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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