1. Fractures and Injuries of the Upper Limb

2. Fractures of the Clavicle
Common in children - usually ‘greenstick’
Caused by fall on outstretched hand or direct blow to the shoulder
Rarely ‘open’
Usually # in mid to outer  with lateral end pulled downwards by weight of arm

3. Fractures of the Clavicle
Complications -rare
brachial plexus
subclavian artery or vein
pleural injury  pneumothorax
non union rare & more likely following internal fixation

4. Fractures of the Clavicle
Treatment
support with a sling - 3 weeks
reduction with figure-of-eight bandage
internal fixation - rare

5. Subluxation & dislocation of acromio-clavicular Joint
Common in sport - usually a ‘sprain’
Caused by fall or direct blow on shoulder
Acromion driven under lateral end of clavicle  sprain/rupture of coracoclavicular ligaments
Treatment - conservative, rarely surgery

6. Dislocation of the Shoulder
Common injury
Fall on outstretched hand or shoulder
Usually anterior dislocation (sub caracoid) can be posterior or inferior
Complications - Axillary nerve damage, occasionally brachial plexus

7. Dislocation of the Shoulder
Treatment
Reduction
Immobilisation in a sling 3 weeks, less in elderly
Recurrent dislocation
Treatment - Putti-Platt & Bankart procedures, tightening and reinforcing the anterior capsule

8. Fractures of the neck of humerus
Often comminuted so MUA not required
Stable #’s may be mobilised early
Unstable #’s maybe displaced & associated with brachial plexus or axillary artery damage
‘Stiff shoulder’ a frequent complication

9. Stable fractures of the neck of humerus
Treatment
immobilisation in a sling 3 weeks
during this period active movement is often encouraged as pain allows

10. Unstable fractures of the neck of humerus
May require MUA and ORIF
Longer period of immobilisation  stiffness, muscle wasting and loss of function
# dislocation a further complication

11. Fractures of the humeral shaft
Common in all age groups
Fall on outstretch hand or direct violence
Spiral and displaced
Radial nerve occasionally involved
Collar and cuff sling, splint, IF or ORIF

12. Supracondylar #’s of elbow
Usually occurs in children
Distal fragment displaced & rotated backwards
Complications
brachial artery, soft tissues, nerves -median & ulnar
late ‘gunstock’ deformity

13. Supracondylar #’s of elbow
Treatment
MUA
collar and cuff sling or splint
Internal fixation
Post reduction swelling sometimes a problem

14. Colles’ fracture Fall on outstretched hand
Common in elderly/middle age - osteoporotic women
# of lower end of radius with backward tilt
Characteristic ‘dinner fork’ deformity

15. Colles’ fracture Treatment Complications if minimally displaced - POP
if displaced MUA as alignment is important for wrist and forearm function
Complications
median nerve damage/compression  carpal tunnel syndrome
malunion, OA, Sudeck’s atrophy