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Clavicle Fractures Similar fractures in adults usually result from greater violence, are much slower to unite, and demand more care. Classification 3 groups:

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Presentation on theme: "Clavicle Fractures Similar fractures in adults usually result from greater violence, are much slower to unite, and demand more care. Classification 3 groups:"— Presentation transcript:

1 Clavicle Fractures Similar fractures in adults usually result from greater violence, are much slower to unite, and demand more care. Classification 3 groups: – Mid-third, 80% – Distal or inter-ligamentous, 15% – Proximal-third 5%

2 Clavicle Fractures Among the most common fracture occurring in children. In children usually heal without problems (the saying goes that if you put two ends of a fractured clavicle in the same room [pediatric] they will heal).

3 Clavicle Fractures Ideal method of management has not yet been developed. Over 200 methods have been described. Most do well with nonoperative management. It may take at least 3 months for adults to resume heavy activities.

4 Clavicle Fractures

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6 Distal clavicle fractures more problematic if involving the coracoclavicular ligaments. fractur e without wts. with wts.

7 Clavicle Fractures Distal clavicle plate

8 Clavicle Fractures Displaced ORIF

9 Clavicle Fractures IM Rod

10 Acromioclavicular Joint

11 AC Separations MOI- direct force that occurs from a fall on the point of the shoulder. Major deformity is the downward displacement of the shoulder.

12 AC Separations Classification:6 types of separation. Types I-III most common. Grade I - mild forces, Grade 6 - occurs with major forces.

13 AC Separation Stress X-rays to differentiate between Grade I and Grade 3. Gr. III has upward displacement % compared to the normal.

14 AC Separation Grade I-III is usually conservative. Sling for comfort. Early ROM. Grade IV-VI is usually surgical. Grade II injuries can develop DJD. Grade III injuries can be repaired in a young laborer who performs overhead work. Treatment

15 The Elbow Little Leaguer’s elbow Little Leaguer’s elbow Osteochondritis dissicans of the capitellum Osteochondritis dissicans of the capitellum Panner’s disease-osteochondrosis of the capitellum Panner’s disease-osteochondrosis of the capitellum

16 Little Leaguer’s Elbow A term used to describe a number of overuse conditions about the elbow associated with repetitive throwing that affects the skeletally immature elbow A term used to describe a number of overuse conditions about the elbow associated with repetitive throwing that affects the skeletally immature elbow MOI is valgus extension overload, which leads to traction stress on the medial aspect of the elbow, the medial collateral ligament, and the medial epicondyle MOI is valgus extension overload, which leads to traction stress on the medial aspect of the elbow, the medial collateral ligament, and the medial epicondyle

17 Little Leaguer’s Elbow Valgus extension overload also results in compression stresses on the lateral aspect of the joint, leading to osteochondritis dissicans of the capitellum, loose bodies, and radial head overgrowth The extension component can cause repetitive irritation of the olecranon in the olecranon fossa, which can lead to impingement & loose bodies

18 Little Leaguer’s Elbow Symptoms Medial pain Medial pain Diminished throwing effectiveness Diminished throwing effectiveness Decreased throwing distance Decreased throwing distance

19 Little Leaguer’s Elbow Examination Tenderness Tenderness Swelling over medial epicondyle Swelling over medial epicondyle Elbow flexion contraction > 15 degrees Elbow flexion contraction > 15 degrees X-ray- fragmentation and widening of the epiphyseal lines X-ray- fragmentation and widening of the epiphyseal lines

20 Little Leaguer’s Elbow

21 Treatment Rest ( 4-6 weeks) Rest ( 4-6 weeks) No throwing No throwing Ice Ice NSAID’s NSAID’s May strengthen when pain free (>6wk) May strengthen when pain free (>6wk)

22 Osteochondritris Dissicans Of The Humeral Capitellum Represents an island of subchondral bone and its articular cartilage that begins to separate from the rest of the humerus Represents an island of subchondral bone and its articular cartilage that begins to separate from the rest of the humerus Symptoms include lateral pain, which is dull and worsens with motion, which locks and catches Symptoms include lateral pain, which is dull and worsens with motion, which locks and catches

