Floating shoulder
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1. A 65-year-old Thai man presented to the emergency department after a motorcycle accident where he was sideswiped by a pickup truck. 2. He suffered a closed fracture of the middle third of his left clavicle and a closed fracture of the neck of his left scapula (floating shoulder injury). 3. He was admitted to the hospital for an open reduction and internal fixation surgery.
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Humeral shaft fractures can often be treated nonoperatively with a brace, though operative options include plating, flexible nailing, or locked intramedullary nailing. Plates and nails have similar union rates but nails have more complications so plates are generally preferable. Flexible nails are also an effective option. Radial nerve palsy is a risk, especially with distal fractures, and may require exploration. Most humeral shaft fractures heal well with either operative or nonoperative treatment depending on the specific situation and patient factors.
Superior Shoulder Suspensory Complex injuries (SSSC)
This document discusses zonal CME conducted at GSLMC on the superior shoulder suspensory complex (SSSC). It defines the SSSC as a bony and soft tissue ring structure that maintains the stable relationship between the scapula and axial skeleton. Injuries to two structures in the SSSC can cause instability known as the "floating shoulder". Treatment depends on the amount of displacement, with conservative management used for displacements under 5mm and no caudal displacement of the glenoid. Surgical stabilization is recommended for larger displacements or malalignment.
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The document discusses a study evaluating the clinical and radiographic outcomes of a modified Sauve-Kapandji procedure for patients with old fractures of the distal radius. The modified procedure involves resection and reinsertion of the distal ulna into the distal radius after a 90-degree rotation. The study reviewed 15 patients who underwent the procedure with at least 7 months of follow up. Results found 80% of patients had excellent outcomes with reduced pain, improved range of motion, and grip strength. The modified Sauve-Kapandji procedure provides an effective treatment for chronic distal radioulnar joint disorders in patients with old distal radius fractures.
TALUS FRACTURE AND MANAGEMENT.
TALUS ANATOMY,BLOOD SUPPLY OF TALUS, MECHANISM OF INJURY, AVIATORS ASATRALAGUS, HAWKIN'S CLASSIFICATION, TALUS NECK FRACTURE, CANALE VIEW X RAY, HAWKIN'S SIGN, MANAGEMENT AND COMPLICATION.
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This study introduces a "three-column fixation" concept for treating complex tibial plateau fractures (Schatzker Types V and VI) based on computed tomography scans. The study evaluates clinical outcomes in 29 patients treated with this column-specific fixation technique. At 2-year follow up, patients had good functional outcomes with SF-36, HSS, and lower extremity measure scores averaging 89, 90, and 87 respectively. Radiographic measurements also showed well-maintained alignment without significant malreduction. The study concludes that three-column fixation is an effective and safe method for multiplanar complex tibial plateau fractures.
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Cubitus varus by Dhrumil Patel
This document discusses cubitus varus, which is a deformity where the forearm is deviated inward at the elbow joint, reducing the normal valgus angle. It describes the causes, types, clinical examination findings, measurements on x-rays, and treatment options. The most common treatment involves corrective osteotomy, with various techniques described such as lateral closing wedge osteotomy, medial open wedge osteotomy, oblique osteotomy, and dome osteotomy. Complications of osteotomy include stiffness, nerve injury, persistent or recurrent deformity, non-union, and skin issues.
floating shoulder ppt-3.pptx Dr Ashish pargaie Orthopaedic resident Aiims ris...
1) A floating shoulder injury involves concurrent fractures of the ipsilateral clavicle and scapular neck.
2) The superior shoulder suspensory complex (SSSC) is a bone and soft tissue structure that connects the scapula, clavicle, and coracoid process to maintain shoulder stability.
3) Floating shoulder injuries are often high-energy injuries associated with other fractures and injuries. Surgical treatment is usually indicated for significantly displaced or articular fractures to restore anatomy and function.
