The document discusses various orthopedic injuries and conditions around the elbow and upper limb, including proximal humerus fractures, humeral shaft fractures, distal humerus fractures, biceps tendon ruptures, lateral and medial epicondylitis, fractures around the elbow in children including supracondylar humerus fractures and lateral/medial epicondyle fractures, pulled elbow, and elbow dislocations. Treatment options including nonsurgical and surgical management are provided for many of the conditions.
The upper limb consists of various joints that enable movement and provide flexibility. These joints can be classified into different types based on their structure and function.
Understanding the anatomy and function of these joints is crucial for assessing and managing conditions related to the upper limb, as well as for rehabilitation and therapeutic interventions. Joint injuries, arthritis, and other disorders may affect the functionality of these joints, and appropriate medical care may be necessary for optimal outcomes.
the slide describes femoral fracture with case presentations as well as rediological diagnosis ,when opened and closed .the management from emergency period and through to stabilization
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
2. INJURIES TO THE UPPER LIMB ( 2 )
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
2
3. PROXIMAL HUMERUS FRACTURES
This type of fracture occur in old and middle age osteoporotic
people .
In the majority of the cases displacement is not marked , only 20%
of cases has considerable displacement .
The fracture occur due to fall on out stretched arm
Proximal humerus include 4 major components these are :
1. head of humerus .
2. greater tuberosity .
3. lesser tuberosity .
4. surgical neck of the humerus .
Classification of this fracture called neer classification .
Clinically : history of trauma , pain ,loss of function , swelling ,
bruises on the skin , sign of axillary nerve or brachial plexus injury
may be detected .
X-ray :a-p , lat.view or axillary view should be taken to exclude
associated dislocation .
3
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
4. PROXIMAL HUMERUS FRACTURES
Treatment :
Minimally displaced fracture (majority) need only sling of the
arm for 3 weeks until the pain subside and then gentle
passive movement is advised ; active movements is
encouraged after 6 weeks .
If there is considerable displacement of one or more of the 4
components , then manipulation is advised , if fail then open
reduction and fixation .
If the fracture is 4 peaces and displaced and the patient is old
then do prosthetic replacement of the proximal humerus .
Complication :
Early : neurovascular injuries (axillary n. , a.)
Late :
stiffness of the shoulder ; this can minimized by early mobilization .
avascular necrosis of the head of the humerus . 4
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
6. HUMERAL SHAFT FRACTURES
This fracture caused by fall on out stretched Hands or by
direct blow on the arm .
Fracture above the deltoid insertion (deltoid tuberosity), the
proximal segment is adducted by pectoralis major muscle ,
and if the fracture below the deltoid insertion then the
proximal segment is abducted by the effect of the deltoid
muscle .
Injury to the radial nerve is common with this fracture
mainly at the junction of the upper two third and the lower
one third of the shaft due to close contact of the nerve to the
bone at that site so it is very important to test for the radial
nerve function with this fracture before and after treatment
and this is done by assessing active extension of fingers and
wrist . 6
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
7. HUMERAL SHAFT FRACTURES
Treatment :
Conservative treatment : this include hanging cast which is p.o.p cast made
from the arm to the wrist with elbow flexed 90`, the limb is slinged from the
wrist so the weight of the cast will pull the fragments into alignment this can
be left for 2-3 weeks and then replaced by shoulder to elbow cast (u-shape
slab) for further 4-6 weeks .
Exercise of the wrist and the fingers should be started from the beginning to
avoid stiffness.
Exercise of the shoulder should be started as early as possible to avoid
stiffness( mainly in elderly).
Operative treatment :
Types of fixation :
compresion plate and screws .
inter locking intra medullary nail .
external fixators .
Indications of fixation :
sever multiple injuries .
open fracture .
segmental fracture .
pathological fracture .
radial nerve palsy after manipulation .
non-union .
7
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
9. HUMERAL SHAFT FRACTURES
Complications :
Early :
vascular injury (brachial artery)
nerve injury ; radial nerve
palsy will cause wrist drop
Late complication :
Delayed union and non union .
Malunion (angulation )
Joint stiffness (minimized by
early activity).