23 Osteochondritris Dissicans Of The Humeral Capitellum Etiology is unclear Etiology is unclear Repetitive stress most likely cause Repetitive stress most likely cause May have genetic predisposition May have genetic predisposition Between ages Between ages Common in throwers and gymnasts Common in throwers and gymnasts

24 Osteochondritris Dissicans Of The Humeral Capitellum Examination Radiocapitellar tenderness Radiocapitellar tenderness Flexion contracture Flexion contracture Crepitation Crepitation Effusion Effusion

25 Osteochondritris Dissicans Of The Humeral Capitellum Radiology Crescent shaped region of sclerotic subchondral bone at the humeral capitellum Crescent shaped region of sclerotic subchondral bone at the humeral capitellum Possible loose bodies Possible loose bodies

26 Osteochondritris Dissicans Of The Humeral Capitellum Treatment If no evidence of separation then rest, ice, ROM, and analgesics If no evidence of separation then rest, ice, ROM, and analgesics Repeat X-ray check for healing Repeat X-ray check for healing Surgery if locking, loose bodies, fragment separation or failure of conservative management Surgery if locking, loose bodies, fragment separation or failure of conservative management

27 Panner’s Disease Osteochondrosis of the humeral capitellum Osteochondrosis of the humeral capitellum Repetitive valgus stress causes compressive stress across the radiocapitellar Repetitive valgus stress causes compressive stress across the radiocapitellar Occurs between 7-12 years of age ( peak incidence at 9 years) Occurs between 7-12 years of age ( peak incidence at 9 years) May be susceptible at this time due to limited blood supply May be susceptible at this time due to limited blood supply

28 Panner’s Disease Pathophysiology Unknown Unknown May be similar to Legg-Calve`-Perthes disease May be similar to Legg-Calve`-Perthes disease

29 Panner’s Disease Symptoms Fairly sudden pain Fairly sudden pain Deep and dull achiness Deep and dull achiness Worsened with throwing Worsened with throwing No mechanical symptoms (locking or catching) No mechanical symptoms (locking or catching)

30 Panner’s Disease Physical exam Tenderness and swelling over the lateral elbow Tenderness and swelling over the lateral elbow Mild to moderate flexion contractures (usually from 5-20 degrees) Mild to moderate flexion contractures (usually from 5-20 degrees)

31 Panner’s Disease Radiology Fragmentation of the capitellum, with alternating area of sclerosis and rarefaction and an irregular joint surface Fragmentation of the capitellum, with alternating area of sclerosis and rarefaction and an irregular joint surface

32 Panner’s Disease Treatment Conservative Conservative Complete rest from throwing until symptoms subside and ROM is normal Complete rest from throwing until symptoms subside and ROM is normal Repeat X-rays to monitor remodeling Repeat X-rays to monitor remodeling May return when X-rays and exam is normal May return when X-rays and exam is normal Long term disability is rare Long term disability is rare

33 The Wrist Gymnast wrist Torus fractures Wrist fractures

34 Gymnast Wrist Chronic overuse injury occurring at the physis if skeletally immature gymnasts Chronic overuse injury occurring at the physis if skeletally immature gymnasts Presents with wrist pain Presents with wrist pain Usually due to repetitive hyperextension and overuse Usually due to repetitive hyperextension and overuse Arms are used as weight bearing devices Arms are used as weight bearing devices Salter-Harris type I injury Salter-Harris type I injury

35 Gymnast Wrist

36 Gymnast’s wrist frequently show physeal irregularities and bony sclerosis on X-ray Gymnast’s wrist frequently show physeal irregularities and bony sclerosis on X-ray If untreated can result in permanent radial deformity and shortening due to growth arrest If untreated can result in permanent radial deformity and shortening due to growth arrest Rest relieves symptoms Rest relieves symptoms Extension splints can prevent recurrence Extension splints can prevent recurrence

37 Gymnast Wrist


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