Fractures and Dislocations of Upper Limb

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Presentation of common upper limb fractures and dislocations. Covering all the injuries from many sides (Definition - Classification - Mechanisms of injury - Clinical features - Radiological studies - Management - Complications)

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Fractures and Dislocations of Upper Limb

  1. 1. Fractures & Dislocations of Upper Limb Mohammad Alsofyani Teaching Assistant – Orthopedic Department Surgery Block - 6th MBBS 1
  2. 2. 2 Syllabus Fractures & Dislocations of U.L Shoulder Girdle Humerus Elbow Forearm Hand Scapular Fr Head Fr Olecranon Fr Forearm bones Fr Scaphoid Fr Clavicular Fr Shaft Fr Elbow Dislocation Monteggia Frdislocation. Rolando’s Fr Shoulder Dislocation Supracondylar Fr Galeazzi Frdislocation. Fr of The Phalanges Colles’ Fr Surgery Block - 6th MBBS
  3. 3. 3 Outcomes  Definition.  Types or Classifications.  Mechanisms of Injury.  Clinical Features.  Imaging Studies.  Management.  Complications. Surgery Block - 6th MBBS
  4. 4. 4 Shoulder Girdles 1. 2. 3. Surgery Block - 6th MBBS Scapular Fractures. Clavicular Fractures. Shoulder Dislocations.
  5. 5. 5 1. Scapular Fractures  Definition: Is a fracture of shoulder blade, represent an uncommon injury.  Types:  Body (A).  Neck (D).  Type I - nonangulated, nondisplaced  Type IIa - shortened / displaced > 1 cm.  Type IIb - Angulated > 40 degree.  Glenoid (B C).  Acromian (E).  Coracoid (G). Surgery Block - 6th MBBS
  6. 6. 6 1. Scapular Fractures  Mechanisms of Injury:  Direct Forces are usually caused by high-energy trauma.  Associated Injuries:  Pulmonary contusion and pneumothorax (23%).  Clavicle fracture (23%).  Shoulder dislocation.  Rib fracture. Surgery Block - 6th MBBS
  7. 7. 7 1. Scapular Fractures  Clinical Features:  Arm is held immobile.  Severe bruising over the scapula or the chest.  Imaging Studies:  True AP view.  True lateral view. Surgery Block - 6th MBBS
  8. 8. 8 1. Scapular Fractures  Imaging Studies: Surgery Block - 6th MBBS
  9. 9. 9 1. Scapular Fractures  Managements:  Conservative:  Body, Neck(Type1), and Acromion.  a simple immobilization in a sling is sufficient.  Pendulum exercises.  Heal without any problem in about 6 weeks. Surgery Block - 6th MBBS
  10. 10. 10 1. Scapular Fractures.  Managements:  Operative:  Neck (Type IIa and IIb), and Glenoid. Surgery Block - 6th MBBS
  11. 11. 11 1. Scapular Fractures.  Complications:  Early:  Neurovascular Injuries.  Late:  Osteoarthritis (posttraumatic arthritis).  Bursitis. Surgery Block - 6th MBBS
  12. 12. 12 2. Clavicular Fractures  Definition: common fracture at all age groups.  Classification:  80% occur in the middle 1/3 (Class A).  15% occur in the lateral or distal 1/3 (Class B).  5% occur in the medial or proximal 1/3 (Class C). Surgery Block - 6th MBBS
  13. 13. 13 2. Clavicular Fractures  Classification: Class B is further subdivided into two subgroups:  Type I: Coracoclavicular ligament intact.  Type II: Coracoclavicular ligament ruptured. Surgery Block - 6th MBBS
  14. 14. 14 2. Clavicular Fractures  Mechanisms of Injury:  Fall on an outstretched hand.  Fall on the point of a shoulder.  Blow on the clavicle.  Birth trauma. Surgery Block - 6th MBBS
