Fractures and Dislocations of the Upper Limb II

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    Fractures & Dislocations of

    the Upper LimbDr Munir Saadeddin, FRCSE

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    Upper Limb include

    Clavicle

    Scapula

    Shoulder Joint

    Humerus

    Elbow Joint

    Forearm Bones

    Wrist Joint

    Scaphoid Bone

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    Mechanismof Injuries of theUpper Limb

    Mostly Indirect

    Commonly described as a fall onoutstretched hand

    Typeof injury depends on positionof

    the upper limb at the time of impact :Flexed, Extended, adducted, abducted,pronated or supinated

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    Mechanism of Injury

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    Splintage & Elevation in Upper Limb

    The Handhas to beHigher than the Elbow

    Simplestsplint is the tri-angular splint which canbe made of any piece ofcloth

    Commonestsplint used

    is the Collar & cuff splint Strapping the upper limb

    to the trunk is onemethod of Immobilisationof shoulder and humerus

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    Fractures of the Clavicle

    A common injury in all ages

    Most fractures are in the Middle third

    Usually it is the result of Indirect injury

    Direct injuries are more serious ( possibleinjury to neuro vascular structures )

    In children it may be a Green stick

    fracture Fracture site can be identified easily

    because clavicle is a subcutaneous bone

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    ? Fracture of the Clavicle

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    ? Fracture of the clavicle

    A child with sudden painful swelling overleft clavicle

    History of a fall injury few days ago

    The swelling is over mid clavicle and istender

    Initial x rays do not show a fracture TheAnsweris to repeat the X ray two

    weeks later

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    Fracture of the clavicle 2 weeks later

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    Fracture of the clavicle in Adults

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    Fracture of the clavicle in Adults

    Usually displaced with deformity

    May be comminuted

    mostly heal with a degree of Mal-Union Delayed union or Non union are less

    common

    Usually is treated conservatively Open reduction gives satisfactory

    alignment but results in unsightly scar

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    Figure of eight Bandage

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    Figure of Eight bandage

    It is the common way for treatingfractures of clavicle conservatively

    Simple to apply in Emergency room

    It helps to reduce overlap of fracture ends

    It should not be applied very tight or it

    may compress the neuro vascularstructures at axilla

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    Union of Fracture of the clavicle

    Early union occurs in 1-2 weeks in children In adults early union occurs in 3 weeks , union

    in 6 weeks and consolidation in 12 weeks

    Callus formation can be visible and palpable

    Mal united overlap of fracture can be treated bytrimming some bone after union of fracture

    Non Union is treated by compression Plating andbone grafting

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    Dislocation of the Shoulder

    MostlyAnterior> 95 % of dislocations

    Posterior Dislocation occurs < 5 %

    True Inferior dislocation ( Luxato Inferno )occurs