FRACTURES AROUND SHOULDER

Fractures around Shoulder Fractures of Clavicle Fractures of Scapula Fractures of proximal Humerus

Fractures of Clavicle

Surgical Anatomy

FRACTURES OF THE CLAVICLE FUNCTIONS OF THE CLAVICLE – Power and Stability of the arm – Motion of the shoulder girdle – Muscle Attachments – Protection of the Neurovscular Structures – Respiratory Function – Cosmesis

FRACTURES OF THE CLAVICLE INCIDENCE OF INJURY: 4% MECHANISM OF INJURY: - Direct - Indirect CLASSIFICATION OF CLAVICLE FRACTURES: – Fractures of the Middle third of the clavicle - 76% – Fractures of the Lateral third of the clavicle- 21% – Fractures of the medial third of the clavicle – 3% CLINICAL PRESENTATION : Pain, swelling, deformity, loss of function

FRACTURES OF THE CLAVICLE ASSOCIATED INJURIES – Associated Skeletal Injuries – Fractures of the clavicle and Scapula – (The Floating shoulder ) – Injuries to the Lungs and Pleura – Brachial plexus Injuries – Vascular Injuries RADIOGRAPHIC FINDINGS – Shaft Fractures – Fractures of the lateral third – Fractures of the Medial third

FRACTURES OF THE CLAVICLE TREATMENT – Conservative: Broad arm sling for 3-4 weeks – Operative

FRACTURES OF THE CLAVICLE INDICATIONS OF OPERATIVE TREATMENT Open fractures Fractures with neurovascular compromise Polytrauma Floating shoulder (combined clavicle & scapula fractures) Symptomatic non-unions Cosmesis

OPEN REDUCTION

FRACTURES OF THE CLAVICLE COMPLICATIONS – Nonunion – Mal-union – Neurovascular compromise

FRACTURES OF SCAPULA

Fractures of Scapula Surgical Anatomy

Incidence: 1% Mechanism of Injury: Direct/Indirect RTA, Fall from height Associated Injuries: Clavicle fractures % Rib fractures % Pulmonary injuries % Humeral fractures 12% Brachial Plexus 5-10% Skull fractures 25% Lower Limb fractures 11% Major Vascular injury 11% Splenic lacerations 8% Fractures of Scapula

Classification: Fractures of body of scapula Fractures of neck of scapula Fractures of glenoid cavity Fractures of coracoid process Fractures of acromion process

Fractures of Scapula Clinical Features: Pain, swelling, deformity, loss of function Diagnosis: Plain X-rays, CT scan Treatment: 90% treated conservatively- Broad arm sling for 4-6 weeks

Fractures of Scapula Indications for Operative treatment: unstable fractures combined injuries

FRACTURES OF THE PROXIMAL HUMEURS

Fracture of the proximal Humeurs Anatomy

Fracture of the proximal Humeurs

MECHANISM Of INJURY Direct injury Indirect injury CLASSIFICATION OF FRACTURES OF THE PROXIMAL HUMEURS Non displaced Displaced Neer four-part classification AO Classification

INVESTIGATIONS X-rays (AP and Lateral views) CT Scan

Treatment NON-OPERATIVE Cuff and collar sling OPERATIVE ORIF with wires Sutures Plates Screws Replacement of humeral head with Prosthesis

OPERATIVE TREATMENT

REHABILITATION Range of motion exercisesRange of motion exercises Muscles strengthing exercisesMuscles strengthing exercises