Anatomy Tutorial week 3

Bone fracture

1- Simple fracture. clean break overlying skin. 1- Simple transverse fractures at right-angles broken stick of chalk. 2- Simple oblique fractures at an angle of 30 degrees 3- Simple spiral fractures the line of the fracture spirals around the bone 1 23

2- Greenstick fracture. incomplete break most occur in children

3-Compound (open ) fracture 1-Fracture open from within out the broken bone and skin from the inside of the body 2-Fracture open from without in the skin was first broken by trauma more severe damage and risk of infection

4- Comminuted (multifragmentary) fracture broken into more than two pieces

5- Impacted fracture. which at least one bone (or fragment of bone) has been driven into another.

6-Complicated fracture. broken bone that has also damaged surrounding structures or organs e.g. a broken rib that has punctured a lung. 7- compression fracture (also crush) e.g. due to a heavy fall / fall from height

8-Pathological fracture break in a bone when the bone itself is either abnormal or diseased.

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Clavicle fracture (broken bone).

Location of clavicle It extends between the sternum (the manubrium) and scapula (the acromion process).

Fracture classification Allman classification: -Group I fractures: The most common (80%). -Group II fractures: Less frequently (12-15%). -Group III fractures: Less than 5%.

Etiology Trauma : -fall on shoulder. -fall on outstretched hand. -car accident. In babies during birth.

Symptoms Pain, and inability to raise the arm because of pain. Swelling. Deformity or bump over the break. Bruising.

Treatment Medications to relieve the pain. Antibiotics and tetanus shot (when do I use them?). Surgery in some cases.

Humerus fracture

humerus fracture may be classified by the location of the humerus involved:humerus the upper or proximal end the shaft or the lower distal.

 Proximal humerus fractures may occur at the surgical neck of the humerus [1 ] and anatomical neck of humerus [2] greater and lesser tubercles.surgical neck of the humerus [1 ] anatomical neck of humerus [2]

 humeral shaft fractures have been described according to the following features [1] :  Location - Proximal, middle, or distal  Type of fracture line - Transverse, oblique, spiral, comminuted, or segmental  Opened or closed status

The lower distal humerus fracture is one type of elbow fracture. The distal humerus is the end of the upper arm bone (the humerus) that forms the upper part of the elbow These types of elbow fractures are fairly uncommon. They account for about 2% of fractures in adults.  Supracondylar  Intercodylar

Hajer Ali Sarah Sameer

What is dislocation of the shoulder? What causes a shoulder dislocation? The shoulder joint is the most mobile joint in the body and allows the arm to move in many directions. This ability to move makes the joint inherently unstable and also makes the shoulder the most often dislocated joint in the body. In the shoulder joint, the head of the humerus (upper arm bone) sits in the glenoid fossa, an extension of the scapula, or shoulder blade. Because the glenoid fossa (fossa = shallow depression) is so shallow, other structures within and surrounding the shoulder joint are needed to maintain its stability. Within the joint, the labrum (a fibrous ring of cartilage) extends from the glenoid fossa and provides a deeper receptacle for the humeral head. The capsule tissue that surrounds the joint also helps maintain stability. The rotator cuff muscles and the tendons that move the shoulder provide a significant amount of protection for the shoulder joint.

Dislocations of the shoulder occur when the head of the humerus is forcibly removed from its socket in the glenoid fossa. It's possible to dislocate the shoulder in many different directions, and a dislocated shoulder is described by the location where the humeral head ends up after it has been dislocated. Ninety percent or more of shoulder dislocations are anterior dislocations, meaning that the humeral head has been moved to a position in front of the joint. Posterior dislocations are those in which the humeral head has moved backward toward the shoulder blade. Other rare types of dislocations include luxatio erecta, an inferior dislocation below the joint, and intrathoracic, in which the humeral head gets stuck between the ribs.

Dislocations in younger people tend to arise from trauma and are often associated with sports or falls. Older patients are prone to dislocations because of gradual weakening of the ligaments and cartilage that supports the shoulder. Even in these cases, however, there still needs to be some force applied to the shoulder joint to make it dislocate.

Anterior dislocation Anterior dislocations often occur when the shoulder is in a vulnerable position. A common example is when the arm is held over the head with the elbow bent, and a force is applied that pushes the elbow backward and levers the humeral head out of the glenoid fossa. This scenario can occur with throwing a ball or hitting a volleyball. Anterior dislocations also occur during falls on an outstretched hand. An anterior dislocation involves external rotation of the shoulder; that is, the shoulder rotates away from the body.

Posterior Dislocation Posterior dislocations are uncommon and are often associated with specific injuries like lightning strikes, electrical injuries, and seizures. On occasion, this type of dislocation can occur with minimal injury in the elderly, and because X-rays may not easily show a posterior dislocation, the diagnosis is often missed should the patient present for evaluation of shoulder painshoulder pain

Other types of dislocation subluxation is defined as a partial or incomplete dislocation that usually stems from changes in the mechanical integrity of the joint Fracture are broken bones. Fractures commonly involve the clavicle (collar bone), proximal humerus (top of the upper arm bone), and scapula (shoulder blade

A.Subluxation B.Partial dislocation C.Complete dislocation Subluxation (A) Partial dislocation (B) Complete dislocation ©

Treatment Physical Therapy In the acute phase of a dislocated shoulder, therapy should be limited. The arm should be immobilized in a sling and swathed for 1-3 weeks Surgical Intervention The recurrence rate for shoulder instability is highly dependent on the age of the patient. Nonoperative care should be performed first before entertaining the thought of surgery

Hajer Ali Sarah Sameer

Stability of the shoulder joint The shallowness of the glenoid fossa of the scapula and the lack of support provided by weak ligaments make this joint an unstable structure. its strength almost entirely depends on the tone of the short muscles that bind the upper end of the humerus to the scapula – namely, the subscapularis in front, the supraspinatus above, and the infraspinatus and teres minor behind. The tendons of these muscles are fused to the underlying capsule of the shoulder joint. Together, these tendons form the rotator cuff. The least supported part of the joint lies in the inferior location, where it is unprotected by muscles.

Dislocations of the shoulder joint 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 gleniod fossa. During this movement, the acromion has acted as fulcrum. The strong flexors and adductors of the shoulder joint now usually pull the humeral head forward and upward into the subcoracoid position.

Dislocation of the shoulder joint Posterior dislocations Posterior dislocation are rare and are usually caused by direct violence to the front of the joint. On inspection of the patient with shoulder dislocation the rounded appearance of the shoulder is seen to be lost because the greater tuberosity of the humerus is no longer bulging laterally beneath the deltoid muscle. A subgelniod displacement of the head of the humerus into the quadrangular space can cause damage to the axillary nerve, as indicated by paralysis deltoidand loss of skin sensation over the lower half of the deltiod. Downward displacement of the humerus can also stretch and damage the radial nerve.

Other types of dislocation subluxation is defined as a partial or incomplete dislocation that usually stems from changes in the mechanical integrity of the joint Fracture are broken bones. Fractures commonly involve the clavicle (collar bone), proximal humerus (top of the upper arm bone), and scapula (shoulder blade

A.Subluxation B.Partial dislocation C.Complete dislocation Subluxation (A) Partial dislocation (B) Complete dislocation ©

Treatment Physical Therapy In the acute phase of a dislocated shoulder, therapy should be limited. The arm should be immobilized in a sling and swathed for 1-3 weeks Surgical Intervention The recurrence rate for shoulder instability is highly dependent on the age of the patient. Nonoperative care should be performed first before entertaining the thought of surgery