Upper_limb_injuries_x_raysjBqbbsbdhns.ppt

UPPER LIMB INJURIES
Dr Abhishek Agarwal
Lecturer
Deptt orthopedics

Upper Limb include
 Clavicle
 Scapula
 Shoulder Joint
 Humerus
 Elbow Joint
 Forearm Bones
 Wrist and Hand

Mechanism of Injuries of the Upper
Limb
 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 : Flexed,
Extended, adducted, abducted, pronated or
supinated
Gutierrez G. Office management of upper limb fractures. .Phys and Sports Med. 24(8):60-80, 2006

Fracture of the clavicle in Adults
 Common especially in children and elderly
 Commonest site is the middle one third
 Mainly due to indirect injury
 Direct injury leads to comminuted fracture

Treatment
 Conservative by an arm sling or figure of eight
bandage
 Operative fixation is indicated if there is an
open fracture, neurovascular injury or
nonunion

Figure of eight Bandage

Dislocation of the Shoulder
 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

Mechanism of anterior shoulder
dislocation
 Usually Indirect fall on Abducted and
extended shoulder
 May be direct when there is a blow on the
shoulder from behind

Anterior Shoulder dislocation
 Usually also inferior
 Bankart’s Lesion

Clinical Picture
 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

Clinical Picture
 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

X Ray anterior Dislocation of
Shoulder

Associated injuries of anterior Shoulder
Dislocation
 Injury to the neuro vascular bundle in axilla (
rare )
 Injury of the Axillary or Circumflex Nerve (
Usually stretching leading to temporary
neuropraxia )
 Associated fracture

Axillary Nerve Injury
 Also called circumflex
nerve
 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
http://ptjournal.apta.org/cgi/collection/injuries_and_conditions_upper_extremity

Axillary nerve injury

Management of Anterior Shoulder
Dislocation
 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

Methods of Reduction of anterior
shoulder Dislocation
 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

Hippocrates Method

Stimpson’s technique

Kocher’s Technique

Complications of anterior Shoulder
Dislocation : Early
 Neuro vascular injury ( rare )
 Axillary nerve injury
 Associated Fracture of neck of humerus or
greater or lesser tuberosities

Complications of anterior shoulder
Dislocation : Late
 Avascular necrosis of the head of the
Humerus (high risk with delayed reduction)
 Heterotopic calcification ( used to be called
Myositis Ossificans )
 Recurrent dislocation

Fractures of The
Humerus
 Proximal Humerus (includes surgical and
anatomical neck )
 Shaft of Humerus
 Distal humerus ( includes Supra Condylar
fracture in children )

Fracture Proximal Humerus

Fracture Proximal Humerus : Plating or
Rush Nail insertion

Intra-medullary K wire fixation

Fractures Shaft of the Humerus
 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

Fracture shaft of the Humerus

Radial Nerve Injury
 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

Management of Radial Nerve
Injury
 When present in open fractures ; immediate
exploration and ± repair
 In closed injuries treated conservatively ; initial
management is doing Nerve Conduction
Studies ( NCS ) and Electromyography ( EMG
) and awaiting for spontaneous recovery

Management of Radial Nerve
injury
 Recovery usually starts after few days but may
take up to 9 months for full recovery
 If No spontaneous recovery occurs in 12
weeks confirmed by NCS and EMG ;then
exploration of the nerve should be carried out

Management of Fracture Shaft
of the Humerus
 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

U Shaped slab of POP

Functional brace Fracture Shaft of
Humerus

Indications for ORIF Fracture
Shaft of Humerus
 Failure to reduce fracture conservatively
 Bilateral humeral fractures
 Open fracture with radial nerve Injury
 Unconscious patient
 Delayed-Union, Non-Union and Mal-Union

Plating fracture Shaft of
humerus

Intra- medullary K Wire Fixation

Supra- condylar Fracture of
Humerus

Pediatric Supra-Condylar Humeral
fracture

Pediatric Supra-condylar fracture

Reduction of supra-condylar
Fracture
 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

Complications Supra-Condylar
Fractures
A. Early= Compartment syndrome
Brachial Artery injury ( Acute
Volkmann's Ischemia )
Nerve Injury : Median, Ulnar or Radial
B. Late= Stiffness
Volkmann's Ischemic contracture
Heterotopic Calcification
Mal-Union ( Cubitus Valgus or varus)

Volkmann's Ischemic
Contracture

Supracondylar fracture.

Fracture dislocation

MONTEGGIA FRACTURE-
DISLOCATION
Markiewitz AD, Andrish JT. Hand and wrist injuries in the preadolescent and adolescent athlete. Clin in Sport Med.
11(1):203-25, 1992.

GALEAZZI FRACTURE-
DISLOCATION
11(1):203-25, 1992.

Distal radius fracture.
11(1):203-25, 1992.

contd
11(1):203-25, 1992.

Types of treatment
11(1):203-25, 1992.

Wrist & Hand Injuries
 Carpal tunnel (CTS)
 result from repetitive stress
to tissue
 64% of work injuries
 Compressive neuropathy
 Wrist flexion/ext and finger
movements
 Risk factors
 exertion
 repetitive stress
 posture
 localized contact
 cold
11(1):203-25, 1992.

 Carpal fractures
 compressive loads to
hyperextended wrist
 hyper flexion
 rotation loading
against a fixed wrist
 Scaphoid
 60-70%
 Lunate
11(1):203-25, 1992.

 Thumb: essential to
prehension
 Sprain: skiers thumb
 fall with thumb in abducted
position
 tensile loads on MCL
 Hyperextension
 Bennets fracture (fighting)
 Bowler’s thumb: ulnar digital
nerve trauma
 tingling, sensitivity
11(1):203-25, 1992.

 Metacarpal &
phalangeal injuries
 Fractures
 Boxers
 Dislocations
11(1):203-25, 1992.

Upper_limb_injuries_x_raysjBqbbsbdhns.ppt

Upper_limb_injuries_x_raysjBqbbsbdhns.ppt

Recommended

Recommended

More Related Content

Similar to Upper_limb_injuries_x_raysjBqbbsbdhns.ppt

Similar to Upper_limb_injuries_x_raysjBqbbsbdhns.ppt (20)

More from DeveshAhir

More from DeveshAhir (20)

Recently uploaded

Recently uploaded (20)

Upper_limb_injuries_x_raysjBqbbsbdhns.ppt