Property of Department of Orthopedic, Faculty of Medicine, University of Zagazig, Egypt

3. Fracture ClavicleFracture Clavicle
♥ Most common bone to be broken.Most common bone to be broken.
♥ Common in childrenCommon in children
♥ Lat. fragment displaced downward,Lat. fragment displaced downward,
forward, and medially.forward, and medially.
* Clinically :* Clinically :
-- local pain, tenderness…local pain, tenderness…
-- patient supports thepatient supports the
affected limb withaffected limb with
other hand & tilting hisother hand & tilting his
head to the fr. side.head to the fr. side.

4. TreatmentTreatment::
♥ Reduction +
♥ figure 8- shaped
bandage .
♥ Complications :
- mal- union .
( but no effect on function )
- non-union

5. Indication for operative
treatment
1. Nonunion.
2. Neurovascular involvement
3. Unstable Fracture of the lateral end
near the acromioclavicular joint in
an adult
4. A persistent wide separation
of the fragments with interposition of
soft tissue
1. Floating shoulder

6. Fracture Scapula
♥ usually no displacementusually no displacement
♥ Supported by muscles on bothSupported by muscles on both
sides.sides.
Treatment :Treatment :
-- arm sling .arm sling .

7. 1- floating
shoulder
2- major
displaced
glenoid fracture
Indications for
operative treatment

8. Fracture HumerusFracture Humerus
♥ Proximal humerus ( SurgicalProximal humerus ( Surgical
neck, greater tuberosityneck, greater tuberosity
♥ ShaftShaft
♥ Distal humerus :Distal humerus :
-- supra condylar fr.supra condylar fr.
-- intercondylar fr. [intercondylar fr. [ TT oror YY fr.fr. ]]
-- fr. med. or lat. epicondyles .fr. med. or lat. epicondyles .

9. Fr. Surgical neck :
♥ Treatment :Treatment :
-- impacted : strappingimpacted : strapping
-- displaced : reductiondisplaced : reduction
U.G.A., then strapping.U.G.A., then strapping.
♥ Surgical reduction andSurgical reduction and
fixation withfixation with
- K-wire- K-wire
- plate and screws- plate and screws
- intramedullary- intramedullary
interlocking nailinterlocking nail

10. Fr. Shaft humerusFr. Shaft humerus
** TreatmentTreatment ::
-- stable, transverse fr. :stable, transverse fr. :
try conservative ttt.try conservative ttt.
-- unstable oblique orunstable oblique or
comminuted fr. :comminuted fr. : O.R.I.F.O.R.I.F.
[ interlocking I.M.N.,[ interlocking I.M.N.,
plate and screws, malleableplate and screws, malleable
medullary nails or ext. fixator ]medullary nails or ext. fixator ]

11. Int. fix. of fr. humerusInt. fix. of fr. humerus
Plate and screws Interlocking nail

12. Most important complicationMost important complication ::
Radial N. injury,Radial N. injury,
[[ manifested by wrist dropmanifested by wrist drop ]]..
Non-unionNon-union

13. Supra condylar fractures :Supra condylar fractures :
♥ Common in childrenCommon in children
♥ Extension, or flexion typesExtension, or flexion types
♥ Clinically :Clinically :
pain, swelling,pain, swelling,
ecchymosis, .. ……..ecchymosis, .. ……..

14. TreatmentTreatment:
♥ In children :In children :
- urgent reduction + post.slab- urgent reduction + post.slab
- if unstable : percutaneous wires .- if unstable : percutaneous wires .
- ORIF with wires, if irreducible- ORIF with wires, if irreducible
♥ In adults :In adults :
O.R.I.F. withO.R.I.F. with
plates and screwsplates and screws

15. Complications of S.C. fr. :
♥ Mal-union : altered carrying angleMal-union : altered carrying angle
-- cubitus varuscubitus varus
-- cubitus valguscubitus valgus
♥ Joint stiffness : due toJoint stiffness : due to
-- adhesionsadhesions
-- mal-unionmal-union

16. Cubitus varus

17. ♥ Vascular complications :
** AcuteAcute ischaemiaischaemia : due to: due to
vascular injury, edema, tight cast.vascular injury, edema, tight cast.
Management of acute ischaemia :Management of acute ischaemia :
-- urgent reduction of the fr.urgent reduction of the fr.
-- release of tight cast or bandagerelease of tight cast or bandage
-- systemic vasodilatorssystemic vasodilators
-- if no improvement : surgicalif no improvement : surgical
exploration.exploration.

