Fracture Help for Adults

Transcription

1 Shoulder injuries injuries in in adults adults Fracture Help for Adults anterior dislocation posterior dislocation inferior dislocation shoulder dislocation tutorial scapula neck of humerus greater tuberosity fracture-dislocation normal AP X-ray view normal axillary X-ray

2 Shoulder anatomy anatomy on on AP AP X-ray X-ray AP X-ray clavicle scapula

3 Shoulder anatomy anatomy on on axillary axillary X-ray X-ray axillary X-ray view anterior neck of humerus posterior

4 Types of of shoulder dislocation dislocation Fracture Help for Adults anterior posterior inferior 97% 3% 0.5%

5 Dislocated shoulder shoulder in in ER ER Adults with a dislocated shoulder must first be assessed for a traction injury to their axillary nerve (deltoid paralysis and badge patch numbness) or to their radial nerve (wrist drop). The patient should have intravenous access and have given written consent before trying to reduce the shoulder in the ER under light sedation.

6 Anterior dislocation dislocation of of shoulder shoulder squared off contour to shoulder socket is empty on AP X-ray mechanism is abduction extension and external rotation axillary nerve is at risk

7 Anterior shoulder shoulder dislocations dislocations After reduction of an anterior dislocation of their shoulder (having assessed axillary nerve function) adult patients are discharged from the ER with: analgesia (Acetaminophen ± Ibuprofen) Polysling CT scan shoulder clinic appointment

8 Posterior dislocation of of shoulder shoulder look for an abnormal gap between humeral head and the glenoid mechanism is internal rotation and adduction in a FOOSH (occurs in < 5% of all shoulder dislocations) light bulb sign is due to internal rotation of arm

9 Posterior shoulder dislocations dislocations After reduction of a posterior dislocation of the shoulder using iv sedation (and having ruled out epileptic fitting as a cause of the dislocation) the patient can be discharged from the ER with: analgesia (Acetaminophen ± Ibuprofen) Polysling and shoulder clinic appointment (CT scan)

10 Inferior shoulder dislocation dislocation of shoulder arm is held above head in hands up position or luxatio erecta motorcycle collision is usual cause due to hyperabduction of arm brachial plexus and axillary artery are at risk in this rare injury

11 Inferior shoulder dislocations dislocations Inferior dislocation of the shoulder is very rare. The patient must be admitted from the ER for: analgesia (iv Acetaminophen or Morphine) check neurovascular status of arm keep NBM (for MUA) operation on emergency list in the OR

12 Fracture-dislocation of of shoulder shoulder avulsion fracture of rotator cuff attachment to greater tuberosity brachial plexus is at risk axillary artery is at risk

13 Shoulder fracture-dislocations Adults with a fractured humeral neck combined with a complete dislocation of the humeral head need emergency admission from the ER for: analgesia (iv Morphine) CT scan keep NBM (for ORIF with plate) operation on next trauma list in the OR

14 Greater tuberosity tuberosity fracture fracture avulsion fracture of rotator cuff attachment to greater tuberosity

15 Greater tuberosity tuberosity fractures fractures Adults with an isolated greater tuberosity fracture of the head of the humerus can be discharged from the ER with: analgesia (Codeine ± Acetaminophen) Polysling CT scan if fracture is displaced may need operation (ORIF with sutures) shoulder clinic appointment

16 Neck of of humerus humerus fracture fracture neck of humerus (NOH) fracture types comprise either 2, 3 or 4 parts: 1 head of humerus 2 shaft of humerus 3 greater tuberosity 4 lesser tuberosity

17 Neck of of humerus humerus fractures fractures Adults with a fractured neck of humerus (NOH) and normal axillary nerve function can usually be discharged from the ER with: analgesia (Codeine ± Acetaminophen) collar and cuff sling CT scan if off-ended may need operation (ORIF with plate) fracture clinic appointment

18 Scapular fracture high energy transfer required to fracture blade of scapula may contuse lung

19 Scapular fractures ALL patients with fractures of the scapula must be assessed for neurologic injury to their upper limb and for injuries to their thorax (contused lung). They are often admitted from the ER for: analgesia (Codeine or Morphine) Polysling CT scan observation with pulse oximetry