upper limb fractures and dislocations

of 62/62
FRACTURES & DISLOCATIONS - DR.AKIF A.B

Post on 21-Feb-2017

78 views

Category:

Health & Medicine

1 download

Embed Size (px)

TRANSCRIPT

Slide 1

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

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

Mechanism of injury for anterior dislocation = abduction and external rotation

Position of arm in anterior dislocation = abduction and external rotation

Position of arm in posterior dislocation = adduction and internal rotation

Most common joint to dislocate = shoulder

Least common joint to dislocate = Ankle

Tests for anterior shoulder dislocation = Bryants test

Callaways Test

Dugas test

Hamilton ruler test

NORMAL SHOULDER X-RAY

Q. Identify type of shoulder dislocation?AB

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

Bankarts lesionABankart lesionis aninjuryof 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 sachs lesionHillSachs fracture, is a cortical depression in the posterolateral head of thehumerus. It results from forceful impaction of the humeral head against the anteroinferiorglenoidrim when theshoulder is dislocatedanteriorly.

Q. What is Reverse Hill sachs Lesion??

Ans. It is defect in Antero medial part aspect of humerus head in posterior dislocation of shoulderMnemonic: 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 : Kochers method :best Stimsons gravity method

Hippocratic method :old

Neglected shoulder dislocation is always managed Surgically

Kochers Method

HIPPOCRATIC METHOD

STIMSONS GRAVITY METHOD

LUXATIO ERECTAAlso 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 instabilityAnterior 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.InjuryNerve Involved1.Shoulder dislocationAxillary2.Fracture surgical neck humerusAxillary

3.Fracture shaft of humerusRadial4.Supracondylar fractureAIN>Median>Radial>Ulnar (AMRU)5.Medial condyle humerus #Ulnar N.6.Monteggia #Post. Interosseus N.7.Volkman ischemic contractureAnt. Interosseus N.8.Lunate dialocationMedian N.9.Hip dislocationSciatic N.10.Knee dislocationCommon peroneal N.

11. Post. Dislocation of shoulder Ulnar N.

CLAVICLEMost 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 : CRITOECapitullum = 2yearsInternal(medial) epicondyle = 6yearsRadius Head = 4years

Trochlea = 8yearsExternal(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 rotationMedial(Internal) Rotation/ Medial Tilt/Medial shiftImpaction (proximal shift)Dorsal displacement/ dorsal tiltCharacteristic 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 ContractureSUPRACONDYLAR #

Lateral Condyle #MILCH Classification is used

MC complication : Non union leads to Cubitus Valgus

Treatment : Open reduction

Treatment of cubitus varus : Modified French Osteotomy

Late complication : Tardy Ulnar N. Palsy

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 ELBOWApulled elbowis 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 theelbowjoint 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 anaesthesiaChid holds elbow in slight flexion with elbow normal

ESSEX- LOPRESTI #

Q. Treatment for Olecranon # ??

A. Tension Band wiring

MONTEGGIA#

Monteggia fractureis a fracture of the proximal third of the ulna with dislocation of the proximal radio-ulnar joint

- Bados classification

TheGaleazzi fractureis a fracture of the radius with dislocation of the distal radioulnar joint.GALEAZZI#

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

COLLES#Displacement : S: SupinationL : lateral displacementI : Impaction(proximal shift)P: Posterior displacement

Cast : below elbow Position: Reverse to displacementpronation ulnar deviation Palmar angulationCommon in elderly menopausal females

COLLES#Complications : 1) Joint Stiffness : Most common

2) malunion : 2nd most common

3) sudecks 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 BONES

Mnemonic: Some Lovers Try Positions That They Cant HandleProximal row lateral to medialDistal row lateral to medial

THANK YOU