Re-written by: Daniel Habashi Upper Extremity Fractures And
Dislocations
Slide 2
Shoulder Girdle Clavicle Scapula Humerus
Slide 3
Clavicle- Mechanism of Injury There is no correlation between
the fracture location and the mechanism of injury Falls onto the
affected shoulder 87% Direct impact 7% Falls onto an outstretched
hand 6%
Slide 4
Clavicle clinical evaluation Arm adducted across the chest and
supported by the contra lateral hand Neurovascular examination
Tenting the skin Crepitus X-ray
Slide 5
Clavicle non operative treatment Reduction if needed Closed
treatment is successful in most cases Dessaulte cast
Figure-of-eight cast 4-6 weeks
Slide 6
Clavicle operative treatment Open fractures Fractures with
associated neurovascular injury Fractures with severe associated
injuries (flail chest with multiple rib fractures) Cosmetic
reasons
Acromioclavicular joint mechanism of injury Most often in the
Spring Fall onto the shoulder with the arm adducted Fall onto an
outstretched hand with force transmission up the arm
Slide 9
AC joint clinical evaluation Step-off deformity Possible
tenting of the skin overlying the distal clavicle Limited range of
motion Tenderness X-ray
Slide 10
AC joint classification Type I sprain of the AC ligament Type
II tear of the AC ligament and sprain of the caracoclavicular
ligament Type III AC and coracoclavicular ligaments torn with AV
joint dislocation
Slide 11
AC joint non-operative treatment Type I - Rest 10 days, ice
packs and sling Type II Sling for 2 weeks, gentle range of motion,
refrain from heavy activity for 6 weeks Type III Sling, early range
of motion, acceptance of deformity
Slide 12
AC joint operative treatment Controversial patients Heavy
laborers, patients 20-25 years of age Open reduction and
suturing
Slide 13
Sternoclavicular joint mechanism of injury Direct hit Indirect
force applied from antero-lateral or postero-lateral aspects of the
shoulder
Slide 14
SC joint classification Anterior dislocation more common
Posterior dislocation
Slide 15
SC joint clinical evaluation Patient supports the affected
extremity across the trunk with the contra-lateral arm Swelling,
tenderness, painful range of motion X-ray
Slide 16
SC joint treatment Mild sprain ice packs, sling for 7 days
Moderate sprain or subluxation ice packs and sling for 4-6
weeks
Slide 17
Scapula mechanism of injury Relatively uncommon injury Result
of high energy trauma Suspicion of associated injuries Fractured
ribs Clavicle Sternum Pneumothorax Pulmonary contusion Spinal
column fractures
Slide 18
Scapula Clinical Evaluation Full trauma evaluation Upper
extremity supported by the contra-lateral hand Swelling of the
posterior thorax X-ray
Slide 19
Scapula treatment Most scapula fractures are treated
non-operatively Sling and early range of motion
Slide 20
Proximal humerus mechanism of injury A fall onto an
outstretched upper extremity from standing height (typically seen
in an elderly osteoporotic woman) High energy trauma (motor vehicle
accident) Direct trauma Pathologic processes
Slide 21
proximal humerus - clinical evaluation Upper extremity
supported by the contralateral hand Pain, swelling, tenderness,
painful range of motion Crepitus, instability, ecchymosis
X-ray
Slide 22
Proximal humerus clinical evaluation A careful neurovascular
evaluation is required
Slide 23
Proximal humerus treatment Open reduction and internal fixation
(plates, screws, K- wires, pins, flexible nails with tension band)
Prosthetic replacement
Slide 24
Humeral shaft mechanism of injury Direct trauma (most common)
Indirect: fall on an outstretched arm
Slide 25
Humeral shaft radial nerve injury Radial nerve injury is
something we must take care of Symptoms of a radial nerve injury
is: dropped hand since its responsible for the innervations of all
the extensors
Slide 26
Humeral shaft clinical evaluation Pain, swelling, deformity,
shortening of the affected arm Instability with crepitus A careful
neurovascular exam with special attention to the radial nerve
function X-ray
Slide 27
Humeral shaft non operative treatment Most humeral shaft
fractures will heal with nonsurgical treatment A hanging cast A
co-aptation splint Thoracobrachial immobilization (Dessaulte,
Velpau dressing)
Slide 28
Humeral shaft operative treatment Open reduction and internal
fixation (plates, screws, intramedullar nails) External fixation
quite quite quite rare
Slide 29
Humeral shaft radial nerve injury Most common with middle third
fractures Generally neuropraxia or axonotmesis (function returns
within 3-4 months) Laceration most common in gunshot injuries
etc
Distal humerus mechanism of injury Fall on outstretched hand
with or without an abduction or adduction force (supra and
transcondylar fractures) Force directed against the posterior
aspect of an elbox flexed more than 90 degrees
Slide 32
Distal humerus clinical evaluation Swelling, painful range of
motion, crepitus, instability Elbow held in the flexed position A
careful neurovascular evaluation is essential because the sharp
fractured end.
Slide 33
Distal humerus treatment Open reduction and internal fixation
(screws, plates) Total elbow arthroplasty
Slide 34
Glenohumeral dislocation The shoulder is the most commonly
dislocated joint of the body (45% of dislocations)
Slide 35
Glenohumeral dislocation classification Anterior (most common
84%) Posterior ( the second most common - 10%) Inferior (rare)
Superior (rare)
Slide 36
Glenohumeral dislocation mechanism of injury
Slide 37
Glenohumeral dislocation clinical evaluation Determine the
nature of the trauma Position of the affected extremity Painful
shoulder, muscular spasm Neurovascular examination X-ray