Fracturas del Extremo Proximal del Húmero

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Cuatro Partes (Codman)

CabezaHumeral

Troquín

Troquiter

DiáfisisHumeral

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Clasificación de De Anquin

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Clasificación de NEER

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Clasificación de la AO

Tipo I

Tipo II

Tipo III

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Schatzker y Tile

� Trazo

� Estabilidad

Intracapsular

Extracapsular.

Estable

Inestable

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Tratamiento

� Fracturas estables.

� Fracturas inestables.

No se desplazan con las cargas fisiológicas

Los fragmentos se mueven

en forma independiente entre sí

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Fracturas inestables

� Con desplazamiento mínimo.

� Con desplazamiento mayor.

Desplazamiento menor de 1 cm.

y angulación inferior a 40°

En dos partesEn tres partes

En cuatro partesFractura-luxación

Articulares

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Fracturas diafisarias de húmeroClasificación AO

A. Fr. Simples: A1 espiraladasA2 oblicuas mayor a 30°A3 transversa menor a 30°

B. Fr. en cuña: B1 cuña en espiralB2 cuña por inclinaciónB3 cuña fragmentada

C. Fr. Complejas: C1 en espiralC2 segmentariaC3 irregular

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Fractura de la Escápula

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Clasificación Anatómica

� Fracturas del cuerpo (cerca del 50%).

� Fracturas del cuello (25%).

� Fracturas glenoideas (10%).

� Fracturas del acromion.

� Fracturas de la coracoides.

� Fracturas de la espina.

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ClasificaciónZdraukovic y Damholt

� Fracturas del cuerpo.

� Fracturas de las apófisis (acromion-coracoides-espina).

� Fracturas del ángulo superoexterno (cuello-glenoides).

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Anillo osteofibrosoComplejo Suspensorio Superior del Hombro

Thomas Goss� Cavidad glenoidea.

� Coracoides.

� Ligamentos coracoclaviculares.

� Tercio distal de la clavícula.

� Ligamentos acromioclaviculares.

� Acromion.

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Anillo osteofibrosoComplejo Suspensorio Superior del

HombroThomas Goss

� Pilar anterosuperior: tercio medio de la clavícula.

� Pilar posteroinferior: cuello-espina-bordelateral de la escápula.

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Anillo osteofibrosoComplejo Suspensorio Superior del Hombro

Thomas Goss

Lesión aislada Lesión combinada(ruptura doble o triple)

hombro flotante

Baja energía Alta energía

Tratamiento funcional Tratamiento quirúrgico

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Fracturas del Cuello

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Clasificación

� Tipo I: No desplazada ni angulada.

� Tipo II A: Acortada o desplazada > 1 cm.

� Tipo II B: Angulada > 40°.

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Tratamiento

Fracturas del Cuello

No desplazadastraslación <1 cm.Angulación <40°

DesplazadasTraslacion > 1 cm.Angulación > 40°

Tratamiento funcional Tratamiento quirúrgico

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Fracturas del Acromion

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ClasificaciónKuhn

� Tipo I: desplazamiento mínimo.

� Tipo II: con desplazamiento sin reduccióndel espacio subacromial.

� Tipo III: con desplazamiento con reduccióndel espacio subacromial.

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Tratamiento

Fracturas del Acromion

Tratamiento funcional Tratamiento quirúrgico

DesplazadasEscalón >1 cm.Reducción del espaciosubacromialFracturas de la base del acromionPseudoartrosis sintomáticas

No desplazadasEscalón <1 cm.Sin reducción del espaciosubacromial

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Fracturas de la Coracoides

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ClasificaciónEyres

� Tipo I: de la punta.

� Tipo II: del cuerpo.

� Tipo III: de la base.

� Tipo IV: incluye la porción adyacente del cuerpo.

� Tipo V: fr. articular que comprende la parte superior de la glenoides.

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Tratamiento

Fracturas de la Coracoides

No desplazadasDiastasis <5mm.

Tratamiento funcional Tratamiento quirúrgico

DesplazadasDiastasis >5mm.

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Fracturas Glenoideas(intraarticulares)

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ClasificaciónIdeberg

� Tipo I: fracturas del reborde (A:anterior, B:posterior).

� Tipo II: transversal a través de la fosa, con fragmentoinferior desplazado con la cabeza humeral.

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ClasificaciónIdeberg

� Tipo III: oblicua con fragmento articular superior queincluye la coracoides ya que el trazo termina en el bordesuperior.

