Upper limb fractures. Mithun Nambiar Orthopaedic Resident Royal Melbourne Hospital
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1 Upper limb fractures Mithun Nambiar Orthopaedic Resident Royal Melbourne Hospital
2
3 Principles of fracture management Restoration of anatomy Stable fracture fixation Preservation of blood supply Early mobilisation of limb and patient
4 Restoration of anatomy Length Alignment Rotation
5 Stable fracture fixation Allows for fracture healing Prevention of loss of anatomy Length Alignment Rotation
6 Preservation of blood supply Soft tissue protection Periosteum Muscle Arteries Veins
7 Early mobilisation Limb Joint stiffness Muscle atrophy Contracture formation Patient Pneumonia DVT/Pulmonary embolus Pressure sores Hospital acquired infections
8 Management Operative Conservative Weight bearing status Wound management Antiobiotics Anticoagulation Smoking Immunomodulators
9 Clavicular fractures
10 Clavicular fractures Medial 1/3 (5%) Usually non-operative, operative if post. displacement Middle 1/3 (80%) Non-operative if <100% displacement Operative if >100% displaced Lateral 1/3 (10%) Neer classification
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15 Clavicular fractures Non operative management Sling vs Figure of 8 NWB 6 weeks Range of movement exercises 2-4 weeks Risks Non union Lateral 1/3 (up to 50%) Fracture displacement/shortening >2cm Decreased shoulder strength
16 Clavicular fractures Operative management Sling 7-10 days, then active range of motion NWB 6 weeks, once union confirmed and pain free range of motion- strengthening Full activity in 3 months Benefits Faster union Improved functional outcomes Improved cosmesis Improved shoulder function strength Risks Implant removal
17 Clavicular fractures
18 Clavicular fractures
19 Clavicular fractures
20 Clavicular fractures
21 Scapular fractures Usually high energy mechanism Location Acromion Corocoid process Neck of scapula Body of scapula
22 Scapular fractures csurgery/files/023489cd701b474692bcdaec6c52f9a8.gif
23 Scapular fractures Non operative management 2 weeks sling, early motion ORIF Glenohumeral instability >25% glenoid >5mm step-off Medialisation of glenoid Open fracture Scapula neck (>40 degrees, 1cm) Coracoid >1cm displacement
24 Humerus fractures Location Proximal Shaft Distal mons/a/ad/gray207.png
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26 Humerus fractures- proximal Non operative management Minimally displaced surgical neck (1,2,3) Greater tuberosity <5mm displacement Consideration for age, bone quality Early range of motion in 14 days Operative management CRPP ORIF IM rod Hemi arthroplasty Total shoulder arthroplasty
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30 pg
31 d_osteonecrosis/humeral_head_osteonecrosis_hemiarthroplasty.jpg
32 /Special%20edition%20usa%202012/ protesi-smr-america.jpg
33 ntent/8149/images/figure6.jpg
34 Humerus fractures- shaft Non operative management Splint then functional bracing <20 degrees anterior angulation <30 degrees varus/valgus angulation <3cm shortening ORIF or IM nail Brachial plexus injury Open fracture Pathological fracture Spiral/oblique
35 Humerus fractures- distal Supracondylar Single/double column fracture Non operative Non displaced single column Operative CRPP ORIF Total elbow arthroplasty Risks Heterotropic ossification Joint stiffness Degenerative joint disease Cubital valgus/varus
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40 Olecranon fractures Non operative Non displaced fractures Immobilisation in degrees of flexion, for 3 weeks, then mobilise Operative TBW IM fixation Plate and screw fixation Fragment excision and triceps advancement
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43 Monteggia fractures
44 Monteggia fractures Non operative- closed reduction More common in children Casting with forearm supination Operative- ORIF ulnar +/- open radial head reduction Comminuted ulna Unable to reduce radius
45 Galeazzi fractures
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47 Galeazzi fractures Operative all cases ORIF radius, stabilisation of DRUJ DRUJ If stable- cast in supination 6 weeks Percutaneous pin fixation Open reduction- ECU ORIF ulnar styloid
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50 Forearm fractures Non operative Distal 2/3 ulna (nightstick) <50% displacement, <10degrees angulation ORIF Proximal 1/3 ulnar All radial shaft fractures Both bone fractures
51
52 Distal radius fractures
53 Distal radius fractures
54 Distal radius fractures
55 Distal radius fractures
56 Distal radius fractures Non operative Extraarticular <5mm shortening Dorsal angulation <5degrees** Surgical fixation Displaced/intraarticular- >2mm step Comminution Loss of volar tilt and radial length after casting >5mm shortening, >5 degrees dorsal angulation**
57
58 Summary Management plan for upper limb fractures based on AO principles: Restoration of anatomy Stable fracture fixation Preservation of blood supply Early mobilisation of limb and patient
59 Acknowledgements Orthobullets Wheeless Textbook of Orthopaedics
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