Orthopedic Care and Consultation
The xray in the image belongs to 24 years old man who sustained the injury following fall from bike and landing on shoulder.
There is a small ship of greater tuberosity probably as result of avusion injury. The fracutre has been managed conservatively.
Note: The xray is not a good quality. But it was interesting xray, therefore I could not resist myself from publishing.
The xray belongs to 70 years old female who fell in the bathroom and suffered from injury in the right shoulder.
The xray revealed fracture of greater tuberosity along with dislocation of shoulder.
The patient was treated with closed reduction under general anesthesia.
The above xray is taken after the closed reduction. The patient was advised fixation for greater tuberosity fracture but refused.
Fracture upper end humerus are common fractures in children as well in adults and elderly. However fractures behave differently in different age groups.
While elderly patients can be treated on conservatively The fractures in an adult on the other hand would require operative treatment owing to the increased demands and active life style.
Most of these fractures in children also unite on conservative treatment. Only those fractures which are severely displaced would need an operative intervention.
The following xrays are of 10 years old child who suffered fracture of upper end of humerus after he fell from height while he was flying a kite.
The fracture is severely displaced as can be seen in the picture. [Read more...]
There could be times when doubts arise in interpretation of history and xrays. Following entities may be considered in differentials of scapular fractures
Epiphyseal Lines
An ossification pattern of the scapula should be known to avoid this confusion. At birth, the body and spine of scapula form one ossified mass, with the coracoid, acromion, glenoid, and inferior angle all being cartilaginous.
At 3 to 18 months, a center of ossification, appears at the mid-coracoid.
At 7 to 10 years, the coracoid base, including the upper third of the glenoid, appears.Sometimes called a subcoracoid bone and it joins the rest of the coracoid at 14 to 16 years. [Read more...]
Fracture of scapula often occur as a result of direct trauma to it. Most of the scapular fractures can be managed on conservative treatment.
This is an xray picture of 48 years old male who fell on the ground and landed on his shoulder after his bike god skidded.
The patient also had closed fracture tibia which was treated with closed reduction and interlock nailing.
The fracture in the picture was treated by keeping the limb in an arm pouch.
Fractures of upper end or proximal humerus are common in all ages and the fracture pattren varies with age. While young adults suffer this injury with high velocity trauma, the fracture can occur with trivial trauma in old age.
This is due to osteoporosis in old age.
While the fracture upper end humerus requires surgical intervention in young adults more commonly, in older patients the fracture may be treated conservatively.
The xray in picture belongs to a 75 years old lady who suffered this injury following fall on hand in her bathroom.
The patient was put on broad arm sling and treated conservatively.
Till last follow up the fracture had started showing signs of union.
Greater and lesser tuberosity fractures are well known fractures of upper end of humerus. Out of these two greater tuberosity is commoner than lesser one.
These fractures are quite often missed in the emergency. This may occur due to following reasons
A large number of patients with fractures of proximal humerus can be managed with non operative methods. The principle of treatment by conservative methods is early protection combined with gradual mobilization.
Elderly people accept non operative treatment quite well. Even deformities like displacement and angulation are taken very well by these patients. Angulation is well compensated for by shoulder motion. [Read more...]
Majority of the proximal humeral fractures occur in older patients. This is so because older patients have osteopenic or osteoporotic bones which get damaged easily by trivial trauma. High energy trauma can produce these fractures in any person of any age.
Mechanism
Most of these fractures occur due to a simple fall on the arm. Strong muscular contraction might be responsible in the setting of electric shock or seizure. [Read more...]
The scapula is a bone that sits congruently against the ribs and stabilizes the upper extremity against the thorax.
It links the upper extremity to the axial skeleton through the glenoid, the acromioclavicular joint, clavicle, and the sternoclavicular joint.
Fracture of the scapula is not that common. The low incidence of scapular fractures has been attributed to thickened edges, great mobility with recoil, and its layers of muscle around it. The fractures generally occur in young patients. [Read more...]
Join Discussions