INJURY muscles and tendons A SHOULDER 1.

MANGO bringing rotator:

Activity prolonged repetitive motion of the shoulder on the head, may cause the handle to stand between the acromion and coracoacromial ligament located above. Microtrauma, inflammation, edema, pain, poor function. Mayor interposition: Vici ous Circle. Risk low blood: diminished Healing Injuries to muscles and tendons

Pain on external rotation and abduction, weakness and pain. Positive sign recycl e empty. Differentiate acromioclavicular dysfunction. Slimming repetitive Interp osition rotator handle and produces ultimate degenerative process. Injuries to muscles and tendons

Pre Qx: special radiographic subacromial space (identify spurs). MRI, U.S.: Dx c hronic tear. Conservative Tx: Modification of the activity, fsioterapia, oral an ti-inflammatory, heat-cold, iontophoresis, micro-stimulation, subacromial cortic osteroid injection Injuries to muscles and tendons Tx Qx: Failure of prolonged conservative tx. Arthroscopic, 6-8 weeks of recovery . Strengthening exercise only after full arc of footwork. Injuries to muscles and tendons Torn rotator handle: It is caused by degeneration of the tendon of the mango, which is assumed is poorly irrigated. Repetitive activity restricted subacromial space. minor trauma, a complete tear. Fall on hand in hyperextension. gra dual loss of strength in abduction and external rotation, with persistent pain. Pain at night and on the head movement, hard to find, deep. Injuries to muscles and tendons

Conservative Tx: Rest prolonged (4-9 months), range of motion exercises. Tx Qx: Failure to control symptoms. Chronic tear more difficult to repair. Rehabilitati on 6-12 months, with gradual increase in exercise to restore function and streng th. Non-professional athletes (partial tear): prone horizontal abduction and ext

ernal rotation prone to restore grip strength (6 weeks). Debridement (6-12 month s of recovery). Subacromial impingement syndrome Reduction Static

Dynamic Stage I Stage II Stage III Features Edema and Hemorrhage <25 Fibrosis and tendinosis 25-40 Typical Age Osteophytes Cuff Rupture> Diag. Differential Subluxation, Arthritis A / C Reversible Clinical Course Recurrent pain Frozen shoulder calcifications bursectomy lig considered active. A / C Radiculitis cervical neoplasms progressive functional limitation Anterior acromioplasty, rotator cuff repairs Treatment Conservative

The size of the rupture of the rotator cuff is important as a prognostic indicat or Classification of rotator cuff RUPTURES BY SIZE Small Medium Large Mass <13> 5cm 5cm 3cm 1cm

Clinical Picture The classic signs are: Crackles painful arc of movement weakness especially abduction and external rota tion.

Important to assess muscle strength Treatment Initial stages physiotherapy, NSAIDs Surgical Arthroscopy

Treatment Neer Classification ion Treatment Minimally displaced Fx: 2 weeks or sling Velpeau and early mobilization to 10 da ys. Anatomical neck Fx: In young people: open reduction and internal fixation. In adults: dentures

Treatment Qx neck Fx: Perform closed reduction by traction with the arm flexed. And Velpeau sling.

Greater tuberosity Fx: If displacement> 1 cm, open reduction and internal fixation. Treatment Tuberosity fx: Sling if the fragment is internal, and internal rotation is preserved. Open redu ction and internal fixation is large or displaced.

Fx into three fragments: Open reduction and internal fixation Treatment Prosthesis Fractures and luxofracturas into 4 parts: Fracture of the humeral head (head-spl itting) Compression fractures of the anatomical neck fractures Fractures and lux ofracturas into three parts in elderly patients with osteoporotic bone In pediatric patients FX 1.

Patterns common pediatric Fx: Fx's similar to adults, Fx's unique. Bone, softer, less soft tissue injuries. Periosteum: Strong, osteogenic. Fx peculiar patterns . Remodeling faster. Tx: Reduction simple closed most of the time. FX IN PEDIATRIC PATIENTS Fx of the epiphysis: plate is cartilaginous region of low resistance. physis recover and resume its growth, except when you lose part of the substance fisia l.\ Fx physis and joint: open reduction. Fx's almost never affect growth pot ential, respect circulation. FX IN PEDIATRIC PATIENTS

