Fractures of pectoral girdle arm & elbow

Fractures of Pectoral Girdle, Arm & Elbow

Dr. Wahby Ghalib CABMS, FJMC, MRCS

Clavicle

Suspends the U.L. to the axial skeleton

Mechanism

Fall on outstretched hand Fall on shoulder Direct

Middle third #

Commonest Displacement : by scm & wt. of arm

Lateral third #

Lateral or medial to the CC ligament

Rx

Arm sling : 3w IF : open # NV injury lateral 1/3 with displacement

Scapula

# of the body occurs in multitrauma pt.


Rx


Arm sling Glenoid : IF in # taking 25% or displacemnt > 2 mm

Proximal humerus #

Usually in osteoporotic bone Displacement in 20% May be # dislaocation

Neer`s classification

Rx

Arm sling CR + arm sling ORIF

Complications

Most commonly injured nerve : axillary AVN : in anatomic neck #

Humerus shaft #

Direct Fall on outstretched hand Fall on elbow Mets

Radial nerve injury

10-15% Site How to examine?

Holstein – Lewis # : distal 1/3 humerus # that may be associated with radial N. inj.


Rx

Hanging cast or back slab f. brace

Sarmiento brace

ORIF

Vascular inj. Nerve inj. post-manipulation Unaccepted position Multi-trauma pt. Segmental # Pathologic # Open # Floating elbow Intra-articular extension Nonunion

Supracondylar # in children

Child 5-10 yrFall on outstrethed hand  distal fragment tilt posteriorFall on elbow  distal fragment tilt anterior

Classification (Gartland)

I : undisplaced II : posterior cortex intact III : both cortices broken


Rx

I : back slab II : CR + back slab III : CR + K. wires ORIF : if CR fails

Complications


Brachial a. inj Nerve inj. : anterior interosseous Compartment s. Cubitus varus Myositis ossificans

# separation of the lateral condylar epiphysis

Displacement by the wrist extensors 2 types : Salter-Harris 4 & 2 (Milch)


Rx

If displaced > 2mm  ORIF

Complications

Nonunion AVN Cubitus valgus or varus

Pulled elbow


Subluxation of the radial head Child 2-3yr Forearm in pronation & extension XR : -ve Reduction

Radial head #

Fall on outstretched hand May be associated with : MCL injury DRUJ (Essex-Lopresti injury)

Classification (Mason)

I : displaced < 2mm II : displaced > 2mm III : comminuted #



Rx


I : arm sling 4d then exercise II : ORIF III : radial head excision but not if MCL or Essex-Lopresti inj.

Olecranon #

Comminuted # : in elderly direct trauma extension is intact arm sling  exercise


Transverse # : triceps contraction extension disrupted back slab or ORIF

Thanks