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Superior Shoulder Suspensory Complex injuries (SSSC)
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Modified sauve kapandji procedure for patients with old fractures
The document discusses a study evaluating the clinical and radiographic outcomes of a modified Sauve-Kapandji procedure for patients with old fractures of the distal radius. The modified procedure involves resection and reinsertion of the distal ulna into the distal radius after a 90-degree rotation. The study reviewed 15 patients who underwent the procedure with at least 7 months of follow up. Results found 80% of patients had excellent outcomes with reduced pain, improved range of motion, and grip strength. The modified Sauve-Kapandji procedure provides an effective treatment for chronic distal radioulnar joint disorders in patients with old distal radius fractures.
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Three column fixation for complex PROXIMAL TIBIA FRACTURES
This study introduces a "three-column fixation" concept for treating complex tibial plateau fractures (Schatzker Types V and VI) based on computed tomography scans. The study evaluates clinical outcomes in 29 patients treated with this column-specific fixation technique. At 2-year follow up, patients had good functional outcomes with SF-36, HSS, and lower extremity measure scores averaging 89, 90, and 87 respectively. Radiographic measurements also showed well-maintained alignment without significant malreduction. The study concludes that three-column fixation is an effective and safe method for multiplanar complex tibial plateau fractures.
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High tibial osteotomy (HTO) is a realignment procedure that unloads the diseased knee joint surface and corrects angular deformities. It has regained popularity for treating medial compartment osteoarthritis in young, active patients. The goals of HTO are to redistribute weight bearing forces across the knee joint. It is commonly performed using either a closing or opening wedge technique. Patient factors like age, activity level, and alignment/deformity guide whether HTO or knee replacement is most appropriate. Long term studies show HTO effectiveness declines over 7-10 years.
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floating shoulder ppt-3.pptx Dr Ashish pargaie Orthopaedic resident Aiims ris...
1) A floating shoulder injury involves concurrent fractures of the ipsilateral clavicle and scapular neck.
2) The superior shoulder suspensory complex (SSSC) is a bone and soft tissue structure that connects the scapula, clavicle, and coracoid process to maintain shoulder stability.
3) Floating shoulder injuries are often high-energy injuries associated with other fractures and injuries. Surgical treatment is usually indicated for significantly displaced or articular fractures to restore anatomy and function.
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1) The document discusses various carpal dislocations including perilunate dislocations and fractures, scapholunate dissociation, and their anatomy, mechanisms of injury, clinical features, imaging, and management.
2) Perilunate dislocations are high energy injuries that commonly involve disruption of the scapholunate ligament followed by other ligaments and can be classified using the Mayfield classification system. Management involves early closed reduction and surgery including open reduction, ligament repair and fixation.
3) Scapholunate dissociation is an important cause of carpal instability that can lead to DISI deformity if left untreated. The scapholunate ligament maintains carpal stability and its anatomy and biomechan
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- Surgical options include open arthrodesis with internal or external fixation, arthroscopic arthrodesis, and mini-open techniques.
- The goals of fusion are to relieve pain, create a stable foot, and position the ankle in 5 degrees of valgus and 5-10 degrees of external rotation.
- Potential complications include non-union, infection, nerve injury, and malunion. Outcomes studies found relief of pain but activity limitations remain.
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This document summarizes a study on the use of semi-occlusive dressing and splint caps for the management of fingertip amputation injuries. The study aimed to show that fingertip injuries can be treated conservatively with comparable results to surgical management like V-Y plasty. It was a prospective study of 20 patients with fingertip amputations who underwent splint cap treatment. The results found that splint caps provided a pain-free environment for healing, with outcomes comparable to surgery but at a much lower cost. Further large-scale studies are still needed to validate splint caps as a viable alternative to surgery.
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High tibial osteotomy ppt
High tibial osteotomy (HTO) is a surgical procedure that redirects the mechanical axis of the knee joint to unload the arthritic compartment and redistribute stress. The goals are to correct angular deformity at the knee and reduce pain from conditions like osteoarthritis. While HTO provides relief in the short-term, results deteriorate over time, so it is considered an interim procedure before potential knee replacement. Candidate patients are generally young and active with isolated medial compartment disease. Surgical techniques include lateral closing wedge and medial opening wedge osteotomies, with risks including patella baja, fracture, nerve injury, and non-union. HTO can postpone knee replacement surgery by 7-10 years when performed correctly.
