRECT MEDIAL/ LATERAL DISPLACEMENTDISPLACEMENT
ELBOW FLEXED WHILE GUIDING ELBOW FLEXED WHILE GUIDING OLECRANON REDUCTONOLECRANON REDUCTON
CLOSED REDUCTION ELBOWCLOSED REDUCTION ELBOW
THE ENDTHE END
THANK YOUTHANK YOU