Fracture ClavicleFracture Clavicle♥ Most common bone to be Most common bone to be

broken.broken.♥ Common in childrenCommon in children♥ Lat. fragment displaced Lat. fragment displaced

downward, forward, and downward, forward, and medially.medially.

* Clinically :* Clinically : -- local pain, tenderness… local pain, tenderness… -- patient supports the patient supports the

affected limb with affected limb with other hand & tilting other hand & tilting hishis

head to the fr. side. head to the fr. side.

TreatmentTreatment: : ♥Reduction +♥ figure 8- shaped bandage .

♥Complications : - mal- union . ( but no effect on function ) - non-union

Indication for operative treatment

1. Nonunion.2. Neurovascular involvement3. Unstable Fracture of the lateral end

near the acromioclavicular joint in an adult

4. A persistent wide separation of the fragments with interposition of

soft tissue1. Floating shoulder

Fracture Scapula♥ usually no displacementusually no displacement♥ Supported by muscles on Supported by muscles on

both sides.both sides. Treatment :Treatment : -- arm sling . arm sling .

1- floating shoulder

2- major displaced glenoid fracture

Indications for operative treatment

Fracture HumerusFracture Humerus♥ Proximal humerus Proximal humerus

( Surgical neck, greater ( Surgical neck, greater tuberositytuberosity

♥ ShaftShaft♥Distal humerus : Distal humerus : -- supra condylar fr. supra condylar fr. -- intercondylar fr. [ intercondylar fr. [ T T oror

Y Y fr.fr. ]] -- fr. med. or lat. fr. med. or lat.

epicondyles .epicondyles .

Fr. Surgical neck :♥ Treatment :Treatment : - - impacted : impacted :

strappingstrapping - - displaced : displaced :

reductionreduction U.G.A., then U.G.A., then

strapping.strapping.

♥ Surgical reduction Surgical reduction and fixation with and fixation with

- K-wire- K-wire - plate and screws- plate and screws - intramedullary - intramedullary

interlocking nailinterlocking nail

Fr. Shaft humerusFr. Shaft humerus* * TreatmentTreatment : : -- stable, transverse fr. : stable, transverse fr. : try conservative ttt.try conservative ttt. - - unstable oblique or unstable oblique or comminuted fr. : comminuted fr. :

O.R.I.F.O.R.I.F. [ interlocking I.M.N., [ interlocking I.M.N., plate and screws, plate and screws,

malleable medullary nails malleable medullary nails or ext. fixator ]or ext. fixator ]

Int. fix. of fr. humerusInt. fix. of fr. humerus

Plate and screws Interlocking nail

Most important complicationMost important complication : : Radial N. injury, Radial N. injury, [[ manifested by wrist drop manifested by wrist drop ]]..Non-unionNon-union

Supra condylar fractures : Supra condylar fractures : ♥ Common in childrenCommon in children♥ Extension, or flexion Extension, or flexion

typestypes♥ Clinically :Clinically : pain, swelling, pain, swelling,

ecchymosis, .. ……..ecchymosis, .. ……..

TreatmentTreatment :♥ In children :In children : - urgent reduction + post.slab- urgent reduction + post.slab - if unstable : percutaneous - if unstable : percutaneous

wires .wires . - ORIF with wires, if - ORIF with wires, if

irreducibleirreducible

♥ In adults :In adults : O.R.I.F. with O.R.I.F. with plates and screwsplates and screws

Complications of S.C. fr. :♥Mal-union : altered carrying Mal-union : altered carrying

angleangle -- cubitus varus cubitus varus - - cubitus valguscubitus valgus

♥ Joint stiffness : due toJoint stiffness : due to - - adhesionsadhesions -- mal-union mal-union

Cubitus varus

♥ Vascular complications :** AcuteAcute ischaemiaischaemia : due to : due to vascular injury, edema, vascular injury, edema,

tight cast.tight cast.Management of acute Management of acute

ischaemia :ischaemia : -- urgent reduction of the fr. urgent reduction of the fr. -- release of tight cast or release of tight cast or

bandagebandage -- systemic vasodilators systemic vasodilators -- if no improvement : surgical if no improvement : surgical exploration.exploration.

Volkmann’s ischaemic contracture :Volkmann’s ischaemic contracture : Fibrosis of deep forearm Fibrosis of deep forearm

muscles muscles [ F.D.P.][ F.D.P.] due to due to prolonged ischaemia.prolonged ischaemia.

