Injuries of the upper extremity

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1 Injuries of the upper extremity Dep. of Traumatology M.Szebeny Egon Schiele

2 Sternoclavicular dislocation Direction: towards the outside or inside (what is behind the dislocation!) Reduction? Retention? Aesthetic problem If Surgery: no pins tendoplasty? resection

3 Clavicular fractures The number 1.

4 shortening Dislocation

5 Non-operative treatment Figure 8 bandage 3 weeks assess tightness!

6 Double fracture 3 Months later good callus formation, full ROM

7 Surgery Classic indications: open fr. associated vessel injury non-union Classic method: plate synthesis

8 Surgery postop. preop. Preop. Relativ indication TEN (titanium elastic nail)

9 Acromioclavicular joint dislocation

10 Acromioclavicular joint dislocation Diagnosis Piano key sign AC dislocation Comparative X-ray under weight Coracoclavicular space

11 Acromioclavicular joint dislocation Classification

12 Surgery Tension-band wire Coraco-clavicular screw Percutaneuos pin

13 Scapula fractures Often associated with chest trauma e.g. serial rib fractures Treatment mostly non-surgical approx. 3 weeks immobilization Dislocation of the glenoid can indicate surgery

14 Scapular neck fracture Surgery aim: reconstruction of the shoulder girdle

15 Scapula fractures Glenoidal dislocation aim: reconstruction of the glenohumeral joint

16 The shoulder

17 Assessment of the shoulder ROM (range of movements) Stability (drawer, apprehension) Rotator tests AC joint tests Biceps tests

18 Dislocation

19 Complications associated with shoulder dislocaton Injury of the axillary vessels or nerves Bony complications: Avulsion of the greater tubercule Bony Bankart lesion Hill-Sachs-lesion impression fracture of the humeral head

20 Reduction methods Hipocrates Kocher Self-reduction

21 Surgery Pediatric s 100% recidiv after the first Adult s % recurrent, or habitual

22 Surgery Reconstruction of the anterior capsule - Bankart OP. (open or arthroscopy)

23 Posterior dislocation Revers Hill-Sachs DG. often missed

24 Rotator cuff

25 Acute or degenerative tears Late sign of RC defect

26 Diagnosis Clinical tests Ultrasound MRI

27 Treatment Non-surgical Rest for 3 weeks, NSAID, physical therapy Surgery Suture or reinsertion of the supraspinatus Subacromial decompression

28 Humeral fractures Distal Diaphyseal Proximal

29 Proximal fractures Neer classification

30 Non-surgical treatment Non-displaced fractures Older patients (osteoporosis) controlled neglect

31 Reduction and types of fixation Gillchrist Collar and cuff Sling Desault

32 Surgery -4.nap 0. nap 8 hét Percutaneous pins

33 Proximal fractures Intramedullary os. UHN

34 Proximal fractures + humeral head dislocation + bony Bankart laesion Long metaphyseal part of the head n Extramedullary Plate os.

35 Primery prosthetic replacement 4 part fracture with dislocation of the head

36 Diaphyseal humerus fr. Radial nerve injury

37 Non-surgical treatment Hanging-cast Brace 8 weeks

38 e.g. treatment with humeral brace

39 Surgery Closed intramedullary osy.: UHN (unreamed humeral nail) Open extramedullary: plate fixation

40 Fractures on the distal end of the humerus AO classification A : metaphyseal B : simple epiphyseal C : A + B

41 (AO-B) fracture - Capitulum

42 AO C fracture Stable osteosynthesis aim: reconstruction of the joint surface early mobilisation

43 Non-surgical treatment In elderly patients with satisfactory functional outcome

44 Dislocation of the elbow Reduction Stability? reass.!

45 Fractures of the olecranon Type of avulsions - triceps

46 Tension-band wire

47 Fractures of the olecranon

48 Comminuted fractures should be fixed by plate synthesis

49 Fractures of the radial haed or neck Non surgical: joint punction, early functional tr. Surgery: if dislocation is more then 3 mm

50

51 Fractures of the forearm

52 Fractures of the forearm Non-S: immob.for 8-16 weeks! Surgery: Stable ostheosynthesis Early mobility Plate

53 Fractures of the forearm TEN or special interlocking nails

54 Special forarm injuries Galeazzi Monteggia

55 Fractures et the distal end Fork deformity Dislocation: to dorsal radial supination Colles

56 palmar Palmar 60 dislocated normal

57 Distal fractures of the radius (Colles) Reduction in extension Plaster for 5-6 week s

58

59 Surgery I. Percutaneuos pin s

60 Surgery II. External fixateur Intraarticular fracture

61 Palmar dislocation Surgery III. Smith Barton Plate osteosynthesis

62 Thank s for attention!!!

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