By Chris Pullen Common Upper Limb Fractures. Common Fractures Clavicle Proximal Humerus Distal...
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By Chris Pullen Common Upper Limb Fractures Slide 2 Common Fractures Clavicle Proximal Humerus Distal radius Scaphoid Slide 3 Clavicle 4% to 15% of all fractures 35% of fractures about the shoulder middle third++ Mechanism Direct trauma indirect - fall onto the outstretched hand Slide 4 Clavicle Middle 1/3 Most are treated non-surgically with a sling for 3 - 4 weeks Thereafter ROM exercises Slide 5 Clavicle Middle 1/3 ORIF Indications open fractures neurovascular injury/compromise displaced fractures with impending skin compromise widely displaced midclavicular fractures shortening (20 mm) or gross displacement are risk factors for the development of nonunion Slide 6 Clavicle Middle 1/3 Slide 7 Clavicle Lateral 1/3 Displaced secondary to a fracture medial to the coracoclavicular ligaments ORIF (30% nonunion) Sling 6 weeks Slide 8 Proximal Humerus 4% to 5% of all fractures age incidence Elderly - fall osteoporotic bone Young significant trauma ~ 85% are minimally displaced Slide 9 Proximal Humerus - Imaging Imaging Plain XR scapular anteroposterior (AP) lateral axillary radiographs +/- CT scan Slide 10 Proximal Humerus - Classification 4 parts (anatomic fragments) humeral head greater tuberosity lesser tuberosity humeral shaft Determination of displacement >1 cm angulation > 45 Slide 11 Proximal Humerus - Nonsurgical Minimally or non-displaced fractures Sling or collar & cuff Rpt XR 1 & 2 weeks Early passive motion within 14 days Active range of motion is started at 4 to 6 weeks A recent report indicated that functional outcome was inferior to previously reported results Slide 12 Proximal Humerus - Surgical Two-part fractures of the surgical neck most common displaced proximal humeral fracture closed reduction - if stable ORIF - if cannot be reduced closed Slide 13 Proximal Humerus - Surgical Two-part fractures of the greater tuberosity commonly occur with a shoulder dislocation After reduction the tuberosity may return to its anatomic position ORIF if displaced (=/- repair of the rotator cuff tear) Slide 14 Proximal Humerus - Surgical Three-part fractures ORIF functional results better Slide 15 Proximal Humerus - Surgical Four-part fractures ORIF young patients good bone quality Humeral head replacement preferred method in the elderly better functional scores Slide 16 Distal Radius common incidence ~ 1 in 500 people bimodal age distribution adolescents and young adults high-energy injuries postmenopausal elderly women Slide 17 Distal Radius - Imaging Plain XR posteroanterior (PA) Lateral oblique radiographs +/- CT scan Slide 18 Distal radius - Nonsurgical Minimally or non-displaced fractures Elderly Below elbow POP 6 weeks Young adult Above elbow POP 6 weeks Rpt XR 1 & 2 weeks ROM exercises Slide 19 Distal Radius - Surgical Indications Radial shortening of < 5mm at DRUJ Dorsal tilt >/= 15 or Volar tilt >/= 20 Intra-articular incongruity of >/= 2mm anatomic reduction is critical Slide 20 Distal Radius - Surgical Slide 21 Options closed reduction +/- K wire fixation external fixation ORIF arthroscopically- assisted reduction bone defect filling Slide 22 Distal Radius - Surgical Slide 23 Slide 24 Scaphoid most common fractures of the carpus 75% of all carpal injuries Rare elderly or children Slide 25 Scaphoid - Imaging Plain XR Some are XR apparent at presentation many a fracture line is not visible until bony resorption at the fracture advances Rpt XR at 10 days +/- bone scan used for diagnosis of occult scaphoid fractures Slide 26 Scaphoid - Nonsurgical Tubercle +/- splintage for analgesia Early ROM exercises Nondisplaced immobilization until clinical or radiographic healing occurs Glass-holding POP 8 to 26 weeks Slide 27 Scaphoid - Surgical Indications > 10 of angular deviation 1 mm of displacement Proximal pole fractures ORIF (compression screw) Slide 28 THE END