Lecture 2 - Fractures of the upper limps Flashcards
(88 cards)
1
Q
how is the indirect fracture of the scapula made
A
Causing fractures-avulsions of the acromion or coracoid process following a violent traction of electric shock
2
Q
Ideberg classification tells us what?
A
the severity of fractures of the glenoid cavity
3
Q
what are the location classifications of fractures of the scapula ?
A
- body
- spine
- neck
- glenoid fossa
- coracoid and acromion
4
Q
where on the scapular are fractures most common ?
A
neck and body
5
Q
Eyres classifcaition is a classification of what?
A
coracoid
6
Q
what are the treatment of a nondisplaced scapula ?
A
immobilization for 2-6 weeks
* Dassault bandage
* Thoraco-brachial cast device
* Functional rehabilitation
Best indicated for
7
Q
what treatment for an intraarticular fracture of the glenoid process ?
A
surgery
8
Q
complications can be late and immediate, explain the immediate complications seen in clavicular fractures
A
○ Tegumentare
○ Vascular
○ Nervous
Pleuropulmonary
8
Q
explain the common mechanism seen in clavicular fractures
A
Common in young and active people
Falling from high speed
Sports injuries
9
Q
please classify the fractures of the clavicle according to the frequency
A
middle one is the most frequent spot for fracture
lateral one is the second most frequent spot for fracute
medial one is the third most frequent spot for fracture
10
Q
what is the Neer classifciaiton -?
A
a classification of the serverity of fractures on the lateral 1/3 of the clavicle
11
Q
explain the clinical picture of clavicular fracture
A
- At middle clavicle = fallen shoulder
- Swollen
- Painful
- Bruising
Examination of vessels and nerves must be performed to avoid complications
12
Q
explain the evolution of healing in a clavicular fracture
A
- Consolidate well
- Healing with shortening
Reduction is difficult to maintain
- Healing with shortening
13
Q
complications can be late and immediate, explain the late complications seen in clavicular fractures
A
○ Vicious callus
○ Pseudarthrosis
Osteitis
14
Q
explain the paraclinical examination of the calvicle
A
- X ray anterior posterior position
- For better view and decision of best treatment we do a 20 degree X ray of cephalic angulation of the radiological apparatus,
or incidences in 20 degrees of internal rotation of the shoulder, is required.
- For better view and decision of best treatment we do a 20 degree X ray of cephalic angulation of the radiological apparatus,
15
Q
what are the treatment in case of nondisplaced clavicle fracgure ?
A
Usually orthopedically treated in a scarf or bandage 8 for 4-6 weeks.
16
Q
where are screws and plates installed on the clavicle ?
A
upper edge
17
Q
when is ostheosynthesis indicated for clavicular fractures ?
A
○ Displacement of more than 2 cm
○ Shortening of more than 2 cm
○ Comminution
○ Vascular and nerve involvement
○ Complicated fracturs
Open fractures
18
Q
complications of the surgical treatment in clavicular fractures
A
- Infections
- Migration of osteosynthesis materials
- Nerve and vascular damage
- Skin lesion
Vicious callus and pseudarthrosis
19
Q
explain mechanisms seen in fractures of the femoral epiphysis
A
osteoporotic in elderly
direct
indrect
20
Q
explain the notion of the KOCHER classifcaition ?
A
it classifies the location of fractures in the proximal end of the humerus
anatomical neck
surgical neck
epiphyseal region
21
Q
explain the notion of CODMAN classification ?
A
it divides the proximal humerus into key parts
a - greater tubercity
b - lesser tubercity
c - humeral head
d - humeral shaft
22
Q
what are the effect of humeral head fractures on the glenohumeral joint?
A
Cartilage injury
Joint instability
Post traumatic arthritis
23
Q
does humeral head fracture has a higher change of AVN compared to other fractrues of the humeral ?
