shoulder fx & dislocation
TRANSCRIPT
Shoulder Fractures & Dislocations
By: Amin YousefelahiRafsanjan Medical School
Shoulder Joint• It’s a connector of Upper limbs to the body• It’s an unstable joint and it’s highly dependent to the muscles and ligaments to be stable.• It’s the most unstable joint in the body thus dislocation is very common.
Shoulder JointBones•Clavicle•Scapula•Humerus (head)
Shoulder Joint
Ligaments•Coracoclavicular•Acromiacalvicular•Coracoacromial
Clavicle Fractures
Clavicle FracturesEpidemiology•One of the most common bony injuries•The most fracture in the children and teenagers
Mechanisms•Fall on the outstretched hand•Direct traumas
Clavicle FracturesClinical manifestation•Sight: swelling & ecchymosis•Touch: pain & tenderness maybe with crepitation•ROM: its restricted and painful
Diagnosis•First of all with history and PE•With XR AP
Clavicle FracturesClassification1.1/3 middle: the most common (80%)2.1/3 distal: it has three types (15%)
i. Type I: minimally displaced; between ligaments.ii. Type II: minimally displaced; between ligaments.iii. Type III: Fracture through AC joint. Ligaments intact
3.1/3 proximal (5%)
Clavicle Fractures1/3 distal: it has three types
Clavicle FracturesTreatment•Non surgical: in the most cases• Fixation and limit the movement of the shoulder
• Triangle bandage
• Figure of 8
• Sling
sling
Clavicle FracturesTreatment•Surgical
• Internal fixation• Indication for surgical operation
1. Nonunion. This is the most frequent indication.
2. Neurovascular involvement. Neurovascular compromise not easily resolved by reduction of the fracture requires immediate open reduction.
3. 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.
5. Floating shoulder. Fractures of the clavicle and the surgical neck of the scapula make the scapular fracture unstable.
6. Its recommended open fixation for type II fracture.
Floating shoulder
Scapula FractureEpidemiology And Etiology•Fracture of coracoid, acromion and body of the scapula commonly caused by direct traumas and accidents.•Fracture of neck of the scapula (glenoid) commonly caused by falling and indirect traumas.
Clinical Manifestation•Sight: ecchymosis, erosion, swelling and maybe with deformity•Touch: tenderness, painful and maybe criptation
Scapula Fracture• ROM: limited and painful
Scapula FractureDiagnosis•X ray• CT often is necessary for accurate assessment of these injuries
Treatment•Non surgical
• Most fractures can be treated by sling and instituting early active motion• In first 18h we can use the ice bag for bleeding limitation
Scapula Fracture• Surgical: following fractures may require open reduction and internal
fixation1. Significantly displaced fractures of the acromion and lateral scapular spine with
retraction of the fragment and encroachment on the subacromial space2. Fractures of the coracoid with acromioclavicular separation3. Glenoid rim fractures
Fracture-Dislocations of the Shoulder
• If shoulder dislocation + great humerus tuberosity fracture• In these cases reduction of the shoulder also will cause tuberosity
dislocation and commonly don’t open reduction
• If close reduction was unsuccessful open reduction is needed.
• If shoulder dislocation + head or neck of humerus• Surgery is needed at first
Proximal Humeral Fractures• Neer classification• Another classification
• Great tuberosity Fracture• Surgical neck fracture
• Diagnosis• Ap shoulder in plan of scapula• Lateral of scapula• Spine axillary view• CT scan if other x rays were not enough
Great Tuberosity Fracture
Etiology•Falling when the arm is abduct and usually are with shoulder joint dislocation•Sudden supraspinatus retraction
Clinical Manifestation•Edema •Painful abduction
Great Tuberosity Fracture
Diagnosis•Lateral x ray•CT
Treatment•3 to 4 weeks with SLING or TRIANGULAR bandage.•If fracture was with displacement it is indication for SURGERY.
Surgical Neck FractureEtiology•Falling
• It could be with no displacement or displacement
Clinical Manifestation•ROM painful and limited•If the fracture pieces stuck together the
Patient can abduct the arm!
Surgical Neck FractureTreatment•Velpeau bandage for 2weeks•In young people with displacement, Surgery should bedone•In old people with displacement it has high risk for avascular necrosis we should replace the fractured pieces with Neer prosthesis or
• Percutaneous pinning• Intramedullary nailing
Acromioclavicular DislocationEtiology
•It is common in the athletes•Falling•It has different types
Clinical Manifestation•Edema and bulging the clavicle •Tenderness in AC joint ligament
Diagnosis •With shoulder AP•If its partial dislocation, radiographies could be normal•If it is complete dislocation, clavicle goes superior to acromion
Acromioclavicular Dislocation
Treatment•It is controversy between the surgical or nonsurgical•For complete dislocation it is better to do operation•For partial SLING is enough•Commonly it doesn't need surgery.
Sternoclavicular Dislocation
Etiology•Falling when the pressure is on the medial side of the shoulder. •In most cases ANTERIOR dislocation, happens but if the POSTERIOR happened it would be more dangerous.
Clinical Manifestation•Swelling in the medial part of the clavicle
Diagnosis•CT scan
Sternoclavicular Dislocation
Treatment•Reduction under the general anesthetic. Sometimes for fixation they use pin
ANT Shoulder Dislocation
Etiology•Falling on the shoulder when the arm is abducted and is in ext rotation.•It is common in the wrestling, epilepsy and electricity Shock
Clinical Manifestation•Deformity in the shape of the arm(two angles on the shoulder)•If circumflex axillary nerve hurts, paresthesia can be detect in lateral and proximal of the arm.(on the deltoid)•We can touch the head of the humerus under the clavicle•ROM is limited and painful
ANT Shoulder Dislocation
Diagnosis•Lateral shoulder X ray
Treatment•Reduction the most common method is Traction and counter traction•Stimson method
POST Shoulder Dislocation
Etiology•Falling on the shoulder when the arm is abducted and in internal rotation.•It is more common in epilepsy and electricity Shock
Clinical Manifestation•Deformity in the shape of the arm•We can touch the head of the humerus posterior of the arm.•ROM is limited and painful
POST Shoulder Dislocation
Diagnosis•Lateral shoulder X ray
Treatment•Reduction •If the reduction was failed Open reduction•if the it was open Dislocation then open reduction
Thanks for your attention