Fractures of upper extremity

FRACTURES OF THE CLAVICLE

common fractures
fall into the shoulder
middle 3rd
evident on inspection
treated non operatively
open fracture, displaced surgically
treated
LATERAL 3RD
Less common
With coracoclavicular ligament
rupture
High risk for non-union
Displaced surgical treatment
Clavicular fracture is treated by?
A. Fixation with plate and screw
B. Open reduction and internal
fixation
C. Skeletal traction
D. Figure of eight bandage
Common injury to baby is
a) Fracture of humerus
b) Fracture of clavicle
c) Fracture of radius and ulna
d) Fracture of femur
Treatment of fracture clavicle in an
infant is best treated by
a) Cuff and sling
b) Figure of eight bandage
c) Open reduction
d) Shoulder cast
Most common complication of
clavicular fracture is?
a) Nonunion
b) Delayed union
c) Malunion
d) Neurovascular damage
Regarding the clavicle, all are correct
EXCEPT:
a. It is an example of the short bones.
b. It is the first bone to ossify in the fetal
life.
c. It ossifies in membrane.
d. It is the commonly fractured bone.
e. It has no medullary cavity.
The most common site of fracture of
the clavicle is:

a. Medial end.
b. Lateral end.
c. Midpoint of the clavicle.
d. Junction of the medial two-thirds and
the lateral third.
e. Junction of the lateral two-thirds and
the medial third.
The inferior surface of the clavicle
gives attachment to all of the
following EXCEPT:
a. Conoid ligament.
b. Trapezoid ligament.
c. Costoclavicular ligament.
d. Pectoralis major muscle.
e. Subclavius muscle.
These muscles are attached to the
medial two thirds of the clavicle
EXCEPT:
a. Sternomastoid.
b. Deltoid.
c. Pectoralis major.
d. Subclavius.
e. Sternohyoid.
Regarding the articulations of the
clavicle, one is correct:
a. The medial end articulates with the
manubrium by fibrous articulation.
b. The medial end articulates with the
manubrium by cartilaginous articulation.
c. The medial end articulates with the
body of the sternum by saddle synovial
joint.
d. The lateral end articulates with the
acromion by fibrous articulation.
e. The lateral end articulates with the
acromion by plane synovial articulation.
One of he following is not attached to
the medial border of the scapula:
a. Levator scapulae.
b. Teres minor.
c. Serratus anterior.
d. Rhombideus minor.
e. Rhomboideus major.
All of the following parts of the
scapula can be felt EXCEPT:
a. Acromion process.
b. Crest of the spine.
c. Upper border.
d. Inferior angle.

Fractures of upper extremity

The glenoid cavity articulates with the

head of the humerus by a:
a. Fibrous articulation.
b. Cartilaginous articulation.
c. Plane synovial articulation.
d. Ball and socket synovial articulation.
e. Hinge synovial articulation.
e. Tip of the coracoid process.
The surgical neck of the humerus is
related to the:
a. Radial nerve.
b. Axillary nerve.
c. Ulnar nerve.
d. Median nerve.
e. None of the above.

Acromioclavicular (AC) joint injuries

Fall on shoulder or outstretched hand
AC ligament and Coracoclavicular
ligament tears
Step off or separation of AC jointradiograph
Majority treated non operatively
Severe displacement surgery

Sternoclavicular joint
Injury is rare
Anterior dislocation is more
common than posterior
Close reduction and
immobilization by arm sling
Posterior dislocation dangerous
Pulmonary or neurovascular injury
Close reduction under anesthesia
with vascular surgeon present
Fracture of scapula
Associated head, ribs, lungs and
spine injuries
Check neurovascular injury
Mostly treated non operatively
Glenoid fracture/intra-articular
fracture open reduction by plates
or screws

Shoulder dislocation
Most commonly dislocated joint
Bankart lession injury labrum
Hill-sachs lession impression
fracture at humeral
Rotator cuff tears
Posterior dislocation seizures and
electric shock
Radiograph
Close reduction + short period
immobilization
Proximal humerus fractures
Common in elderly
Fall on shoulder/direct blow/
high energy trauma
Neer classification
Treatment
o Displacement
o Angulation
o Comminution
o Age

Proximal humerus fractures

Radiography AP, Axillary,
scapular Y view
Intra-articular fracture Computed
tomography/3d reconstruction
Treatment
o Immobilization
o ORIF
o Prosthetic replacement
elderly and osteoporotic
patient
Humeral shaft fractures
Direct blow, fall on outstretch arm
Neurovascular examination
o Radial nerve injury
(neuropraxia)
Radiography arm apl
Acceptable alignment
o Coaptation splint
o Functional bracing
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Fractures of upper extremity

o

Close monitoring with

radiograph
Unacceptable alignment or angulation
o OR Plate fixation
o OR intramedullary nailing
o Minimally invasive plate
osteosynthesis (MIPO)

Distal Humerus Fractures

Fall on elbow/outstretch arm
Radiography elbow apl
Supracondylar fractures/
capitellum
Undisplaced LAPM
Displaced dual plating
Intraarticular goal
o Anatomic reduction with
stable fixation
o Restoration of anatomic
alignment of the joint
o Early range of motion
o ! TOTAL ELBOW
REPLACEMENT

Elbow dislocation
Fall outstretch hand
Radiography elbow apl
Posteriorly directed
Ruptured of lateral collateral ligament
Associated with fracture of radial
head, coronoid, or epicondyle
Reduced urgently with LAPM
Associated with fractures
treated surgically
TERRIBLE TRIAD
o Elbow dislocation
o Radial head fracture
o Coronoid fracture
Unstable injuries repair of LCL, fixer replace
radial head, coronoid fixation

Surgical treatment displaced

supination/pronation block
ORIF (open reduction internal
fixation)
Radial head replacement
Excission

Olecranon Fractures
Fall directly onto flexed elbow
Swelling/tenderness
Radiography elbow APL
Non-surgical undisplaced,
immobilization
o Early ROME
o Close ff-up
Surgical treatment pull of triceps
cause displaement
Tension Band Wiring (TBW) tranverse facture
Plates and screws
comminuted fracture
Forearm Fractures
High energy trauma
Deformity, swelling, tenderness
Radiography forearm APL
Non surgical undisplaced
SURGICAL restoration of radial bow
angle
Plates and screws
Intramedullary rod
Night stick fracture isolated fracture
of ulna
Monteggia fracture fracture of ulna
with radial head dislocation
Galeazzi fracture fracture of radius
with dislocation of distal radioulnar
joint (DRUJ)

Radial Head Fractures

Fall on outstretch hand
Swelling tenderness
Radiography elbow APL
Non surgical - immobilization
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