Fracture of Upper Limb

Property of Department of Orthopedic, Faculty of Medicine, University of Zagazig, Egypt

3. Fracture ClavicleFracture Clavicle
♥Most common bone to be broken.Most common bone to be broken.
♥Common in childrenCommon in children
♥Lat. fragment displaced downward, Lat. fragment displaced downward,
forward, and medially.forward, and medially.
* Clinically :* Clinically :
-- local pain, tenderness… local pain, tenderness…
-- patient supports the patient supports the
affected limb with affected limb with
other hand & tilting hisother hand & tilting his
head to the fr. side. head to the fr. side.

4. TreatmentTreatment : :
♥Reduction +
♥ figure 8- shaped
bandage .
♥Complications :
- mal- union .
( but no effect on function )
- non-union

5. 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

6. Fracture Scapula
♥usually no displacementusually no displacement
♥Supported by muscles on both Supported by muscles on both
sides.sides.
Treatment :Treatment :
-- arm sling . arm sling .

7. 1- floating
shoulder
2- major
displaced
glenoid fracture
Indications for
operative treatment

8. Fracture HumerusFracture Humerus
♥Proximal humerus ( Surgical Proximal humerus ( Surgical
neck, greater tuberosityneck, greater tuberosity
♥ShaftShaft
♥Distal humerus : Distal humerus :
-- supra condylar fr. supra condylar fr.
-- intercondylar fr. [ intercondylar fr. [ T T oror Y Y fr.fr. ]]
-- fr. med. or lat. epicondyles . fr. med. or lat. epicondyles .

9. Fr. Surgical neck :
♥Treatment :Treatment :
- - impacted : strapping impacted : strapping
- - displaced : reduction displaced : reduction
U.G.A., then strapping.U.G.A., then strapping.
♥Surgical reduction and Surgical reduction and
fixation with fixation with
- K-wire- K-wire
- plate and screws- plate and screws
- intramedullary - intramedullary
interlocking nailinterlocking nail

10. Fr. Shaft humerusFr. Shaft humerus
* * TreatmentTreatment : :
-- stable, transverse fr. : stable, transverse fr. :
try conservative ttt.try conservative ttt.
- - unstable oblique or unstable oblique or
comminuted fr. : comminuted fr. : O.R.I.F.O.R.I.F.
[ interlocking I.M.N., [ interlocking I.M.N.,
plate and screws, malleable plate and screws, malleable
medullary nails or ext. fixator ]medullary nails or ext. fixator ]

11. Int. fix. of fr. humerusInt. fix. of fr. humerus
Plate and screws Interlocking nail

12. Most important complicationMost important complication : :
Radial N. injury, Radial N. injury,
[[ manifested by wrist drop manifested by wrist drop ]]..
Non-unionNon-union

13. Supra condylar fractures : Supra condylar fractures :
♥Common in childrenCommon in children
♥Extension, or flexion typesExtension, or flexion types
♥Clinically :Clinically :
pain, swelling, pain, swelling,
ecchymosis, .. ……..ecchymosis, .. ……..

14. TreatmentTreatment :
♥In children :In children :
- urgent reduction + post.slab- urgent reduction + post.slab
- if unstable : percutaneous wires .- if unstable : percutaneous wires .
- ORIF with wires, if irreducible- ORIF with wires, if irreducible
♥In adults :In adults :
O.R.I.F. with O.R.I.F. with
plates and screwsplates and screws

15. Complications of S.C. fr. :
♥Mal-union : altered carrying angleMal-union : altered carrying angle
-- cubitus varus cubitus varus
- - cubitus valguscubitus valgus
♥Joint stiffness : due toJoint stiffness : due to
- - adhesionsadhesions
-- mal-union mal-union

16. Cubitus varus

17. ♥ Vascular complications :
** AcuteAcute ischaemiaischaemia : due to : due to
vascular injury, edema, tight cast.vascular injury, edema, tight cast.
Management of acute ischaemia :Management of acute ischaemia :
-- urgent reduction of the fr. urgent reduction of the fr.
-- release of tight cast or bandage release of tight cast or bandage
-- systemic vasodilators systemic vasodilators
-- if no improvement : surgical if no improvement : surgical
exploration.exploration.

18. Volkmann’s ischaemic contracture :Volkmann’s ischaemic contracture :
Fibrosis of deep forearm muscles Fibrosis of deep forearm muscles
[ F.D.P.][ F.D.P.] due to prolonged due to prolonged
ischaemia.ischaemia.
♥Treatment : Treatment :
surgical excision of fibrosed muscles + surgical excision of fibrosed muscles +
tendon operations tendon operations [[ transfer or lengtheningtransfer or lengthening ]]

19. Intercondylar fracturesIntercondylar fractures
♥T or Y – shaped fr.T or Y – shaped fr.
♥Intra-articularIntra-articular [ [ affecting affecting
the joint surfacethe joint surface ] ] . .
♥Treatment :Treatment :
-- Open reduction internal Open reduction internal
fixation to restore fixation to restore
smooth articularsmooth articular
surface.surface.

