Professional Documents
Culture Documents
Upper Extremity Fractures
Upper Extremity Fractures
Patient education :
No overhead activity first 6 weeks
No heavy manual work for 3 months
Management :
Identification of associated injuries
Sling 4-6 weeks
If involve glenoid fossa with significant displacement -> Internal fixation
A 42 yo male surfer presents to ER with Left
Shoulder pain after he was hit by a strong
wave.
Xray is shown.
Posterior dislocation : associated with high energy trauma, epileptic fit, electric shock
Very unusual injury in children
Physical Exam :
Anterior : humeral head palpable on anterior sub-coracoid, loss of shoulder roundness
Posterior : glenohumeral joint is fixed in internal fixation
Assess Axillary Nerve and Brachial plexus palsy
Complication :
Axillary nerve palsy
Brachial plexus palsy
Rotator cuff tears
Treatment :
Closed reduction
Open reduction – more for posterior dislocation
3-4 weeks immobilization
Risk :
< 20 yo – 80% of recurrent dislocation
> 40 yo – rotator cuff tears and nerve injury more frequent
Warning :
If after 4-6 weeks no active abduction -> MRI to diagnose rotator tear
ANTERIOR SHOULDER DISLOCATION
ASSOCIATED COMMON FRACTURES AND DEFOMITIES
WITH ANTERIOR SHOULDER DISLOCATION
OPTIONS FOR SHOULDER REDUCTION
Matson’s Traction Counteraction Stimson’s Methode Hippocratic Methode
CUNNINGHAM TECHNIQUE
Massage on the shoulder and arm while pulling down the arm
A 29 yo female, after an episode of convulsion, she
complains of pain on her right shoulder.
Treatment :
I and II - > non-operative, sling
III -> best surgically, coraco-clavicular screw
ACROMIOCLAVICULAR JOINT INJURY Inferior cortex of
acromion process
and
Inferior cortex of
clavicle should be
in one line
CORACOCLAVICULAR LIGAMENT INJURY
Complication :
Mal-union
Shoulder stiffness
Troublesome if osteoporotic
HUMERAL SHAFT FRACTURES
Direct or indirect trauma to upper arm
High energy, elderly patient or drunk patient who fell
12% Radial nerve palsy
Treatment :
Non-operative : U-slab, after 2-4 weeks replaced with functional brace
ORIF (plating or intramedullary nailing
DISTAL HUMERAL FRACTURES
Not common, but difficult to treat in adults
After a fall directly on to the elbow
Treatment :
Non-operative : above-elbow cast
ORIF – most common treatment
Complication :
Stiffness – most common
Ulnar nerve palsy
Heterotopic offication
Post-traumatic arthritis
Infection
A 19 yo male fell down while playing basketball,
hitting his left elbow.
Xray :
If no obvious fracture, check fat pad signs
Treatment :
Surgery
Xray as shown.
Xray as shown.
Treatment :
Closed reduction with sedation
10-14 days of immobilization in back-slab plaster
Treatment :
Cast 3-5 weeks
Radiograph 1 and 2 weeks after reduction
A 42 yo male fell on his left arm during motorbike accident
His xray as shown
Treatment : Surgery
ROLANDO FRACTURE