Traumatologie Membre Supérieur au SAU PDF

# Traumatologie Membre Superieur au SAU Dr. Celine Meguerditchian ## Generalites | Functionnel | Orthopedique | Surgical | Pain | Evaluation | |---|---|---|---|---| | Immobilisation antalgique de courte durée | Immobilisation jusqu'à la consolidation | **Conservative**: Osteosynthesis **Non-Con...

# Traumatologie Membre Superieur au SAU Dr. Celine Meguerditchian ## Generalites | Functionnel | Orthopedique | Surgical | Pain | Evaluation | |---|---|---|---|---| | Immobilisation antalgique de courte durée | Immobilisation jusqu'à la consolidation | **Conservative**: Osteosynthesis **Non-Conservative**: Arthroplasty, Arthrodesis, amputation **Osteosynthesis**: Broches, vis, osteosynthesis, ligature **Centromuscular pin**: Long bones **Plated screw**: Long bones/articulation **External Fixator**: Open or comminuted fracture | **Location**: **Irradiation**: **Type**: **Irradiation**: **Duration**: **Rhythm**: **Aggravating**: **Calmants**: | **Ech of pain evaluation**: 0-10 EVA (non-communicating/slightly communicating) Algoplus (elderly patients) | | Attelle provisoire, repos au lit | Plasters, resins or orthotics | | | | | |   | ⇨ REEVALUATION !!! | ## Les Pathologies | Location | Clinic | Imagerie | Treatment | Complications | |---|---|---|---|---| | Fracture de la clavicule | deformation, fall, shoulder pain | Rx clavicular and chest x-ray, frontal view. Rx AC frontal view, ascending | **Orthopedic**: Simple sling, figure-eight brace, consolidation in 6 to 8 weeks **Surgical**: *Indications*: no bone contact, manual worker, >2 cm shortening, 1/4 fracture, skin damage *Advantages*: restored anatomy, early mobilization | *In case of major displacement*: risk of vascular and nervous injury. *In case of skin compromise*: risk of fracture. **Orthopedic**: frequent callus deformities, pseudarthrosis is rare **Surgical**: periosteal stripping, devascularization, delayed consolidation, possible infection | | | | | **Orthopedic**: stages 1 & 2 Rockwood | | | Dysjonction acromio claviculaire (fall onto shoulder ) | | | | | | | | | **Surgical**: stages 4-6. Stage 3: controversial | | | | Mobility: superior and inferior, anterior posterior | Comparative frontal view x-ray of both clavicles CT scan if uncertain | | | | | | | | | | Coiffe des rotateurs (traumatic rupture) | Differenciate between fresh lesions on healthy tendons and degenerative lesions (worn out) | standard x-ray | **Orthopedic**: Analgesics, Immobilization with an anti-shoulder sling, CPU if acute episode, shoulder ultrasound if it is degenerative | | | | *Testing*: Jobe: Supraspinatus, arms in 90 degrees abduction at 30 degrees of frontal view, thumbs rotated inwards, positive if there is no resistance. *Testing*: infraspinatus, arms in 90 degrees, elbows at 90 degrees, external rotation, positive if there is no resistance | | | | | Instability shoulder | Head of the humerus anteriorly bulging scaption of the acromion empty glenoid cavity arm is abducted and externally rotated | Pre and post reduction X-ray | CAT, reduction with sedation | Early: axillary vascular injury, Circumflex nerve paralysis, Brachial plexus injury, Shoulder and deltoid pain | | | | | Procédural Pre and post reduction vascular and nerve assessment | | | | | | Immobilization with elbow against the body (3 weeks), Rehab: mobilization, muscle strengthening, proprioception, Orthopedic consultation | | | | | | | | | Luxation posterior shoulder | almost no deformation, anterior concavity unable to mobilize, painful, severe pain | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Inability Pain Deformation caused by hematoma | Rx: necessary to identify bone displacement | CT scan if slightly displaced | | | | Search of vascular complications | | | | | | Classification: *Extra-articular fractures* *Articular fractures* *Head and tuberosity fractures* *Luxations* | | | | | | | | *Surgical* if extremely displaced Osteosynthesis 65-70 years old *Prosthesis* autonomous if fracture severely displaced | | | | | | | | | Fracture of the distal radius | | Rx AP and Lateral, +/- CT scan for articular fractures | Orthopedic: *BABP* Little displacement, Closed reduction with CPU, X-ray Consolidation 6 weeks. Displacement: immobilization after reduction | | | | | | Surgical in case of displacement Early mobilization Broaches (post locking) or a plate (anterior locking) | | | | | | | | | | | | | | | | | | | | | | Fall on the hand *Hyper*extension (dorsal shift) *Hyper*flexion (palmar shift) Radial inclination (external wedge fracture) Ulnar inclination | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |