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

Anterior shoulder dislocation

Two Views. AP AP Lateral

REDUCTION

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

COMPLICATIONS AXILLARY NERVE INJURY AXILLARY NERVE INJURY VASCULAR INJURY VASCULAR INJURY FRACTURE DISLOCATION FRACTURE DISLOCATION RECURRENT DISLOCATION RECURRENT DISLOCATION BRACHIAL PLEXUS INJURY BRACHIAL PLEXUS INJURY

Posterior shoulder dislocation APLateral

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

COMPLICATIONS AXILLARY NERVE INJURY AXILLARY NERVE INJURY VASCULAR INJURY VASCULAR INJURY FRACTURE DISLOCATION FRACTURE DISLOCATION RECURRENT DISLOCATION RECURRENT DISLOCATION BRACHIAL PLEXUS INJURY BRACHIAL PLEXUS INJURY

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

AC DISLOCATION

Fractures of the Clavicle.

Fractures of the clavicle

Treatment- conservative. Treatment- conservative. –Sling or collar and cuff.  Surgery. –Open fractures. –Neurovascular injuries. –21 st Century.

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

SCAPULA FRACTURES

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

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

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

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

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

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

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

ELBOW DISLOCATION

ELBOW FRACTURE DISLOCATION

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

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

CLOSED REDUCTION ELBOW

THE END THANK YOU