18. Volkmann’s ischaemic contracture :Volkmann’s ischaemic contracture :
Fibrosis of deep forearm musclesFibrosis of deep forearm muscles
[ F.D.P.][ F.D.P.] due to prolongeddue to prolonged
ischaemia.ischaemia.
♥Treatment :Treatment :
surgical excision of fibrosed muscles +surgical excision of fibrosed muscles +
tendon operationstendon operations [[ transfer or lengtheningtransfer or lengthening ]]

19. Intercondylar fracturesIntercondylar fractures
♥ T or Y – shaped fr.T or Y – shaped fr.
♥ Intra-articularIntra-articular [[ affectingaffecting
the joint surfacethe joint surface ]] ..
♥ Treatment :Treatment :
-- Open reduction internalOpen reduction internal
fixation to restorefixation to restore
smooth articularsmooth articular
surface.surface.

20. Fr. of the humeral condylesFr. of the humeral condyles::
♥ Avulsion fr. of the med. orAvulsion fr. of the med. or
lateral condyles.lateral condyles.
♥ Common in children.Common in children.
♥ Treatment :Treatment :
-- O.R.I.F. by K. wire.O.R.I.F. by K. wire.

21. Fracture head radiusFracture head radius
♥ Intra-articular fr.Intra-articular fr.
♥ Treatment :Treatment :
-- large fragment : I.F.large fragment : I.F.
-- comminuted fr. : excision, orcomminuted fr. : excision, or
arthroplasty: head prosthesisarthroplasty: head prosthesis

22. Fracture olecranon
♥ Intra articular fractureIntra articular fracture
♥ Treatment :Treatment :
-- O.R.I.F. : by tensionO.R.I.F. : by tension
band wiringband wiring
- plate fixation if comminuted- plate fixation if comminuted

23. Monteggia
Fracture-Dislocation
♥ FR. upper 1/3 ulna + dislocationFR. upper 1/3 ulna + dislocation
of the superior R-U joint.of the superior R-U joint.
♥ Types :Types :
-- extension typeextension type
- flexion type- flexion type
- lateral type- lateral type
♥ Treatment :Treatment :
O.R.I.F. of the ulna.O.R.I.F. of the ulna.

24. Galeazzi Fracture-
Dislocation
fracture of the distal
third of the shaft of
the radius and
dislocation of the
distal radioulnar joint
Treatment:
Open Reduction
Internal Fixation of
the radial fracture
plating

25. Fracture both bones forearm
♥ in children : usually green-stick.in children : usually green-stick.
treatment : closed reduction and abovetreatment : closed reduction and above
elbow cast fixationelbow cast fixation
♥ In adults : treatment eitherIn adults : treatment either
-- conservative: closed reductionconservative: closed reduction
+ plaster fixation+ plaster fixation
-- if failed O.R.I.F.if failed O.R.I.F.
plate & screws or nailsplate & screws or nails
♥ Complications :Complications :
-- mal-unionmal-union
-- cross unioncross union

27. Colles’ fracture
♥ Fr. distal 1 inch of the radius,Fr. distal 1 inch of the radius,
with or without avulsion of thewith or without avulsion of the
ulnar styloid .ulnar styloid .
♥ Common in old age dueCommon in old age due
to osteoporosis.to osteoporosis.

28. Displacement of the distal fragmentDisplacement of the distal fragment::
♥ Backwards, upwards,Backwards, upwards,
and laterally.and laterally.
( displacement and tilt )( displacement and tilt )
♥ Clinically :Clinically :
-- pain, tenderness…….pain, tenderness…….
-- dinner-fork deformity.dinner-fork deformity.

30. Treatment :
♥ Closed reduction + plaster fixationClosed reduction + plaster fixation
♥ If comminuted, with intra-articularIf comminuted, with intra-articular
extension of the fr. ( Barton)extension of the fr. ( Barton)
O.R.I.F.O.R.I.F.
♥ Complications :Complications :
-- mal-unionmal-union
rupture E.P.L. tendon.rupture E.P.L. tendon.
-- Sudeck’s atrophy.Sudeck’s atrophy.

31. Fracture scaphoid
♥ may be impacted,not evident early in x-ray.may be impacted,not evident early in x-ray.
♥ Clinically : max.tenderness in snuff-boxClinically : max.tenderness in snuff-box
♥ Treatment: immobilization in scaphoid cast.Treatment: immobilization in scaphoid cast.
♥ Complications :Complications :
- non-union and AVN of prox.- non-union and AVN of prox.
fragment.fragment.
** Treatment of non-union :Treatment of non-union :
-- I.F.+ B.G.I.F.+ B.G.
-- late cases with O.A. wrist:late cases with O.A. wrist:
arthrodesis.arthrodesis.

32. Fractures of the metacarpals and
phalanges:
♥ Easily treated by :Easily treated by :
- closed reduction- closed reduction
to correct deformityto correct deformity
+ plaster fixation.+ plaster fixation.

33. Bennet’s fracture:
♥ Fr. Base 1Fr. Base 1stst
. metacarpal, extending into. metacarpal, extending into
the 1the 1stst
carpo-metacarpal joint.carpo-metacarpal joint.
♥ Usually needs I.F.Usually needs I.F.
by k. wire.by k. wire.