Fractures and dislocations of the shoulder girdle and elbow and fractures of the humerus

1. Fractures and dislocations of the shoulder girdle and elbow and fractures of the humerus H. Sithebe

2. Anterior shoulder dislocation

3. Two Views. • AP • Lateral

4. REDUCTION

5. POST REDUCTION • CONTROL X-RAY • SLING 2-3 WEEKS • AVOID EXTERNAL ROTATION AND ABDUCTION

6. COMPLICATIONS • AXILLARY NERVE INJURY • VASCULAR INJURY • FRACTURE DISLOCATION • RECURRENT DISLOCATION • BRACHIAL PLEXUS INJURY

7. Posterior shoulder dislocation AP Lateral

8. REDUCTION • ARM PULLED AND EXTERNALLY ROTATED • HUMERAL HEAD IS PUSHED FOREWARD • ARMSLING 3 WEEKS • AVOID ADDUCTION,FOREWARD FLEXION AND INTERNAL ROTATION

9. COMPLICATIONS • AXILLARY NERVE INJURY • VASCULAR INJURY • FRACTURE DISLOCATION • RECURRENT DISLOCATION • BRACHIAL PLEXUS INJURY

10. AC joint injuries - Mechanism • Direct – fall on point of shoulder with arm aducted • Indirect – upward force on outstretched arm is transmitted up the arm (rare) • Indirect – downward force pull with heavy weight (rare)

11. AC DISLOCATION

12. Fractures of the Clavicle.

13. Fractures of the clavicle

14. Fractures of the clavicle • Treatment- conservative. • Sling or collar and cuff. • Surgery. • Open fractures. • Neurovascular injuries. • 21st Century.

15. Complications of clavicle #’s • Neurovascular • Non-union 1.9% • Mal-union > 20 mm shortening leads to pain • Post-traumatic arthritis

16. SCAPULA FRACTURES

17. SCAPULAR FRACTURES • ASSOCIATED INJURIES 35-98% • 10-15% MORTALITY • SEVERELY INJURED PATIENT • C-Spine injury! • ARTERIAL INJURY • BRACHIAL PLEXUS INJURY • PNEUMOTHORAX • FRACTURED RIBS • PULMONARY CONTUSION

18. Humeral Shaft Fractures Non-Operative Treatment • Modified U slab • Hanging cast • Functional bracing (Sarmiento)

19. Hanging Arm Cast • Mid-shaft fractures with shortening • Oblique or spiral pattern • Should extend 2 cm proximal to fracture • NOT transverse fractures • 96% union

20. Modified U splint • Fractures with minimal shortening • Can be exchanged for functional brace 2 weeks after injury • Disadvantages: lost shoulder movement, axillary irritation, patient discomfort and bulkiness

22. Functional Bracing • Fracture reduction through soft tissue compression • Prefabricated anterior shell and posterior shell • Velcro straps • Contraindications: massive soft tissue injury or bone loss, unreliable patient, and inability to maintain alignment

24. Indications – surgery (radial nerve palsy) • Open fractures • Holstein-Lewis distal 1/3 fractures • Secondary palsies developing after closed reduction

25. ELBOW DISLOCATION • A FALL ON THE ELBOW • MOST COMMON POST LATERAL • DEFORMITY OBVIOUS • NEURO VASCULAR EXAM • X-RAY

26. ELBOW DISLOCATION

27. ELBOW FRACTURE DISLOCATION

28. COMPLICATIONS • ASSOCIATED FRACTURES RADIAL HEAD CORONOID OLECRANON MEDIAL EPICONDYLE • HETEROTOPIC BONE FORMATION • NEUROVASCULAR • RECURRENT DISLOCATION • STIFF ELBOW

29. TREATMENT • GENTLE TRACTION WITH COUNTERTRACTION • CORRECT MEDIAL/ LATERAL DISPLACEMENT • ELBOW FLEXED WHILE GUIDING OLECRANON REDUCTON

30. CLOSED REDUCTION ELBOW

31. THE END THANK YOU