A
yes
24
what complication is the most frequent in proximal humeral fracture ?
malpracrice
25
what happens if the humeral fracture treatment is delayed ?
can lead to an unfavourable evolution due to the **formation of heterotopic ossifications and soft tissue fibrosis** can prevent the restoration of normal anatomy
26
what causes displacement fractures in greater tuberocity ?
contraction of the rotator cuff
27
what type of dislocation is assocaited with greater tuberocity fracture?
anterior dislocation
28
which movements are assocaited with lesser truperocity fractrues ?
internal rotation and adduction
29
explain the movements assocaited with surgical neck fractures ?
adduction nad abduction
dispalcement due to muscle contraction
30
explain the notion of acromo-condylar distance in humeral fractures
This is the distance between the acromion (shoulder tip) and the lateral epicondyle of the humerus (elbow)
Shortening may indicate bone overlap or displacement
31
what is plastic abduction seen in humeral fractures ?
A passive, abnormal abduction positioning of the arm
Indicates loss of muscle tension control, sometimes from associated rotator cuff dysfunction
32
differential diagnosis in proximal fractures of the humerus
◼ Contusion or sprain
◼ Scapulohumeral dislocation
◼ Fracture of the lateral angle of the scapula
◼ Fracture of the coracoid process
◼ Fracture of the acromion
33
orthopedic treatment of proximal humeral fraactures are ?
BOHLER manuver
Thoracobrachial device in abduction
Desault Bandage – 3 Weeks
Hanging Cast (Caldwell Method)
34
surgical treatment of the proximal part of the humeral
* Reduction with closed focar
□ Osteosynthesis with K wires and cannular screws
* Reduction with open focar
□ Osteosynthesis with screw, plates with screws, Centro medullary rod
NEER prosthesis
35
what are the indirect mehcnaism in diaphysis fractures of the humeral ?
axial fall on the arm
fall on the elbow
torsion
36
orthopedic treatment of diaphysis of the humeral
* U splint with epaulet
□ Early stage or mild fractures
□ Initial support and soft stabilization
* Caldwell, hanging cast
□ Mid-diaphyseal fractures
□ Gravity-assisted aligment
* Hemi decubitus during sleep
□ All fracture types
□ Prevents nocturnal displacment
* Thoracobrachial cast device
□ Unstable or complex diaphyseal fractures
Rigid immobilization of arm and shoulder
37
surgical treatment of the humeral diaphysis ?
* Osteosynthesis with plate and screws
* Centromedulary osteosynthesis with ENDER rods
□ Telegraph rod
□ Screwed kuntcher rod
Osteosynthesis with ilizarov external fixator
38
what are the immediate fractrues of the diaphysis humeral ?
* Open fracturs
* Vascular lesions
Nervous lesions on the radial nerve
39
what are the late fractrues of the diaphysis humeral ?
◼ Pseudarthrosis
◼ Vicious callus
◼ Post-traumatic osteitis
◼ Late radial n. paresis (paralysis)
40
which of the distal huraml is included ?
* Supracondylar fractures
* Supra and inter condylar fractures
* Epitrochlear fractures (medial epicondyle)
External condyle fractures (humeral head)
41
Mechanism of supracondylar fractures
* Direct
* Indirect includes
□ Hiperextension and hiperflexion (abduction and adduction)
Multiple displacement
42
KIRMISSION linear ecchymosis is found where ?
supracondylar fractrues of the distal humeral
43
orhtopedic treatmetn of the distal humeral fractures
* Immediate reduction
* Brachiopalmar cast at 90 degrees for 6 weeks
* Progressive reduction
* Continued traction
□ When reduction cannot be maintained soley by casting
2 K wires through the focar
44
what are the immediate complications of supracondylar fractrues of the humeral ?
□ Opening of the focar
□ Never radial
□ Vascular
□ Brachial artery
□ Septic
VOLKMAN syndrome
44
surgical treatment of distal humeral fractures
* Y shaped plate
□ Semitubular plate
Screws
45
what are the late complications of supracondylar fractrues of the humerus
□ Vicious callus
Periarticular ossifications
46
explain the Riseborough classifciaiton
Fractures of the Capitellum of the Humerus (Elbow).
