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

Anterior shoulder dislocationAnterior shoulder dislocation

Two Views.Two Views.

APAP LateralLateral

REDUCTIONREDUCTION

POST REDUCTIONPOST REDUCTION

CONTROL X-RAYCONTROL X-RAY SLING 2-3 WEEKSSLING 2-3 WEEKS AVOID EXTERNAL ROTATION AND AVOID EXTERNAL ROTATION AND

ABDUCTIONABDUCTION

COMPLICATIONSCOMPLICATIONS

AXILLARY NERVE INJURYAXILLARY NERVE INJURY VASCULAR INJURYVASCULAR INJURY FRACTURE DISLOCATIONFRACTURE DISLOCATION RECURRENT DISLOCATIONRECURRENT DISLOCATION BRACHIAL PLEXUS INJURYBRACHIAL PLEXUS INJURY

Posterior shoulder dislocationPosterior shoulder dislocation

APAP LateralLateral

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

COMPLICATIONSCOMPLICATIONS

AXILLARY NERVE INJURYAXILLARY NERVE INJURY VASCULAR INJURYVASCULAR INJURY FRACTURE DISLOCATIONFRACTURE DISLOCATION RECURRENT DISLOCATIONRECURRENT DISLOCATION BRACHIAL PLEXUS INJURYBRACHIAL PLEXUS INJURY

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)

AC DISLOCATIONAC DISLOCATION

Fractures of the Clavicle.Fractures of the Clavicle.

Fractures of the clavicleFractures of the clavicle

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.

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

SCAPULA FRACTURESSCAPULA FRACTURES

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

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)

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

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

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

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

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

ELBOW DISLOCATIONELBOW DISLOCATION

ELBOW FRACTURE ELBOW FRACTURE DISLOCATIONDISLOCATION

COMPLICATIONSCOMPLICATIONS

ASSOCIATED FRACTURESASSOCIATED FRACTURES RADIAL HEADRADIAL HEAD CORONOIDCORONOID OLECRANONOLECRANON MEDIAL EPICONDYLEMEDIAL EPICONDYLE HETEROTOPIC BONE FORMATIONHETEROTOPIC BONE FORMATION NEUROVASCULARNEUROVASCULAR RECURRENT DISLOCATIONRECURRENT DISLOCATION STIFF ELBOWSTIFF ELBOW

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

CLOSED REDUCTION ELBOWCLOSED REDUCTION ELBOW

THE ENDTHE END

THANK YOUTHANK YOU