Fx patterns. Fx are undergoing joint or misalignment of the parties fisiarias ha ve worse prognosis. Fast Healing (4 weeks). Close monitoring FX UPPER EXTREMITY IN PEDIATRIC 1. Clavicle Fx: Among the most common. Closed heal quickly (sling). Non-union (Rare ). FX UPPER EXTREMITY IN PEDIATRIC Fx proximal humerus: Usually epiphyseal (Salter-Harris II) physis rapid grow th: rapid Remodeling 3-4 weeks immobilization sling or without reductions. F x with extreme angulation (> 90 degrees): Reduction and fixation Qx. FX UPPER EXTREMITY IN PEDIATRIC Elbow Region: difficult to manage. Mostly indirect injuries. incomplete os sification: Difficulty of radiological interpretation. Inflammation intense: S x compartment. Reduction unstable Qx intervention with 4 weeks immobilization. FX UPPER EXTREMITY IN PEDIATRIC


Supracondylar humeral Fx: metaphyseal bone proximal to articulation, does not af fect the growth plate. Nerve stretch injury. Inflammation: Decreased circulation . Tx: rapid anatomic reduction under general anesthesia, fixation. Poor reductio n: Varo ulna. FX UPPER EXTREMITY IN PEDIATRIC Lateral condyle Fx: Fx sliding sideways. Occurs when the radial head is orie nted toward the head of the humerus during the fall. Lack of ossification: Fal se Salter-Harris II. Very unstable. Salter-Harris IV open reduction and fixa tion with nails. FX UPPER EXTREMITY IN PEDIATRIC Radial neck Fx: Similar to the lateral condyle. angulation up to 70-80 degre es. angulation <45 degrees remodels spontaneously, symptomatic Tx. Greater a ngles: Closed reduction FX UPPER EXTREMITY IN PEDIATRIC Forearm Fx: Falls. Both Bones: Moved, tilt / Fx green stem. Overlapping ends . Closed reduction and plaster FX UPPER EXTREMITY IN PEDIATRIC Monteggia Fx: Ulna, radius intact. Radio humeral head dislocates. Reductio n mostly closed. Reduction inappropriate: chronic loss of elbow motion FX UPPER EXTREMITY IN PEDIATRIC Radius torus Fx: Rizo under dorsal cortex of the distal radius. 1-2 cm dista l physis. Fall lower Confusion on the sprained hand. Stable, painless. Scar 3-4 weeks. Pelvis and hip injuries in children Traumatology and Orthopedics Femoral neck fractures General:

The neck of the femur of children is very strong, it requires a violent trauma t o injure. There are common but are serious when they occur. In addition to poor blood supply is common in such cases post-traumatic avascular necrosis. These ar e unstable injuries that can not be solved by closed reduction, external fixatio n or traction continued. Femoral neck fractures Treatment:

It must be treated with closed reduction combined with internal skeletal fixatio n guided percutaneous image intensifier. It also needs a spica cast for 3 months , by the fact that children can not maintain the limb in shock.

• internal skeletal fixation guided percutaneous image intensifier Femoral neck fractures Complications: Coxa vara .- It consists of nonunion and progressive deformity of the femoral ne ck by poor internal fixation or lack thereof. Produces shortening of the limb. P osttraumatic avascular necrosis .- It's when the femoral head loses its blood ve ssels break them in the fracture. It occurs in 30% of cases. No radiological evi dence of this until several months after the trauma.

Coxa vara Coxa vara corrected with bone graft and internal fixation with a blade plate Type I injury of the distal epiphysis of the neck Rare but serious. It can cause early closure of the epiphyseal plate underneath. This is the same way as the femoral neck fracture, ie, internal skeletal fixati on.

Slipped epiphysis of the proximal femur in a 1 year old hit by a truck Slipped epiphysis of the femur, 10 years later shows coxa plana and coxa vara Traumatic dislocation of the hip General: This joint dislocation is more vulnerable when in flexion and abduction. In this position you can give a posterior dislocation, capsular tear producing well. Th e strength to do this in the child is less than that required in adults.

Traumatic dislocation of the hip Diagnosis:

The limb is in flexion, adduction and internal rotation. In the rare cases that arise from anterior dislocation of the hip, the limb will be in extension, abduc tion and external rotation.