9
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
10. DISTAL HUMERUS FRACTURES
Fractures of adult distal humerus are relatively
uncommon (extra-articular ,intra-articular )
Distal humerus fractures are most often caused
by:
Falling directly on the elbow
Receiving a direct blow to the elbow from
something hard
Falling on an outstretched arm with the
elbow held tightly to brace against the fall
Treatment Principles
1. Anatomic articular reduction
2. Stable internal fixation of articular surface
3. Restoration of articular axial alignment
4. Stable internal fixation of the articular segment to
the metaphysis and diaphysis
5. Early range of motion of the elbow 10
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
11. DISTAL HUMERUS FRACTURES
Treatment
Nonoperative
cast immobilization
Operative
Closed reduction and percutaneous pinning
(CRPP)
Open reduction internal fixation (ORIF)
Total elbow arthroplasty
Complications
Elbow stiffness (most common)
Heterotopic ossification
Nonunion
Malunion
cubitus valgus (lateral column fractures)
cubitus varus (medial column fractures)
AIN injury
Ulnar nerve injury
DJD
11
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
Heterotopic
ossification
12. BICEPS TENDON RUPTURE
A biceps rupture is a condition characterized by
complete tearing of one or more tendons or
muscle bellies of the biceps muscle.
Rupture of the biceps tendon often occurs after
a sudden contraction of the biceps with
resistance to flexion and supination of the
forearm.
Patient often experiences a painful “pop” as
the elbow is eccentrically loaded from flexion to
extension.
When the proximal biceps tendon ruptures, the
muscle moves towards the elbow and becomes
a big ball of muscle called the Popeye sign.
Distal biceps tendon rupture typically occurs in
athletes such as body builders or in people who
perform manual labour
12
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
13. BICEPS TENDON RUPTURE
Signs and symptoms
Sudden sharp acute pain in the upper arm
Tenderness
Weakness
Sometime an audible pop or snap
Bicep muscle cramp
Bruising from the middle of the upper
arm down to ward the elbow
Difficulty turning the arm palm up or palm
down a bulge in the upper arm above the
elbow
("Popeye Muscle") may appear
Treatment
Conservative ( especially in elderly and
proximal rupture ) (analgesics, ice packs,
rest)
Surgical ( young athletes )
13
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
14. LATERAL/MEDIAL EPICONDYLITIS
The common term “tennis elbow” refers to lateral epicondylitis
which affects the origin of the wrist extensor muscles, while the
term “golfer’s elbow” refers to medial epicondylitis which affects
the origin of the flexor/pronator muscles.
Epicondylitis is an overuse injury in which the rate of tendon
damage exceeds the rate of tendon repair. This disequilibrium
causes pain at the elbow and, ultimately, leads to impaired
function - primarily in tasks that involve a power grip and require
a stable wrist joint.
Patients with epicondylitis present with a chief complaint of pain
in the elbow on the affected side, especially with grasping.
Patients with epicondylitis often volunteer a history of repetitive
forearm use, including sports involving rackets or bats, but also
occupational activities such as working with tools. 14
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
15. LATERAL/MEDIAL EPICONDYLITIS
Treatment :
It is best treated initially by a
period of relative rest ,
avoiding provocative activities
Splinting the wrist may also be
helpful for this elbow pain
Simple analgesics alongside
topical NSAIDs should be
prescribed to help with the
pain
Physical therapy
Cortisone injections
Autologous blood products -
eg, platelet-rich plasma (PRP) 15
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
16. FRACTURES AROUND THE ELBOW IN CHILDREN
There are six epiphysis
around the elbow.
C-R-I-T-O-E: Capitellum,
Radial head, Internal
(medial) epicondyle,
Trochlea, Olecranon,
External (lateral) epicondyle
Time of their appearance:-
C-1
R-3
I-5 “CRITOE”
T-7
O-9
E-11.
These epiphysis
generally unite 2 years
after they first appear 16
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
17. FRACTURES AROUND THE ELBOW IN CHILDREN
SUPRACONDYLAR FRACTURE OF THE HUMERUS
It is very common fracture in children , and according to the
displacement of the distal segment the fracture will be of two types :
Extension type : it is the most common type about 95% of the cases , it is
occur due to fall on out stretched hand , the humerus breaks just above the
condyles , the distal fragment is displaced backward .
Flexion type : it is due to direct blow on the elbow posteriorly ; it is rare
Classification :
Type I: undisplaced fracture .
Type II: angulated fracture with the posterior cortex is still in continuity .
Type III: completely displaced fracture .
17
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
18. Clinically :
History of fall on out stretched hand , the child is in
pain , swelling , deformity .
It is very important to check the distal pulsation
(radial pulse) and capillary refilling to asses the distal
circulation , also checking the nerves for any injuries (
mainly the median nerve ) .