� Tipo IV: horizontal con trazo que llega al borde medial.

� Tipo V: combina los tipo II y IV.

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FRACTURAS ARTICULARES

(Glenoideas)

No desplazadasSin inestabilidad

Tratamientofuncional

DesplazadasEscalón o diastasis > 2mm.Con inestabilidad GH.

Tratamientoquirúrgico

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Fracturas de la Clavícula

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Clasificación

Grupo I: fractura del tercio medio

Craig EV: Fractures ofthe clavicle, 1990

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Clasificación

Grupo II: fractura del tercio distal

� Tipo I: desplazamiento mínimo (interligamentoso)

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� Tipo II: con desplazamiento secundario a una fractura medial a los ligamentos coracoclaviculares

A. Conoide y trapezoide intactos

B. Conoide desgarrado, trapezoide intacto

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� Tipo III: fracturas de la superficie articular

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� Tipo IV: ligamentos hacia el periostio intactos (niños, con desplazamiento del fragmento proximal)

�seudoluxacion acromioclavicular�

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� Tipo V: conminuta: sin ligamentos adheridos en la porción proximal o distal, sino hacia un fragmento conminuto inferior.

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Grupo III: fracturas del tercio proximal

� Tipo I: desplazamiento mínimo

� Tipo II: desplazamiento (rotura ligamentos)

� Tipo III: intraarticular

� Tipo IV: separación epifisaria (niños y adultos jóvenes)

� Tipo V: conminuta

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Fracturas supracondileas de Codo

A extrarticulares A1 avulsion metafisariaA2 simple metafisariaA3 metafisaria multifragmentaria

B articulares B1 articular parcial lateral sagitalB2 articular parcial medial sagitalB3 articular parcial frontal

C suprainterart. C1 articular y metafisaria simpleC2 articular simple metafisaria complejaC3 multifragmentaria

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Fracturas supracondileas de Codo

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Fractura de la Cúpula Radial

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Clasificación (Mason)

� Tipo 1: No desplazada o mínimo desplazamiento.

� Tipo 2: Desplazada, en general por cizallamiento con un solo fragmento.

� Tipo 3: Conminuta.

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Mason Tipo IV

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Clasificación(Duparc)

� Tipo 1: Fractura no desplazada.� Tipo 2: Fractura-separación de dos (tipo 2a) o

tres (tipo 2b) fragmentos.� Tipo 3: Fractura-hundimiento subcapital,

encajada (tipo 3a) o desencajada (tipo 3b).� Tipo 4: Fractura mixta (separación-

hundimiento, encajada (tipo 4a) o desencajada (tipo 4b).

� Tipo 5: Estallido de la cabeza del radio.

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Tratamiento conservadorIndicaciones

� Fracturas tipo 1, no desplazadas(Duparc).

� Fracturas tipo 3a, fractura-hundimiento encajada (Duparc), con desplazamiento menor de 20º.

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Tratamiento Conservador

� Artrocentesis evacuadora.

� Yeso Braquiopalmar.

� Movimientos activos y pasivos autocontrolados.

� Evitar durante las primeras semanas la flexión en pronación.

� Controles radiográficos periódicos.

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Tratamiento quirúrgicoIndicaciones

� Fracturas tipo 2a (fractura-separación de dos fragmentos).

� Fracturas tipo 2b (fractura-separación de tres fragmentos).

� Fracturas tipo 3a (fractura-hundimiento encajada) desplazada más de 20º.

� Fracturas tipo 3b (fractura-hundimiento desencajada).

� Fracturas tipo 4a (fractura separación-hundimiento encajada).

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Tratamiento quirúrgico

� Escisión de fragmentos separados.

� Osteosíntesis.

� Cupulectomía.

� Artroplastía.

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Fractura del Olécranon

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Clasificaciones

� Colton.

� Schatzker.

� AO/ASIF.

� OTA.

Criterios

- Desplazamiento.- Dirección del trazo fracturario.- Conminución articular.- Porcentaje involucrado.- Lesiones asociadas.

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Clasificación (Morrey)

� Tipo 1: no desplazada. a: no conminuta, b:conminuta.

� Tipo 2:desplazada-estable. a: no conminuta, b:conminuta.

� Tipo 3: inestable. a: no conminuta, b:conminuta.

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Fracturas de la CoronoidesClasificación Regan y Morrey

�Tipo 1: Avulsión simple.

�Tipo 2: Fragmento único o conminuto que afecta al 50%.

