upper limb fractures and dislocations
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FRACTURES & DISLOCATIONS- 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
Q.Rotator Interval ??
Ans. Rotator interval is interval between subscapularis and suprascapularis. Coracohumeral ligament passes through this interval
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
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.
Line is straight..so
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
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
C Crank test
S- surprise test (Most Accurate)
Posterior Instability : Jerk Test Posterior apprehension test Posterior clunk test Push-pull test
Inferior Instability : Sulcus test
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
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 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
Pain in anatomical snuff box
MC complication : Non union
Cast : Glass holding cast
Mnemonic: Some Lovers Try Positions That They Cant HandleProximal row lateral to medialDistal row lateral to medial