X-ray : the fracture is seen clearly in A-P , and lateral
views .
In undisplaced fracture the fat-pad sign which is
triangular lucency in front of the distal humerus this
will raise the suspicion of the fracture.
18
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
FRACTURES AROUND THE ELBOW IN CHILDREN
SUPRACONDYLAR FRACTURE OF THE HUMERUS
19. Treatment :
Non-operative : long arm
casting with less than 90° of
elbow flexion
Operative
closed reduction and
percutanous pinning (CRPP)
open reduction,
percutaneous pinning
Complications
vascular damage
nerve damage (most
commonly the anterior
interosseous nerve (AIN))
Malunion
Cubitus valgus
Cubitus varus
19
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
FRACTURES AROUND THE ELBOW IN CHILDREN
SUPRACONDYLAR FRACTURE OF THE HUMERUS
20. FRACTURES AROUND THE ELBOW IN CHILDREN
FRACTURE OF THE LATERAL EPICONDYLE OF THE HUMERUS
The most common mechanism of
injury is a fall onto an outstretched
arm with the elbow in varus, which
causes avulsion of the lateral
humeral condyle
The fracture piece although it look
small in the x-ray but it in fact is
large and it pulled by extensor
muscle of the wrist which attached
to it .
In sever cases the piece is rotated
by the action of the extensor
muscle and become capsized lead
to nonunion later on if not treated .
Clinically :
The elbow swollen and deformed ,
tenderness at the site of the
fracture .
20
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
21. FRACTURES AROUND THE ELBOW IN CHILDREN
FRACTURE OF THE LATERAL EPICONDYLE OF THE HUMERUS
Treatment :
If there is no or minimal displacement
we can do back slab above the elbow
which is 90` flexed and the forearm is
neutral ; after 7 days repeat the x-ray
for checking and full p.o.p. for 3-4
weeks , followed by active
physiotherapy
Displaced fracture need open
reduction and fixation by K-wire or
screw .
Complications :
Stiffness
Delayed Union
Nonunion
Cubitus Valgus ± tardy ulnar nerve palsy
Lateral overgrowth/prominence
(spurring)
Growth arrest
21
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
22. FRACTURES AROUND THE ELBOW IN CHILDREN
FRACTURE MEDIAL EPICONDYLE OF THE HUMERUS
It is occur due to fall on out stretched hands ; the medial epicondyl is
avulsed by the effect of the strong flexor muscles of the wrist .
The most common mechanism of injury is an avulsion that can occur as a
result of a valgus stress
If the elbow joint is dislocated or subluxated even momentarily , the
fracture piece may introduced into the joint .
Clinically :
History of trauma , pain and tenderness , swelling , sensation and power
of the fingers should be tested to exclude ulnar nerve damage .
22
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
23. FRACTURES AROUND THE ELBOW IN CHILDREN
FRACTURE MEDIAL EPICONDYLE OF THE HUMERUS
Treatment :
Minor displacement less than 5
mm. need only back slab in
elbow flexed , after 7 days do
full p.o.p. for 2-3 weeks
If the piece is trapped into the
joint , then it must be freed
either by manipulation under
anesthesia , if failed or the
piece is severely displaced then
we should do open reduction
and fixation by K wire or screw .
Complication : early : ulnar
nerve damage .
late : stiffness of the elbow . 23
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
24. PULLED ELBOW ( NURSEMAID'S ELBOW )
If children under 4 years of
age are lifted by their hands
the radial head can slip partly
out of the annular ligament.
The child will experience pain,
will not use the arm, and the
radiographs will be normal.
Treatment
While holding the arm
supinated the elbow is then
maximally flexed , the
physician’s thumb applies
pressure over the radial head
and a palpable click is often
heard with reduction of the
radial head 24
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
25. DISLOCATIONS OF THE ELBOW
Although the elbow is a mechanically
stable joint, it can be dislocated by a fall
on the outstretched arm in almost full
extension .
Elbow dislocations are the most common
major joint dislocation second to the
shoulder
It is the most common dislocated joint in
children
Posterolateral dislocation is the most
common type of dislocation (80%)
Treatment
closed reduction and splinting at least 90°
for 10 days, early therapy
Operative
Complications
Joint stiffness
Ectopic ossification
Neurovascular injuries
Recurrent instability
25
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
26. OLECRANON FRACTURE
The olecranon is easily fractured in
direct falls onto the point of the
elbow because the lower end of the
humerus acts like a chisel and splits
the olecranon at its narrowest point
.