�Tipo 3: Fr. que afecta a mas del 59%.

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Fracturas del Extremo Proximal del Húmero

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Cuatro Partes (Codman)

CabezaHumeral

Troquín

Troquiter

DiáfisisHumeral

Clasificación de De Anquin

Clasificación de NEER

Clasificación de la AO

Tipo I

Tipo II

Tipo III

Schatzker y Tile

� Trazo

� Estabilidad

Intracapsular

Extracapsular.

Estable

Inestable

Tratamiento

� Fracturas estables.

� Fracturas inestables.

No se desplazan con las cargas fisiológicas

Los fragmentos se mueven

en forma independiente entre sí

Fracturas inestables

� Con desplazamiento mínimo.

� Con desplazamiento mayor.

Desplazamiento menor de 1 cm.

y angulación inferior a 40°

En dos partesEn tres partes

En cuatro partesFractura-luxación

Articulares

Fracturas diafisarias de húmeroClasificación AO

A. Fr. Simples: A1 espiraladasA2 oblicuas mayor a 30°A3 transversa menor a 30°

B. Fr. en cuña: B1 cuña en espiralB2 cuña por inclinaciónB3 cuña fragmentada

C. Fr. Complejas: C1 en espiralC2 segmentariaC3 irregular

Fractura de la Escápula

Clasificación Anatómica

� Fracturas del cuerpo (cerca del 50%).

� Fracturas del cuello (25%).

� Fracturas glenoideas (10%).

� Fracturas del acromion.

� Fracturas de la coracoides.

� Fracturas de la espina.

ClasificaciónZdraukovic y Damholt

� Fracturas del cuerpo.

� Fracturas de las apófisis (acromion-coracoides-espina).

� Fracturas del ángulo superoexterno (cuello-glenoides).

Anillo osteofibrosoComplejo Suspensorio Superior del Hombro

Thomas Goss� Cavidad glenoidea.

� Coracoides.

� Ligamentos coracoclaviculares.

� Tercio distal de la clavícula.

� Ligamentos acromioclaviculares.

� Acromion.

Anillo osteofibrosoComplejo Suspensorio Superior del

HombroThomas Goss

� Pilar anterosuperior: tercio medio de la clavícula.

� Pilar posteroinferior: cuello-espina-bordelateral de la escápula.

Anillo osteofibrosoComplejo Suspensorio Superior del Hombro

Thomas Goss

Lesión aislada Lesión combinada(ruptura doble o triple)

hombro flotante

Baja energía Alta energía

Tratamiento funcional Tratamiento quirúrgico

Fracturas del Cuello

Clasificación

� Tipo I: No desplazada ni angulada.

� Tipo II A: Acortada o desplazada > 1 cm.

� Tipo II B: Angulada > 40°.

Tratamiento

Fracturas del Cuello

No desplazadastraslación <1 cm.Angulación <40°

DesplazadasTraslacion > 1 cm.Angulación > 40°

Tratamiento funcional Tratamiento quirúrgico

Fracturas del Acromion

ClasificaciónKuhn

� Tipo I: desplazamiento mínimo.

� Tipo II: con desplazamiento sin reduccióndel espacio subacromial.

� Tipo III: con desplazamiento con reduccióndel espacio subacromial.

Tratamiento

Fracturas del Acromion

Tratamiento funcional Tratamiento quirúrgico

DesplazadasEscalón >1 cm.Reducción del espaciosubacromialFracturas de la base del acromionPseudoartrosis sintomáticas

No desplazadasEscalón <1 cm.Sin reducción del espaciosubacromial

Fracturas de la Coracoides

ClasificaciónEyres

� Tipo I: de la punta.

� Tipo II: del cuerpo.

� Tipo III: de la base.

� Tipo IV: incluye la porción adyacente del cuerpo.

� Tipo V: fr. articular que comprende la parte superior de la glenoides.

Tratamiento

Fracturas de la Coracoides

No desplazadasDiastasis <5mm.

Tratamiento funcional Tratamiento quirúrgico

DesplazadasDiastasis >5mm.

Fracturas Glenoideas(intraarticulares)

ClasificaciónIdeberg

� Tipo I: fracturas del reborde (A:anterior, B:posterior).

� Tipo II: transversal a través de la fosa, con fragmentoinferior desplazado con la cabeza humeral.

ClasificaciónIdeberg

� Tipo III: oblicua con fragmento articular superior queincluye la coracoides ya que el trazo termina en el bordesuperior.

