Kaan Yücel M.D., Ph.D. 08.January.2014 Wednesday

2 one of the most frequently fractured bones common in children often caused by an indirect force transmitted from an outstretched hand through the bones of the forearm/ arm to shoulder during a fall or a fall directly on the shoulder The weakest part of the clavicle junction of its middle and lateral thirds one of the most frequently fractured bones common in children often caused by an indirect force transmitted from an outstretched hand through the bones of the forearm/ arm to shoulder during a fall or a fall directly on the shoulder The weakest part of the clavicle junction of its middle and lateral thirds

3 usually the result of severe trauma as occurs in pedestrian-vehicle accidents usually also fractured ribs most fractures require little treatment scapula is covered on both sides by muscles. usually the result of severe trauma as occurs in pedestrian-vehicle accidents usually also fractured ribs most fractures require little treatment scapula is covered on both sides by muscles.

4 most injuries of the proximal end fractures of the surgical neck especially common in elderly people with osteoporosis usually result from a minor fall on the hand, with the force being transmitted up the forearm bones of the extended limb most injuries of the proximal end fractures of the surgical neck especially common in elderly people with osteoporosis usually result from a minor fall on the hand, with the force being transmitted up the forearm bones of the extended limb

5 usually the result of severe injury direct injury usually produces transverse fractures at the same level usually in the middle third of the bones because of interosseous membrane, a fracture of one bone associated with dislocation of the nearest joint. usually the result of severe injury direct injury usually produces transverse fractures at the same level usually in the middle third of the bones because of interosseous membrane, a fracture of one bone associated with dislocation of the nearest joint.

6 Common in adults > 50 more frequently in women osteoporosis Common in adults > 50 more frequently in women osteoporosis Colles’ fracture complete transverse fracture of the distal 2 cm of the radius most common fracture of the forearm distal fragment displaced dorsally often comminuted (broken into pieces)

7 usually result of trying to ease a fall by outstretching the upper limb the force drives the distal fragment posteriorly and superiorly distal articular surface inclined posteriorly. this posterior displacement produces a posterior bump “dinner-fork deformity” forearm & wrist resemble the shape of a fork. usually result of trying to ease a fall by outstretching the upper limb the force drives the distal fragment posteriorly and superiorly distal articular surface inclined posteriorly. this posterior displacement produces a posterior bump “dinner-fork deformity” forearm & wrist resemble the shape of a fork.

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9 Most commonly fractured carpal bone Scaphoid bone often results from a fall on the palm when the hand is abducted Dislocation of the lunate bone occasionally occurs in young adults on the outstretched hand in a way that causes hyperextension of the wrist joint. Most commonly fractured carpal bone Scaphoid bone often results from a fall on the palm when the hand is abducted Dislocation of the lunate bone occasionally occurs in young adults on the outstretched hand in a way that causes hyperextension of the wrist joint.

10 occur as a result of direct violence such as the clenched fist striking a hard object. always angulates dorsally. Boxer’s fracture commonly produces an oblique fracture of the neck of the fifth and sometimes the fourth metacarpal bones. occur as a result of direct violence such as the clenched fist striking a hard object. always angulates dorsally. Boxer’s fracture commonly produces an oblique fracture of the neck of the fifth and sometimes the fourth metacarpal bones.

11 strong costoclavicular ligament firmly holds medial end of the clavicle to first costal cartilage. violent forces directed along the long axis usually result in fracture dislocation occasionally. If the costoclavicular ligament ruptures completely, difficult to maintain the normal position of the clavicle once reduction has been accomplished.

12. A severe blow on the point of the shoulder during blocking or tackling in football or any severe fall can result in the acromion being thrust beneath the lateral end of clavicle tearing the coracoclavicular ligament this condition shoulder separation displaced outer end of the clavicle easily palpable A severe blow on the point of the shoulder during blocking or tackling in football or any severe fall can result in the acromion being thrust beneath the lateral end of clavicle tearing the coracoclavicular ligament this condition shoulder separation displaced outer end of the clavicle easily palpable

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14. Anterior–Inferior Dislocations Sudden violence applied to the humerus with the joint fully abducted tilts the humeral head downward onto the inferior weak part of the capsule, which tears, and the humeral head comes to lie inferior to the glenoid fossa. Anterior–Inferior Dislocations Sudden violence applied to the humerus with the joint fully abducted tilts the humeral head downward onto the inferior weak part of the capsule, which tears, and the humeral head comes to lie inferior to the glenoid fossa.

15. Anterior–Inferior Dislocations

16. Posterior Dislocations rare usually caused by direct violence to the front of the joint. rounded appearance of the shoulder is seen to be lost greater tuberosity of the humerus is no longer bulging laterally beneath the deltoid muscle. Posterior Dislocations rare usually caused by direct violence to the front of the joint. rounded appearance of the shoulder is seen to be lost greater tuberosity of the humerus is no longer bulging laterally beneath the deltoid muscle.

17. Posterior Dislocations

18 Elbow joint is stable because of the wrench-shaped articular surface of the olecranon pulley-shaped trochlea of the humerus strong medial and lateral ligaments Elbow joint is stable because of the wrench-shaped articular surface of the olecranon pulley-shaped trochlea of the humerus strong medial and lateral ligaments

19 When examining the elbow joint, the physician must remember the normal relations of the bony points. medial & lateral epicondyles & top of the olecranon in a straight line When examining the elbow joint, the physician must remember the normal relations of the bony points. medial & lateral epicondyles & top of the olecranon in a straight line bony points form the boundaries of an equilateral triangle.

20 common & most posterior posterior dislocation follows falling on the outstretched hand posterior dislocation common in children parts of the bones that stabilize the joint are incompletely developed avulsion of the epiphysis of medial epicondyle common in childhood then medial ligament stronger than bond of union between epiphysis & diaphysis common & most posterior posterior dislocation follows falling on the outstretched hand posterior dislocation common in children parts of the bones that stabilize the joint are incompletely developed avulsion of the epiphysis of medial epicondyle common in childhood then medial ligament stronger than bond of union between epiphysis & diaphysis

21 proximal radioulnar joint communicates w/ elbow joint distal radioulnar joint does not communicate w/ wrist joint elbow joint infection involves proximal radioulnar joint proximal radioulnar joint communicates w/ elbow joint distal radioulnar joint does not communicate w/ wrist joint elbow joint infection involves proximal radioulnar joint

22 Strength of proximal radioulnar joint depends on integrity of the strong anular ligament Rupture in cases of anterior dislocation of head of radius on capitulum of humerus In young children head of the radius still small & undeveloped sudden jerk on the arm – radial head pulled down through the anular ligament Strength of proximal radioulnar joint depends on integrity of the strong anular ligament Rupture in cases of anterior dislocation of head of radius on capitulum of humerus In young children head of the radius still small & undeveloped sudden jerk on the arm – radial head pulled down through the anular ligament

23 A fall on the outstretched hand anterior ligament of wrist joint synovial effusion joint pain limitation of movement Differential diagnosis fractured scaphoid /dislocation of lunate bone A fall on the outstretched hand anterior ligament of wrist joint synovial effusion joint pain limitation of movement Differential diagnosis fractured scaphoid /dislocation of lunate bone

24 Scaphoid bone Distal end of radius across the interosseus membrane Ulna Humerus through the glenoid fossa Scapula to the coracoclavicular ligament Clavicle Sternum

25 If forces excessive, different parts of the upper limb under strain. The area affected related to age Young child posterior displacement of distal radial epiphysisTeenage Clavicle fracture Young adult Scaphoid fractureElderly Colles’ fracture