FractureofUpperExtremitiesLiangChen,MDPhDDeputyChiefPhysicianandAssociateResearchFellowDepartmentofOrthopaedicsThe2ndAffiliatedHospitalofCQMUSChongqing,China400010HotTipBonethatcomposeupperlimb:CompanyLogoThegirdleofupperlimb——clavicleandscapularThefreeboneofupperlimb——humerus,radius,ulna,carpale、metacarpal,phalange.ContentsFractureofClavicle1FractureofHumerus2FractureofRadiusandUlna3FRACTUREOFCLAVICLESectionIFractureofClavicleAnatomy:Thegeneralviewofanatomy：Theshapeis“S”.Locatedposition:Superficial.Proximalend—sterno-clavicularjoint.Distalend—acromio-clavicularjoint.CompanyLogoSternalendAcromionendFractureofClavicleacromioclavicularjoint&sternoclavicularjointCompanyLogoFractureofClavicleImportantmechanicalroles:interconnectingtheupperextremityandthorax,maintainingdistancebetweenthemSuspensionofthescapulabyacromioclavicularjointprotectingsubclavicularvesselsandnervesCompanyLogoFractureofClaviclePathogenesis

IndirectForce：

byappliedthroughtheoutstretchedupperextremitybyforcedinwardrotationoftheshoulder

Directforce:

SomethingfellontotheshoulderAccountingfor5%to10%ofallfractureintheadultpopulationCompanyLogoFractureofClavicleClassification:oblique,transverse,comminutedfracturegreenstickfractures(childrenusually)CompanyLogoFractureofClavicleClassification:MostclassificationschemesareaccordingtofracturesiteGroup1:withinthemiddlethirdandarethemostcommonsite(accountingfor80%)Group2:occurwithinthedistalthirdandareoftentheresultsofdirecttraumatotheregion(accountingfor10%)Group3:relativelyuncommon,involvingthemedialendoftheclavicleCompanyLogoFractureofClavicleDisplacementofmiddlethirdfractureMedial

fragmentwasdisplacedsuperiorlyandposteriorly

SternocleidomastoidM

Lateralfragmentwasdisplacedinferiorlyandanteriorlyweightofarmand

PectoralismajorMCompanyLogoFractureofClavicleClinicalfeaturesAdequatehistory::detailsthemechanismofinjuryandascertainthepresenceandabsceneofadditionalregionalorremotetrauma.Specialpose:supportingthearmonthesideoffractureatthesideofthebodyreluctanttomoveitowingtopainCompanyLogoFractureofClavicleClinicalfeaturesObservation:

deformity,openwoundsSubclavianvesselscompromise:

asymmetricpulseorpulsatilehematomaBrachialplexusinjury:

neurologicalexaminationCompanyLogoFractureofClavicleDiagnosisThehistoryoftraumaclinicalmanifestationX-rayfilmCompanyLogoFractureofClavicleTreatmentNon-operativemethods:nondisplacedorminimallydisplacedfracturearetreatedwithasling

forcomfort.Adultneedtowearaslingfor4-6weeksCompanyLogoFractureofClavicleFigure-of-8straptomaintaintheshoulderinaretractedpositiontoimprovethealignmentoffracture.CompanyLogoFractureofClavicleSurgicaltreatmentindication1Neurovascularinjuries2Openfracture3Lesionsinmutil-fractureindividuals.

Operationwouldfacilitatemobilizationandnursing4Atrophicnon-unionCompanyLogoFractureofClavicleCompanyLogoFractureofClavicleResultsThemajorityofclaviclefractureshealuneventfullyNeerreportedthatlessthan1%failtouniteFactorsinfluencingunionDegreeofdisplacement:

greatthan2.5cmofoverlap,greatthan1.0cmbetweenfragmentsSoft-tissuestrippingandinterpositionCompanyLogoFRACTUREOFHUMERUSSectionIIPartI:FractureofsurgicalneckofhumerusPartII:FracturesofhumeralshaftPartIII:SupracondylarFracturesSectionII-PartIPartI:FracturesofSurgeryNeckofHumerusFractureofsurgicalneckofhumerusThegeneralviewofanatomyInferiortotheanatomicalneckofhumerus2-3cm,justlocateintheintersectionofthecompactboneandspongybone,soitiseasetobefracturedCompanyLogoFractureofsurgicalneckofhumerusTherearebrachialplexusandaxilvesselsmediallytothesurgicalneckofhumerus,it'spossibletobeinjuriedCompanyLogoFractureofsurgicalneckofhumerusEtiologicalfactorIndirectforceisthemostcausesoffracture,themaincasesareadultsandoldpeopleCompanyLogoFractureofsurgicalneckofhumerusclassificationAccordingtothedisplacementandthedirectionofdisplacement,thefracturescanbeclassified.NodisplacementtypefractureAbductiontypefractureAdductiontypefractureComminutedtypefractureCompanyLogoFractureofsurgicalneckofhumerusNondisplacementfractureFissuredfracture:causedbydirectviolencemostly.Compactfracture:causedbyindirectviolencemostly.ClinicalmanifestationPain,swelling,ecchymosis,dysfunctionoftheshoulder.DiagnosisHistoryoftrauma,clinicalmanifestationandxray.TreatmentSling

with

triangularbandage,andearlyexercise.