Avulsion injuries due to the pull of
the triceps muscle are also
common.
Treatment
Unless the fragments are
undisplaced, which is unusual,
internal fixation is needed, using
either a screw or tension band
wiring .
Comminuted fractures in which the
fragments cannot be reassembled
and fixed can be treated by excision
of the olecranon, especially in the
elderly 26
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
27. FRACTURES OF THE RADIAL HEAD AND NECK
mechanism of injury : fall on outstretched
hand (elbow in extension + forearm in
pronation ) most force transmitted from wrist
to radial head.
Treatment
Treatment varies according to the type of
fracture.
Undisplaced fractures and those with little
displacement need blood aspirating from the
joint, a soft supporting bandage and early
mobilization.
Displaced fractures through the radial neck
with more than 30° of angulation cause a
painful restriction of pronation and supination
if left untreated.
The displacement should be corrected, by
open reduction if necessary.
Comminuted fractures. Grossly displaced or
comminuted fractures of the radial head are
best treated by radial head excision and early
mobilization.
Prosthetic replacement of the radial head has
been tried but excision is usually preferred
27
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
28. FRACTURES OF THE RADIUS AND ULNA
Mechanism of injury :
Fractures of the shaft of both bones occur
commonly in road traffic accidents , it can
ben caused by :
twisting force , which cause spiral fracture in
both bones in different levels .
direct blow , lead to transverse fractures at the
same level.
Additional rotation which lead to more
displacement can be caused by the pronator
muscles (pronator teres , pronator quadratus
) in the middle and the lower thirds ,and the
supinator muscles (biceps , supinator ) in the
upper third of the forearm.
Clinically :
Fracture is usually quite obvious but we
should do checking of the nerves and arteries
(distal pulsation )distal to the site of the
fracture which can be affected by
compartment syndrome .
28
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
29. FRACTURES OF THE RADIUS AND ULNA
Treatment
In children : with green stick fracture , the closed treatment is usually
successful because the thick periosteum tend to guide and control
the reduction ; after reduction we put back slab above elbow which
is 90` flexed and ask the patient to elevate the limb to decrease the
edema ; after 10 days we change the slab to complete p.o.p. if the
fracture is in the upper third we put the fore arm in supination , if it
in the middle third we put the fore arm in neutral and if it in the
distal third we put the fore arm in pronation . The p.o.p. should be
left for another 4 weeks . Followed by physiotherapy .
Open reduction is indicated in :
if the fracture can not be reduced .
if the reduction is unstable .
The fixation will be by plate and screw , intramedullary nail,
In adult : closed reduction of this fracture in adult is very difficult and
redisplacement in the cast is common so most of the surgeons prefer
the open reduction and fixation from the beginning by plate and
screws .
Open fracture : need external fixation because internal fixation can
not be used in compound fracture
29
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
31. FRACTURES OF THE RADIUS AND ULNA
Complication
Early :
nerve injury . It is rarely occur in this fracture but it can be caused by the
surgeons e.g. posterior interosseous nerve .
vascular injury . Ulnar and radial arteries .
compartment syndrome .
Late :
delayed union and nonunion .
malunion which lead to limitation of pronation and supination
31
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
32. ISOLATED ULNAR SHAFT FRACTURE
Isolated ulnar shaft fractures are rare fractures of the forearm caused
by either direct blow to the forearm ("nightstick" fracture) or indirect
trauma (fall).
Diagnosis and treatment plans made primarily by physical exam and
plain radiographs.
Minimally displaced are often treated nonsurgically, while treatment
has historically been surgical open reduction and internal fixation
32
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
33. MONTEGGIA FRACTURE DISLOCATION OF THE ULNA
It is fracture of the proximal third of the ulna with dislocation or
subluxation of the proximal radio- ulnar joint or radial head .
Clinically : the ulnar deformity is usually obvious but the dislocated
head of radius is masked by the swelling .
X-ray : in isolated fracture ulna it is essential to take true a-p and
lateral views of the elbow ; the normal radial head is usually
pointing to wards the capitulum in monteggia it is not ; in addition
to appearance of the fracture .
33
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
34. MONTEGGIA FRACTURE DISLOCATION OF THE ULNA
Treatment :
the most important point in treatment is to restore the length of the fractured
ulna and only in this case the dislocation will be reduced and remain stable ; so
in adult this mean operation (reduction and fixation by plate and screws) if the
dislocation not reduced , then open reduction of the joint .