46
what is the mechanism of condylar fractures of he humerus ?
hypertextension of the olecranon tip
47
treatment of epicondylar fractrues of the humerus
□ Orthopedic
® Continuous traction
® Casted split and precocious mobilization
□ Surgical
® Modelled/reconstruction plates and screws
Transolecranian access
48
complications of the epicondylar fractures of the humerus ?
□ Immediate
® Open fracture
® Nerve - radial
® Artery - brachial
® Septic
® VOLKMAN syndrome
□ Late
® Vicious callus
® Periarticular ossifications
® Elbow movement limitation
Posttraumatic arthrosis
49
what are the types of fractures found in epitrochlear
* Extraarticular
* Vertical trajectory
With or without displacement
49
aspects of epitrochlear factrues without displacement
* Ulnar nerve irritation
* Orthopedic treatment
* 90 degree immobilization for 3 weeks
Pain at a fixed point
50
clinical picture of latreal condyle fracture
* Pain in lat side
* Lack of mobility
* Los of function
* Deviation of valgus
Swelling
51
aspects of epitrochlear factrues with displacement
* Distally displaced
* Enclaved intraarticular
○ Meaning the fracture can become trapped inside the joint
○ Surgical emergency
* Abnormal movement in valgus (inwards)
○ Valgus stress test
Associated with post elbow displacement
○ De enclavation of the trapped fracture
○ Screws
Release of the ulnar
52
treatment of lateral condyle fracture
* As usual
○ With out displacement = orthopedics
○ Brachiopalmar device for 3-4 weeks
○ Elbow immobility at 90 degress
* With displacement
Surgery
53
mechanism of olecranon fractures
* Fall with flexed elbow
* Locations
○ Base
○ Body
○ Tip
* With and without displacement
* Swollen
Inability to extend elbow against the ground/gravity
54
treatment of Olecranon fractrures
* Not displaced
○ Orthopedic treatment by immobilization in a posterior splint for 21 days followed by gentle mobility
* Displaced
○ osteosynthesis with
§ Screws
§ Plate
§ Figure of 8 tension wire
Consolidation after 6-8 weeks
55
what is the MASON classifcaition ?
classification of the fractuers of the radial head
56
treatment of the radial head
* Fragment ablation in small non-reconstructible fragments, with minimal impact on the joint
* Osteosynthesis
○ Screws
○ Plates
○ Pins
* Radial head resection/removal of the entire head
○ Severe comminuted fractures
* Silastic endoprosthesis
○ Radial head replacement
○ Non-fixable fractures
○ Resection would compromise elbow stability
In young and active people
57
what is the direction of radial diaphysis fracture ?
mostly in the distal third
associated with ulnar fractrue too
58
Essex-Lopresti fracture ?
Radial shaft fracture + radial head fracture
58
Galeazzi fracture?
This fracture is related to the radial-ulnar dislocation
* Ulna undergoes a distal displacement
Distal radial fragment undergoes palmar or dorsal displacement + an angular displacement
59
treatment of radial head fracture
* No displacement
○ Immobilization in a branchoantebrachial-palmar cast
○ Elbow is 90 degree
○ Hand in a functional position
○ Duration 4-6 weeks
○ Immobilization not more than 3 weeks
* Displacement
○ Reduced orthopedically
○ Open reduction and osteosynthesis with plate and screws
○ Consolidation - 3 months
In open fractures the external fixator can also be used
60
Monteggia fracture ?
Ulna fracture with radial head dislocation
60
mechanism in ular diaphysis fractures ?
related to defense fractrues
- Indirect fall
Fall on the hand with pronation can cause ulna fracture and radial head dislocation anteriorly or posteriorly
61
Complications of monteggia fracture
* Irreducible dislocation of the radial head
* Pseudoarthrosis of the ulna
* Periarticular ossifications of the elbow
* Radioulnar synostosis
Radial nerve motor ramus lesion
61
complication of forearm fractures
- Immediate
* Open fracture
* Vascular lesions
* Compartment syndrome
- Late
* Compartment syndrome
* Vicious callus
* Pseudoarthrosis
- Vicious callus
* In bayonet
* With angulation
* With delay
* Radioulnar synostosis
- Pseudoarthrosis
❑ Muscular interposing
❑ Insufficient reduction
❑ Insufficient immobilization
❑ Fracture of a single bone
❑ Extended deperiosteation
❑ Insifficient osteosynthesis
62
main cause of distal forearm fractures ?
mainly caused by the radius
- Caused by fall on the hand
* Hyperextension
Hyperflexion
62
"backward fork".?