CompanyLogoFractureofsurgicalneckofhumerusAbductiontypefractureIndirectviolence:Handtouchontheground→violenttransmitalongthelimb→theaffectedlimbabduct→abductiontypefracture.ClinicalmanifestationPain,swell,ecchymosis,dysfunctionoftheshoulder.Xfilm:theproximalfragmentadduct,thedistalfracturepieceabduct,angulationdisplacementorlateraldisplacement,oroverlapdisplacement.Diagnosis

Thehistoryoftrauma,clinicalmanifestationandxray.

PayattentiontoinjuryofnervesandbloodvesselsCompanyLogoFractureofsurgicalneckofhumerusTreatmentLocalanesthesiaandmanipulativereduction,externalfixationwithsplint.OpenreductionandinternalfixationCompanyLogoFractureofsurgicalneckofhumerusCompanyLogoAdductiontypefractureIndirectviolence:falldownwiththehandandelbowtouchontheground→violencetransmittotheshoulderalongtheaxisofthearmClinicalmanifestationPain,Swell,ecchymosis,dysfunctionoftheshoulder,XfilmDiagnosisThehistoryoftrauma,clinicalmanifestationandxray.

PayattentiontoinjuryofnervesandvesselsTreatmentlocalanesthesiaandmanipulativereduction,externalfixationwithsplint,shouldabduct70°withabductframe.Openreductionandinternalfixation.FractureofsurgicalneckofhumerusCompanyLogoComminutedfractureStrongviolenceandosteoporosis,mostcasesareoldpatients.ClinicalmanifestationPain,

swell,ecchymosis,dysfunctionoftheshoulder.Xrayshowthenumber,thesizeandthelocationofthefragments.DiagnosisThehistoryoftrauma,clinicalmanifestationandXray.TreatmentConservativetreatment：slingwithtriangularbandageorbonetractionandsplintfixation.Operationtreatment：openreductionandfixationwithscrewandplatePayattentiontoinjuryofnervesandbloodvesselsSectionII-PartIIPartII:FracturesofHumeralShaftFracturesofHumeralShaftCompanyLogoPrefaceAccountingfor1%-3%ofallfracturesAssociatedneurologicinjuriesoccurwiththesefracturesFracturesofHumeralShaftCompanyLogoAnatomyOnthebackofthemiddlethird,thereisashallowspiralgrooveforradialnerveonthebone2cmproximaltosurgicalneck2cmdistaltosupracondyleFracturesofHumeralShaftCompanyLogoPathogenesisDirectforce：blow,sharptraumaIndirectforce:pitching,wrestling,afallontheoutstretchedextremityClinicalfeaturesAdequatehistoryAssociatedwithswelling,ecchymosis,pain,deformityoftheupperarmAcarefulsoft-tissueandneurologicalexaminationshouldbeperformedSensory:dorsalfirstwebspaceMotor:extensionofthewristandmetacarpophalagealjointthewristandmetacarpophalagealjointcannotbeactivelyextendedFracturesofHumeralShaftFracturesofHumeralShaftCompanyLogoRadiographicevaluationIncludingtwoorthogonalradiographicviews(anteroposteriorandlateral)ofhumeralshaftandadjacentjoint(shoulderorelbow)FracturesofHumeralShaftCompanyLogoDisplacementoffragmentsAfracturebetweentheinsertionofthepectoralismajorandthedeltoid1.The

proximal

fragmentisadductedbythepectoralismajor,teresmajorandlatissimusdorsi.2.The

distalfragmentisshortenedanddisplaced

laterally

bydeltoidFracturesofHumeralShaftCompanyLogoAfracturebelowthedeltoidinsertionThe

proximalfragmentisabductedbydeltoidThe

distal

fragmentisdisplacedproximallybybiceps

and

tricepsTreatmentClosedmanagement:nonsurgicaltreatmentresultsinhigherincidenceofunionandfewercomplicationthanopenreductionandinternalfixationSplint:

theuseofthistechniquerequiresfrequentadjustmentstomaintainfracturealignmentandcomfort(nottoolooseningandtootightening)

FracturesofHumeralShaftHangingarmcast:Thehumer