Ligamentotaxis principle in the treatment of intra articular fractures of dis...
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This document discusses floating knee injuries, which involve ipsilateral fractures of the femur and tibia. It describes the classification system for floating knee injuries, which includes true floating knee injuries (extra-articular fractures of both bones) and various types involving articular fractures. These injuries often result from high-energy trauma and are associated with injuries to other body parts. Treatment involves stabilizing the patient, addressing any life-threatening injuries, and providing initial stabilization of the fractures often using external fixation before definitive surgical fixation of the fractures.
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sarmiento principle
The document discusses the Sarmiento principle of functional bracing for tibial fractures developed in 1967 as an alternative to rigid immobilization. It involves early controlled movement and weight bearing to promote healing. Guidelines are provided for factors like length, rotation, valgus, and varus when applying braces. Proximal, mid-shaft, and distal tibial fractures are considered in terms of brace candidacy based on the fibula condition and soft tissue damage. The conclusion reinforces bracing for closed, axially unstable fractures with an acceptable degree of shortening and angular deformity within a few degrees of normal.
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This document summarizes a study on operative management of pediatric supracondylar humerus fractures. The study found that between 2006-2008, medial pins were routinely used for type III fractures, but between 2009-2011 there was an effort to minimize medial pin use. For type III fractures, there was a statistically significant decrease in the use of cross pin fixation between the two time periods. Clinical outcomes such as nerve injury, malalignment, and re-operation rates were comparable between the groups that received lateral-only pinning versus cross pinning. The study concludes that lateral-only pinning can effectively treat these fractures while avoiding risks of iatrogenic nerve injury associated with medial pinning.
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This document discusses high tibial osteotomy (HTO), a procedure that corrects knee alignment to relieve pressure from arthritic areas. It was first described in 1961 and involves cutting and reshaping the tibia to transfer weight from an arthritic to a healthier area of cartilage. The document outlines indications, contraindications, techniques like closing wedge and opening wedge osteotomy, management of the fibula, fixation methods, advantages and disadvantages of different techniques, expected results, and potential complications. HTO is a well-established procedure for unicompartmental knee arthritis with typical satisfactory results in 80% of cases.
Interesting case pimpitcha
- A 52-year-old Thai man presented with right knee and shoulder pain after falling off his motorcycle while wearing a helmet.
- X-rays showed closed fractures of the right patella and greater tuberosity of the right humerus.
- Treatment for the patellar fracture includes either non-operative management with long leg casting or operative treatment with open reduction and internal fixation using tension band wiring or screws, depending on the degree of displacement and integrity of the extensor mechanism.
Extern conference orthokorat Thanakorn KONG
A 48-year-old Thai woman presented to the emergency department after being struck from behind by a cow 30 minutes earlier. She reported severe low back pain that was exacerbated by movement. On examination, she had swelling and tenderness in her low back but no neurological deficits. X-rays revealed a compression fracture of her L3 vertebra. She was admitted and prescribed bed rest and pain medication.
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Ankle and foot arthrodesis
This document provides an overview of ankle arthrodesis, including:
- Indications for the procedure include pain, deformity, and instability from conditions like trauma, infection, arthritis.
- Surgical options include open arthrodesis with internal or external fixation, arthroscopic arthrodesis, and mini-open techniques.
- The goals of fusion are to relieve pain, create a stable foot, and position the ankle in 5 degrees of valgus and 5-10 degrees of external rotation.
- Potential complications include non-union, infection, nerve injury, and malunion. Outcomes studies found relief of pain but activity limitations remain.
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This document summarizes a study on the use of semi-occlusive dressing and splint caps for the management of fingertip amputation injuries. The study aimed to show that fingertip injuries can be treated conservatively with comparable results to surgical management like V-Y plasty. It was a prospective study of 20 patients with fingertip amputations who underwent splint cap treatment. The results found that splint caps provided a pain-free environment for healing, with outcomes comparable to surgery but at a much lower cost. Further large-scale studies are still needed to validate splint caps as a viable alternative to surgery.
