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EXTREMITIES FRACTURES

Rima Zakiyah
Desember 2014
CLAVICULAR FRACTURE
Extremely common
Mx: Fall on outstretched hand, fall onto
outside of shoulder, direct hit to clavicle
Treatment: Figure-of-8 sling; No
activities that exacerbate pain; full
recovery in 12 weeks.
SCAPULAR FRACTURE
Uncommon
Scapular body fx are the most common type
Commonly (80-90%) associated with other
injuries lung and chest
Dont require surgery

GLENOID (cartilage) fracture requires


surgery when unstable or fragments are far
out of alignment
HUMERUS FRACTURE
Proximal occur near the shoulder joint;
treatment depends on rotator cuff tendon
position
Mid-shaft Injury to radial nerve causes wrist
drop and numbness of the hand dorsum
Distal are uncommon in adults; often require
surgery
Most heal without surgery
Over 90% with nerve injury have complete
recovery of nerve in 3-4 months
HOLSTEIN-LEWIS FRACTURE
Distal third humeral fracture
18% are associated with radial nerve palsy,
particularly if break is between middle and
distal thirds of humerus
Due to direct blow or torsion injury
ULNAR FRACTURE
Forearm is struck by an object
Nightstick Fracture

Treatment of isolated ulnar fx: cast or


brace; surgery if unstable
MONTEGGIA FRACTURE
Giovanni Monteggia 1814

Fracture of Ulna
Dislocation of radial head within the elbow
joint

Treatment: Surgery
RADIAL HEAD
Most common part broken in elbow
fracture
Most common caused by fall onto
outstretched hand
+/- surgery depending on displacement
GALEAZZI FRACTURE
Fracture of Radius
Injury of the distal radio-ulnar joint of
wrist (shortening and dislocation of distal
ulna)
Mechanism: fall on outstretched hand
with elbow flexed
Treatment: Surgery to repair radius, then
inspection of distal radio-ulnar joint
NURSEMAIDS ELBOW
Common in young children (< 5 yo)
Subluxation of radius at elbow joint bone
has slid out of proper position
Classically a sudden pull on childs arm
If treated (replaced) quickly, immobilization
is not necessary
For multiple subluxations, cast to allow
ligaments to heal
SMITHS FRACTURE
Fracture of distal radius near the wrist joint
Volar/anteriorly displacement (in front of
normal position)
Most common found after falling on to the
back of the hand
Often referred to as a reverse Colles fracture .
Treatment: Requires fixation
Smith Fracture
COLLES FRACTURE
Fracture of distal radius
Displaced posteriorly (behind normal
position)
Most common after fall onto outstretched
hand

Treatment: Cast +/- surgery, depending


on shortening and displacement of radius
SCAPHOID BONE FX
BOXERS FRACTURE
Classically at the base of 5th metacarpal
(metacarpal neck)
Seen after punching person or object
Treatment: casting or surgery (pins)
BENNETTS FRACTURE
Intra-articular fracture/dislocation of base
of 1st metacarpal
Mechanism: forced abduction of thumb

Treatment: open reduction and internal


fixation
ROLANDO FRACTURE
Fracture through thumb metacarpal base
Comminuted intraarticular fracture

Prognosis is worse than Bennetts


Treatment: open reduction and internal
fixation
INTERTROCHANTERIC HIP FX
Occurs lower than femoral neck fracture
Bone blood flow is usually intact, so repair,
not replacement is performed

Treatment: Metal plate and screws


FEMORAL NECK FRACTURE
Just below the ball of the ball-and-socket
hip joint
The ball is disconnected from rest of the
femur
Blood supply is often disrupted, so theres
a high risk of non-healing

Treatment: Often with partial hip


replacement, esp if > 65 yo
FEMORAL SHAFT FX
Severe injury

Treatment: Intramedullary rod (Most


commnon), plate and screws, or external
fixator
SUPRACONDYLAR FEMUR FX
Unusual injury just above knee joint
High risk of knee arthritis later
More common in pts with severe
osteoporosis and those with previous knee
replacement surgery

Treatment: Cast, brace, external fixator,


plate, screws, intramedullary rod
PATELLAR FRACTURE
Fall onto knee cap or when quadriceps is
contracting, but knee joint is straightening
(eccentric contraction)
Attempt straight leg raise
yes? Non-operative treatment may be possible
no? surgery combo of pins, screws, and wires
TIBIAL PLATEAU FRACTURE
Just below knee joint
Involves the joint cartilage risk of
arthritis

Treatment: If non-displaced, may be


treated without surgery. Surgery for
displaced fractures
TIBIAL SHAFT FRACTURE
Most common type of tibial fracture
Most can be treated by long leg cast
May require plates, screws, external
fixator, or intramedullary rod
TIBIAL PLAFOND FRACTURE
Tibial Pilon Fracture
End of shin bone and involves ankle
Soft-tissue around ankle may be
problematic if very swollen makes
surgery difficult

Treatment: casting, external fixation,


limited internal fixation, internal fixation,
ankle fusion
POTTS FRACTURE
Fracture of the lower end of fibula with
displacement of tibia
Causes the foot to turn out
TALUS FRACTURE
Complications:
Ankle arthritis
Subtalar arthritis
Foot deformity
Avascular necrosis
CALCANEUS FRACTURE
Fall from heights
Like an orange if you stand on it, the
calcaneus widens and squashes flat
Inversion and eversion are affected
(subtalar joint between talus and
calcaneus)
FRACTURES OF
5th METATARSAL
Avulsion Fx: Dancers fracture; tiny
flecks of bone are pulled off by attached
tendon; heal well in cast
Jones Fx: occurs at proximal end (in
midportion of foot); cast for 6-8 wks
Avulsion (Dancers)
Jones fracture
TORUS FRACTURE
Buckle fracture
Compression fracture of a long bone,
mostly in children; usually occurs near
metaphysis
Better seen on lateral films
Distal radius is most common site
Treatment: well-fitting immobilizing cast
for 2-4 weeks
GREENSTICK FRACTURE
Usually from a quick twisting motion
occompanied by axial compression such as
a fall backwards on the outstretched hand
Supinated twist palmar angulation
Pronated twist dorsal angulation
No disruption of cortex; may have
buckling on opposite side of bone from the
break; incomplete break
THE END
Wassalam

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