Fracture of the Upper Extremities part I

 

Clavicle Fracture

-       Mechanism of injury

  • Indirect injury
    • Oblique fracture
    • Transverse fracture
  • Direct injury
    • abrasion ,laceration wound, open fracture
    • comminuted pattern

-       Clinical features

-       Investigation

  • X-ray
    • 30 degree cephalic tilt 
  • CT scan

-       Classification

  • Allman Classification
    • Middle third (80%)
    • Medial third (5%)
    • lateral third (15%)
      • Type I   : Coracoclavicular ligament intact
      • Type II : Coracoclavicular ligament detached from medial fragment
      • Type III : Fracture extension into acromioclavicular joint

-       Treatment

  • Non-operative treatment
    • figure of eight splint หรือsimple arm sling
  • Operative treatment
    • plate and screw fixation, Intramedullary pinning ,tension band wiring

-       Complications

  • Early complications
    • pneumothorax, Subclavian artery injury, Brachial plexus injury
  • Late complications
    • nonunion, malunion, shoulder stiffness

Scapula Fracture

-       Mechanism of injury

  • Body of scapular: Direct injury
  • Neck of scapular: Lateral force
  • Coracoid process:avulsion fracture
  • Acromion: Direct injury
  • Glenoid fossa Lateral force from humeral head

-       Clinical features

  • bruising ,ecchymosis
  • Asso inj.
    • chest wall (rib fracture, pneumothorax)
    • brachial plexus
    • spine
    • abdomen

-       Investigation

  • X-ray
  • CT scan
    • Glenoid fracture

-       Classification :Anatomical classification

  • scapular body
  • neck
  • glenoid
  • acromion
  • coracoid process

-       Treatment

  • Body fractures: arm sling , ROM exercise
  • Isolated scapula neck fracture : arm sling , early exercise
  • Glenoid fractures
    • indication for surgery (screw fixation)
      • humeral head subluxation
      • fracture displacement > 5
      • fracture fragment > 1/3 ofarticular surface
  • Acromion fractures
    • indication for surgery (fixation tension band wiring)
      • inferior displacement with reduce sub-acromial space screw
  • Coracoid fracture
    • indication for surgery ( screw fixation)
      • displaced fracture of coracoid base

 

Proximal Humerus fracture

-       Clinical features

  • bruising ,ecchymosis
  • Neurovascular: axillary nerve

-       Investigation

  • X-ray : AP Lateral
  • CT scan

-       Classification

-       Neer’s classification

  • displacement > 1, angulation > 45degree
  • One part, two part, three part, four part

-       Treatment

  • One-part fracture (minimal displacement) :arm sling
  • Two-part fracture
    • Surgical neck :arm sling
    • Greater tuberosity internal fixation
  • Three-part fracture : ORIF with plate-screw
  • Four part
    • Youneg age : fixation
    • Elderly : Hemiarthroplasty

-       Complications

  • Neurovascular injury : axillary nerve
  • avascular necrosis
  • stiffness
  • malunion

Humerus fracture

-       Mechanism of injury

  • Indirect injury
    • Spiral
    • Oblique fracture
    • Transverse fracture
  • Direct injury
    • comminuted pattern

-       Clinical features

  • bruising ,ecchymosis
  • Neurovascular: Radial nerve

-       Investigation

  • X-ray : AP Lateral

-       Classification

-       Treatment

  • Conservative treatment : hanging cast (shoulder to wrist8
  • Surgical treatment :plate-screw ,intramedullary nail
    • indication
      • multiple fracture
      • segmental fracture
      • pathologic fracture
      • floating elbow
      • radial nerve palsy

-       Complications

  • Neurovascular injury : Radial nerve injury

 

 

Distal Humerus fracture

-       Clinical features

  • bruising ,ecchymosis
  • Neurovascular

-       Investigation

  • X-ray : AP Lateral
  • CT scan

-       Classification

• Type A : extra - articular supracondylar fracture

• Type B : intra - articular unicondylar fracture

• Type C : bicondylar fracture

-       Treatment

  • Conservative treatment : undisplaced
  • Surgical treatment : Displaced
    • plate-screw

-       Complications

  • neurovascular injury
  • joint stiffness
  • heterotopic ossification (HO)

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