Lecture 2 - Upper Limb Injuries Flashcards
Sternoclavicular dislocation
Rare
Difficult to recognize on X ray
Can be life threatening with posterior displacement (RARE)
Clavicle fracture
Common
Mostly children
Fall on outstretched hand
TREATMENT: sling, internal fixation
Acromioclavicular dislocation
Common
TREATMENT: sling immobilisation
Scapula fracture
Due to direct trauma
TREATMENT: Sling unless it extends into glenohumeral join
Shoulder dislocation - Anterior most common
- Forced external rotation of shoulder
- associated with anterior capsular tear and glenoid labral injury
- axillary nerve comonly injured
TREATMENT: - reduction methods with muscle relaxation: Kocher or hippocratic
- Surgical restoration of stability: arthroscopic capsular plication or labral repair
Fractured neck of humerus
- very common
- surgical neck more common
- associated with avascular necrosis of humeral head
TREATMENT:
- sling if minimally displaced
- if displacement: internal fixation or arthroplasty
Mid shaft humerus fracture
- Typically due to axial load or direct trauma
- associated with radial nerve injury
TREATMENT
- U-slab
- thermoplastic splint
- internal fixation
- High incidence of non-union
Supracondylar fracture
- in children, peak age 8
- fall on outstretched hand
Gartland classification according to angulation and displacement
- significant angulation requires reduction
TREATMENT
- closed reduction and cast application
- supplemental wires if fracture is unstable
Growth center appearance in children
- capitulum
- radial head
- medial epicondyle
- trochlea
- olecranon
- lateral epicondyle
- 1
- 4
- 6
- 8
- 10
- 12
Medial epicondylar fracture in children
- avulsion fracture caused by valgus force
- May require internal fixation if large displacement
- can damage ulnar collateral ligament and flexors of forearm
Lateral condylar fracture in children
Difficult to recognize due to incomplete ossification
- articular fracture : requires anatomical reduction
Elbow dislocation
- common
- TREATMENT: closed reduction and casting at 90 degrees
Olecranon fracture
Proximal migration of olecranon due to pull of triceps
TREATMENT: internal fixation, wiring
Radial head fracture
- fall on outstretched hand
- Mason classification for severity
TREATMENT:
- sling and gradual mobilisation
- type III: internal fixation and arthroplasty
Forearm fractures
- radius and ulna fractures are associated
- displacement and mild angulation will remodel with growth
TREATMENT: - generally internally fixed because unstable