20. Fr. of the humeral condylesFr. of the humeral condyles : :
♥Avulsion fr. of the med. or Avulsion fr. of the med. or
lateral condyles.lateral condyles.
♥Common in children.Common in children.
♥Treatment :Treatment :
-- O.R.I.F. by K. wire. O.R.I.F. by K. wire.

21. Fracture head radiusFracture head radius
♥Intra-articular fr.Intra-articular fr.
♥Treatment :Treatment :
-- large fragment : I.F. large fragment : I.F.
-- comminuted fr. : excision, or comminuted fr. : excision, or
arthroplasty: head prosthesisarthroplasty: head prosthesis

22. Fracture olecranon
♥Intra articular fractureIntra articular fracture
♥Treatment :Treatment :
-- O.R.I.F. : by tension O.R.I.F. : by tension
band wiringband wiring
- plate fixation if comminuted- plate fixation if comminuted

23. Monteggia
Fracture-Dislocation
♥FR. upper 1/3 ulna + dislocation FR. upper 1/3 ulna + dislocation
of the superior R-U joint.of the superior R-U joint.
♥Types : Types :
-- extension type extension type
- flexion type - flexion type
- lateral type- lateral type
♥Treatment :Treatment :
O.R.I.F. of the ulna.O.R.I.F. of the ulna.

24. Galeazzi Fracture-
Dislocation
fracture of the distal
third of the shaft of
the radius and
dislocation of the
distal radioulnar joint
Treatment:
Open Reduction
Internal Fixation of
the radial fracture
plating

25. Fracture both bones forearm
♥in children : usually green-stick.in children : usually green-stick.
treatment : closed reduction and above treatment : closed reduction and above
elbow cast fixationelbow cast fixation
♥In adults : treatment eitherIn adults : treatment either
-- conservative: closed reduction conservative: closed reduction
+ plaster fixation+ plaster fixation
- - if failed O.R.I.F.if failed O.R.I.F.
plate & screws or nailsplate & screws or nails
♥Complications :Complications :
-- mal-union mal-union
-- cross union cross union

27. Colles’ fracture
♥Fr. distal 1 inch of the radius,Fr. distal 1 inch of the radius,
with or without avulsion of the with or without avulsion of the
ulnar styloid .ulnar styloid .
♥Common in old age due Common in old age due
to osteoporosis.to osteoporosis.

28. Displacement of the distal fragmentDisplacement of the distal fragment : :
♥Backwards, upwards,Backwards, upwards,
and laterally. and laterally.
( displacement and tilt )( displacement and tilt )
♥Clinically :Clinically :
- - pain, tenderness……. pain, tenderness…….
- - dinner-fork deformity. dinner-fork deformity.

30. Treatment :
♥Closed reduction + plaster fixationClosed reduction + plaster fixation
♥If comminuted, with intra-articular If comminuted, with intra-articular
extension of the fr. ( Barton) extension of the fr. ( Barton)
O.R.I.F.O.R.I.F.
♥Complications :Complications :
- - mal-union mal-union
rupture E.P.L. tendon.rupture E.P.L. tendon.
-- Sudeck’s atrophy. Sudeck’s atrophy.

31. Fracture scaphoid
♥may be impacted,not evident early in x-ray.may be impacted,not evident early in x-ray.
♥Clinically : max.tenderness in snuff-boxClinically : max.tenderness in snuff-box
♥Treatment: immobilization in scaphoid cast.Treatment: immobilization in scaphoid cast.
♥Complications :Complications :
- non-union and AVN of prox.- non-union and AVN of prox.
fragment.fragment.
** Treatment of non-union : Treatment of non-union :
-- I.F.+ B.G. I.F.+ B.G.
- - late cases with O.A. wrist:late cases with O.A. wrist:
arthrodesis.arthrodesis.

32. Fractures of the metacarpals and
phalanges :
♥Easily treated by :Easily treated by :
- closed reduction - closed reduction
to correct deformityto correct deformity
+ plaster fixation.+ plaster fixation.

33. Bennet’s fracture :
♥Fr. Base 1Fr. Base 1
stst
. metacarpal, extending into . metacarpal, extending into
the 1the 1
stst
carpo-metacarpal joint. carpo-metacarpal joint.
♥Usually needs I.F. Usually needs I.F.
by k. wire.by k. wire.