هذه المحاظرة تحتاج مراجعة الصور في البوربوينت
كسور دكتور وهبيFractures of Pectoral Girdle, Arm & Elbow
Clavicle
.{Suspends the U.L. to the axial skeleton }
Mechanism
Fall on outstretched hand
Fall on shoulder
Direct
Middle third
Commonest
Displacement : by scm & wt. of arm
Lateral third
Lateral or medial to the CC ligament
Rx
Arm sling : 3w
IF :
open #
NV injury
lateral 1/3 with displacement
Scapula
# of the body occurs in multitrauma pt.
Rx
Arm sling
Glenoid : IF in # taking 25% or
displacemnt > 2 mm
Proximal humerus
Usually in osteoporotic bone
Displacement in 20%
May be # dislaocation
Neer`s classification
4 fragments
Displacement : 45° or 1cm separation
1-2-3-4 parts #
Rx
Arm sling
CR + arm sling
ORIF
Complications
Most commonly injured nerve : axillary
AVN : in anatomic neck
Humerus shaft
Direct
Fall on outstretched hand
Fall on elbow
Mets
Radial nerve injury
10-15%
Site
How to examine
Holstein – Lewis # : distal 1/3 humerus # that may be associated with radial N. inj.
Rx
Hanging cast or back slab f. brace
ORIF
Vascular inj.
Nerve inj. post-manipulation
Unaccepted position
Multi-trauma pt.
Segmental #
Pathologic #
Open #
Floating elbow
Intra-articular extension
Nonunion
Supracondylar # in children
Child 5-10 yr
Fall on outstrethed hand distal fragment tilt posterior
Fall on elbow distal fragment tilt anterior
Classification (Gartland)
I : undisplaced
II : posterior cortex intact
III : both cortices broken
Rx
I : back slab
II : CR + back slab
III : CR + K. wires
ORIF : if CR fails
Complications
Brachial a. inj
Nerve inj. : anterior interosseous
Compartment s.
Cubitus varus
Myositis ossificans
# separation of the lateral condylar epiphysis
Displacement by the wrist extensors
2 types : Salter-Harris 4 & 2 (Milch)
Rx
If displaced > 2mm ORIF
Complications
Nonunion
AVN
Cubitus valgus or varus
Pulled elbow
Subluxation of the radial head
Child 2-3yr
Forearm in pronation & extension
XR : -ve
Reduction
Radial head
Fall on outstretched hand
May be associated with :
MCL injury
DRUJ (Essex-Lopresti injury)
Classification (Mason
I : displaced < 2mm
II : displaced > 2mm
III : comminuted
Rx
I : arm sling 4d then exercise
II : ORIF
III : radial head excision but not if
MCL or Essex-Lopresti inj.
Olecranon
Comminuted # :
in elderly
direct trauma
extension is intact
Transverse # :
triceps contraction
extension disrupted
back slab or ORIF
arm sling exercise