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Common Upper Limb Fractures

Common Upper limb fractures presentations by Dr. Chris Pullen

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Common Upper Limb Fractures

  1. 1. Common Upper Limb<br />Fractures<br />By Chris Pullen<br />
  2. 2. Common Fractures<br />Clavicle <br />Proximal Humerus<br />Distal radius<br />Scaphoid<br />
  3. 3. Clavicle<br />4% to 15% of all fractures <br />35% of fractures about the shoulder<br />middle third++<br />Mechanism<br />Direct trauma <br />indirect - fall onto the outstretched hand<br />
  4. 4. Clavicle – Middle 1/3<br />Most are treated non-surgically with a sling for 3 - 4 weeks<br />Thereafter ROM exercises<br />
  5. 5. Clavicle – Middle 1/3<br />ORIF<br />Indications<br />open fractures<br />neurovascular injury/compromise<br />displaced fractures with impending skin compromise <br />widely displaced midclavicular fractures<br />shortening (20 mm) or gross displacement are risk factors for the development of nonunion<br />
  6. 6. Clavicle – Middle 1/3<br />
  7. 7. Clavicle – Lateral 1/3<br />Displaced <br />secondary to a fracture medial to the coracoclavicular ligaments<br />ORIF (30% nonunion)<br />Sling 6 weeks<br />
  8. 8. Proximal Humerus<br />4% to 5% of all fractures<br />↑ age ↑ incidence<br />Elderly - fall osteoporotic bone<br />Young – significant trauma<br />~ 85% are minimally displaced<br />
  9. 9. Proximal Humerus - Imaging<br />Imaging<br />Plain XR<br />scapular anteroposterior (AP)<br />lateral<br />axillary radiographs <br /> +/- CT scan<br />
  10. 10. Proximal Humerus - Classification<br />4 parts (anatomic fragments)<br />humeral head<br />greater tuberosity<br />lesser tuberosity<br />humeral shaft<br />Determination of <br />displacement >1 cm <br />angulation > 45°<br />
  11. 11. Proximal Humerus - Nonsurgical<br />Minimally or non-displaced fractures<br />Sling or collar & cuff<br />Rpt XR 1 & 2 weeks<br />Early passive motion within 14 days<br />Active range of motion is started at 4 to 6 weeks<br />A recent report indicated that functional outcome was inferior to previously reported results<br />
  12. 12. Proximal Humerus - Surgical<br />Two-part fractures of the surgical neck <br />most common displaced proximal humeral fracture<br />closed reduction - if stable<br />ORIF - if cannot be reduced closed<br />
  13. 13. Proximal Humerus - Surgical<br />Two-part fractures of the greater tuberosity <br />commonly occur with a shoulder dislocation<br />After reduction the tuberosity may return to its anatomic position<br />ORIF if displaced (=/- repair of the rotator cuff tear) <br />
  14. 14. Proximal Humerus - Surgical<br />Three-part fractures<br />ORIF <br />functional results better<br />
  15. 15. Proximal Humerus - Surgical<br />Four-part fractures <br />ORIF <br />young patients<br />good bone quality<br />Humeral head replacement <br />preferred method in the elderly<br />better functional scores<br />
  16. 16. Distal Radius<br />common <br />incidence ~ 1 in 500 people<br />bimodal age distribution<br />adolescents and young adults<br />high-energy injuries<br />postmenopausal elderly women <br />
  17. 17. Distal Radius - Imaging<br />Plain XR<br />posteroanterior (PA)<br />Lateral<br />oblique radiographs<br />+/- CT scan<br />
  18. 18. Distal radius - Nonsurgical<br />Minimally or non-displaced fractures<br />Elderly <br />Below elbow POP 6 weeks<br />Young adult<br />Above elbow POP 6 weeks<br />Rpt XR 1 & 2 weeks<br />ROM exercises<br />
  19. 19. Distal Radius - Surgical<br />Indications<br />Radial shortening of < 5mm at DRUJ<br />Dorsal tilt >/= 15° or Volar tilt >/= 20°<br />Intra-articular incongruity of >/= 2mm<br />anatomic reduction is critical <br />
  20. 20. Distal Radius - Surgical<br />
  21. 21. Distal Radius - Surgical<br />Options<br />closed reduction +/- K wire fixation<br />external fixation<br />ORIF<br />arthroscopically-assisted reduction<br />bone defect filling<br />
  22. 22. Distal Radius - Surgical<br />
  23. 23. Distal Radius - Surgical<br />
  24. 24. Scaphoid<br />most common fractures of the carpus<br />75% of all carpal injuries<br />Rare elderly or children<br />
  25. 25. Scaphoid - Imaging<br />Plain XR<br />Some are XR apparent at presentation<br />many a fracture line is not visible until bony resorption at the fracture advances <br />Rpt XR at 10 days +/- bone scan used for diagnosis of occult scaphoid fractures<br />
  26. 26. Scaphoid - Nonsurgical<br />Tubercle<br />+/- splintage for analgesia<br />Early ROM exercises<br />Nondisplaced <br />immobilization until clinical or radiographic healing occurs<br />‘Glass-holding’ POP<br />8 to 26 weeks<br />
  27. 27. Scaphoid - Surgical<br />Indications<br />> 10° of angular deviation <br />1 mm of displacement <br />Proximal pole fractures<br />ORIF (compression screw) <br />
  28. 28. THE END<br />

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