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High tibial osteotomy (HTO) is a surgical procedure that redirects the mechanical axis of the knee joint to unload the arthritic compartment and redistribute stress. The goals are to correct angular deformity at the knee and reduce pain from conditions like osteoarthritis. While HTO provides relief in the short-term, results deteriorate over time, so it is considered an interim procedure before potential knee replacement. Candidate patients are generally young and active with isolated medial compartment disease. Surgical techniques include lateral closing wedge and medial opening wedge osteotomies, with risks including patella baja, fracture, nerve injury, and non-union. HTO can postpone knee replacement surgery by 7-10 years when performed correctly.
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CORA (center of rotation of angulation)
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Seminar recent advances reverse shoulder arthroplasty
This document discusses reconstructive surgery of the glenohumeral joint, including reverse total shoulder arthroplasty. It provides an anatomical overview of the glenohumeral joint and describes the indications, surgical procedure, components, and complications of reverse total shoulder arthroplasty. Reverse total shoulder arthroplasty involves replacing the normal ball and socket articulation with a convex glenoid component and concave humeral cup to improve function and range of motion, especially for conditions involving rotator cuff dysfunction.
Floating Knee
This document discusses floating knee injuries, which involve ipsilateral fractures of the femur and tibia. It describes the classification system for floating knee injuries, which includes true floating knee injuries (extra-articular fractures of both bones) and various types involving articular fractures. These injuries often result from high-energy trauma and are associated with injuries to other body parts. Treatment involves stabilizing the patient, addressing any life-threatening injuries, and providing initial stabilization of the fractures often using external fixation before definitive surgical fixation of the fractures.
Early Appropriate care in Orthopedics.pptx
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Pediatric supracondylar humerus fractures
This document summarizes a study on operative management of pediatric supracondylar humerus fractures. The study found that between 2006-2008, medial pins were routinely used for type III fractures, but between 2009-2011 there was an effort to minimize medial pin use. For type III fractures, there was a statistically significant decrease in the use of cross pin fixation between the two time periods. Clinical outcomes such as nerve injury, malalignment, and re-operation rates were comparable between the groups that received lateral-only pinning versus cross pinning. The study concludes that lateral-only pinning can effectively treat these fractures while avoiding risks of iatrogenic nerve injury associated with medial pinning.
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Similar to Floating shoulder
Interesting case pimpitcha
- A 52-year-old Thai man presented with right knee and shoulder pain after falling off his motorcycle while wearing a helmet.
- X-rays showed closed fractures of the right patella and greater tuberosity of the right humerus.
- Treatment for the patellar fracture includes either non-operative management with long leg casting or operative treatment with open reduction and internal fixation using tension band wiring or screws, depending on the degree of displacement and integrity of the extensor mechanism.
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A 48-year-old Thai woman presented to the emergency department after being struck from behind by a cow 30 minutes earlier. She reported severe low back pain that was exacerbated by movement. On examination, she had swelling and tenderness in her low back but no neurological deficits. X-rays revealed a compression fracture of her L3 vertebra. She was admitted and prescribed bed rest and pain medication.
Extern conference ortho
This document describes the case of a 69-year-old Thai man who presented to the emergency department with right thigh pain after falling 1.5 meters from the roof of his house. On examination, he had swelling and tenderness of the left thigh with limited range of motion. Radiographs revealed an intertrochanteric fracture of the left femur. Intertrochanteric fractures occur between the greater and lesser trochanters and are common in elderly patients, often resulting from low-energy falls. Treatment depends on the stability of the fracture but may involve internal fixation with screws or cephalomedullary nails. Complications can include malunion, nonunion, and loss of fixation.
Galeazzi fx saraj pcm
- 64-year-old Thai man was in a motorcycle accident where he fell and used his left arm to brace himself, injuring his left forearm.
- Physical exam and x-rays showed a fracture of the midshaft to distal radius with dislocation of the distal radioulnar joint (Galeazzi fracture).