  15. 15. 15 2. Clavicular Fractures  Clinical Features:  History of trauma followed by pain, swelling, and crepitus.  Inability to raise the shoulder.  The outer fragment displaces medially and downwards.  The inner fragment displaces upwards. Surgery Block - 6th MBBS
  16. 16. 16 2. Clavicular Fractures  Imaging Studies:  Routine AP view of the clavicle.  Lordotic view if the fracture is doubtful. Surgery Block - 6th MBBS
  17. 17. 17 2. Clavicular Fractures  Management:  Conservative:  Accurate reduction is neither possible nor essential.  Need to support the arm in a sling.  Fig of ‘8’: this is popularly used.  Encourage shoulder exercise after severe pain subsides. Surgery Block - 6th MBBS
  18. 18. 18 2. Clavicular Fractures  Management:  Operative:  Class B II due to rupture of coracoclavicular ligament.  Neurovascular deficit.  Nonunion.  Cosmetic. Surgery Block - 6th MBBS
  19. 19. 19 2. Clavicular Fractures  Complications:  Early:  Life threatening: hemothorax, or pneumothorax  limb threatening: injury to subclavian vessels, and injury to brachial plexus.  Late:  Delayed union and nonunion.  Malunion generally left done. Surgery Block - 6th MBBS
  20. 20. 20 3. Shoulder Dislocations  Definition: head of humerus loses its articulation with the glenoid cavity of the scapula.  Classification:  Anterior dislocation (98%)  Posterior dislocation (2%)  Inferior dislocation (Luxatio erecta) (very rare) Surgery Block - 6th MBBS
  21. 21. 21 3. Shoulder Dislocations  Mechanisms of Injury:  Anterior dislocation:  Direct blow from the posterior aspect of the shoulder.  Abduction + External rotation + Extension injury.  Posterior dislocation:  Direct blow from the anterior aspect of the shoulder.  Internal rotation + Adduction + Flexion injury. Surgery Block - 6th MBBS
  22. 22. 22 3. Shoulder Dislocations  Mechanisms of Injury: Surgery Block - 6th MBBS
  23. 23. 23 3. Shoulder Dislocations  Clinical Features: Anterior Dislocation Posterior Dislocation Pain +++ +++ Arm Position Abducted and external rotation. Abducted and internal rotation. Range of Motion Adduction is restricted Abduction is restricted Normal Shoulder Contour Lost Test Dugas’ test: Inability to touch the opposite shoulder. Surgery Block - 6th MBBS Lost
  24. 24. 24 3. Shoulder Dislocations  Clinical Features: Surgery Block - 6th MBBS
  25. 25. 25 3. Shoulder Dislocations  Imaging Studies:  X-ray AP view of the shoulder to know the types of dislocation.  Checking the presence or absence of fracture. Surgery Block - 6th MBBS
  26. 26. 26 3. Shoulder Dislocations  Imaging Studies: Surgery Block - 6th MBBS
  27. 27. 27 3. Shoulder Dislocations  Management:  Conservative: Anterior Dislocation Technique of reduction Surgery Block - 6th MBBS Posterior Dislocation Kochers method: I. Traction with the elbow flexed. II. External rotation. III. Adduction. IV. Internal rotation. • Distal traction on the injured limb with External rotation on the upper arm.
  28. 28. 28 3. Shoulder Dislocations  Management:  Operative:  Failed closed reduction.  Soft tissue interposition.  Greater tuberosity fracture displaced > 1 cm. Surgery Block - 6th MBBS
  29. 29. 29 3. Shoulder Dislocations  Complications: Anterior Dislocation Early Posterior Dislocation Axillary nerve damage Unreduced dislocation Late Surgery Block - 6th MBBS Recurrent dislocation. Traumatic osteoarthritis. Shoulder stiffness
  30. 30. 30 Humerus 1. 2. 3. Surgery Block - 6th MBBS Humeral Head Fracture. Humeral Shaft Fracture. Supracondylar Fracture.
