1. The document discusses fractures and dislocations that can occur in the shoulder girdle, which includes the clavicle, scapula, and humerus. 2. It describes the mechanisms of injury, clinical presentations, treatments, and complications for fractures of the clavicle and scapula as well as dislocations of the sternoclavicular joint, acromioclavicular joint, and glenohumeral joint. 3. The treatments discussed include slings, braces, closed reduction, open reduction with internal fixation, and surgical procedures like the Bankart repair.

1. DEPARTMENT OF ORTHOPAEDICS
S.S. Medical College Rewa & Associated G.M.H &
SGM Hospital ,Rewa (M.P.)
Directed By
Dr. P.K.
Lakhtakia
(Professor &
HOD)
Presented by-
Aayush Rai
Akash Chaturve
Akash Sahu
(Batch 2013-R
Guided By-
Dr. Rahul Kundar
(Assistant Professor )

3. SHOULDER GIRDLE
 Comprises of Clavicle, scapula and Humerus.

4. JOINTS IN THE SHOULDER
GIRDLE
Sternoclavicular Joint
Acromio Clavicular Joint
GlenoHumeral Joint

5. FRACTURE OF CLAVICLE
Relavant Anatomy
Sternoclavicular Joint.
Acromioclavicular Ligament .
The Muscles Related To Clavicle Are :
Sternocleidomastoid(origin) And Subclavius
Muscle(insertion) .
The Subclavian Vessels And Brachial Plexus Lie
Posterior To Clavicle .

6. MECHANISM OF INJURY :
Direct traumatic impact or fall on the shoulder
87% .
Direct impact to clavicle 07% .
Fall on outstretched hand 06% .
Fall on the side .
Vigorous muscle contraction , seizures [rare] .
Pathological fracture [rare]

7. MECHANISM OF INJURY

9. DIAGNOSIS
•History Of Trauma Followed By
Pain,swelling, Crepitus At Fracture Site
•Confirmed By Xray.

10. TREATMENT
FRACTURE CLAVICLE
MINIMAL
DISPLACEMENT
TRIANGULAR SLING
FOLLOWED 20-
25DAYS BY ACTIVE
SHOULDER
EXERCISES WHEN
THE PAIN SUBSIDES
SEVERE
DISPLACEMENT OR
NEUROVASCULAR
DEFICIT
OPEN REDUCTION
AND INTERNAL
FIXATION

11. FIGURE OF 8 BRACE
TRIANGULAR SLING

12. Surgical treatment :
Rarely indicated in :
- lateral one third fracture .
- presence of neurovascular injury .
- non union cases .
Internal fixation plate .
Closed Reduction & Internal
Fixation by nailing .

13. Complication:
EARLY : [subclavian or carotid artery injury
,pneumothorax and hemothorax ,brachial injury ]
LATE :
Malunion .
Nonunion(rarely) : treated by internal fixation and
bone grafting .
Neurovascular injury [rare] .
Stiffness of shoulder in elderly .
Ulnar neuropathy .
Refracture .

14. Fracture of scapula :
Fractures of scapula are uncommon because
of scapula location and surrounding muscles
which protect it .
- Fractures of scapula
are result of high energy
trauma with high incidence
Of associated injuries
by 60-98 % .

15. Associated life threatening injuries
with scapula # :
 Pneumothorax
 Pulmonary Contusion
 Arterial Injury
 Abdominal Injury
 Head Injury
 Splenic Or Liver Laceration
 Brachial Plexus Injury

16. Mechanism of injury :
# of body : From Sever Direct Trauma
- Fall From Height With Direct
Landing On Posterior Aspect Of Trunk .
- Motor Vehicle Crush .
# of neck : Direct Blow To Shoulder
- Fall On Shoulder .
- Fall On Outstretched Hand .

17. # Of Glenoid : Direct Blow To Lateral
Aspect Of Shoulder .
Or Impaction Of Humeral
Head In To Glenoid Fossa .
# Of Coracoid Process :
Direct Blow Or Shoulder Dislocation .
# Of Acromion :
Direct Down Ward Blow To Shoulder
.

18. Clinical picture :
 Sight > swelling, deformity,
ecchymosis & erosion .
Tenderness, crepitation .
Pain exacerbated by movement .

19. Clinical picture :
- Brusing over scapula or chest area .
- Pain in movement .
- Swelling around back of shoulder .
- Tenderness at site of # .
Arm is held immobile .