- Treatment involves open reduction and internal fixation of the radius fracture with a plate to restore anatomy and function, along with splinting the forearm in full supination for 6 weeks to maintain stability of the distal radioulnar joint.
Extern conference ortho
1. A 17-year-old Thai male presented to the emergency department with an abrasion wound on his left face and left shoulder following a motorcycle accident 5 hours prior.
2. Imaging revealed a T3-T4 fracture-dislocation with spinal cord compression. He was diagnosed with a spinal cord injury and underwent treatment including methylprednisolone and surgical stabilization of his spine.
3. His injury resulted in lower extremity weakness and loss of sensation. He will require long-term rehabilitation for his spinal cord injury.
.Ortho.
An 81-year-old Thai woman presented to the hospital with left hip pain after falling three days prior. Imaging revealed a Garden type 3 fracture of the left femoral neck. She was diagnosed with a displaced left femoral neck fracture. Her treatment plan included pain control, skin traction of the left leg, and a left bipolar hemiarthroplasty surgery. Femoral neck fractures typically result from low-energy falls in older patients and require prompt surgical management to reduce complications.
Clavicle fracture
1. The patient is a 75-year-old Thai man who fell off his bicycle 6 hours prior, injuring his left elbow and clavicle.
2. Radiographs show a fracture of the left shaft of the clavicle.
3. Clavicle fractures are commonly classified using the Allman or Neer classifications to determine appropriate treatment. Non-displaced or stable fractures are typically treated non-operatively while displaced or unstable fractures often require surgical fixation.
Conference
The document summarizes the case of a 3-year-old boy who fell from a height of 1.5 meters and injured his right elbow. On examination, he was found to have a deformity and swelling of the right elbow with limited range of motion due to pain. X-rays revealed a closed, displaced fracture of the right supracondylar humerus, classified as Gartland type 3. The boy underwent closed reduction with percutaneous pinning under general anesthesia and was placed in a posterior long arm slab.
Burst fracture
1. The patient is a 57-year-old Thai man who fell from a mango tree approximately 3 meters while picking mangoes. He experienced back and left foot pain after the incident and could not walk, having to crawl for help.
2. Examination found mild lumbar tenderness and moderate ankle tenderness with limited range of motion due to pain. Imaging showed a burst fracture of L1 with retropulsion into the spinal canal and a comminuted fracture of the left calcaneus.
3. The patient was diagnosed with a burst fracture of L1 and a closed fracture of the left calcaneus. He underwent pedicle screw fixation from T12 to L2 to stabilize the spinal fracture
Ant.shoulder dislocation
This document summarizes an orthopedic case of a 42-year-old Thai male who presented to the emergency room with left shoulder pain after hearing a popping sound while lifting roof tiles. On examination, he was found to have deformity and tenderness of the left shoulder with the humeral head palpable in the anterior shoulder, indicating an anterior shoulder dislocation. X-rays confirmed an anterior shoulder dislocation with an associated greater tuberosity fracture. The patient was taken to the operating room for closed reduction of the dislocation and rehabilitation.
Ac sep
- A 37-year-old Thai man presented to the emergency department with left shoulder pain after a motorcycle accident. He was not wearing a helmet when a dog cut in front of his motorcycle, causing him to crash and land on his left shoulder.
- Radiographs showed a type V AC separation with disruption of both the AC and CC ligaments. The patient was admitted and taken to the operating room for open reduction and internal fixation with tightrope fixation to restore the coracoclavicular interval.
- AC separations are commonly caused by direct blows to the shoulder. They are classified based on the degree of ligament disruption and bone displacement. Nonoperative treatment is usually indicated for low-grade injuries while
Ortho..
- The patient is a 38-year-old Thai man who was in a motorcycle accident after drinking alcohol. He complains of left knee pain for 3 hours.
- Radiographs show a fracture of the left tibial plateau and left fibula. Physical examination reveals tenderness over the left knee with limited range of motion due to pain.
