luxatia umarului
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ortopedieTRANSCRIPT
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Luxatiile umarului
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Luxatiile umarului
posterioare anterioare
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Luxatiile anterioare ale umarului
96 %
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Luxatii antero-interne
Mecanisme
• Cadere pe mana• Rotatie externa+abductie
• Uneori trauma in abductie si retroductie
Rara la copii
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Deformare caracteristica la inspectie
• capul humeral deplasat anterior
• proeminenta acromionului (semnul epoletului)
• glena goala
• bratul in abductie si retroductie
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Leziuni asociate ale luxatiei S-H
Leziuni constante
• Ruptura capsulei – smulsa la insertie
– decolare cu periostul omoplatului
• Leziunea bureletului
Leziuni asociate• Fractura glena
• Amprenta pe capul humeral
• Ruptura coafei
• Fractura trohiter
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Radiografia de fata
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Complicatii precoce
Leziuni vasculo-nervoase
Paralizie circonflex Plex brahial
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Reducerea luxatiei – procedeu Hippocrate
Reducerea poate fi instabila si poate fractura glena
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Reducere progresiva fara anestezie
Tractiune Rotatie externa Adductie Rotatie interna
1 2 3 4
Reducere ortopdeica procedeu Kocher
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Radiografie inainte si dupa reducere
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Imobilizare bandaj Velpeau (3 saptamani)
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Alte mijloace de contentie
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1 Fractura Trohiter
Leziuni asociate
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Leziuni asociate1 Fractura Trohiter
Radiografie inainte si dupa reducere ortopedica
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1 Fractura de trohiter
Daca fragmentul este nedeplasat :
Contentia se face in rotatie neutra a umarului cu mana privind anterior
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Tratamentul chirurgical al fracturii de trohiter
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2 Fractura anterioara a glenei
Importanta scaneruluiFragmentul ramane deplasat dupa reducerea luxatiei
tratament chirurgical
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2 Fractura anterioara a glenei
tratament chirurgical
Fractura neglijata=luxatie recidivanta
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3 Amprenta cefalica – faciliteaza recidiva luxatiei
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In luxatia neglijata amprenta se umple cu grefa osoasa
3 luni
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4 Fractura trohinului
Prin smulgerea de catre M.sub-scapular
Fixarea fragmentului prin tratament chirurgical
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Fractura-Luxatie
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Repararea rupturii de coafa a rotatorilor
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Recidiva este favorizata de laxitatile congenitale
Photos H Coudane
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Hiperlexitatea constitutionala=semn Sulcus test
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Semnele clinice ale laxitatii congenitale a umarului
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Tratamentul chirurgical – operatia Bankart (capsuloplastie anterioara)
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Tratamentul luxatiilor anterioare recidivante
1 Operatia Bankart – capsuloplastie
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Tratamentul luxatiilor anterioare recidivante
2. Operatia Rockwood – capsuloplastie anterioara
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2 Grefon osos pe fata anterioara a glenei
Tratamentul luxatiilor anterioare recidivante
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Grefon osos
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3 Transpozitia apofizei coracoidei
Procedeul Latarjet modificat de Bristaw
(sectiunea sub-scapularului) (transmuscular)
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Luxatia erecta
Traumatism in ABD
Reducere prin tractiune in ABD
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Luxatie posterioara
MecanismeCadere pe bratul in rotatie interna
Lovire directa a umarului
Crize comitiale, electrocutare
ExamenCapul humeral se palpeaza posterior
Exista un spatiu anterior
Mobilizare imposibila, durere
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Dublu contur pe radiografia de fata
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Luxatie posterioara
Amprenta pe fata anterioara a capului
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Luxatie posterioaraLeziuni asociate
Amprenta sau fractura pe marginea posterioara a glenei
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Reducerea luxatiei posterioare (urgenta)
Urgenta
Tractiune in abductie urmata de rotatie externa
Imobilizare in abductie lejera, antepulsie si lejera rotatie externa