  31. 31. 31 1. Humeral Head Fracture  Definition: common in elderly patients and it accounts for 4 to 5 cent of all fractures.  Classification: According to Neer’s classification  This system of classification includes four segments  The head of the humerus.  The greater tuberosity.  The lesser tuberosity.  The shaft of the humerus. Surgery Block - 6th MBBS
  32. 32. 32 1. Humeral Head Fracture  Classification:  Distinguishes between the number of displaced fragments.  Displacement defined as greater than 45° of angulation or 1 cm of separation. Surgery Block - 6th MBBS
  33. 33. 33 1. Humeral Head Fracture  Classification  Undisplaced fragments : one-part fracture.  Displaced one segment : two-part fracture.  Displaced two fragments : three-part fracture.  Displaced all the major parts : four-part fracture. Surgery Block - 6th MBBS
  34. 34. 34 1. Humeral Head Fracture  Classification:  Muscle forces action:  The supraspinatus and the infraspinatus pull the greater tuberosity superiorly.  The subscapularis pulls the lesser tuberosity medially.  The pectoralis major adduct the shaft medially. Surgery Block - 6th MBBS
  35. 35. 35 1. Humeral Head Fracture  Mechanisms of Injury:  Fall on an outstretched hand (FOSH) Surgery Block - 6th MBBS
  36. 36. 36 1. Humeral Head Fracture  Clinical Features:  Pain and loss of function following trauma.  Swelling are the most common symptoms on initial presentation.  paresthesias or weakness (Axillary or brachial plexus injury) Surgery Block - 6th MBBS
  37. 37. 37 1. Humeral Head Fracture  Imaging Studies:  AP and lateral view of shoulder joint in scapular plane  The axillary view can be obtained with the use of the Velpeau view. Surgery Block - 6th MBBS
  38. 38. 38 1. Humeral Head Fracture  Imaging Studies: Surgery Block - 6th MBBS
  39. 39. 39 1. Humeral Head Fracture  Imaging Studies: Surgery Block - 6th MBBS
  40. 40. 40 1. Humeral Head Fracture  Management:  Conservative:  Undisplaced fracture.  Immobilized in plaster slab.  Encourage active exercise after 1 - 2 weeks.  Healing usually after 6 weeks. Surgery Block - 6th MBBS
  41. 41. 41 1. Humeral Head Fracture  Management:  Operative:  Displaced fractures.  Open reduction and internal fixation (ORIF).  Prosthetic replacement of the proximal humerus. (4 part fractures especially in middle aged and elderly) Surgery Block - 6th MBBS
  42. 42. 42 1. Humeral Head Fracture  Complications:  Early:  Neurovascular injury: axillary nerve is at particular risk both from the injury and from the surgery.  Late:  Malunion.  Stiffness.  Avascular necrosis (AVN): 10% of three-part fractures and 20% of four-part fractures Surgery Block - 6th MBBS
  43. 43. 43 2. Humeral Shaft Fracture  Definition: known as diaphyseal fracture of the humerus, and common at any age.  Types:  Transverse.  Oblique.  Spiral.  Comminuted.  Segmental. Surgery Block - 6th MBBS
  44. 44. 44 2. Humeral Shaft Fracture  Mechanisms of Injury:  Indirect mechanism: fall on an outstretched hand (FOSH).  Direct mechanism: a blow on to the arm.  Birth injuries: second most common birth fracture after clavicle. Surgery Block - 6th MBBS
  45. 45. 45 2. Humeral Shaft Fracture  Clinical Features:  The arm is painful, bruised, and swollen.  Radial nerve injury could be present.  Important to test for radial nerve function. Surgery Block - 6th MBBS
  46. 46. 46 2. Humeral Shaft Fracture  Pathological Anatomy:  Fractures above the deltoid insertion, the proximal fragment is adducted by pectoralis major.  Fractures below the deltoid insertion, the proximal fragment is abducted by deltoid. Surgery Block - 6th MBBS
  47. 47. 47 2. Humeral Shaft Fracture  Imaging Studies:  X-ray of the entire upper arm including both the shoulder joint above and the elbow joint below. Surgery Block - 6th MBBS
  48. 48. 48 2. Humeral Shaft Fracture  Management:  Conservative:  Closed reduction and maintenance in a ‘U’ slab or cast.  Or maintaining the fracture reduction in a ‘Hanging Cast’.  The wrist and fingers are exercised from the start. Surgery Block - 6th MBBS
