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Fractures and Injuries of the Upper Limb

Fractures and Injuries of the Upper Limb. Fractures of the Clavicle. Common in children - usually ‘greenstick’ Caused by fall on outstretched hand or direct blow to the shoulder Rarely ‘open’ Usually # in mid to outer  with lateral end pulled downwards by weight of arm.

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Fractures and Injuries of the Upper Limb

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  1. Fractures and Injuries of the Upper Limb

  2. Fractures of the Clavicle • Common in children - usually ‘greenstick’ • Caused by fall on outstretched hand or direct blow to the shoulder • Rarely ‘open’ • Usually # in mid to outer  with lateral end pulled downwards by weight of arm

  3. Fractures of the Clavicle • Complications -rare • brachial plexus • subclavian artery or vein • pleural injury  pneumothorax • non union rare & more likely following internal fixation

  4. Fractures of the Clavicle • Treatment • support with a sling - 3 weeks • reduction with figure-of-eight bandage • internal fixation - rare

  5. Subluxation & dislocation of acromio-clavicular Joint • Common in sport - usually a ‘sprain’ • Caused by fall or direct blow on shoulder • Acromion driven under lateral end of clavicle  sprain/rupture of coracoclavicular ligaments • Treatment - conservative, rarely surgery

  6. Dislocation of the Shoulder • Common injury • Fall on outstretched hand or shoulder • Usually anterior dislocation (sub caracoid) can be posterior or inferior • Complications - Axillary nerve damage, occasionally brachial plexus

  7. Dislocation of the Shoulder • Treatment • Reduction • Immobilisation in a sling 3 weeks, less in elderly • Recurrent dislocation • Treatment - Putti-Platt & Bankart procedures, tightening and reinforcing the anterior capsule

  8. Fractures of the neck of humerus • Often comminuted so MUA not required • Stable #’s may be mobilised early • Unstable #’s maybe displaced & associated with brachial plexus or axillary artery damage • ‘Stiff shoulder’ a frequent complication

  9. Stable fractures of the neck of humerus • Treatment • immobilisation in a sling 3 weeks • during this period active movement is often encouraged as pain allows

  10. Unstable fractures of the neck of humerus • May require MUA and ORIF • Longer period of immobilisation  stiffness, muscle wasting and loss of function • # dislocation a further complication

  11. Fractures of the humeral shaft • Common in all age groups • Fall on outstretch hand or direct violence • Spiral and displaced • Radial nerve occasionally involved • Collar and cuff sling, splint, IF or ORIF

  12. Supracondylar #’s of elbow • Usually occurs in children • Distal fragment displaced & rotated backwards • Complications • brachial artery, soft tissues, nerves -median & ulnar • late ‘gunstock’ deformity

  13. Supracondylar #’s of elbow • Treatment • MUA • collar and cuff sling or splint • Internal fixation • Post reduction swelling sometimes a problem

  14. Colles’ fracture • Fall on outstretched hand • Common in elderly/middle age - osteoporotic women • # of lower end of radius with backward tilt • Characteristic ‘dinner fork’ deformity

  15. Colles’ fracture • Treatment • if minimally displaced - POP • if displaced MUA as alignment is important for wrist and forearm function • Complications • median nerve damage/compression  carpal tunnel syndrome • malunion, OA, Sudeck’s atrophy

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