Injuries of the upper and lower limbs
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Injuries of the upper and lower limbs. Some regional fractures and dislocation. Injuries of shoulder girdle . ( A) Fractures : Clavicle Scapula Proximal humerus , the most commonly fractures are those of greater tuberosity and surgical neck. (B) Dislocations

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Injuries of the upper and lower limbs

Injuries of the upper and lower limbs

Some regional fractures and dislocation

Injuries of shoulder girdle
Injuries of shoulder girdle

  • (A) Fractures :

  • Clavicle

  • Scapula

  • Proximal humerus , the most commonly fractures are those of greater tuberosity and surgical neck.

  • (B) Dislocations

  • (1) shoulder :common and mostly affects young adult male than female classified according to position of humeral head as:

  • Anterior (commonest)

  • Posterior (uncommon)

  • Inferior (rare)

  • (2) Acromio-clavicular joint :common injury mainly in young athletic

  • (3) Sterno-clavicular joint : rare dislocation

Scapula fracture

Acromio-clavicular dislocation

Fracture of the mid-shaft of clavicle

AP anterior dislocation glenohumeral


relationship of radial nerve to fractures in the

spiral groove

The elbow and forearm
The elbow and forearm

  • Injuries of elbow

    A .Fractures

    1- fractures f the distal end of the humerus such as fractures of .

    a - superacondylar b -condylar c-infercodylar

    2- Fractures of proximal end of the ulna

    3- Fractures of proximal end of the radius

    4- avulsion fracture of the epiphysis of the humeral (medial and lateral condyle)

Partial avulsion of the medial epicondyle

  • SUPRACONDYLAR fractures

  • Are most often seen in children and the distal fragment may be  displaced posteriorly or anteriorly.

  • B. Dislocations

  • 1-acromio-cavicular joint dislocation : it is common injury mainly in young athletic

  • 2- sterno-clavicular joint dislocation : it is rare  

Undisplaced supracondylarfracture

Open reduction and fixation of monteggia fracture dislocation
Open reduction and fixation of Monteggia fracture-dislocation


  • This is a fracture of the proximal third of the ulna with dislocation of the proximal  (superior) radio-ulnar joint.

  • It usually arises due to fall on to the hand with body  twisting at the point of impact leading to a pronation of the forearm leading to  dislocation of the radial head.

  • Open reduction and fixation of Monteggia fracture dislocation

  • Radiographs of the forearm with the superior radio-ulnar joint is essential. 

  • dislocation. In adults this usually requires surgery, with post operative  

  • immobilisation of the arm in above elbow cast for six weeks to prevent redislocation  of the radial head. 

Fractures of the forearm
Fractures of the forearm


  • Fractures of the shaft of the radius or the ulna alone are uncommon and are usually caused by a direct blow. Ulnar fractures are rarely displaced were as in radial  

  • fractures of both bones (radius and ulnar) is relatively common in children.

Galeazzi fracture dislocation of the forearm

  • This fracture is caused by a fall on to the hand with a rotational force super-imposed.  

  • The radius fracture is in the lower third with dislocation of the inferior radio-ulna  Joint .

  • The treatment In adults is carried out by open reduction and plating of the radius.

open reduction and fixation of Galeazzi fracture -dislocation

Colles fracture

  • Abraham Colles’ first described this injury in 1814 as a transverse fracture of the  distal radius with dorsal displacement of the distal fragment associated with fracture of ulnar styloid process.

  • It is one of the  commonest fractures of the elderly. The fracture occurs due to the application of a  longitudinal force in the length of the radius with the wrist in extension.

  • Radiographs show dorsal displacement, radial displacement (dinner fork) deformity . 

Smiths fracture

  • In this fracture the distal fragment is displaced towards the volar aspect of the wrist as  a result the fracture is often called a reversed Colles’.

  • It is often caused by a fall on  the back of the hand.

  • The forearm is placed in a cast with the wrist in extension. 

fracture through waist of scaphoid

Injuries to the scaphoid

  • Scaphoid injuries account for almost 70% of the carpus injuries.

  • The mechanism of  injury is a fall on the dorsi-flexed hand. There is tenderness in s. Radiographs taken include lateral, two oblique and a A.P view of the  

  • carpus.

  • The fracture line is usually transverse and frequently through the waist of the  

  • scaphoid.

  • It is important to look for angulation of the distal fragment since this is  often a cause of non-union.

  • fracture through waist of scaphoid.

  • Sometimes early diagnosis is not possible however if there is an index of suspicion  

  • the forearm is placed in a scaphoid plaster with check radiographs at two weeks. The scaphoid glass holding position.  