  49. 49. 49 2. Humeral Shaft Fracture  Management:  Operative: Indications       Noncompliance. Failure of closed reduction. Displaced, comminuted, or segmental fracture. Open fracture. Fracture associated with neurovascular injury. Fracture with intra-articular extension.  Implants:  Plates and screws.  Intramedullary nails  External fixators are used in open fractures. Surgery Block - 6th MBBS
  50. 50. 50 2. Humeral Shaft Fracture  Complications:  Early:  Brachial artery damage.  Radial nerve palsy.  Late:  Delayed union and non-union.  Joint stiffness.  Malunion. Surgery Block - 6th MBBS
  51. 51. 51 3. Supracondylar Fracture  Definition:  occurs just above the two condyles of the lower humerus, commonly seen in children between the age of 5-10 years. Surgery Block - 6th MBBS
  52. 52. 52 3. Supracondylar Fracture  Types:  Posterior angulation or displacement (Extension Type) 95%.  Anterior angulation or displacement (Flexion Type). 5% Surgery Block - 6th MBBS
  53. 53. 53 3. Supracondylar Fracture  Classification: Gartland’s  Type I: Undisplaced fracture.  Type II: Angulated fracture with the posterior cortex still in continuity.  Type III: Completely displaced fracture. Surgery Block - 6th MBBS
  54. 54. 54 3. Supracondylar Fracture  Mechanisms of Injury:  Posterior Type:  Fall on an outstretched hand with hyperextension injury.  Anterior Type:  Due to direct violence with the elbow in flexion. Surgery Block - 6th MBBS
  55. 55. 55 3. Supracondylar Fracture  Clinical Features:  Pain and swollen elbow.  S – deformity of the elbow is usually obvious and the bony landmarks are abnormal.  Dimple sign due to one of the spikes of proximal fragment penetrating the muscle and tethering the skin.  Arm is short. Surgery Block - 6th MBBS
  56. 56. 56 3. Supracondylar Fracture  Imaging Studies:  AP and lateral view of the elbow.  Extremely important not only to diagnose the fracture but also to check for adequacy of reduction.  AP view measurements:  Baumann’s angle.  Lateral view measurements and signs:  Tear drop sign (Fad Pad Sign).  Anterior humeral line. Surgery Block - 6th MBBS
  57. 57. 57 3. Supracondylar Fracture  Imaging Studies:  Baumann’s angle:  Benefit:  to assess the accuracy of distal fragment reduction.  How to measure it ??  Line on the longitudinal axis of humeral shaft and a line through the coronal axis of the capitellar physis.  Interpretation:  Normally 90°.  < 90° suggests cubitus valgus.  > 90° suggests cubitus varus. Surgery Block - 6th MBBS
  58. 58. 58 3. Supracondylar Fracture  Imaging Studies:  Tear drop sign (Fat Pad Sign):  Fat pad being pushed forward by a hematoma. Surgery Block - 6th MBBS
  59. 59. 59 3. Supracondylar Fracture  Imaging Studies:  Tear drop sign (Fat Pad Sign): Surgery Block - 6th MBBS
  60. 60. 60 3. Supracondylar Fracture  Imaging Studies:  Anterior humeral line:  Benefit:  To assess the displacement of distal fragment.  How to measure it ??  A line drawn along the anterior border of the distal humeral shaft.  Interpretation:  Normally, passing through the middle 1/3 of capitulum.  Passing through anterior 1/3 it indicates posterior displacement of distal fragment. Surgery Block - 6th MBBS
  61. 61. 61 3. Supracondylar Fracture  Imaging Studies:  Anterior humeral line: Surgery Block - 6th MBBS
  62. 62. 62 3. Supracondylar Fracture  Management:  Conservative:  Closed reduction under general anesthesia by traction and counter traction methods.  The medial and lateral tilt is corrected first and posterior displacement next.  The elbow is immobilized in hyperflexion.  The forearm is pronated.  Check radiograph is taken and all the angels. Surgery Block - 6th MBBS
  63. 63. 63 3. Supracondylar Fracture  Management:  Operative:  Open reduction and internal fixation (ORIF).  Closed reduction failed.  Complicated fracture.  Comminuted fracture. Surgery Block - 6th MBBS
  64. 64. 64 3. Supracondylar Fracture  Complications:  Early:  Neurovascular injuries:  Median nerve 32%.  Ulnar nerve 23%.  Brachial artery <1%.  Late:  Malunion.  Varus > valgus.  Elbow stiffness. Surgery Block - 6th MBBS
  65. 65. 65 Elbow 1. Olecranon Fracture. 2. Elbow Dislocation. Surgery Block - 6th MBBS