Child Traumatic posterior dislocation of the hip Traumatic dislocation of the hip Treatment:

Constitutes an emergency for the risk of post-traumatic avascular necrosis. Ther efore, correction is necessary within the first 8 hrs. This is achieved by close d reduction and pulls the thigh flexed and dislocated femoral head pushing forwa rd. Spica cast is placed in extension, abduction and external rotation for 6 wee ks. Traumatic dislocation of the hip Complications:

Are rare sciatic nerve injury and the acetabular rim fracture. Posttraumatic ava scular necrosis is most common, especially if reduction is not within the first 8 hours. There may be soft tissue interposition of the capsule, which may lead t o subluxation and arthritis degnerativa. This complication is resolved surgicall y. Pelvic fractures General:

The pelvis of children is more flexible and malleable than adults. Therefore, pe lvic fractures in children are rare, but can occur as a result of major trauma. In general, pelvic fractures are not the major problem, but its complications su ch as severe internal bleeding (they can lose up to 60% by volume) and extravasa tion of urine due to rupture of the bladder or urethra. Pelvic fractures


On physical examination there may be pain, swelling and deformity of the hips. X -rays:

Anteroposterior. Tangential plane of the pelvic ring with the tube up to 50 degr ees. Projecting into the pelvic ring with the tube down 60 degrees. CT may be us eful. Traumatic Separation of the symphysis pubis in a boy of 2 years Pelvic fractures Treatment:

Initially the treatment is geared to internal bleeding and subsequent hypovolemi c shock. While the crash is to do a catheterization:

If the probe fails to reach citostomía suprapubic bladder. If the tube enters the bladder, but no blood cystogram to look for tears and correct with surgery . Pelvic fractures Treatment: Stable fractures of the pelvis: It is when you do not disrupt the pelvic ring. Because most of the pelvis is spo ngy bone with good irrigation, fractures are resolved quickly.

Unstable fractures of the pelvis:

It is when there is complete separation of the pubic symphysis. Is reduced by in ternal rotation of both hips and maintained with a hip spica. In cases of comple

x and highly unstable fractures require open reduction and internal fixation wit h plates. Hip and pelvis injuries in adults Vidal Rosas Eduardo Esquer Hip and pelvis injuries in adults Hip Intertrocanterias the femur Fx Fx Fx femoral neck fx built-lx dislocations and t raumatic hip pelvis Fx fx Type

Pelvis PELVIS Pelvis Fracture

The adult pelvis is a ring strong, rigid, surrounded by vital structures necessa ry fx pelvis violent trauma: Traffic accidents, falls from great heights and crushing

Multiple lesions of other structures associated complications Pelvis Fracture Clinical History of trauma Shock EF hemorrhage erness unstable Fx: deformity of hip and pelvic ring Pelvis Fracture radiographic special screenings are needed: Anteroposterior (two-dimensional view) projection profile (provided the 3rd dime nsion) local swelling and tend

complex Fx TAC Pelvis Fracture Emergency Tx Two major complications: Hemorrhage: bleeding laceration of vessels shock blood extravasation of ur ine into the urethra or do not enter the tube (urethra broken), cystogram

Pelvis Fracture Treatment of pelvic fx

are consolidating rapidly (abundant vascularization)

Correction of deformities to prevent malunion and alt function Types of Pelvis Fx unstable isolated Fx Fx not affecting the pelvic ring does not impair the stab ility of the pelvis Require no reduction in direct contusion, pain, discharge on the affected side ( until it subsides the pain) tear of the urethra or bladder rupture

Fx isolated iliac

Fx isolated from the pubic rami Types of Pelvis Fx Fx Unstable fractures coming to the ring causing it to break Injuries that a ffect the stability of the pelvis and are potentially lethal The break in pelv ic ring point, occurs if there is another break Types of Pelvis Fx

Anterosuperior compression Fx Fx Fx combined lateral compression and lateral com pression Fx rotation vertical shear Pelvis Fx Complications Hemorrhage and shock injury of the bladder or urethra injury of the sacral plexu s nerves Fx and acetabular fx-lx HIP Intertrochanteric fractures of the femur

Fx between lesser and greater trochanter, in addition to the fx through the troc hanters tx as extracapsular or intertrochanteric fx are common in adults over 60 years (> Women) Same age and sex incidence in intracapsular and fx fx Colles

Senile and postmenopausal osteoporosis are usually severely comminuted Intertrochanteric fractures of the femur Clinical Manifestations Pac (old) pushed or falls on the outer surface of the hip Pain and absolute instability of focus fx

Tip full external rotation, shortened to the proximal thigh swollen (extracaps ular hemorrhage) Intertrochanteric fractures of the femur Treatment Vascularization of cancellous bone of the trochanteric region is abu ndant consolidated Conservative tx 12-16 wk Intertrochanteric fractures of the femur Tx of choice Open reduction and internal fixation with compression tornilloplaca (dynamic hip screw, DHS) consolidation drive

alternative method of insertion of multiple needles Enders Intertrochanteric fractures of the femur They have few complications vs tails. Malunion intracapsular coxa vara (<2cm)