In children if the fracture is green- stick then manipulation under anesthesia can
be helpful, but if the fracture is complete then open reduction and fixation like
adult .
Complication :
nerve injury : which occur either due to manipulation or during surgery
malunion : unless the fracture has been perfectly reduced , the radial head
remain dislocated and limiting elbow flexion , limitation of pronatiopn and
supination ; if this happened in children no treatment but if occur in adult then
excision of the head of the radius can be done
non union of the ulna : the treatment by rigid internal fixation and bone graft .
34
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
35. GALEAZZI FRACTURE DISLOCATION OF THE RADIUS
It is caused by fall on the hand , there is fracture in the lower third of the
radius and dislocation of the inferior radio- ulnar joint .
Clinically : it is much more common than monteggia , prominence and
tenderness over the lower end of the ulna is an important point in
examination
Treatment : the most important point is to restore the length of the
fractured radius , other wise the dislocation will not reduced .
In children close reduction is possible but if fail , then open reduction and
fixation .
In adult , the treatment will be by open reduction and internal fixation .
Complication :
The most important complication is limitation of pronation and
supination .
35
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
36. FRACTURES OF THE DISTAL RADIUS
COLLES` FRACTURE
Colles` fracture
This fracture is described by Ibraham colles` in 1814 .
It is a transverse fracture of the distal end of the radius with
posterior (dorsal) displacement of the distal fragment.
It is the most common of all fractures in the human being ;
mainly in old osteoporotic people , but it occur in all age groups .
It is occur due to fall on out stretched hands
The fracture that Colles described:
1. Was within 1 inch (2.5 cm) of the wrist joint.
2. Had dorsal angulation of the distal fragment.
3. Had dorsal displacement of the fragment.
4. Was associated with a fracture of the ulnar styloid.
Colles’ fracture is most often caused by a fall on the outstretched
arm in patients over 50, usually women.
Deformity. The obvious deformity of a Colles’fracture is the
classical ‘dinner fork’ of backward angulation
36
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
37. FRACTURES OF THE DISTAL RADIUS
COLLES` FRACTURE
Clinically :
The deformity of this fracture
called dinner – fork deformity .
The patient also has the sign
and symptoms of any other
fracture like pain , tenderness ,
loss of function , swelling …..etc
X-ray : there is transverse
fracture of the radius at the
cortico – cancellous junction ,
and the distal fragment is
displaced posteriorly ( dorsally)
; some time it is severely
comminuted or crushed 37
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
38. FRACTURES OF THE DISTAL RADIUS
COLLES` FRACTURE
Treatment :
Nonoperative
closed reduction and splint/cast immobilization
Operative
Closed reduction percutaneous pinning (CRPP)
Open reduction and internal fixation (ORIF)
38
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
39. FRACTURES OF THE DISTAL RADIUS
COLLES` FRACTURE
Complication :
Median nerve neuropathy [carpal- tunnel syndrome (CTS) ]
The extensor pollicis longus (EPL) rupture.
malunion : it is common due to unreduced fracture or due to
redislpacement .
delayed union and non union .
stiffness of the wrist ,fingers, elbow and shoulder
sudeck`s dystrophy (Complex regional pain syndrome (CRPS)
39
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
40. SMITH FRACTURE :
it is the same as colles` fracture but the distal segment is
displaced anteriorly
40
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
41. RADIAL STYLOID PROCESS FRACTURE :
Here the fracture line extend from the articular surface of the
radius laterally .
Mechanism of injury:
Direct blow to distal radius or fall onto outstretched hand, often with
compression of scaphoid against styloid fragment
Known as Chauffeur's fracture
Treatment :
Although these fractures are often undisplaced, they are relatively
unstable and often benefit from percutaneous lag-screw fixation or
pinning .
41
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali
42. BARTON`S FRACTURE
It is intra-articular fracture of the lower end of the radius with
subluxation of the wrist joint.
It is of two types :
Volar Barton's`: called true Barton fracture and it
associated with volar subluxation of the carpus . The
fracture line run obliquely across the volar lip of the radius
into the wrist joint . The distal segment displaced anteriorly
carrying the carpus with it .
dorsal Barton`s: it is the reverse of the volar one
Treatment :
The fracture easily reduced but it is unstable so it can easily
redisplaced so the treatment will be by open reduction and
fixation by special plate called Buttress plate 42
Orthopedic
Surgery
-
Dr.
Rami
Abo
Ali