X

Download Shoulder and Humerus Fractures and Dislocations PowerPoint Presentation


Login   OR  Register
X

Share page



  Preview

               
Home / Health & Wellness / Health & Wellness Presentations / Shoulder and Humerus Fractures and Dislocations PowerPoint Presentation

Shoulder and Humerus Fractures and Dislocations PowerPoint Presentation

worldwideweb By : worldwideweb

On : Aug 07, 2014

In : Health & Wellness

Embed :
774
views

0
downloads
Login / Signup - with account for


  • → Make favorite
  • → Flag as inappropriate
  • → Download Presentation
  • → Share Presentation
  • Slide 1 - Shoulder and Humerus Fractures and Dislocations Steve Lan Aug 28, 03
  • Slide 2 - Overview Common shoulder and humerus injuries seen in the ED For each injury Mechanism Physical exam Diagnostic imaging Classification Management Watch out!
  • Slide 3 - Mechanism of Injury
  • Slide 4 - Injuries to be Covered AC separation Clavicle fracture Scapula fracture Shoulder dislocation Humeral Fractures proximal mid shaft
  • Slide 5 - Shoulder Anatomy
  • Slide 6 - How bad is it doc??
  • Slide 7 - AC Separation Mechanism Downward force on tip of shoulder AC and CC ligaments disrupted Watch for associated # of clavicle, coracoid process
  • Slide 8 - Normal AC joint
  • Slide 9 - AC classification – Clinically Grade I Mild tenderness over AC joint, mild swelling Full ROM Grade II Mod/severe pain, clavicle slightly displaced up Grade III Arm kept in adduction, obvious deformity
  • Slide 10 - AC Classification Grade I Mechanism Grade II Grade III
  • Slide 11 - AC Imaging AP shoulder (cephalic tilt) Normal CC distance 1.1-1.3cm (injury if > 5mm on comparison) Axillary lat view ?Stress views - 10-15lbs tied to wrists Watch for os acromiale Secondary ossification centre on distal acromion
  • Slide 12 - AC Separation
  • Slide 13 - Management I and II Conservative (sling, ice, analgesia, physio) 6/52 before lifting III Conservative with late distal clavicle excision Refer to Ortho <72h
  • Slide 14 - Ouch!
  • Slide 15 - Clavicle Fractures Function “strut”, only bony connection to axial skeleton Mechanism direct blow > FOOSH
  • Slide 16 - Clavicle - Physical Exam Gross deformity Palpation potential injury to medial cord (Ulnar N dysfunction)
  • Slide 17 - Clavicle fracture
  • Slide 18 - Clavicle Imaging AP 30 degree cephalad view
  • Slide 19 - Is it Broke?
  • Slide 20 - Classification Proximal/middle/distal third
  • Slide 21 - Clavicle # - Middle third 80% of fractures medial portion - displaced up by sternocleidomastoid lateral portion - displaced down by weight
  • Slide 22 - Clavicle # - Middle third Management Management figure of eight vs sling (J Acta Ortho Scand 58 (1):71-4, 1987) 2-4 wks kids, 4-8 wks adults Kids: possible greenstick – immobilize and recheck in 7-10d Indication for OR (increases risk of non union) - cosmesis, tenting, open, vascular injury
  • Slide 23 - Clavicle Fracture Sling and Swathe
  • Slide 24 - Clavicle Fracture Velpeau
  • Slide 25 - Clavicle # - Distal Third 10-15% Classification I: minimal displacement II: torn CC ligament, prone to non-union III: articular surface (may mistake for 1st AC) Management conservative (J. Acta. Ortho. Scand. 64 (1):87-91, 1993 ?OR for II (BJAS 23(1): 44-6, 1992.
  • Slide 26 - Distal third #
  • Slide 27 - Clavicle # - complications Injury to brachial plexus, great vessels, lungs watch out for floating shoulder if associated with scapular surgical neck #
  • Slide 28 - Scapular Fractures Rare, high energy Males ~30 y.o. Associated with other injuries (lung, rib, clavicle)
  • Slide 29 - Scapular # Clinically If awake, arm adducted Tender, crepitus, hematoma
  • Slide 30 - Scapular # Classification Type I Body and spine Type II Acromion or coracoid process Type III Scapular neck or glenoid fossa Type I Type III Type II
  • Slide 31 - Scapular Fracture
  • Slide 32 - Scapular # - Management Conservative OR Displaced acromial # impinging on joint Associated coracoid # if CC ligament disrupted Scapular neck/glenoid fossa #
  • Slide 33 - Shoulder Dislocation Men 20-30, women 60-80 yo kids more prone to # through growth plate (joint capsule and ligaments 2-5x stronger than epiphyseal plate)
  • Slide 34 - Shoulder Dislocation - Classification Anterior (95-97%) Subcoracoid (most common) subglenoid (1/3 associated with # greater tuberosity, or # glenoid rim) subclavicular Posterior Inferior and superior
  • Slide 35 - Shoulder Dislocation Anterior dislocations Traumatic/nontraumatic Primary/recurrent
  • Slide 36 - Shoulder Dislocation Anterior
  • Slide 37 - Shoulder Dislocation Anterior Clinically Slight abduction, ext rotation Squared off, loss of coracoid process Mechanism abduction+extension+posterior force shoulder capsule torn
  • Slide 38 - Shoulder Dislocation Anterior: Exam Check brachial plexus, Axillary N
  • Slide 39 - Shoulder Dislocation - Imaging Do you want films? Recurrent dislocation vs primary, ?nontraumatic Avulsion # of greater tuberosity in 10-15% True AP Axillary view trans-scapular view Stryker Notch: West point Axillary Apical oblique view
  • Slide 40 - Anterior dislocation