- The diagnoses are a fracture of the left tibial plateau, a fracture of the left fibula, and a mild head injury. The patient is placed in a long leg splint and advised to remain non-weightbearing on the left leg. Close monitoring is needed for compartment syndrome or neurological changes.
Closed fracture at the humeral shaft
This document discusses the case of a 41-year-old Thai woman who experienced a humerus shaft fracture after falling from a motorbike. On examination, she had deformity and swelling of the right forearm with an abrasion on the elbow but intact motor and sensory function. X-rays showed a fracture of the right humerus. The document summarizes treatment approaches for humerus shaft fractures, including non-operative management with a brace or operative fixation with plates or nails, depending on the fracture pattern and patient factors. Complications like radial nerve palsy are also addressed.
Conference
This case conference discusses a 45-year-old Thai male who was in a motor vehicle accident where he sustained a left humerus fracture. On physical examination, his left arm was tender and swollen with limited range of motion due to pain. X-rays confirmed a closed midshaft left humerus fracture. Treatment options for humerus fractures include non-operative management with a hanging arm cast or functional brace, or operative management with plate fixation or intramedullary nails depending on the fracture pattern and patient factors. Complications can include radial nerve palsy.
Scaphoid fx
- A 26-year-old Thai man presented to the emergency department with right wrist pain after falling 1 meter from a motorcycle 10 hours prior.
- Examination and x-rays revealed a non-displaced distal fracture of the right scaphoid bone. The patient was placed in a thumb spica cast and instructed to follow-up in 1 week.
- Scaphoid fractures are common injuries of the wrist, often occurring from falls onto an outstretched hand. Proper diagnosis requires standard x-ray views of the wrist due to the potential for missed or delayed fractures. Nondisplaced fractures are usually treated conservatively with casting while displaced or unstable fractures often require surgical fixation.
Extern conference-sani
1. The document describes a 43-year-old Thai woman who presented to the hospital after slipping and injuring her right elbow.
2. Physical examination revealed tenderness and limited range of motion of the right elbow due to pain and mild swelling. X-rays showed a fracture of the right radial neck.
3. The patient was diagnosed with a complex right elbow dislocation with a radial neck fracture. She underwent closed reduction with placement in a posterior long arm splint.
Ortho present
1. A 30-year-old Thai man was brought to the emergency room after falling off his motorcycle while riding for 2 hours. He sustained a deep laceration to his left fifth toe.
2. On examination, he was conscious and alert with stable vital signs. His left fifth toe had a 3cm deep laceration down to the bone with decreased sensation. X-rays showed an open fracture of the proximal phalange of the left fifth toe.
3. He was given antibiotics and analgesics for pain. He was admitted for debridement and fixation of the open toe fracture with K-wires under anesthesia.
Extern orthopedics-conference
1) The patient is a 60-year-old Thai male who presented to the hospital with left hip pain after being hit by a motorcycle 14 hours prior.
2) Physical examination revealed localized tenderness and limited range of motion of the left hip. X-rays showed a closed fracture of the left intertrochanteric region.
3) Intertrochanteric fractures occur between the greater and lesser trochanters. Surgical treatment with an intramedullary hip screw is usually recommended for unstable patterns to stabilize the fracture.
Case discussion ortho jeen
This document discusses the case of a 6-year-old Thai boy who fell from a half-meter height at school, landing on his outstretched right arm and elbow. On examination, he had swelling and deformity of the right elbow with limited range of motion due to pain. X-rays revealed a Gartland Type III closed supracondylar fracture of the left humerus. The boy underwent closed reduction with pinning under fluoroscopy and was placed in a posterior long arm slab for 4 weeks. Supracondylar fractures are common elbow fractures in children aged 5-10 years old and usually result from a fall onto an outstretched hand.
