fractures and dislocations- upper limb

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  • - DR.AKIF A.B

  • 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

  • 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 = Bryants test Callaways Test Dugas test Hamilton ruler test

  • 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

  • A 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.

  • HillSachs 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.

    https://en.wikipedia.org/wiki/Humerushttps://en.wikipedia.org/wiki/Glenoidhttps://en.wikipedia.org/wiki/Dislocated_shoulder

  • Q. What is Reverse Hill sachs 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

  • Treatment of choice : Reduction techniques : Kochers method :best Stimsons gravity method Hippocratic method :old Neglected shoulder dislocation is always managed Surgically

  • -Also known as Inferior dislocation of Shoulder.

    - caused by severe hyperabduction of force.

    - MC Nerve injury associated is : Axillary N.

  • 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

  • S.No. Injury Nerve Involved

    1. Shoulder dislocation Axillary

    2. Fracture surgical neck humerus Axillary

    3. Fracture shaft of humerus Radial

    4. Supracondylar fracture AIN>Median>Radial>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.

  • -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

  • Ans.

  • -A spiral fracture of lower 3rd of humerus is k/a Holstein Lewis fracture

    - MC nerve injury is : Radial N.

    - Treatment : Hanging cast

  • Ossification centres :

    Capitullum = 2years

    Internal(medial) epicondyle = 6years

    Radius Head = 4years

    Trochlea = 8years

    External(Lateral) epicondyle = 12years

    Olecranon = 10years

  • 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

  • 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

  • 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

  • A 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

    Chid holds elbow in slight flexion with elbow normal

  • Q. Treatment for Olecranon # ??

  • A. Tension Band wiring

  • -Monteggia fracture is a fracture of the proximal third of the ulna with dislocation of the proximal radio-ulnar joint - Bados classification

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

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

  • Displacement : S: Supination L : lateral displacement I : Impaction(proximal shift) P: Posterior displacement Cast : below elbow Position: Reverse to displacement pronation ulnar deviation Palmar angulation

    Common in elderly menopausal females

  • Complications : 1) Joint Stiffness : Most common 2) malunion : 2nd most common 3) sudecks osteodystrophy 4) carpal tunnel Sx

  • Reverse of colles

    Cast : Above elbow

  • -Pain in anatomical snuff box

    - MC complication : Non union

    - Cast : Glass holding cast

  • Mnemonic: Some Lovers Try Positions That They Cant Handle

    Proximal row lateral to medial

    Distal row lateral to medial