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Fractures and Injuries of the Upper Limb

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Fractures and Injuries of the Upper Limb. Fractures of the Clavicle ... Usually # in mid to outer with lateral end pulled downwards by weight of arm ... – PowerPoint PPT presentation

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Title: Fractures and Injuries of the Upper Limb


1
Fractures and Injuries of the Upper Limb
2
Fractures of the Clavicle
  • Common in children - usually greenstick
  • Caused by fall on outstretched hand or direct
    blow to the shoulder
  • Rarely open
  • Usually in mid to outer ? with lateral end
    pulled downwards by weight of arm

3
Fractures of the Clavicle
  • Complications -rare
  • brachial plexus
  • subclavian artery or vein
  • pleural injury ? pneumothorax
  • non union rare more likely following internal
    fixation

4
Fractures of the Clavicle
  • Treatment
  • support with a sling - 3 weeks
  • reduction with figure-of-eight bandage
  • internal fixation - rare

5
Subluxation dislocation of acromio-clavicular
Joint
  • Common in sport - usually a sprain
  • Caused by fall or direct blow on shoulder
  • Acromion driven under lateral end of clavicle ?
    sprain/rupture of coracoclavicular ligaments
  • Treatment - conservative, rarely surgery

6
Dislocation of the Shoulder
  • Common injury
  • Fall on outstretched hand or shoulder
  • Usually anterior dislocation (sub caracoid) can
    be posterior or inferior
  • Complications - Axillary nerve damage,
    occasionally brachial plexus

7
Dislocation of the Shoulder
  • Treatment
  • Reduction
  • Immobilisation in a sling 3 weeks, less in
    elderly
  • Recurrent dislocation
  • Treatment - Putti-Platt Bankart procedures,
    tightening and reinforcing the anterior capsule

8
Fractures of the neck of humerus
  • Often comminuted so MUA not required
  • Stable s may be mobilised early
  • Unstable s maybe displaced associated with
    brachial plexus or axillary artery damage
  • Stiff shoulder a frequent complication

9
Stable fractures of the neck of humerus
  • Treatment
  • immobilisation in a sling 3 weeks
  • during this period active movement is often
    encouraged as pain allows

10
Unstable fractures of the neck of humerus
  • May require MUA and ORIF
  • Longer period of immobilisation ? stiffness,
    muscle wasting and loss of function
  • dislocation a further complication

11
Fractures of the humeral shaft
  • Common in all age groups
  • Fall on outstretch hand or direct violence
  • Spiral and displaced
  • Radial nerve occasionally involved
  • Collar and cuff sling, splint, IF or ORIF

12
Supracondylar s of elbow
  • Usually occurs in children
  • Distal fragment displaced rotated backwards
  • Complications
  • brachial artery, soft tissues, nerves -median
    ulnar
  • late gunstock deformity

13
Supracondylar s of elbow
  • Treatment
  • MUA
  • collar and cuff sling or splint
  • Internal fixation
  • Post reduction swelling sometimes a problem

14
Colles fracture
  • Fall on outstretched hand
  • Common in elderly/middle age - osteoporotic women
  • of lower end of radius with backward tilt
  • Characteristic dinner fork deformity

15
Colles fracture
  • Treatment
  • if minimally displaced - POP
  • if displaced MUA as alignment is important for
    wrist and forearm function
  • Complications
  • median nerve damage/compression ? carpal tunnel
    syndrome
  • malunion, OA, Sudecks atrophy
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