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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