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Trauma

Trauma. Dr. DUJUNHUA 杜峻华. Department of Orthopaedics ， the First Affiliated Hospital ， Medical Collage ， Zhejiang University 浙江大学医学院附属第一医院 骨科 Call me ： 13858039976. Trauma of the Upper Limb. Content. Clavicle Fractures Shoulder Dislocations Humerus Fractures

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Trauma

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  1. Trauma

  2. Dr. DUJUNHUA 杜峻华 Department of Orthopaedics， the First Affiliated Hospital， Medical Collage， Zhejiang University 浙江大学医学院附属第一医院 骨科 Call me：13858039976

  3. Trauma of the Upper Limb Content • Clavicle Fractures • Shoulder Dislocations • Humerus Fractures • Fractures of the Forearm • Distal radius fractures

  4. Clavicle Fractures • Mechanism • Fall onto shoulder (87%) • Direct blow (7%) • Fall onto outstretched hand (6%)

  5. Classification • Type I Middle Third (80%) • Type II Distal Third (15%) • Type III Medial Third (5%)

  6. Clinical Evaluations • Pain • Local deformity/abnormal motion • Radiography

  7. Treatments • Conservative Treatment: Eight bandage immobilization for 4 weeks.

  8. Treatments • Surgery • Fractures with neurovascular injury • Fractures with severe associated chest injuries • Open fractures • Cosmetic reasons, uncontrolled deformity • Nonunion

  9. Shoulder Dislocations • Epidemiology • Anterior: Most common • Posterior: Uncommon, 10% • Inferior: Rare, hyperabduction injury

  10. Evaluations • Clinical Evaluation • Lose of a round shape of the shoulder • Dysfunction • Dugas sign (+)

  11. Evaluations • Radiographic Evaluation

  12. Treatments • Closed Reduction • Hippocratic technique: effective for one person • Appropriate sedation

  13. Treatments

  14. Post-reduction • Dugas sign (-) • Reduced local pain • Post X-ray films are a must to confirm reduction • Immobilization for 1-2 weeks before progressive ROM • Operative indications • Irreducible shoulder, failed due to soft tissue interposition • With fractures of the humeral head • Habitual dislocations

  15. Proximal Humerus Fractures • Most common fracture of the humerus • Higher incidence in the elderly, thought to be related to osteoporosis • Females 2:1 greater incidence than males • Most commonly due to a fall onto an outstretched arm from standing height;

  16. Proximal Humerus Fractures • Minimally displaced fractures- Sling immobilization, early motion • Complicated fractures: Open reduction and internal fixation (ORIF)

  17. Humeral Shaft Fractures • Commonly resulted from indirect injury • Indirect injury results in Spiral or Oblique fractures • Complications : - Radial nerve injury - Delayed union & non-union

  18. Clinical Evaluation • pain, swelling, deformity of the upper arm • Careful nerve exam is important as the radial nerve is in close proximity to the humerus and can be injured: wrist drop

  19. Treatments • Closed reduction & immobilization with a splint or hanging cast . • Goal of treatment is to establish union with acceptable alignment • >90% of humeral shaft fractures heal with nonsurgical management

  20. Treatments • Open reduction internal fixation by plate and screws or internal locking nail. • Indications: inadequate reduction, nonunion, associated injuries, open fractures, segmental fractures, associated vascular or nerve injuries

  21. Supra-condylar Fracture of Humerus • More common in Children • Indirect injury

  22. Typical treatment: Surgery K wires fixation

  23. Plate and Screws

  24. Fractures of the Forearm • Direct trauma or falling on the outstretched hand • Patients typically present with gross deformity of the forearm and with pain, swelling, and loss of function at the hand • Careful exam is essential, with specific assessment of radial, ulnar, and median nerves and radial and ulnar pulses • Tense compartments, unremitting pain, and pain with passive motion should raise suspicion for compartment syndrome

  25. Radius and ulna fractures

  26. Monteggiafractures A fracture of the proximal ulna with an associated radial head dislocation

  27. Distal radius fractures • One of the most common fractures in elderly; • Gross deformity of the wrist with variable displacement of the hand; • Most common: Colles fractures

  28. Distal Radius Fractures • Colles’ Fracture : Fracture of the distal end of the radius, most common among elderly women, related to postmenopausal osteoporosis • Mechanism : 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

  29. Radiographic Evaluation • Normal bony relationships of the wrist 11 Deg 23 Deg 11 mm

  30. Treatment • Displaced fractures require and attempt at reduction. • Hematoma block-10ccs of lidocaine or a mix of lidocaine and marcaine in the fracture site • Reproduce the fracture mechanism and reduce the fracture • Place in cast

  31. Manipulative reduction • Use the soft tissue hinge to reduce fracture

  32. Operative Management • For the treatment of intraarticular, unstable, malreduced fractures.

  33. Trauma of the Lower Limb Content • Hip Fractures / Dislocations • Femur Fractures • Patella Fractures • Tibia Fractures

  34. Hip Dislocations • Significant trauma, usually MVA • Posterior: Hip flexion, inner rotation, adduct

  35. Mechanism • Anterior: rare

  36. Closed Reduction: Emergency • Emergency is necessary for reducing risk of DVT and AVN, under anesthesia • Need a team! • Allis Maneuver

  37. After Reduction • Repeat AP pelvis film • No flexion >60 degrees • Early mobilization under aid • Follow the risk of avascular necrosis

  38. Hip Neck Fractures • One of the most common fractures in the elderly • Female > male • May result from a simple fall • Intra-capsular fracture

  39. Anatomy

  40. Classifications • Garden Classification • I Valgus impacted • II Non-displaced • III Complete: Partially Displaced • IV Complete: Fully Displaced • Functional Classification • Stable (I/II) • Unstable (III/IV) I II III IV

  41. Treatments • Non-operative • Very little role • Traction • Operative • ORIF (canulated screws or DHS) • Hemiarthroplasty (>65 years old) • Total Hip Replacement

  42. Treatments

  43. Intertrochanteric Hip Fractures • Extra-capsular femoral fractures • To inferior border of the lesser trochanter

  44. Treatments • Typically surgery: DHS, DCP, PFN

  45. Femoral Shaft Fractures • Intra-madullary nail • ORIFwith plate and screws

  46. Distal Femur Fractures • High energy, multiple trauma • High incidence of post-traumatic arthritis if the knee was disrupted

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