� Tipo IV: horizontal con trazo que llega al borde medial.

� Tipo V: combina los tipo II y IV.

FRACTURAS ARTICULARES

(Glenoideas)

No desplazadasSin inestabilidad

Tratamientofuncional

DesplazadasEscalón o diastasis > 2mm.Con inestabilidad GH.

Tratamientoquirúrgico

Fracturas de la Clavícula

Clasificación

Grupo I: fractura del tercio medio

Craig EV: Fractures ofthe clavicle, 1990

Clasificación

Grupo II: fractura del tercio distal

� Tipo I: desplazamiento mínimo (interligamentoso)

� Tipo II: con desplazamiento secundario a una fractura medial a los ligamentos coracoclaviculares

A. Conoide y trapezoide intactos

B. Conoide desgarrado, trapezoide intacto

� Tipo III: fracturas de la superficie articular

� Tipo IV: ligamentos hacia el periostio intactos (niños, con desplazamiento del fragmento proximal)

�seudoluxacion acromioclavicular�

� Tipo V: conminuta: sin ligamentos adheridos en la porción proximal o distal, sino hacia un fragmento conminuto inferior.

Grupo III: fracturas del tercio proximal

� Tipo I: desplazamiento mínimo

� Tipo II: desplazamiento (rotura ligamentos)

� Tipo III: intraarticular

� Tipo IV: separación epifisaria (niños y adultos jóvenes)

� Tipo V: conminuta

Fracturas supracondileas de Codo

A extrarticulares A1 avulsion metafisariaA2 simple metafisariaA3 metafisaria multifragmentaria

B articulares B1 articular parcial lateral sagitalB2 articular parcial medial sagitalB3 articular parcial frontal

C suprainterart. C1 articular y metafisaria simpleC2 articular simple metafisaria complejaC3 multifragmentaria

Fracturas supracondileas de Codo

Fractura de la Cúpula Radial

Clasificación (Mason)

� Tipo 1: No desplazada o mínimo desplazamiento.

� Tipo 2: Desplazada, en general por cizallamiento con un solo fragmento.

� Tipo 3: Conminuta.

Mason Tipo IV

Clasificación(Duparc)

� Tipo 1: Fractura no desplazada.� Tipo 2: Fractura-separación de dos (tipo 2a) o

tres (tipo 2b) fragmentos.� Tipo 3: Fractura-hundimiento subcapital,

encajada (tipo 3a) o desencajada (tipo 3b).� Tipo 4: Fractura mixta (separación-

hundimiento, encajada (tipo 4a) o desencajada (tipo 4b).

� Tipo 5: Estallido de la cabeza del radio.

Tratamiento conservadorIndicaciones

� Fracturas tipo 1, no desplazadas(Duparc).

� Fracturas tipo 3a, fractura-hundimiento encajada (Duparc), con desplazamiento menor de 20º.

Tratamiento Conservador

� Artrocentesis evacuadora.

� Yeso Braquiopalmar.

� Movimientos activos y pasivos autocontrolados.

� Evitar durante las primeras semanas la flexión en pronación.

� Controles radiográficos periódicos.

Tratamiento quirúrgicoIndicaciones

� Fracturas tipo 2a (fractura-separación de dos fragmentos).

� Fracturas tipo 2b (fractura-separación de tres fragmentos).

� Fracturas tipo 3a (fractura-hundimiento encajada) desplazada más de 20º.

� Fracturas tipo 3b (fractura-hundimiento desencajada).

� Fracturas tipo 4a (fractura separación-hundimiento encajada).

Tratamiento quirúrgico

� Escisión de fragmentos separados.

� Osteosíntesis.

� Cupulectomía.

� Artroplastía.

Fractura del Olécranon

Clasificaciones

� Colton.

� Schatzker.

� AO/ASIF.

� OTA.

Criterios

- Desplazamiento.- Dirección del trazo fracturario.- Conminución articular.- Porcentaje involucrado.- Lesiones asociadas.

Clasificación (Morrey)

� Tipo 1: no desplazada. a: no conminuta, b:conminuta.

� Tipo 2:desplazada-estable. a: no conminuta, b:conminuta.

� Tipo 3: inestable. a: no conminuta, b:conminuta.

Fracturas de la CoronoidesClasificación Regan y Morrey

�Tipo 1: Avulsión simple.

�Tipo 2: Fragmento único o conminuto que afecta al 50%.

�Tipo 3: Fr. que afecta a mas del 59%.