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Complication 1.Joint stiffness Early : compartment syndrome , infection , vascular injury , 1.AVN Early :Thromboembolism , pressure sores
2.Complex regional pain syndrome nerve injury , 2.Non union Late :Failure of fixation , malunion
3.OA Late : malunion , joint stiffness , OA , Osteoperosis 3.OA
Fracture of upper limbs
Types Distal radius Humerus Montegia Galeazzi Supracondylar
Classification Colles Smith’s -Proximal 1/3 rd ulnar -distal 1/3 radius B>G
fracture fracture Proximal humerus # fracture with proximal radio - shaft AND -Extraarticular
-radial shift -fall on the ulnar joint injury / radial head -associated
-radial back of the *low-energy falls dislocation distal radioulnar Gartland classification :
shortening hand -elderly with osteoporotic bone Bado classification : joint (DRUJ)
-2.5cm from *high-energy trauma Type I injury Extension Flexion
the wrist -young individual -# of proximal or middle Type Undisplaced Undisplaced
-outstrech -concomitant soft tissue and third ulna with anterior I
hand neurovascular injuries dislocation of the radial Type Displaced , Displaced ,
head II posterior anterior
Neer classification : Type II cortex cortex intact
-# of proximal or middle intact
third ulna with posterior Type Completely Completely
Dosal Volar dislocation of the radial III displaced , displaced
displacement displacement head posterior anterolateral
Dorsal Volar Type III cortex not
angulation angularion -# of the ulnar metaphsis intact
Dinner fork Garden with lateral dislocation of
deformity spade the head
deformity -# of proximal or middle
third ulna and radius with
dislocation of the radial
head in any direction
Humeral shaft #
-distal to the surgical neck & proximal
to the supracondylar ridge
Mechanism :
1.Fall on the hand may twist the
humerus spiral #
2.Fall on the elbow with arm
abducted may hinge the bone
transverse or oblique #
3.Direct blow to the arm
transverse /comminuted #
Management Conservative Operative Proximal Humeral shaft 1.CMR of radial head Operative: OPERATIVE NON
immolization Unstable # 1.Arm in a sling 1.Cast & elbow 2.ORIF +ulnar plating ORIF +plating +/- OPERATIVE
in a cast for Should be 2.Active exercise 90 3.Open reduction + annular K wire (DRUJ) -Cast -ORIF
3weeks fixed with k 3.Closed reduction 2. Internal ligament repaired if failed immobilization using k
wires of 4.Internal fixation fixation head CMR for 3 weeks WRE
plate -Three 4.Radial head fixation if -Dunlop
part fracture traction
5.Prosthetic
replacement
-Four part
Complication 1.Circulatory impairment 1.Fracture of shaft of humerus radial Early : PIN neuropathy 1.compartment Early – vascular and nerve injury ,
2.Nerve injury nerve palsy ( wrist drop ) Late : malunion syndrome compartment syndrome,infection
3.Joint stiffness 2.Fracture of proximal shoulder Non union 2.neurovascular Late- Malunion , joint stiffness ,
4.malunion dislocation , vascular and nerve injuries , injury volkman ischaemic contracture
stiffnesss 3.Non union
Dislocation
Shoulder Elbow
Anterior dislocation -90 % Terrible triad injury :
1.Posterior elbow dislocation
-Fall on back stretching hand 2.Radial head #
-Forced abduction and external rotation of the shoulder 3.Radial head # + coronoid #