Injuries of the upper extremity Dep. of Traumatology M.Szebeny Egon Schiele
Sternoclavicular dislocation Direction: towards the outside or inside (what is behind the dislocation!) Reduction? Retention? Aesthetic problem If Surgery: no pins tendoplasty? resection
Clavicular fractures The number 1.
shortening Dislocation
Non-operative treatment Figure 8 bandage 3 weeks assess tightness!
Double fracture 3 Months later good callus formation, full ROM
Surgery Classic indications: open fr. associated vessel injury non-union Classic method: plate synthesis
Surgery postop. preop. Preop. Relativ indication TEN (titanium elastic nail)
Acromioclavicular joint dislocation
Acromioclavicular joint dislocation Diagnosis Piano key sign AC dislocation Comparative X-ray under weight Coracoclavicular space
Acromioclavicular joint dislocation Classification
Surgery Tension-band wire Coraco-clavicular screw Percutaneuos pin
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
Scapular neck fracture Surgery aim: reconstruction of the shoulder girdle
Scapula fractures Glenoidal dislocation aim: reconstruction of the glenohumeral joint
The shoulder
Assessment of the shoulder ROM (range of movements) Stability (drawer, apprehension) Rotator tests AC joint tests Biceps tests
Dislocation
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
Reduction methods Hipocrates Kocher Self-reduction
Surgery Pediatric s 100% recidiv after the first Adult s 30-40 % recurrent, or habitual
Surgery Reconstruction of the anterior capsule - Bankart OP. (open or arthroscopy)
Posterior dislocation Revers Hill-Sachs DG. often missed
Rotator cuff
Acute or degenerative tears Late sign of RC defect
Diagnosis Clinical tests Ultrasound MRI
Treatment Non-surgical Rest for 3 weeks, NSAID, physical therapy Surgery Suture or reinsertion of the supraspinatus Subacromial decompression
Humeral fractures Distal Diaphyseal Proximal
Proximal fractures Neer classification
Non-surgical treatment Non-displaced fractures Older patients (osteoporosis) controlled neglect
Reduction and types of fixation Gillchrist Collar and cuff Sling Desault
Surgery -4.nap 0. nap 8 hét Percutaneous pins
Proximal fractures Intramedullary os. UHN
Proximal fractures + humeral head dislocation + bony Bankart laesion Long metaphyseal part of the head n Extramedullary Plate os.
Primery prosthetic replacement 4 part fracture with dislocation of the head
Diaphyseal humerus fr. Radial nerve injury
Non-surgical treatment Hanging-cast Brace 8 weeks
e.g. treatment with humeral brace
Surgery Closed intramedullary osy.: UHN (unreamed humeral nail) Open extramedullary: plate fixation
Fractures on the distal end of the humerus AO classification A : metaphyseal B : simple epiphyseal C : A + B
(AO-B) fracture - Capitulum
AO C fracture Stable osteosynthesis aim: reconstruction of the joint surface early mobilisation
Non-surgical treatment In elderly patients with satisfactory functional outcome
Dislocation of the elbow Reduction Stability? reass.!
Fractures of the olecranon Type of avulsions - triceps
Tension-band wire
Fractures of the olecranon
Comminuted fractures should be fixed by plate synthesis
Fractures of the radial haed or neck Non surgical: joint punction, early functional tr. Surgery: if dislocation is more then 3 mm
Fractures of the forearm
Fractures of the forearm Non-S: immob.for 8-16 weeks! Surgery: Stable ostheosynthesis Early mobility Plate
Fractures of the forearm TEN or special interlocking nails
Special forarm injuries Galeazzi Monteggia
Fractures et the distal end Fork deformity Dislocation: to dorsal radial supination Colles
palmar Palmar 60 dislocated normal
Distal fractures of the radius (Colles) Reduction in extension Plaster for 5-6 week s
Surgery I. Percutaneuos pin s
Surgery II. External fixateur Intraarticular fracture
Palmar dislocation Surgery III. Smith Barton Plate osteosynthesis
Thank s for attention!!!