  66. 66. 66 1. Olecranon Fracture  Definition: This is usually seen in adults.  Types:  Clean transverse fracture.  Undisplaced.  Displaced.  Comminuted fracture. Surgery Block - 6th MBBS
  67. 67. 67 1. Olecranon Fracture  Mechanisms of Injury:  Direct:  Trauma due to fall on the point of elbow.  Indirect:  Due to fall on a semiflexed elbow with forcible triceps contraction (Avulsion Fracture). Surgery Block - 6th MBBS
  68. 68. 68 1. Olecranon Fracture  Clinical Features:  Pain, swelling, and bruising over the elbow.  With transverse fracture there may be a palpable gap and the patient unable to extend the elbow. Surgery Block - 6th MBBS
  69. 69. 69 1. Olecranon Fracture  Imaging Studies:  Routine AP and lateral views of the elbow.  The position of radial head should be checked; it may be dislocated. Surgery Block - 6th MBBS
  70. 70. 70 1. Olecranon Fracture  Management:  Conservative:  Undisplaced transverse that doesn’t separate when the elbow is x-rayed in flexion.  Operative:  Displaced transverse fracture:  Open reduction and internal fixation using the technique of tension bandwiring.  Comminuted fracture:  Fixation using plates and screws. Surgery Block - 6th MBBS
  71. 71. 71 1. Olecranon Fracture  Complications:  Early:  Nonunion: occurs after inadequate reduction and fixation.  Late:  Stiffness: used to be common.  Osteoarthritis: especially if reduction is less than perfect. Surgery Block - 6th MBBS
  72. 72. 72 2. Elbow Dislocation  Definition: Is fairly common in adults than in children, rare in children below 10 years of age.  Types: According to the direction.  Posteriorly (90%)  Anteriorly (10%) Surgery Block - 6th MBBS
  73. 73. 73 2. Elbow Dislocation  Mechanisms of Injury:  Posterior:  Fall on an outstretched hand with arm in abducted and extension.  Anterior:  A powerful blow to the posterior aspect of the elbow. Surgery Block - 6th MBBS
  74. 74. 74 2. Elbow Dislocation  Clinical Features:  The patient supports his or her forearm with the elbow in slight flexion.  The bony landmarks may be palpable and abnormally.  Shortening of the forearm. Surgery Block - 6th MBBS
  75. 75. 75 2. Elbow Dislocation  Imaging Studies:  AP view of distal humerus with proximal ulna and olecranon is essential.  Lateral view coronoid process. Surgery Block - 6th MBBS
  76. 76. 76 2. Elbow Dislocation  Management:  Conservative:  Closed manipulation under anesthesia by Stimson’s principles.  Immobilization for a period of three weeks.  Followed by gradual mobilization  Posterior dislocations are immobilized in flexion.  Anterior dislocations are immobilized in extension. Surgery Block - 6th MBBS
  77. 77. 77 2. Elbow Dislocation  Management:  Operative:  Complex dislocations are managed by open reduction and stabilization.  Associated fractures. Surgery Block - 6th MBBS
  78. 78. 78 2. Elbow Dislocation  Complications:  Early:  Brachial artery injury.  The median or ulnar nerve injury.  Late:  Stiffness: loss of 20° to 30° of extension.  Heterotopic ossification (Myositis Ossificans).  Recurrent dislocation: rare Surgery Block - 6th MBBS
  79. 79. 79 Forearm 1. 2. 3. 4. Surgery Block - 6th MBBS Fractures of The Forearm Bones. Monteggia Fracture-Dislocation. Galeazzi Fracture-Dislocation. Colles’ Fracture.
  80. 80. 80 1. Fr of The Forearm Bones  Definition: The radius and ulna are commonly fractured together – termed fracture of ‘both bones of the forearm’  Types:  Proximal 1/3 fractures.  Middle 1/3 fractures.  Lower 1/3 fractures. Surgery Block - 6th MBBS
  81. 81. 81 1. Fr of The Forearm Bones  Mechanisms of Injury:  Fall on an outstretched hand with forearm pronated.  Direct blow onto the forearm. Surgery Block - 6th MBBS
  82. 82. 82 1. Fr of The Forearm Bones  Clinical Features: Proximal 1/3 Fr Middle and Lower 1/3 Fr Site • Above the insertion of pronator teres. • Below the insertion of pronator teres. Displacement • The proximal fragment is supinated. The distal fragment is pronated. • The proximal fragment is in midprone position. • The distal fragment is pronated. Supinated by the action of biceps brachii Pronated by the action of pronator teres and pronator quadratus. • Midprone position because the action of biceps brachii and pronator teres balance. • Deforming Forces Surgery Block - 6th MBBS • •
