Conservative management of upper limb fractures

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  • 1.Conservative treatment of upper limb fractures

2. Assessment
Reduction
Immobilization
Functional activity
Basic principles in management of a closed fracture
3. Economical
No operative risks
No displacement ends together mostly always unite.
Why conservative?
4. Reduction by applying traction generally in the line of the limb
After reduction, it must be prevented from redisplacing until it has united. -
Plaster slabs
Plaster bandages ( casts) full circumference
Readymade braces
What is done?
5. Slab an example
6. Plaster splints need 1012 layersof plaster inupper extremities
Slabs should be dipped, squeezed, when out of water, smoothed then applied with no wrinkles.
Thickness of plaster slab
7. Shoulder: resting at the side of the body
Elbow: 90 angle between forearm and arm, neutral pronation/supination
Wrist: neutral supination/pronation, 2030 wrist extension
Thumb: thumb in 45 abduction, 30 flexion
Metacarpals, MCP joint, proximal phalanges: MCP joint in 90 flexion, DIP and PIP joints in full extension
IP joints, middle/distal phalanx: full extension at IP joints
Positions in splinting
8. Indications
Elbow fractures
Supracondylar fractures
Above elbow slab
9. Extends from the middle of the upper arm to the point just proximal to the knuckles in the dorsum of the hand.
patient's forearm is held in mid prone position with the elbow in 900flexed position.
Above elbow slab
10. 11. 12. 13. 14. 15. 16. 17. 18. Indications
Non displaced fractures of the wrist
Soft tissue injuries to the wrist or forearm
Colles fracture
Below elbow slab
19. Extends from a point about 5 cm below the top of the olecranon to the level just proximal to the knuckles in the dorsum of the hand and the distal crease in the palmar aspect.
The forearm is held with the elbow in a 900flexed and the wrist in the position of function of 250dorsiflexion.
The fingers should be free to move fully at the metacarpo-phalangeal joints.
Below elbow slab
20. 21. Indications
Soft tissue injuries to 4th and 5th fingers
4th n 5th metacarpal fracture
Fractures of 4th n 5th phalanges
Ulnar gutter slab
22. measure the plaster from the fifth distal interphalangeal joint to the proximal third of the forearm
Apply the wet plaster, over the padding, to the medial or ulnar surface of the forearm.
The wrist and hand should be in a neutral position. Extend the wrist to 20 and flex the metacarpophalangeal joints to 70.
23. Upper limb fractures conservative management
24. Clavicle fracture
25. Group 1 middle 1/3 (80%)
Group 2 distal 1/3
Group 3 proximal 1/3
Allman classification
26. More than 90% of clavicle fractures are successfully healed by non-operative treatment.
If the fracture is at the lateral end, the risk of nonunion is greater than if the fracture was of the shaft.
Clavicle fracture
27. Treatment
Board arm sling
Ring/quoit method
Figure of 8 bandage
Clavicle fracture
28. Sling
Support shoulder girdle, raising lateral fragment upward.
Clavicle - sling
29. Figure of 8 bandage/brace
Depress the medial fragment
Elderly patients tolerate clavicular bracing methods poorly
Clavicle - Figure of 8
30. Why sling or figure of 8?
31. For 4-6 weeks
During this period, active range of motion of the elbow, wrist and hand should be performed.
Immobilization
32. Acromioclavicular joint injury
33. Type 1 sprain of ac ligament
2- with coracoclavicularlig sprained
3- with joint dislocation
4 clavicle displaced posteriorly
5- displaced superiorly
6 inferior displacement
AC joint injury
34. Type 1-3 conservative management
4-6 operative
Conservative management
Ice packs
Sling for 2 weeks.
AC - conservative
35. Sternoclavicularjoint injury
36. Ice for first 24 hrs.
Mild sprain sling 3-4 days
Moderate sprain sling and swathe/ figure of 8 bandage 1 week, then sling 4-6 weeks
Medial physeal injury sling n swathe/figure of 8 bandage for 4-6 weeks
SC joint injury
37. Scapula fracture
38. Anatomic
Type 1 scapula body
Type 2 acromion n coracoid
Type 3 scapular neck n glenoid.
Classification
39. Non Surgical Treatment: - vast majority of scapula fractures may be treated non operatively (extraarticular) - closed reduction of these frx is usually not possible - treatment consists of support of a sling and early motion - most fractures will heal by 6 weeks
Scapula fracture
40. A simple sling can be used
Scapula fractures
41. Glenohumeral dislocation
42. Shoulder most commonly dislocated major joint
Anterior dislocation common
Recurrence rate 50%
43. Closed reduction
Traction countertraction
Hippocratic technique
Stimson technique
Milch technique
Kocher maneuver
Post reduction care immobilzation for 2-5weeks
Anterior glenohumeral dislocation
44. Hippocratic technique
45. Milch technique
46. 20-30min
Stimson maneuver
47. Subacromial
Pt supine, traction appllied to adducted arm in the line of deformity
Postreduction sling and swathe immobilization for 3-6weeks.
Posterior glenohumeral dislocation
48. Luxatoerecta
Salute fashion humerus 110-160 degrees abduction and forward elevation
Reduction traction countertraction maneuvers. Traction in line with humeral position superiolaterally.
Immobilized in a sling for 3-6weeks.
Inferior glenohumeral dislocation
49. Very rare
Foreshortened arm held in adduction
Closed reduction
Traction inferior direction.
Superior glenohumeral dislocation
50. Fractures of proximal humerus
51. Neer classification
4 parts
Greater tuberosity
Lesser tuberosity
Humeral shaft
Humeral head
Displaced if >1cm displacement/ >45 degrees angulation.
52. Nondisplaced Fractures