  • Slide 41 - Shoulder dislocation - Management Anesthesia - conscious sedation vs intra-articular lidocaine Reduction (“know three methods well”) External rotation Scapular rotation Stimson’s Milch
  • Slide 42 - Shoulder Dislocation Reductions
  • Slide 43 - Shoulder Dislocation Reductions
  • Slide 44 - Shoulder dislocation - Management Check NV post reduction ? Repeat films (advised by Rosen) Sling and swathe, Velpeau Uncomplicated: sling x 3-4/52 if < 20 y.o., 1-2/52 if > 40 y.o. (early mobilization!) Complications: NV injury, rotator cuff tear, etc. f/u with ortho
  • Slide 45 - Shoulder Dislocation - Complications Bankart lesion primary lesion in recurrent ant instability Hill Sach lesion 35-40% of ant dislocations, predisposes to recurrent injury recurrent dislocation young adults redislocation in 55-95% skeletally mature, < 30yo: ? Early arthroscopic reconstruction (Arthroscopy 15(5) 1999: 507-12)
  • Slide 46 - Shoulder Dislocation Posterior 2-4% of shoulder dislocations Secondary to seizure, direct blow to shoulder Need to dx early to prevent long term complications
  • Slide 47 - Shoulder Dislocation Posterior: clinical features Arm held across chest Adducted Internally rotated Flat and squared off
  • Slide 48 - Shoulder Dislocation Posterior: Imaging AP may appear normal! Loss of half moon elliptical overlap of humeral head and glenoid fossa “Rim sign” – increased distance between ant glenoid rim and articular surface of humeral head “light bulb” – int rotation of humeral head “trough sign” Reverse Hill Sachs (anteromedial impaction)
  • Slide 49 - Shoulder Dislocation Posterior: Imaging
  • Slide 50 - Shoulder Dislocation Posterior: Management Conscious sedation and closed reduction Axial traction, pressure on humeral head, external rotation Complications: Missed Dx: “locked” – ORIF # glenoid rim, tuberosities, humeral head
  • Slide 51 - Shoulder Dislocation Inferior (Luxatio Erecta) Rare Arm locked overhead 110-160 deg abduction, hand resting on head AP radiograph: spine parallel to humerus Reduce with traction
  • Slide 52 - Shoulder Dislocation Inferior (Luxatio Erecta)
  • Slide 53 - Humerus Fractures Proximal Mid shaft Supra condylar
  • Slide 54 - Proximal Humerus Fractures Primarily older population FOOSH, arm pronated limits abduction Older pts #, while younger pts dislocate Both if middle aged Arm held close to body, mov’t limited by pain Tender, hematoma, bruising
  • Slide 55 - Proximal Humerus Fractures 85% minimally displaced – conservative rx Separation along old epiphyseal lines Articular surface (anatomic neck) Greater and lesser tuberosity Humeral shaft (surgical neck) Considered displaced if: > 1cm away > 45 degrees
  • Slide 56 - Proximal Humeral Fractures Neer’s Classification
  • Slide 57 - Proximal Humeral Fractures Minimal displaced 3 part #
  • Slide 58 - Proximal Humerus Fractures Management Minimally displaced # held together by capsule, periosteum, muscles Analgesia, sling and swathe x 3-4/52 2,3,4 part – consult ortho Fracture/dislocation – caution with force, don’t want to displace segments Complications: adhesive capsulitis
  • Slide 59 - Proximal Humeral Epiphysis Rare Usually Males 11-17 FOOSH # through zone of hypertrophy of epiphyseal plate Arm held close to body, swelling Classification: Salter Harris
  • Slide 60 - Proximal Humeral Epiphysis
  • Slide 61 - Proximal Humeral Epiphysis Management Potential for growth disturbance <6 yo : usually Salter I, analgesia, sling and swathe > 6 yo: usually Salter II If > 20 deg need to reduce
  • Slide 62 - Midshaft Humerus Fractures Mechanism Direct blow, severe twisting, FOOSH Obvious deformity, crepitus Shortened limb, rotated Assess radial nerve Exam shoulder and elbow
  • Slide 63 - Midshaft Humerus Fractures
  • Slide 64 - Midshaft Humerus Fractures Management Hanging arm cast (displaced) / Sugar tong (nondisplaced) F/U with ortho in 24-48h overriding #: accept up to 1 inch shortening ORIF unacceptable alignment, radial nerve involvement, segmental #, other upper extremity injuries, pathological #, limited to bedrest
  • Slide 65 - Midshaft Humerus Fractures 1 in prox to #
  • Slide 66 - Midshaft Humerus Fractures
  • Slide 67 - Midshaft Humerus Fractures Children Radial nerve injury is rare accept 1-1.5cm shortening, 15-20 deg angulation 4-6 wks in modified Velpeau or sling and swathe (compliance difficult for hanging cast)
  • Slide 68 - Supracondylar Fracture Usually < 8yo Extension (95%) vs flexion
  • Slide 69 - Supracondylar Fracture- Mechanism
  • Slide 70 - Supracondylar Fracture- clinically Mild swelling to gross deformity arm held to side, immobile, extension S-shaped configuration
  • Slide 71 - Supracondylar Fracture- Classification Gartland I - nondisplaced II - displaced with intact posterior cortex III - displaced fracture, no intact cortex A: postermedial rotation of distal fragment B: posterolateral rotation
  • Slide 72 - Supracondylar Fracture- Management If NV compromise - urgent ortho consult if no response in 60 min may attempt 1 reduction watch brachial artery and median nerve Gartland I - splint and ortho f/u 24h Gartland II - controversy but most get pinned Gartland III - closed reduction and pin
  • Slide 73 - Supracondylar Fracture- Reduction
  • Slide 74 - Spot the #
  • Slide 75 - Spot the #
Dieting Free PowerPoint Template