  83. 83. 83 1. Fr of The Forearm Bones  Imaging Studies:  AP and lateral view of the forearm with the entire elbow and wrist joints. Surgery Block - 6th MBBS
  84. 84. 84 1. Fr of The Forearm Bones  Management:  Conservative:  In children, closed treatment is usually successful because the tough periosteum tends to guide and then control.  Full length cast, from axilla to metacarpal shaft. Surgery Block - 6th MBBS
  85. 85. 85 1. Fr of The Forearm Bones  Management:  Operative:  All adults unless the fragments are in close apposition.  Open reduction and internal fixation. Surgery Block - 6th MBBS
  86. 86. 86 1. Fr of The Forearm Bones  Complications:  Early:  Compartment syndrome: from the fracture and operation.  Nerve injury: Posterior interosseous.  Vascular injury: radial or ulnar artery.  Late:  Delayed union and non-union.  Malunion. Surgery Block - 6th MBBS
  87. 87. 87 2. Monteggia Fr-Dislocation  Definition: It is fracture upper third of ulna with dislocation head of the radius. Surgery Block - 6th MBBS
  88. 88. 88 2. Monteggia Fr-Dislocation  Types:  According to the position of ulna and radial head.  Mechanisms of Injury:  Fall on an out stretched hand with forced pronation. Surgery Block - 6th MBBS
  89. 89. 89 2. Monteggia Fr-Dislocation  Clinical Features:  The ulnar deformity is usually obvious.  The dislocated head of radius is masked by swelling.  A useful clue is pain and tenderness on the lateral side of the elbow. Surgery Block - 6th MBBS
  90. 90. 90 2. Monteggia Fr-Dislocation  Imaging Studies:  AP and lateral view of the elbow. Surgery Block - 6th MBBS
  91. 91. 91 2. Monteggia Fr-Dislocation  Management:  Conservative:  Not preferred due to the deforming forces of the muscles.  Operative:  The aim is to restore the length of the fractured ulna.  Open reduction and internal fixation with plate and screws.  The radial head usually reduced once the the ulna has been fixed. Surgery Block - 6th MBBS
  92. 92. 92 2. Monteggia Fr-Dislocation  Complications:  Early:  Non-union.  Late:  Malunion Surgery Block - 6th MBBS
  93. 93. 93 3. Galeazzi Fr-Dislocation  Definition: This is a fracture of the lower third of the radius with associated subluxation or dislocation of the distal radioulnar joint. Surgery Block - 6th MBBS
  94. 94. 94 3. Galeazzi Fr-Dislocation  Mechanisms of Injury:  Fall on an outstretched hand with hyperpronated forearm.  Clinical Features:  Prominence or tenderness over the lower end of the ulna.  Piano key sign Surgery Block - 6th MBBS
  95. 95. 95 3. Galeazzi Fr-Dislocation  Imaging Studies:  AP and lateral views.  A transverse or short oblique fracture with angulation or overlap. Surgery Block - 6th MBBS
  96. 96. 96 3. Galeazzi Fr-Dislocation  Management:  Conservative:  Closed reduction is usually not successful due to the deforming forces of the muscles.  Operative:  Open reduction and internal fixation (ORIF).  Using long plates and screws. Surgery Block - 6th MBBS
  97. 97. 97 3. Galeazzi Fr-Dislocation  Complications:  Early:  Non-union.  Late:  Malunion. Surgery Block - 6th MBBS
  98. 98. 98 4. Colles’ Fracture  Definition:  It is a fracture occurring approximately within an inch and half of the inferior articular surface of the radius.  With or without fracture of the ulnar styloid process.  With or without subluxation/dislocation of the inferior radioulnar joint.  Most common of all fractures in older people. Surgery Block - 6th MBBS
  99. 99. 99 4. Colles’ Fracture  Mechanisms of Injury:  Fall on an outstretched hands with dorsiflexion of the hand. Surgery Block - 6th MBBS
  100. 100. 100 4. Colles’ Fracture  Clinical Features:  Dinner-fork deformity is a classical deformity in a Colles’ fracture. Surgery Block - 6th MBBS
  101. 101. 101 4. Colles’ Fracture  Imaging Studies:  AP and lateral views of the affected wrist and lower end of the radius. Surgery Block - 6th MBBS
  102. 102. 102 4. Colles’ Fracture  Management:  Conservative:  Closed reduction under anesthesia.  The is applied from 4 – 6 weeks.  The fracture unites in about 6 weeks. Surgery Block - 6th MBBS
