Upper Limb Trauma PDF
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Uploaded by SpiritedCalifornium
Canadian International College
Mohamed Abdelhamid
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Summary
This document is a detailed presentation about upper limb trauma, covering various fractures, treatments, and complications. It provides a comprehensive overview of the subject and is suitable for medical professionals.
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بسم هللا الرحمن الرحيم اللهم إنى ظلمت نفسى ظلما كثيرا وال يغفر الذنوب إال أنت فاغفر لى مغفرة من عندك وارحمنى إنك أنت الغفور الرحيم Upper Limb Trauma By Prof. Dr. Mohamed Abdelhamid Professor of Orthopedics and Traumatology Fracture Clavicle ♥ Mos...
بسم هللا الرحمن الرحيم اللهم إنى ظلمت نفسى ظلما كثيرا وال يغفر الذنوب إال أنت فاغفر لى مغفرة من عندك وارحمنى إنك أنت الغفور الرحيم Upper Limb Trauma By Prof. Dr. Mohamed Abdelhamid Professor of Orthopedics and Traumatology Fracture Clavicle ♥ Most common bone to be broken. ♥ Common in children ♥ Lat. fragment displaced downward, forward, and medially. * Clinically : - local pain, tenderness… - patient supports the affected limb with other hand & tilting his head to the fr. side. Treatment : ♥ Reduction + ♥ Sling or figure 8- shaped bandage 3 weeks. ♥ Complications : - mal- union. ( but no effect on function ) - non-union Indication for operative treatment 1. Nonunion. 2. Neurovascular involvement 3. Unstable Fracture of the lateral end near the acromioclavicular joint in an adult 4. A persistent wide separation of the fragments with interposition of soft tissue 1. Floating shoulder Fracture Scapula ♥ usually no displacement ♥ Supported by muscles on both sides. Treatment : - arm sling. Indications for operative treatment 1- floating shoulder 2- major displaced glenoid fracture Fracture Humerus ♥ Proximal humerus ( Surgical neck, greater tuberosity ♥ Shaft ♥ Distal humerus : - supra condylar fr. - intercondylar fr. [ T or Y fr. ] - fr. med. or lat. epicondyles. Fr. Surgical neck : ♥ Treatment : - impacted : strapping - displaced : reduction U.G.A., then strapping. ♥ Surgical reduction and fixation with - K-wire - plate and screws - intramedullary interlocking nail Fr. Shaft humerus * Treatment : - stable, transverse fr. : try conservative ttt. - unstable oblique or comminuted fr. : O.R.I.F. [ interlocking I.M.N., plate and screws, malleable medullary nails or ext. fixator ] Int. fix. of fr. humerus Plate and screws Interlocking nail Most important complication : Radial N. injury, [ manifested by wrist drop ]. Non-union Supra condylar fractures : ♥ Common in children ♥ Extension, or flexion types ♥ Clinically : pain, swelling, ecchymosis,.. …….. Treatment : ♥ In children : - urgent reduction + post.slab - if unstable : percutaneous wires. - ORIF with wires, if irreducible ♥ In adults : O.R.I.F. with plates and screws Complications of S.C. fr. : ♥ Mal-union : altered carrying angle - cubitus varus - cubitus valgus ♥ Joint stiffness : due to - adhesions - mal-union Cubitus varus ♥ Vascular complications : * Acute ischaemia : due to vascular injury, edema, tight cast. Management of acute ischaemia : - urgent reduction of the fr. - release of tight cast or bandage - systemic vasodilators - if no improvement : surgical exploration. Volkmann’s ischaemic contracture : Fibrosis of deep forearm muscles [ F.D.P.] due to prolonged ischaemia. ♥Treatment : surgical excision of fibrosed muscles + tendon operations [ transfer or lengthening ] Intercondylar fractures ♥ T or Y – shaped fr. ♥ Intra-articular [ affecting the joint surface ]. ♥ Treatment : - Open reduction internal fixation to restore smooth articular surface. Fr. of the humeral condyles : ♥ Avulsion fr. of the med. or lateral condyles. ♥ Common in children. ♥ Treatment : - O.R.I.F. by K. wire.