20. Diagnosis :
X – ray :
Anteroposterior view lateral axillary view
.

22. Treatment :
Reduction Is Usually Unnecessary .
Patient Wears A Sling For Comfort And For
Start Movement.
# Of Body By :
Conservatively By Analgesics And Simple Sling To
Rest Shoulder For 2-3 Weeks .

23. # Of Acromion Process :
Un Displaced :
Sling For 3-4 Weeks For Rest
Shoulder.
Displaced :
Acromion Should Be Reduced
And Fixed .

24. # of coracoid :
conservatively in major , using a sling for
2-3 weeks.
Vigorous exercises should be prohibited
for 2 m .
# of neck and glenoid :
- sling for 2-3 weeks
- open reduction > indicated if fractures
associated with dislocation or subluxation
of shoulder .

25. STERNO CLAVICUAR JOINT
DISLOCATION
 Rare injury
 Medial end of clavicle is displace forward or rarely
backward.
 Clinical diagnosis is easier
 Treated by reduction by direct pressure on
dislocated end which is then maintained by figure
of 8 bandage.

26. ACROMIO CLAVICULAR JOINT DISLOCATION
MECHANISM:
FALL ON OUTSTRETCHED
HAND
ANATOMY

28. XRAY
TREATMENT:
• Rest In Triangular
Sling
• Analgesics
GRADE 1 &
2 INJURY
• Sugical Repair.
GRADE 3
INJURY

29. SHOULDER DISLOCATION
MOVEMENT AT SHOULDER JOINT

30. MECHANISM OF INJURY
 COMMONEST :Fall on an outstretched hand with
the shoulder abducted and externally rotated
 POSTERIOR DISLOCATION:by direct blow from
the front of the shoulder or from epileptiform
convulsions or electric Shock.

31. ANTERIOR DISLOCATION POSTERIOR DISLOCATION

32. POSTERIOR SHOULDER DISLOCATION
(adducted and internally rotated arm)
ANTERIOR DISLOCATION
(Slight abducted and internal
rotated arm)
INFERIOR DISLOCATION

33. PATHOLOGICAL CHANGES IN ANTERIOR
DISLOCATION
 BANKART’S LESION
 HILL SACHS LESION
 ROUNDING OFF
 ASSOCIATED INJURIES

34. BANKARTS LESION
Seen in anterior dislocation.
Stripping of glenoid labrumalong with
periosteum .
Antero inferior Surface of glenoid and
scaular neck.
Avulsion of anteroinferior Glenoid rim
causes Bony Bankart Lesion.

35. HILL SACHS LESION
Depresson on humeral
head in its postero lateral
quadrant
Due to impingment by
the anterior edgeof
glenoid on the head as it
dislocates

36. OTHERS
 ROUNDING OFF OF ANTERIOR GLENOID RIM
: in chronic cases due to repeated dislocation of
head over it
 ASSOCIATED INJURIES like Fracture greater
Tuberosity ,Rotator Cuff Tear,Chondral Damage
etc .

37. DIAGNOSIS
 History of fall on outstretched hand followed by
pain and inability to move the shoulder.
SIGNS:
1)LIGHTBULB SIGN :In Posterior
Dislocation

38. 2) GLENOID RIM:Distance between
the medial border of the
humeral head an anterior
glenoid rim is >6mm.
3)DUGAS’ TEST:In Anterior Dislocation,Inability To
touch the opposite Shoulder.
4)HAMILTON RULER TEST:due to flattening ,ruler
can be placed on the lateral side of arm touching the
lateral condyle and acromion simultaneously.

39. HILL SACH LESION BANKART LESION

40. ANTERIOR DISLOCATION
INFERIOR DISLOCATION

41. TREATMENT
 REDUCTION :
 1) KOCHERS MANOEUVRE
2) HIPPOCRATES MANOUEVRE
 3)STIMSONS MANOUEVRE

42. KOCHERS MANOUEVRE
 I)Traction –with the elbow flexed at right angle
,steady traction applied along long axis of
humerus
 II)External Rotation
 III)Adduction
 IV)Internal Rotation

45. COMPLICATIONS
 NERVE INJURY :Axillary and
musculocutaneous nerve injury
 Recurrent dislocation

46. SURGICAL OPERATIONS
 I)PUTTI PLATT OPERATION:Double breasting of
subscapularis to prevent ER and Adduction.
 II)BANKARTS OPERATION:Glenoid labrum and
capsule reattached to front of glenoid rim.

47.  III)BRISTOWS OPERATION:Coracoid process
osteomized at base and fixed to lower half of the
anterior margin of glenoid.