Prepared by

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FRACTURES OF UPPER LIMB

• Prepared by

Dr. Mohsen Abdul Ghaffar Consultant
Orthopaedic Surgery Ibn Sina National College
Al Jedaani Group of Hospitals
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Acute Anterior DislocationOf The Shoulder

• Most common shoulder dislocation , about 98
• - Mechanism of Injury - Falling on outstretched
  hand, the
• limb behind the body. Trauma to UL while in
  extension,
• abduction ,ext.rotation
• - Clinically severe pain ,loss of contour, loss
  of range of
• movement, head of the humerus is palpable
  in sub-
• subcoracoid space , sometimes in
  subclavicular area
• - X-Ray AP lat. especially Axillary view
• - Treatment - Closed reduction under anaethesia
  is recommended .Open reduction is indicated in
  open injury, irreducible cases , associated
  fracture .
• - Complications Circumflex nerve injury ,
  vascular injury
• ( Axillary artery), Rotator cuff tear,
  Fracture dislocation ,
• Stiffness ,Recurrent dislocation, locking .

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Acute Posterior DislocationOf The Shoulder

• Less common , often misdiagnosed
• - Mechanism of Injury Internal
  rotation,adduction,flexion
• commonly follows electric shock injury or
  convulsions
• - Clinically Severe pain ,loss of contour ,
  loss of range ,
• joint is locked in internal
  rotation , the head
• of the humerus is felt in
  infraspinous area .
• - X-Ray Axillary view is most important, if not
  sure C.T.
• - Treatment
• Closed reduction under GA, by traction
  ,external rotation
• and pushing the head anteriorly .
• Surgery is indicated in irreducible
  cases,locked posterior
• dislocation ,
• - Complications Locking , fracture dislocation
  , stiffness ,
• recurrent dislocation
• -

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Fracture Clavicle

• - Insidence Frequent
• Patient any age
• Mechanism of injury
• - Fall on the shoulder .
• - Direct trauma .
• - Types Middle 1/3(85) , Lat.1/3(10) ,
  Med.1/3(5)
• - Management ,
• - Closed reduction immobilization with
  clavicular strap,
• 8- bandage or sling .
• - Open reduction internal fixation
  rarely indicated for
• marked displacement ,severely
  comminuted ,extensive
• soft tissue injury .

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Fracture Of Proximal Humerus

• Incidence About 4-5 of all fractures
• Patient Any age, common in elderly, due to
  osteoporosis
• Mechanism of Injury - Fall on outstretshed hand
• - Direct
  trauma to the side of the
• shoulder
• Pathological Anatomy - Abduction type
• - Adduction
  type
• Treatment - Conservative treatment ,(
  Immobilization
• by sling arm-chest
  bandage) , in non or
• mild displacement
  especially in elderly
• - ORIF in displaced
  irreducible conditions
• especially in young
  athlete
• Complication Avascular necrosis ,non-union
  ,stiffness ,
• Circumflex nerve injury
  ,Vascular injury .

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Examples of Internal FixationFracture surgical
Neck Rt. Humerusfixed by K-WiresA) Preop.
B) Postop.
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Fracture Shaft Of Humerus

• Incidence Approximately 1 of all fractures
• Patient Any age
• Mechanism of Injury -Direct trauma
• -Indirect
  trauma (Falling on hand,
• RTA,
  Twisting , Child abuse)
• Comlications - Radial nerve injury
• - Delayed union
  non-union
• Treatment - Closed reduction
  immobilization with a
• splint or hanging cast .
• - Open reduction internal
  fixation by plate
• and screws or inter
  locking nail .

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Examples of Internal FixationComminuted
Fracture Rt. Humerusfixed by plate screws
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Fractures Of Distal HumerusSupracondylar Fracture

• Incidence The most common fracture in children
• Patient Children less than 10 years, (peak from
  5-8)
• Mechanism of injury 2 types
• - Falling on outstretched hand
  ,Extension Type
• - Falling on flexed elbow , Flexion Type
• Pathological Anatomy
• - Extension Type most common, the
  distal fragment
• is displaced
  posteriorly
• - Flexion Type fragment displaced
  anteriorly, in both
• types some
  rotation is present
• Treatment - Immobilization by POP
• - Closed reduction ,
  percutaneous pinning
• - Open reduction ,
  internal fixation
• Complications Nerve injury ( Median n.,Radial
  n.),Vascular
• injury (Brachial
  artery), Deformity (Cubitus varus
• is more common
  ,Cubitus valgus is rare),Stiffness

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Example of Internal FixationSupracondylar
Fracture Lt. Elbowfixed by K-Wires
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Dislocation Elbow
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Fractures of the Forearm

• - Mechanism
• - Direct trauma .
• - Falling on the outstretched hand .
• - R.T.A.
• - Management
• - Children - closed reduction
  P.O.P.
• - Adults open reduction internal
  fixation .

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Fracture Both Bones Lt. Forearmfixed by plates
screws
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Fractures Of Distal Radius

• Colles Fracture
• Fracture of the distal end of the Radius ,
  most common among elderly women ,related to
  postmenopausal osteoporosis
• Mecanism
• - Falling on outstretched hand, with wrist
  between 40-90
• degrees of dorsiflexion
• Pathological Anatomy
• - The distal fragment is displaced upwards
  ,dorsally and
• laterally producing the classical
  dinner fork deformity
• Treatment
• - Closed reduction , POP fixation .
• - K-wires are used in unstable cases (
  percutaneously).

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Malunited Fracture Distal Radius( Dinner Fork
Deformity)
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• Fractures of the Hand
• - Mechanism
• - Direct trauma .
• - Machine injury .
• - R.T.A.
• - Management
• - Splint for undisplaced fractures .
• - O.R.I.F. with depridement
  irrigation .

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Thank you