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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 . ( 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

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  1. Injuries of the upper and lower limbs Some regional fractures and dislocation

  2. 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

  3. Fracture of the mid-shaft of clavicle AP anterior dislocation glenohumeral joint relationship of radial nerve to fractures in the spiral groove

  4. 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

  5. Open reduction and fixation of Monteggia fracture-dislocation • 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. 

  6. Fractures of the forearm • SINGLE FOREARM BONE FRACTURES • 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.

  7. 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

  8. 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 . 

  9. 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

  10. 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.  

  11. 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

  12. Lower limb fractures • INTRODUCTION • 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. • FRACTURES OF THE FEMORAL NECK (INTRA-CAPSULAR) • 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

  13. FEMORAL SHAFT FRACTURES • FEMORAL SHAFT FRACTURE • 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

  14. 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

  15. 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.

  16. 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

  17. 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

  18. 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

  19. Base of 5th metatarsal fracture Posterior dislocation of the right hip.Note the acetabular posterior column fracture. Lateral view of a calcaneal fracture

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