Orthopedic Care and Consultation
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.
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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.
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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
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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...]
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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...]
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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...]
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Anteroposterior view of shoulder revealing posterior dislocation
Posterior dislocation is rarer as compared to anterior dislocation. When it occurs damage to the structures is much more owing to the force required for disruption of the joint.
These patients present with pain and deformity. The patients have much more pain than those with acute traumatic anterior dislocations.
After the clinical examination and xrays the diagnosis can be reached at with certainty. A greater damage to the glenoid and humeral head may be evident on xrays.
Careful note is made of associated fractures, including the extent of the impression fracture of the anteromedial humeral head.
Closed reduction should be caried out as soon as possible.
Because of associated muscle spasms, the reduction may not be achievable with sedation and muscle relaxants. [Read more...]
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Like any other dislocation acute dislocations of the glenohumeral or shoulder joint should be reduced as quickly and gently as possible. There are many advantages of early reduction of shoulder dislocation.
If patient reports within short time, some dislocations can be reduced without medication especially in thinly built patients. Reduction is difficult without medications if patient is very muscular , dislocation is of a long standing duration, the dislocation is locked in soft tissue. [Read more...]
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There would be history of trauma to shoulder and patient would present with severe pain in the shoulder.
The shoulder would be held in position of typical attitude depending on direction of dislocation.
Anterior Dislocation
The physical examination is almost diagnostic.
Muscles are in spasm because there is an attempt to stabilize the joint. The head of humerus may be palpable anteriorly especially in case of thin patients. The glenoid area appears hollow. The attitude of uper limb is abduction and external rotation at the shoulder.
Patient is unable to perform adduction and internal rotation (Duga’s Test).
A detailed examinaton to look for neural and vascular injury should be done. Axillary nerve is a commonly injured nerve in anterior dislocaion of shoulder, therefore should be always looked for.
Posterior Dislocation
The shoulder is held in the traditional sling position of adduction and internal rotation. The classic features of a posterior dislocation include:
In both kind of injuries treatment is reduction of the dislocation preferably closed
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Radiography is a very important aid in making and confirming diagnosis of shoulder dislocation. It also helps to find if any associated injuries.
To make a wholesome diagnosis of the injury, the physician needs to know the following
Following views are used around the shoulder [Read more...]
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Xray of Fracture Of Scapula 21 seconds ago
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