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
- indication for surgery (screw fixation)
- Acromion fractures
- indication for surgery (fixation tension band wiring)
- inferior displacement with reduce sub-acromial space screw
- indication for surgery (fixation tension band wiring)
- Coracoid fracture
- indication for surgery ( screw fixation)
- displaced fracture of coracoid base
- indication for surgery ( screw fixation)
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
- indication
- 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)