It is similar to the other types of distal radial epiphysis fractures, except that the deformation has a specific aspect, of a fork
63
Laugier's sign?
radial styloid elevation
64
complication of distal radial fractures ?
* External fixator
In a cast the hand is aducted toward the ulnar
65
complications of radial distal fractures
Vicious callus
65
mechanism of scaphoid fractures
* Fall on the hand
Hyperextended hand
66
fracture distribution of the carpal scaphoid
proximal pole - 20 %
neck - 70 %
distal pole - 10 %
67
non dispalcement treatment of the scaphoid
* Immobilization of the proximal phalanx of the thumb in abduction
* The first
* Dorsal flexion
* Pronation
* Ulnar inclincation
6 weeks
67
bone grafting in scaphoid fractuers
in case of nonunion
* Nonunion due to its precarious blood supply (especially proximal pole)
* AVN (avascular necrosis) if healing is delayed or inadequate
Chronic instability and wrist arthritis if untreated
68
types of grafting in scaphoid fractures ?
Standard Russe Graft
Winged Graft
69
mechanism of 1 metacarpal bone fractue
* Direct trauma
* Muscle crushes or integumentary damage
* The fracture focus is usually located at the level of the diaphysis and has a spiral path, but a transverse fracture path is not excluded.
Metacarpal fractures can be with or without displacement and can be located at the intra-articular level.
70
Type I: Bennett Fracture-Dislocation
* Fracture at the base of the 1st metacarpal, extending into the CMC joint.
* The volar ulnar fragment remains attached to the trapezium via the anterior oblique ligament.
* The rest of the metacarpal is displaced dorsally and radially.
Treatment: Often requires closed or open reduction with internal fixation.
71
Type II: Rolando Fracture
* Comminuted intra-articular fracture of the base of the 1st metacarpal.
* Often has a “Y” or “T” shape.
* Difficult to reduce due to multiple fragments.
Treatment: Surgical fixation or external fixation depending on comminution
72
Type IIIA & IIIB: Extra-articular Fracture-Dislocation
* IIIA:
○ Oblique fracture of the base of the metacarpal extending toward the diaphysis.
○ No significant articular involvement.
* IIIB:
○ May involve the articular surface minimally or not at all but shows subluxation.
Treatment: Conservative or surgical, depending on displacement.
72
Type IV: Complex Fracture-Dislocation
* Multi-fragmentary base fracture with dislocation.
* Represents the most unstable configuration.
* Often associated with ligamentous injury.
Treatment: Requires open reduction and internal fixation or other surgical techniques.
73
Wagner Technique
* Seen on the left side of the image.
* Utilizes percutaneous K-wires to stabilize the reduced fracture by crossing the CMC joint.
* Provides temporary fixation to maintain reduction of the fracture and joint congruity.
Often used for Bennett fractures.
74
Advantages of K-Wire Fixation
* Minimally invasive
* Quick and effective stabilization
* Cost-effective
Preserves soft tissue and joint capsule
74
Iselin Technique
* Depicted in the middle and right side.
* Involves multiple K-wires:
○ One transfixes the metacarpal to the trapezium.
○ Others may pass obliquely through fracture fragments to compress and stabilize.
Offers more rigid fixation, particularly useful in comminuted (e.g., Rolando) fractures.
75
Indications for K-Wire Fixation
* Displaced intra-articular fractures (especially if reduction can't be maintained conservatively)
* Failed closed reduction
* Unstable fracture-dislocations
Patients requiring early mobilization or precise joint alignment
76
Considerations of K wire
* K-wires are usually removed after 4–6 weeks
* Risk of:
○ Pin tract infection
○ Loosening or migration
Loss of reduction if not properly positioned
