The document discusses upper limb fractures, specifically focusing on clavicle and shoulder joint injuries. It details characteristics of the clavicle, common fracture types, treatment methods, and complications of shoulder dislocation, including tests for diagnosis and management strategies. Additionally, it covers various lesions associated with recurrent dislocations and outlines surgical procedures for shoulder instability.

1. Upper Limb Fractures
(Clavicle & Shoulder Joint)
------ Soushrita Purkait
3rd professional MBBS, part 1
N. R. S Medical College and Hospital

2. Clavicle Trauma

3. Clavicle Bone
● Only horizontally arranged longbone .
● Only bone to ossify in membrane.
● Starts ossification in 5th week of IUL.
● Only bone with 2 primary center of ossification.
● Medial 1/3rd : tubular
● Lateral 1/3rd : flat
● Most common sit of fracture: Junction of medial
2/3rd and lateral 1/3rd

4. Fracture displacement of clavicle
● Most common fracture at birth or in neonates.
● Medial fragment is pulled up due to traction of sternocleidomastoid muscle
● Lateral fragment is pulled down due to weight of pectoralis muscle.
● Complications:
Mal-union ( most common)
Injury to brachial plexus and subclavian vessels
● Treatment:
Conservative- armsling/ arm of pouch.
Figure of B bandage
Surgery- done in-
Open clavicle fracture
Massive displacement ( skin necrosis)
Neurovascular damage
Fracture involving acromioclavicular joint
Floating shoulder (Fracture of clavicle+glenoid)

5. Shoulder Joint
Trauma

6. Shoulder joint
● It is a ball ( head of humerus )and socket
(glenoid) type of joint.
● Most common joint to dislocate.
● The stabilisers of shoulder joint are
STATIC
DYNAMIC
Capsule Rotator cuff muscle
Labrum (Fibro- supraspinatus
cartilagenous infraspinatus
ring around teres minor
glenoid) subscapularis
Glenohumoral
Liguments Deltoid and long head of
Superior biceps
Middle
Inferior

7. Anterior Dislocation Of Shoulder
● Emergency
● SUBTYPES:
Pre-glenoid
Subcoracoid (most common)
Subclavicular
Intrathoracic.
● CINICAL PRESENTATIONS:
Attitude of limb-
-Arm by the side of the body, abducted
and externally rotated
-Shoulder conture is lost

8. Contd.
● TESTS:
1. Hamiltons ruler test : Place a ruler on the
lateral aspect of arm and check is it touching the
acromian process and lateral epicondyle of arm.
2. Dugas test : check if patient can touch the
opposite shoulder.
3. Callaways test: Compare the girth of affected and
un affected side. If girth is more in affected side then
it indicates dislocation.
4.Bryants test: Vertical axillary circumference
increases.
● Tests for neurovascular injury: Axillary nerve may get
damaged.
Axillary function test : Motor – supplies deltoid ,
can’t be tested.
Sensory- REGIMENTAL BADGE
SIGN – Parasthesia / burning sensation over teres minor

9. Contd.
● RADIOLOGY:
X-Ray AP view : head is dislocated.
X-Ray Lateral view :confirmatory
● MANAGEMENT: Reduce the dislocation.
MODIFIED KOCHERS TECHNIQUE: (most common)
1. Traction
2. External rotation
3. Adduction
4. Medial roration
STIMSON MANEUVER : Traction of dislocated
limb
HIPPOCRATIC METHOD : Obsolete

10. Contd.
● COMPLICATIONS:
- Most common complication: Recurrent shoulder
dislocation.
- Most common late complication: Recurrent shoulder
dislocation.
- Most common early complication: Axillary nerve
injury.
● LESIONS:
1. Bankert’s lesion: (most common) avulsion of labrum
form antero-inferior glenoid rim.
2. Bony Bankert’s lesion : If some part of bone also get
avulsed.
3. Hill Sach’s lesion : Because of recurrent dislocation
head of humerus hits the glenoid repeatedly leading to
indentation on the postero-lateral head of humerus.

11. Posterior dislocation Of Shoulder
● MECHANISM OF INJURY:
-High voltage electric shock
- Seizure Hand abducted
- Fall on outstretched hand & internally
rotated
Very difficult to
diagnose clinically
● RADIOLOGY: X-Ray shows light bulb sign.
● LESIONS: - Reverse Bankert (Antero-inferior)
- Reverse Hill Sach’s (Antero-medial)

12. Inferior Dislocation Of Shoulder
● Aka Luxatio erecta.
● Extremely rare.
● MECHANISM OF INJURY: Hyperabduction injury
Patient present with erected
hand by the side of the head.
● TESTS FOR SHOULDER INSTABILITY:
1. Anterior:
Fulcrum test
Crank test
Apprehension test (Abduct and externally rotate the shoulder)
2. Posterior: Jerk test
3. Inferior : Sulcus test
● SURGERIES FOR SHOULDER IMSTABILITY:
Putti-Plat procedure: Double breasting the subscapsularis muscle using capsule.
Bristow-Latarjet procedure: Osteotomization of coracoid process and
repositioning on the anterior surface of glenoid to prevent dislocation.