  103. 103. 103 4. Colles’ Fracture  Management:  Operative:  Surgical intervention is rarely required.  Consists of percutaneous Kirschner wire fixation. Surgery Block - 6th MBBS
  104. 104. 104 4. Colles’ Fracture  Complications:  Early:  Median nerve entrapment.  Reflex sympathetic dystrophy: Full picture of Sudeck’s atrophy.  Late:  Malunion: Common.  Tendon rupture of extensor pollicis longus. Surgery Block - 6th MBBS
  105. 105. 105 Hand 1. Scaphoid Fracture. 2. Rolando’s Fracture. 3. Fractures of The Phalanges. Surgery Block - 6th MBBS
  106. 106. 106 1. Scaphoid Fracture  Definition: Accounts for 60% of carpal injuries, commonly seen in young adults.  Types: Based on Mayo’s Classification:  Distal articular surface (1).  Tuberosity (2).  Distal third (3).  Waist (4).  Proximal pole (5). Surgery Block - 6th MBBS
  107. 107. 107 1. Scaphoid Fracture  Mechanisms of Injury:  Radial compression and dorsiflexion occurring at the wrist during a fall on an outstretched hand.  Clinical Features:  Fullness and tenderness in the anatomical snuffbox. Surgery Block - 6th MBBS
  108. 108. 108 1. Scaphoid Fracture  Imaging Studies:  AP, lateral, and oblique are all essential.  Signs of instabilities are:  Displacement of the fracture fragments.  Motion between the two fragments. Surgery Block - 6th MBBS
  109. 109. 109 1. Scaphoid Fracture  Management:  Conservative:  Undisplaced fractures.  No need for reduction and are treated in plaster.  The cast is applied from the upper forearm to just short of the metacarpophalangeal joints.  90% should heal. Surgery Block - 6th MBBS
  110. 110. 110 1. Scaphoid Fracture  Management:  Operative:  Displaced fracture.  Open reduction and internal fixation (ORIF) with a compression screw. Surgery Block - 6th MBBS
  111. 111. 111 1. Scaphoid Fracture  Complications:  Early:  Non-union.  Late:  Avascular Necrosis (AVN).  Osteoarthritis. Surgery Block - 6th MBBS
  112. 112. 112 2. Rolando’s Fracture  Definition: This is an intra-articular fracture across the base of the first metacarpal in the shape of T or Y with subluxation of carpometacarpal joint. Surgery Block - 6th MBBS
  113. 113. 113 2. Rolando’s Fracture  Mechanisms of Injury:  Axial loading and abduction injury of the thumb.  Clinical Features:  Pain, tenderness, and limitation of movement. Surgery Block - 6th MBBS
  114. 114. 114 2. Rolando’s Fracture  Imaging Studies:  AP and lateral views of the hand. Surgery Block - 6th MBBS
  115. 115. 115 2. Rolando’s Fracture  Management:  Operative:  Closed reduction and K-wiring.  Open reduction and mini-screw fixation.  Immobilization in thumb Spica. Surgery Block - 6th MBBS
  116. 116. 116 3. Fr of the phalanges  Definition: Common fracture and could be includes proximal, middle, or distal phalanx.  Types:  Undisplaced.  Displaced.  Mechanisms of Injury:  Fall on a heavy object on the finger or crushing of fingers. Surgery Block - 6th MBBS
  117. 117. 117 3. Fr of the phalanges  Imaging Studies:  AP, lateral, and oblique views. Surgery Block - 6th MBBS
  118. 118. 118 3. Fr of the phalanges  Management:  Conservative:  Undisplaced fracture:  Treatment is basically for relief of pain.  Simple method of splintage.  Displaced fracture:  Manipulation and Immobilized in a simple aluminum splint. Surgery Block - 6th MBBS
  119. 119. 119 3. Fr of the phalanges  Management:  Operative:  If displacement can’t be controlled by conservative methods.  A percutaneous fixation or open reduction and internal fixation using K-wiring may be necessary. Surgery Block - 6th MBBS
  120. 120. 120 References Textbook of Orthopedics (John Ebnezar). Aply’s System of Orthopedics and Fractures. Essential of Orthopedics (RM Shenoy). Essential Orthopedics (J.Maheshwari). Field Guide to Fracture Management (Richard B. Birrer).  Current Diagnosis and Treatment of Orthopedic (Harry B. Skinner).  Essential Orthopedic and Trauma (David J. Dandy)  Pocket of Orthopedics and Fractures. (Ronald McRae).      Surgery Block - 6th MBBS
  121. 121. 121 Surgery Block - 6th MBBS

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