♥Treatment : Treatment : surgical excision of fibrosed muscles + surgical excision of fibrosed muscles + tendon operations tendon operations [[ transfer or lengtheningtransfer or lengthening ]]

Intercondylar fracturesIntercondylar fractures♥ T or Y – shaped fr.T or Y – shaped fr.♥ Intra-articularIntra-articular

[[ affecting affecting the joint surfacethe joint surface ] ] . .

♥ Treatment :Treatment : -- Open reduction Open reduction

internal fixation to internal fixation to restore restore

smooth articularsmooth articular surface.surface.

Fr. of the humeral condylesFr. of the humeral condyles: : ♥ Avulsion fr. of the med. Avulsion fr. of the med.

or lateral condyles.or lateral condyles.♥ Common in children.Common in children.♥ Treatment :Treatment : -- O.R.I.F. by K. wire. O.R.I.F. by K. wire.

Fracture head radiusFracture head radius♥ Intra-articular fr.Intra-articular fr.

♥ Treatment :Treatment : -- large fragment : I.F. large fragment : I.F. -- comminuted fr. : comminuted fr. :

excision, orexcision, or arthroplasty: head arthroplasty: head

prosthesisprosthesis

Fracture olecranon♥ Intra articular fractureIntra articular fracture♥ Treatment :Treatment : -- O.R.I.F. : by tension O.R.I.F. : by tension band wiringband wiring - plate fixation if - plate fixation if

comminutedcomminuted

Monteggia Fracture-Dislocation♥ FR. upper 1/3 ulna + FR. upper 1/3 ulna +

dislocation of the dislocation of the superior R-U joint.superior R-U joint.

♥ Types : Types : -- extension type extension type - flexion type - flexion type - lateral type- lateral type♥ Treatment :Treatment : O.R.I.F. of the ulna.O.R.I.F. of the ulna.

Galeazzi Fracture-Dislocation

fracture of the distal third of the shaft of the radius and dislocation of the distal radioulnar joint

Treatment: Open Reduction

Internal Fixation of the radial fracture plating

Fracture both bones forearm♥ in children : usually green-stick.in children : usually green-stick. treatment : closed reduction and treatment : closed reduction and

above elbow cast fixationabove elbow cast fixation♥ In adults : treatment eitherIn adults : treatment either -- conservative: closed reduction conservative: closed reduction + plaster fixation+ plaster fixation - - if failed O.R.I.F.if failed O.R.I.F. plate & screws or nailsplate & screws or nails♥ Complications :Complications : -- mal-union mal-union -- cross union cross union

Colles’ fracture♥ Fr. distal 1 inch of the radius,Fr. distal 1 inch of the radius, with or without avulsion of with or without avulsion of

the the ulnar styloid .ulnar styloid .

♥ Common in old age due Common in old age due to osteoporosis.to osteoporosis.

Displacement of the distal fragmentDisplacement of the distal fragment: : ♥Backwards, upwards,Backwards, upwards, and laterally. and laterally. ( displacement and tilt )( displacement and tilt )

♥ Clinically :Clinically : - - pain, tenderness……. pain, tenderness……. - - dinner-fork dinner-fork

deformity.deformity.

Treatment :♥ Closed reduction + plaster fixationClosed reduction + plaster fixation♥ If comminuted, with intra-articular If comminuted, with intra-articular extension of the fr. ( Barton) extension of the fr. ( Barton) O.R.I.F.O.R.I.F.

♥ Complications :Complications : - - mal-union mal-union rupture E.P.L. tendon.rupture E.P.L. tendon. -- Sudeck’s atrophy. Sudeck’s atrophy.

Fracture scaphoid♥may be impacted,not evident early in x-may be impacted,not evident early in x-

ray.ray.♥ Clinically : max.tenderness in snuff-boxClinically : max.tenderness in snuff-box♥ Treatment: immobilization in scaphoid Treatment: immobilization in scaphoid

cast.cast.♥ Complications :Complications : - non-union and AVN of prox.- non-union and AVN of prox. fragment.fragment. ** Treatment of non-union : Treatment of non-union : -- I.F.+ B.G. I.F.+ B.G. - - late cases with O.A. wrist:late cases with O.A. wrist: arthrodesis.arthrodesis.

Fractures of the metacarpals and phalanges:

♥ Easily treated by :Easily treated by : - closed reduction - closed reduction to correct deformityto correct deformity + plaster fixation.+ plaster fixation.

Bennet’s fracture: ♥ Fr. Base 1Fr. Base 1stst. metacarpal, . metacarpal,

extending into the 1extending into the 1stst carpo- carpo-metacarpal joint.metacarpal joint.

♥Usually needs I.F. Usually needs I.F. by k. wire.by k. wire.