Presentation is loading. Please wait.

Presentation is loading. Please wait.

Common Upper Limb Fractures By Chris Pullen.

Similar presentations

Presentation on theme: "Common Upper Limb Fractures By Chris Pullen."— Presentation transcript:

1 Common Upper Limb Fractures By Chris Pullen

2 Common Fractures Clavicle Proximal Humerus Distal radius Scaphoid

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

4 Clavicle – Middle 1/3 Most are treated non-surgically with a sling for weeks Thereafter ROM exercises

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

6 Clavicle – Middle 1/3

7 Clavicle – Lateral 1/3 Displaced ORIF (30% nonunion) Sling 6 weeks
secondary to a fracture medial to the coracoclavicular ligaments ORIF (30% nonunion) Sling 6 weeks

8 Proximal Humerus 4% to 5% of all fractures ↑ age ↑ incidence
Elderly - fall osteoporotic bone Young – significant trauma ~ 85% are minimally displaced

9 Proximal Humerus - Imaging
Plain XR scapular anteroposterior (AP) lateral axillary radiographs +/- CT scan

10 Proximal Humerus - Classification
4 parts (anatomic fragments) humeral head greater tuberosity lesser tuberosity humeral shaft Determination of displacement >1 cm angulation > 45°

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

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

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)

14 Proximal Humerus - Surgical
Three-part fractures ORIF functional results better

15 Proximal Humerus - Surgical
Four-part fractures ORIF young patients good bone quality Humeral head replacement preferred method in the elderly better functional scores

16 Distal Radius common incidence ~ 1 in 500 people
bimodal age distribution adolescents and young adults high-energy injuries postmenopausal elderly women

17 Distal Radius - Imaging
Plain XR posteroanterior (PA) Lateral oblique radiographs +/- CT scan

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

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

20 Distal Radius - Surgical

21 Distal Radius - Surgical
Options closed reduction +/- K wire fixation external fixation ORIF arthroscopically-assisted reduction bone defect filling

22 Distal Radius - Surgical

23 Distal Radius - Surgical

24 Scaphoid most common fractures of the carpus
75% of all carpal injuries Rare elderly or children

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

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

27 Scaphoid - Surgical Indications ORIF (compression screw)
> 10° of angular deviation 1 mm of displacement Proximal pole fractures ORIF (compression screw)


Download ppt "Common Upper Limb Fractures By Chris Pullen."

Similar presentations

Ads by Google