3. Mostly Indirect
Commonly described as “ a fall on
outstretched hand “
Type of injury depends on
position of the upper limb at the time of impact
force of injury
age
4. Common fracture
Commonest site is the middle one third
Mainly due to indirect injury
Direct injury leads to comminuted fracture
5.
6.
7.
8. Conservative by an arm sling or figure of
eight bandage
Operative fixation is indicated if there is:
tenting of the skin
open fracture
neurovascular injury
nonunion
9.
10.
11.
12. Mostly Anterior > 95 % of dislocations
Posterior Dislocation occurs < 5 %
True Inferior dislocation (luxatio erecta) occurs < 1%
Habitual Non traumatic dislocation may present as
Multi directional dislocation due to generalized
ligamentous laxity and is Painless
13. Usually Indirect fall on Abducted and
extended shoulder
May be direct when there is a blow on the
shoulder from behind
15. Patient is in pain
Holds the injured limb
with other hand close to
the trunk
The shoulder is abducted
and the elbow is kept
flexed
There is loss of the
normal contour of the
shoulder
16. Loss of the contour of
the shoulder may
appear as a step
Anterior bulge of head
of humerus may be
visible or palpable
A gap can be palpated
above the dislocated
head of the humerus
17.
18.
19. Injury to the neuro vascular bundle in axilla
Injury of the Axillary Nerve ( Usually
stretching leading to temporary neuropraxia )
Associated fracture
20.
21. It is a branch from posterior
cord of Brachial plexus
It hooks close round neck of
humerus from posterior to
anterior
It pierces the deep surface
of deltoid and supply it and
the part of skin over it
22.
23. Is an Emergency
It should be reduced in less than 24 hours or
there may be Avascular Necrosis of head of
humerus
Following reduction the shoulder should be
immobilised strapped to the trunk for 3-4
weeks and rested in a collar and cuff
24. Hippocrates Method ( A form of anesthesia
or pain abolishing is required )
Stimpson’s technique ( some sedation and
analgesia are used but No anesthesia is
required )
Kocher’s technique is the method used in
hospitals under general anesthesia and
muscle relaxation
25.
26.
27.
28. Neuro vascular injury ( rare )
Axillary nerve injury
Associated Fracture of neck of humerus or
greater or lesser tuberosities
29. Avascular necrosis of the head of the
Humerus (high risk with delayed reduction)
Heterotopic ossification ( used to be called
Myositis Ossificans )
Recurrent shoulder dislocations
30. Proximal Humerus (includes surgical and
anatomical neck )
Shaft of Humerus
Distal humerus ( includes Supra Condylar
fracture in children )
31.
32.
33.
34. Commonly Indirect injury
Indirect injury results in Spiral or Oblique
fractures
Direct injuries results in transverse or
comminuted fracture
May be associated with Radial Nerve injury
35.
36.
37. Most of the time is Conservative
Closed Reduction in upright position
followed by application of U shaped Slab of
POP or Cylinder cast
Few weeks later or initially in stable fractures
Functional Brace may be used
38.
39.
40.
41.
42. Failure to reduce fracture conservatively
Ipsilateral elbow or forearm fractures
Bilateral humeral fractures
Open fracture with radial nerve Injury
Unconscious patient
Delayed-Union, Non-Union and Mal-Union
43.
44.
45.
46. Results in Wrist drop
Associated with fracture humerus in up to 12% of
fractures
2/3 ( 8%) of Radial injury are Neuropraxia
1/3 ( 4%) are nerve lacerations or transection
47.
48.
49.
50.
51. Absolute Emergency
Should de done under G A by experienced
doctor as soon as possible
In the past the arm was held in flexed elbow
position in back-slab POP after reduction
At present time Percutaneous K wire
fixation is ALWAYS carried out after
reduction
52. A. Early= Compartment syndrome
Brachial Artery injury
Nerve Injury : Median, Ulnar or Radial
B. Late= Stiffness
Volkmann's Ischemic contracture
Heterotopic Ossification
Mal-Union ( Cubitus valgus or varus)
