DEPARTMENT OF ORTHOPAEDICS

S.S. Medical College Rewa & Associated G.M.H &

SGM Hospital ,Rewa (M.P.)

Directed By Guided By- Presented by-

Dr. P.K. Dr. Rahul Kundar Aayush Rai
Lakhtakia (Assistant Professor Akash
) Chaturve
(Professor & Akash Sahu
HOD) (Batch 2013-R
SHOULDER GIRDLE
 Comprises of Clavicle, scapula and Humerus.
JOINTS IN THE SHOULDER
GIRDLE

 Sternoclavicular Joint

 Acromio Clavicular Joint

 GlenoHumeral Joint
FRACTURE OF CLAVICLE
Relavant Anatomy
Sternoclavicular Joint.
Acromioclavicular Ligament .

The Muscles Related To Clavicle Are :

Sternocleidomastoid(origin) And Subclavius

Muscle(insertion) .
The Subclavian Vessels And Brachial Plexus Lie
Posterior To Clavicle .
MECHANISM OF INJURY :
Direct traumatic impact or fall on the shoulder
87% .
Direct impact to clavicle 07% .
Fall on outstretched hand 06% .
Fall on the side .
Vigorous muscle contraction , seizures [rare] .
Pathological fracture [rare]
MECHANISM OF INJURY
DIAGNOSIS
•History Of Trauma Followed By
Pain,swelling, Crepitus At Fracture Site
•Confirmed By Xray.
TREATMENT
FRACTURE CLAVICLE

SEVERE
MINIMAL DISPLACEMENT OR
DISPLACEMENT NEUROVASCULAR
DEFICIT

TRIANGULAR SLING
FOLLOWED 20-
25DAYS BY ACTIVE OPEN REDUCTION
SHOULDER AND INTERNAL
EXERCISES WHEN FIXATION
THE PAIN SUBSIDES
FIGURE OF 8 BRACE
TRIANGULAR SLING
 Surgical treatment :
Rarely indicated in :
- lateral one third fracture .
- presence of neurovascular injury .
- non union cases .

Internal fixation plate .

Closed Reduction & Internal
Fixation by nailing .
Complication:

EARLY : [subclavian or carotid artery injury

,pneumothorax and hemothorax ,brachial injury ]

LATE :
Malunion .
Nonunion(rarely) : treated by internal fixation and
bone grafting .
Neurovascular injury [rare] .
Stiffness of shoulder in elderly .
Ulnar neuropathy .
Refracture .
 Fracture of scapula :
Fractures of scapula are uncommon because
of scapula location and surrounding muscles
which protect it .

- Fractures of scapula
are result of high energy
trauma with high incidence
Of associated injuries
by 60-98 % .
Associated life threatening injuries
with scapula # :
 Pneumothorax
 Pulmonary Contusion
 Arterial Injury
 Abdominal Injury
 Head Injury
 Splenic Or Liver Laceration
 Brachial Plexus Injury
Mechanism of injury :
# of body : From Sever Direct Trauma
- Fall From Height With Direct
Landing On Posterior Aspect Of Trunk .
- Motor Vehicle Crush .

# of neck : Direct Blow To Shoulder

- Fall On Shoulder .
- Fall On Outstretched Hand .
# Of Glenoid : Direct Blow To Lateral
Aspect Of Shoulder .
Or Impaction Of Humeral
Head In To Glenoid Fossa .

# Of Coracoid Process :
Direct Blow Or Shoulder Dislocation .

# Of Acromion :
Direct Down Ward Blow To Shoulder
.
Clinical picture :
 Sight > swelling, deformity,
ecchymosis & erosion .

Tenderness, crepitation .

Pain exacerbated by movement .

Clinical picture :
- Brusing over scapula or chest area .
- Pain in movement .
- Swelling around back of shoulder .
- Tenderness at site of # .
Arm is held immobile .
 Diagnosis :
X – ray :
Anteroposterior view \ lateral \ axillary view
.
Treatment :
Reduction Is Usually Unnecessary .
Patient Wears A Sling For Comfort And For
Start Movement.