Acromioclavicular Joint Dislocation
clerked a case, presented to 5 orthopaedics professors for end of posting evaluation and here it is,with a thought of sharing online (eventho this is not a good one)
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Floating shoulder
- 1. Case discussion Extรามา ธนกร ปัทมาวไล
- 2. ชายไทยคู่ อายุ 65 ปี CC : ปวดไหล่ซ้ายมาก 30 min PTA PI : 30 min PTA ผู้ป่วยขับรถจักรยานยนต์ ถูกรถกระบะเฉี่ยวชน ตนจึงล้มรถจักรยานยนต์ กระเด็นออกจากรถ 2 m ไหล่ซ้ายกระแทกพื้น หลังจากนั้นปวดไหล่ซ้ายมาก ยกแขนซ้ายไม่ได้ ไม่สลบ รู้สึกตัวดีตลอดจาเหตุการณ์ได้ มีแผลถลอกตามตัว หายใจสะดวกดี ไม่เจ็บแน่นหน้าอก กู้ภัยฮุก 31 จึงนาส่ง รพช.ปักธงชัย
- 3. Primary survey • A : Airway patent ,can talk ,can move neck ,not tender along C spine • B : no chest wound ,no dyspnea ,no accessory muscle used ,trachea in midline ,clear and equal breath sound both lungs ,no adventitious sound • C : good consciousness ,BP 140/60 mmHg ,PR 80 / min ,no external bleeding • D : E4V5M6 ,pupil 3 mm RTLBE ,can’t move Lt arm limit due to pain • E :keep warm , multiple abrasion wound at Lt shoulder , Lt forearm ,and Lt knee ,not tender along spine
- 4. Adjunctive to primary survey • CXR : Old fracture Lt. rib 2rd -5th ,no hemopneumothorax
- 6. Secondary survey • Allergy : no history of drug or food allergy • Medication : no current medication • Past history : no known u/d • Last meal :ประมาณ 18.00 น. 12/5/60 ข้าว • Event : ตาม present illness Refer จากรพช.ปักธงชัย
- 7. Physical examination • GA : A Thai middle age man ,good consciousness • Vital sign : BT 36.8c , BP 140/60 mmHg ,PR 80 bpm ,RR 20/min • HEENT :not pale conjunctivae ,anicteric sclerae • Skin : multiple abrasion wound • Heart :normal S1,S2 ,no murmur , full and symmetrical pulse all exts. • Lung no accessory muscle used ,trachea in midline ,normal breath sound ,no adventitious sound • Abdomen : not distend ,soft ,not tender • Extremities : Abrasion wound 1x2cm at Lt shoulder, 1x5cm at Lt forearm and 2x3cm at Lt knee. No tenderness at forearm and knee ,stepping at mid shalf of Lt clavicle and tenderness ,limit ROM due to pain ,radial and brachial pulse 2 + ,normal deltoid sensation
- 10. Film Lt shoulder AP view Film Lt shoulder transcapular view
- 11. Diagnosis : Closed fracture middle shalf of Lt clavicle and closed fracture neck of left scapular Floating shoulder
- 12. Management Initial management -asscess neurovascular injury -immobilization with arm sling Definite management -Admit for surgery (ORIF)
- 13. Clavicle fracture Mechanism -> direct blow to lateral aspect of shoulder -> fall on an outstretched arm or direct trauma Associated injuries • ipsilateral scapular fracture • scapulothoracic dissociation • rib fracture • pneumothorax • neurovascular injury
- 14. Allman Classification with Neer's Modification
- 15. Treatment Non-operative indication Nondisplaced Gr I (middle third) Stable GrII fracture(Type I,III,IV) Anterior Gr III(medial third) Choice Figure of eight or arm sling immobilization With gentle ROM exercise for 2-4 wks Open reduction internal fixation indications • unstable Gr II fractures (Type IIA, Type IIB, Type V) • open fxs • displaced fracture with skin tenting • subclavian artery or vein injury • floating shoulder (clavicle and scapula neck fx) • symptomatic nonunion • posteriorly displaced Gr III fxs • displaced Group I (middle third) with >2cm shortening
- 16. Floating shoulder coracoacromial (CA) ligament
- 17. Floating shoulder • Ipsilateral fracture of clavicle and surgical neck of scapula. • Rare , high-energy trauma • Treatment Non-operative immobilization Operative ->ORIF of the clavicle alone (recommended ) ->ORIF of both clavicle and scapular
- 18. The end