  • Displaced fractures are treated by open reduction and compression screws.  

Metacarpal fractures

  • Fractures of the fifth metacarpal are common

  • The fracture usually is at the neck or the shaft of the metacarpal and is usually spiral  in pattern.  

  • Bennett's fracture-subluxation

  • This is fracture of the base of the first metacarpal with oblique fracture line

  • Complete separation of fragemeublant allows posterior subluxation or dislocation of the remainder of the bone

Lower limb fractures
Lower limb fractures


  • Fractures of the lower limb are common especially in the elderly.

  • They are often associated  with considerable morbidity

  • Pelvic fractures

  • Usually secondary to massive force, such as a road traffic accident or fallfrom a height.


  • This is one of the commonest fractures of the elderly, with vast number of the patients being  women in the ages between 60-80 years.

  • The fracture usually arises due to a fall on the  greater trochanter.

  • The classification commonly used to describe the displacement of the  femoral head is referred to as the Gardens classification which is composed of the following  stages: 

  • grade1: incomplete impacted fracture of the femoral neck. 

  • grade 2: complete undisplaced fracture. 

  • grade 3: complete fracture with moderate displacement. 

  • grade 4: severely displaced fracture. 

  • Clinically the patient complains of pain in the hip and the limb may be shortened and  externally rotated. 

Subcapital fracture

Pelvic fracture following a road traffic accident

Femoral shaft fractures


  • This is usually a fracture of young adults and the fracture pattern may vary considerably  depending on the cause.

  • A spiral fracture is usually produced by a fall in which the foot has  been anchored whilst a twisting force is transmitted to the femur.

  • Transverse and oblique  fractures are often due to direct violence.

  • It has to be remembered that up to two units of blood may be lost from a femoral  shaft fracture and that shock may be present therefore it is important to ensure that blood is  available. Management.

  •  Primary survey. In young patients these injuries are usually high energy injuries which may be associated with additional trauma.   

  • A.P and lateral radiographs of the entire femur. There may well be an associatedsubcapital fracture with a fracture of the shaft of the femur

fixation of femoral shaft fracture

Intertrochanteric fractures of the femur

  • The fracture is caused by a fall on to the greater trochanter and the fracture runs  between the lesser and greater trochanter

  • Management.

  • This is similar to subcapital fractures but the consent is for a Dynamic Hip screw. 

  • The classification used for these fractures is referred to as the Jensons classification.

Types of intertrochanteric fractures

Supracondylar fractures

  • These are produced as a result of direct violence or due to a fall in elderly patients. Clinically  

  • the knee is swollen and painful and movement should not be tested, however a record of the  

  • neurovascular status should be documented. Radiologically the fracture is seen just above the 

  • femoral condyles and the fracture pattern may be transverse or comminuted

  • Primary survey in young patients these injuries are usually high energy injuries which may be associated with additional trauma.

Fractures of the patella

  • Fractures of the patella may be caused by direct or indirect trauma. The direct injury may be  

  • due to a fall on the knee and fracture is usually easily visible in A.P radiographs. 

  • patello-femoral osteoarthritis is a common complication.

Transverse patella fracture

Fractures of the tibia and fibula

  • These are relatively common fractures and in  addition open fractures of the tibia are more common than in any other long bone.

  • The  method of fracture is usually blunt trauma and the risk of complications is directly related to  

  • the degree and nature of soft tissue damage. 

  • The fracture pattern is also variable depending upon the nature of the injury and subsequently  

  • Fractures of the shaft of the tibia are usually cased by rotational forces and lead to spiral  fractures .

  • Fractures of the fibula may be due to direct violence or may occur in association with external rotation and abduction injuries of the ankle.

  • It is  important to exclude ankle injuries in the presence of fibular fractures. 

  • Fractures of both bones usually occur as a result of direct trauma with road traffic being the  commonest cause.

Fracture mid shaft of tibia, note the associated fracture of the fibula

Comminuted mid-femoral shaft fracture

Fractures of the ankle

  • The ankle is usually injured by indirect forces,  

  • The important factor in  ankle fractures is the stability of the ankle mortice.  

  • An important point to remember is that ankle injuries may present as fracture-dislocations.  In these injuries the skin may be tented and neurovascular structures may be compromised by  the displaced bone.

  • Bimalleolar fracture of the ankle

Weber C ankle fracture

Base of 5th metatarsal fracture

Posterior dislocation of the right hip.Note the acetabular

posterior column fracture.

Lateral view of a calcaneal fracture