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By Chris Pullen Common Upper Limb Fractures. Common Fractures Clavicle Proximal Humerus Distal radius Scaphoid.

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Presentation on theme: "By Chris Pullen Common Upper Limb Fractures. Common Fractures Clavicle Proximal Humerus Distal radius Scaphoid."— Presentation transcript:

1 By Chris Pullen Common Upper Limb Fractures

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 –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 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 Options –closed reduction +/- K wire fixation –external fixation –ORIF –arthroscopically- assisted reduction –bone defect filling

22 Distal Radius - Surgical

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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 –> 10° of angular deviation –1 mm of displacement –Proximal pole fractures ORIF (compression screw)

28 THE END


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