fractures and dislocations of the shoulder girdle and elbow and fractures of the humerus h. sithebe
TRANSCRIPT
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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
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Anterior shoulder dislocationAnterior shoulder dislocation
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Two Views.Two Views.
APAP LateralLateral
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REDUCTIONREDUCTION
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POST REDUCTIONPOST REDUCTION
CONTROL X-RAYCONTROL X-RAY SLING 2-3 WEEKSSLING 2-3 WEEKS AVOID EXTERNAL ROTATION AND AVOID EXTERNAL ROTATION AND
ABDUCTIONABDUCTION
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COMPLICATIONSCOMPLICATIONS
AXILLARY NERVE INJURYAXILLARY NERVE INJURY VASCULAR INJURYVASCULAR INJURY FRACTURE DISLOCATIONFRACTURE DISLOCATION RECURRENT DISLOCATIONRECURRENT DISLOCATION BRACHIAL PLEXUS INJURYBRACHIAL PLEXUS INJURY
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Posterior shoulder dislocationPosterior shoulder dislocation
APAP LateralLateral
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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
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COMPLICATIONSCOMPLICATIONS
AXILLARY NERVE INJURYAXILLARY NERVE INJURY VASCULAR INJURYVASCULAR INJURY FRACTURE DISLOCATIONFRACTURE DISLOCATION RECURRENT DISLOCATIONRECURRENT DISLOCATION BRACHIAL PLEXUS INJURYBRACHIAL PLEXUS INJURY
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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)
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AC DISLOCATIONAC DISLOCATION
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Fractures of the Clavicle.Fractures of the Clavicle.
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Fractures of the clavicleFractures of the clavicle
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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.
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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
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SCAPULA FRACTURESSCAPULA FRACTURES
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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
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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)
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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
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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
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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
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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
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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
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ELBOW DISLOCATIONELBOW DISLOCATION
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ELBOW FRACTURE ELBOW FRACTURE DISLOCATIONDISLOCATION
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COMPLICATIONSCOMPLICATIONS
ASSOCIATED FRACTURESASSOCIATED FRACTURES RADIAL HEADRADIAL HEAD CORONOIDCORONOID OLECRANONOLECRANON MEDIAL EPICONDYLEMEDIAL EPICONDYLE HETEROTOPIC BONE FORMATIONHETEROTOPIC BONE FORMATION NEUROVASCULARNEUROVASCULAR RECURRENT DISLOCATIONRECURRENT DISLOCATION STIFF ELBOWSTIFF ELBOW
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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
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CLOSED REDUCTION ELBOWCLOSED REDUCTION ELBOW
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THE ENDTHE END
THANK YOUTHANK YOU