# Of Body By :
Conservatively By Analgesics And Simple Sling To
Rest Shoulder For 2-3 Weeks .
# Of Acromion Process :
Un Displaced :
Sling For 3-4 Weeks For Rest
Shoulder.
Displaced :
Acromion Should Be Reduced
And Fixed .
# of coracoid :
conservatively in major , using a sling for
2-3 weeks.
Vigorous exercises should be prohibited
for 2 m .
# of neck and glenoid :
- sling for 2-3 weeks
- open reduction > indicated if fractures
associated with dislocation or subluxation
of shoulder .
STERNO CLAVICUAR JOINT
DISLOCATION

 Rare injury
 Medial end of clavicle is displace forward or rarely
backward.
 Clinical diagnosis is easier
 Treated by reduction by direct pressure on
dislocated end which is then maintained by figure
of 8 bandage.
ACROMIO CLAVICULAR JOINT DISLOCATION

ANATOMY
MECHANISM:
FALL ON OUTSTRETCHED
HAND
 XRAY

TREATMENT:

• Rest In Triangular
GRADE 1 & Sling
2 INJURY • Analgesics

• Sugical Repair.
GRADE 3
INJURY
 SHOULDER DISLOCATION
MOVEMENT AT SHOULDER JOINT
 MECHANISM OF INJURY
 COMMONEST :Fall on an outstretched hand with
the shoulder abducted and externally rotated

 POSTERIOR DISLOCATION:by direct blow from

the front of the shoulder or from epileptiform
convulsions or electric Shock.
ANTERIOR DISLOCATION POSTERIOR DISLOCATION
ANTERIOR DISLOCATION INFERIOR DISLOCATION
(Slight abducted and internal
rotated arm)

POSTERIOR SHOULDER DISLOCATION

(adducted and internally rotated arm)
PATHOLOGICAL CHANGES IN ANTERIOR
DISLOCATION
 BANKART’S LESION
 HILL SACHS LESION
 ROUNDING OFF
 ASSOCIATED INJURIES
BANKARTS LESION
Seen in anterior dislocation.

Stripping of glenoid labrumalong with

periosteum .

Antero inferior Surface of glenoid and

scaular neck.

Avulsion of anteroinferior Glenoid rim

causes Bony Bankart Lesion.

HILL SACHS LESION

Depresson on humeral
head in its postero lateral
quadrant
Due to impingment by
the anterior edgeof
glenoid on the head as it
dislocates
 OTHERS
 ROUNDING OFF OF ANTERIOR GLENOID RIM

: in chronic cases due to repeated dislocation of

head over it

 ASSOCIATED INJURIES like Fracture greater

Tuberosity ,Rotator Cuff Tear,Chondral Damage

etc .
 DIAGNOSIS
 History of fall on outstretched hand followed by
pain and inability to move the shoulder.

SIGNS:

1)LIGHTBULB SIGN :In Posterior

Dislocation
 2) GLENOID RIM:Distance between
the medial border of the
humeral head an anterior
glenoid rim is >6mm.

3)DUGAS’ TEST:In Anterior Dislocation,Inability To

touch the opposite Shoulder.

4)HAMILTON RULER TEST:due to flattening ,ruler

can be placed on the lateral side of arm touching the
lateral condyle and acromion simultaneously.
HILL SACH LESION BANKART LESION
 INFERIOR DISLOCATION
ANTERIOR DISLOCATION
TREATMENT
 REDUCTION :

 1) KOCHERS MANOEUVRE
2) HIPPOCRATES MANOUEVRE
 3)STIMSONS MANOUEVRE
KOCHERS MANOUEVRE
 I)Traction –with the elbow flexed at right angle
,steady traction applied along long axis of
humerus
 II)External Rotation
 III)Adduction
 IV)Internal Rotation
COMPLICATIONS

 NERVE INJURY :Axillary and

musculocutaneous nerve injury

 Recurrent dislocation
SURGICAL OPERATIONS
 I)PUTTI PLATT OPERATION:Double breasting of

subscapularis to prevent ER and Adduction.

 II)BANKARTS OPERATION:Glenoid labrum and

capsule reattached to front of glenoid rim.

 III)BRISTOWS OPERATION:Coracoid process

osteomized at base and fixed to lower half of the

anterior margin of glenoid.