Dieting

Views : 391

Virtual Identity Free PowerPoint Template

Virtual Identity

Views : 426

DNA Free PowerPoint Template

DNA

Views : 463

Obesity Free PowerPoint Template

Obesity

Views : 745

Credit Debit Card Free PowerPoint Template

Credit Debit Card

Views : 412

Easter Eggs Free PowerPoint Template

Easter Eggs

Views : 618

Question Free PowerPoint Template

Question

Views : 510

Smoking Free PowerPoint Template

Smoking

Views : 450

Statistics and Graph Free PowerPoint Template

Statistics and Graph

Views : 645

Social Media Words Free PowerPoint Template

Social Media Words

Views : 408

Email Symbol Free PowerPoint Template

Email Symbol

Views : 456

Success Achievement Free PowerPoint Template

Success Achievement

Views : 460

Whilte Tulip Free PowerPoint Template

Whilte Tulip

Views : 490

Lab Equipment Free PowerPoint Template

Lab Equipment

Views : 451

Health Tips Free PowerPoint Template

Health Tips

Views : 1025

Back to School Free PowerPoint Template

Back to School

Views : 493

Coffee Free PowerPoint Template

Coffee

Views : 818

Guitar Free PowerPoint Template

Guitar

Views : 884

Yoga Free PowerPoint Template

Yoga

Views : 2341

Yoga Meditation Free PowerPoint Template

Yoga Meditation

Views : 741

Description : Available Shoulder and Humerus Fractures and Dislocations powerpoint presentation for free download which is uploaded by steve an active user in belonging ppt presentation Health & Wellness category.

Tags : humerus fractures | fractures

Shortcode : Get Shareable link