The document discusses various types of upper limb fractures, including clavicle, humerus, scapula, and shoulder dislocations, emphasizing clinical features, diagnosis, and treatment approaches. It elaborates on the mechanisms of injury, with a focus on pediatric cases and the different treatment modalities for children and adults, as well as potential complications such as neurovascular injuries and shoulder stiffness. Specifically, it addresses dislocations of the shoulder joint, outlining treatment options for acute and chronic cases, including surgical interventions for recurrent dislocations and associated lesions.

1. Fractures of upper limb

2. Clavicle fracture
Incidence
common in infants and young,birth
fractures
Mechanism
fall on outstreched hands,
breach deliivery
Clinical features-
outer and middle third junction of bone
swelling and tenderness

3. Fracture displacement s..

5. • Diagnosis –
history of fall
pain on shoulder movement
swelling and tenderness
• Radiological features-
anteriopoterior radigraph-
crack(not displaced)
displaced(Inner fragment upwards)

6. X ray…..

8. • Treatment
 infants and children-
strapping across clavicle . cuff
and collar application.
 Older children and adults
figure of 8 bandage . arm sling.
open reducton &internal fixation-
cosmetic pourpose, neurovascular
compromise ,severe displacent.

12. • Complications
1. brachial plexus and vessels injury
2. stiff shoulder(commonest)
3. malunion
Fractures of outer end of clavicle-
usually not displaced and managed with
cuff and collar (3 wks)

13. Dislocation of acromioclavicular joint
• Mechanism –
fall on outer aspect of shoulder
• Coracoclavicular ligament-
partial ruptre-subluxation of am
joint
complete rupture-dislocation of am
joint

14. Clinical presentation-pain at top of shoulder
Radiology- degree of displacement
treatment – strapping for mild to moderate
displacemet
- open reduction for gross
displacement

15. Fractures of humerus
Classification
Four parts:These are the greater
and lesser tuberosities, humeral
shaft, and humeral head
Depending on the part displaced they
are termed two,three,four part
fractures

16. SIMPLIFIED NEER’S
 NEER’S
– 2 part
SN / AN / GT / LT
– 3 part
SN+GT / SN+LT
AN+GT / AN+LT
– 4 part
Neck + GT + LT

18. • Clinical features
1. pain ,swelling and ecchymosis in proximal
end of humerus
2. abnormal mobility
Radiograph
undisplaced fracture at neck(most common)
displaced two, three, four part fractures

20. • Treatment
1. impacted fractures-
cuff and collarfor 2 to 3 weeks till
pain subsides and active pendular
exercises
2. severely displaced fractures
manipulation under anesthesia followed
by immobilization in u plaster slab for
3 to 4 weeks
3. in youger age group –
3 or 4 part fracture ma need surgical reduction and
internal fixation
4. severely displaced fractures may need replacement
arthroplasty

21. • Complications
neurovascular injury and stiffness
of shoulder

22. Fracture dislocation
• In young
open reduction internal fixation with
screw /plate
• In elderly
reduce dislocation and impact the
fragment
if fails early mobilization of shoulder is
done

23. Fractures of shaft of humerus
mechanism
direct violence
trauma during birth (breach)
Types
transverse
oblique and spiral
comminuted

24. • Clinical features
local tenderness and bony deformity
abnormal mobility
injury to the radial nerve-wrist drop
Radiology-shows types and displacement of
fracture

25. • Treatment
fracture reduced and kept in u shaped
plaster slab and cuff and collar given
functional cast bracing-after 2 to 3 weeks
surgery is indicated in early immobilization

28. • Complications
1. wrist drop- treated with wrist drop splnt 4-6 WEEEKS
Explored if not recovered >8 weeks
2. fractures of lower part of shaft are prone
for non union treated with surgical
reduction and internal rotation

29. Scapula fracture
Mechanism -
direct injury from back
Types
1. fracture neck of scapula
2. body
3. acromion
4. coracoid
Treatment-
cuff and collar for 2 to 3 weeks

30. Dislocation of shoulder joint
• Types
1. acute
a) anterior dislocation(most common)
b) posterior dislocation
c) inferior dislocation
2. old unreduced(chronic) dislocation
3. recurrent dislocation

31. • Anterior dislocation
mechanism-
fall on outstreched hand abducted and
externally rotated
traumatic pathology
tear of glenoid labrum from anterior
margin and slip of head below coracoid
(subcoracoid) or clavicle (subclavicular)

32. PATIENT PRESENTATION
The patient presents with the arms held to the
side.

33. On examination

34. • Clincal features
1. arm kept away from the body and elbow
and forearm supported with other hand
2. flattening of deltoid
3. emptiness of glenoid
4. Dugas sign-patient cannot put the
hand on opposite shoulder
5.calaways test
6.Hamilton ruler test.
• Radiological feature-
1.empty glenoid
2.head of the humerus present elsewhere.

35. • Treatment
1. Kochers manoeuvre
longitudinal traction-external
rotation-adduction-intrnal
rotation of affected limb
strapping, and cuff and
collar applied for 3 wks in internal
rotation

36. Posterior dislocation
• Mechanism-
fits and electroconvulsive therepy
• Clinical presentation-
restriction of abduction and external
rotation
• Types-
subacromial and subspinous

37. Old unreduced dislocation
• Treatment-
upto 4 wks- reduction under general
anaesthesia
after 4 wks –
in young-open reduction
in elders – active movements

38. Recurrent dilocation of shoulder
• Clinical features
1. male adult atheletic type
2. insufficient immobilizaion after first
dislocation
3. subsiquent dislocation when person
does normal external rotation
4. external rotation and abduction are
resisted during examination for
apprehension of dilocation
(APPREHENSION SIGN)

39. • Traumatic pathology
1. bankart lesion –
failure of healing of detached anterior
part of glenoid labrum
2. hill sachs lesion
depression on the posterolateral
aspect of head of humerus due
to compression during first dislocation

40. Hill-Sachs lesion associated with anterior shoulder dislocation.
Upon dislocation, the posterior aspect of the humeral head
engages the anterior glenoid rim. The glenoid rim then
initiates an impression fracture that can enlarge

41. Radiological –
AP views in internal rotation-
shows defect in head of humerus

42. Lesions seen in ant dislocation cont…
• Hill-Sachs lesions, posterolateral humeral head
indentation fracture (77%)

43. • Treatment
1. surgical treatment –
a) Bankarts operation-
fixing the detached labrum
and capsule back to anterior
margin of bony glenoid
b) putti platt operation
double breasting of anterior capsule and
subscapularis

44. c) bristo helfet operation
coracoid process with attached
muscles osteotomised and
reattached to anterior bony
glenoid
d) saha operation
osteotomising neck of scapula
for changing direction of articular
surface