Upper Limb Trauma PDF

‫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.