Avoided in young pac

Mortality rate (elder) Femoral neck fractures


Subcapital, transcervical (midcervical) or basilar (base of the neck) are found within the capsule of the hip (intracapsular) Fx most troublesome and complicate d Adults over the 6th years (> Women)


senile and postmenopausal osteoporosis

Femoral neck fractures Garden Classification: Type I: Incomplete Type II: complete but nondisplaced Type III: partially displa ced Type IV: fully shifted

Type III and IV have a high incidence of avascular necrosis and nonunion Femoral neck fractures Clinical manifestations of displaced fx Trying to straighten Torsional strength and instability of the focus of fx Pac emf greater fall, slip, trip sudden can not get up because of pain

Fx displaced (95%)

EF roración

external limb (not complete, abbreviated and not obvious swelling

Femoral neck fractures radiographic distal fragment provided externally rotated and moved proximally Femoral neck appears short

Two right angle projections (anteroposterior and lateral) lines fx - shear Femoral neck fractures Special problems related Great instability of the focus of internal fixation fx Coverage osteoporotic bon e periosteal limited osteogenic potential endosteal callus formation preca rious blood supply, tension development of haemarthrosis

Femoral neck fractures Treatment of displaced fx

DHS internal fixation

Closed reduction Flexion, adduction and internal rotation and extension after hip

Aspiration of hemarthrosis (avascular necrosis)

To assess the vascularity of the femoral head Contrasts radiopaque and radioactive isotopes


hemiarthroplasty using endoprostheses

Pac advanced age, pathological fx Femoral neck fractures Complications of displaced fx 50% success (osteosynthesis)

Avascular necrosis of the femoral head Non-union degenerative joint disease of t he hip

Femoral neck fractures Avascular necrosis of the femoral head

Precarious blood frequent complication rx signs are not immediately visible ne crosis Fx delayed the consolidation that is not consolidated, there is no revasc ularization Tx removal of the head and hemiarthroplasty with bipolar endoprost heses Femoral neck fractures Non-union It appears in more than 30% may be due to avascular necrosis consequence of cont inuous movement at the focus of metallic stents fx

Femoral neck fractures Post-traumatic degenerative joint disease

It develops slowly (years) as a result of deformity avascular necrosis of femora l head or articular cartilage injury Initial injury or treatment Recessed Fractures 5% of the PAC and is reasonably stable physical signs are minimal and the affect ed hip is passively moves without pain Rx fracture in two planes built in abdu ction

Recessed Fractures Treatment Consolidated in three months and may become unstable desempotrarse employees and fixed-Pac Lodging 4 weeks - 8 weeks crutches internal fixation with cannulated screws

Pac employees and no underrun Dislocations and Lx Fx-traumatic hip It is one of the most stable joints in the body needed a very violent trauma to dislocate the hip may dislocate the hip

Later or earlier (with or without associated fx) Central (there is always a fx)

Dislocations and post-Lx Fx

It is more vulnerable in flexion and adduction and subsequent movement of the fe moral head on the edge of the acetabulum extraarticular type dislocation

Clinical manifestations and Rx

Pac-lying with the hip in flexion, adduction and internal rotation contracture a nd painful limb Rx shortened femoral head above the acetabulum is oblique proj ections also show that after

Treatment There is a blockage of circulation to the femoral head Emergency dislocation r eduction (before 8 hours after trauma) Closed reduction: traction to the thigh f lexed upward rotation external pressure forward on the head from behind or i mmobilization Bedfast for 3 weeks

Post-Lx Fx 50% pac with lx, takes a piece of the trailing edge (labrum) Open reduction of a cetabular remove the fragment of the sciatic nerve injury complications

Avascular necrosis degenerative joint disease Dislocations and above-Lx Fx

Much less common than later trauma is caused by violent force in hip extension, abduction and external rotation Rx femoral head under the acetabulum in the re gion of the obturator foramen Projections show that predates Profile Dislocations and above-Lx Fx Treatment

Closed reduction or fraction the muscle flexed and internally rotated by sayin g hip spica plaster immobilization (3 wk) Components of fx over the head of the femur in the acetabulum

The fx-lx above are rare Central fracture-dislocation

Violent trauma on the outside, in abduction with comminuted fx of the medial wal l of the acetabulum Treatment

Moving head light reduction with longitudinal traction with a nail in the dist al femur with a needle lateral traction on the greater trochanter 8 wk Continuou s traction consolidation Fx-central Lx

not extensive comminution, open reduction and internal fixation of the joint m obility delayed reconstruction

Complications Post-traumatic degenerative joint disease