Study material for the course: a
Authors: MUDr. Roman Hasara, MUDr. Jan Konečný, Ph.D., MUDr. Ondřej Veškrna
Department: 1st Department of Surgery, St. Anne's University Hospital, Faculty of Medicine, Masaryk University in Brno
Learning goals: Summary of upper extremity traumatology from shoulder to elbow, including ligament and tendon injury.
Time estimated: 60-90 min
Introduction: Injuries
of upper extremity are very common. Whereas clavicular fractures and
acromioclavicular dislocations are typical in young, active individuals,
especially those who participate in activities or sports (bicycling),
proximal humeral fractures are more frequent in elderly after banal
falls due to osteoporosis. Humeral shaft and distal humeral fractures
can be seen after lower energy trauma in elderly patients and also after
high-energy trauma in younger patients. Shoulder dislocation is the
most frequent dislocation. In child’s age there are specific problems
distal humeral fractures and subluxation of radial head known like
„pronatio dolorosa“. Basic knowledge of upper limb traumatology is
essential in everyday clinical practice.
Contents:
Basic shoulder girdle anatomy
Sternoclavicular joint injury
Clavicle fractures
Acromioclavicular joint injury
Scapular fractures
Dislocation of glenohumeral joint
Proximal humeral fractures
Humeral shaft dislocation
Tendineus injury of shoulder and arm
Distal humeral fractures
Elbow dislocations
Pronatio dolorosa
Distal humeral fractures in child´s age
· Essential clinical examination – neurovascular state
· X-ray diagnostics – 2 perpendicular projections
· CT diagnostics in case of intraartcular fractures
· Shoulder girdle injury could be associated with injury of brachial plexus and arteria axilaris
· Clavicular fractures and injury of acromioclavicular joint are very common in younger active patients /cyclists/
· Scapular
fractures are not very frequent. Scapular body fractures are usually
after high-energy trauma and are often associated with another injuries
(chest, head, etc.)
· Shoulder dislocation is the most frequent dislocation – diagnostic and treatment.
· Proximal
humeral fractures are one of the most common fractures at all,
especially in elderly people due to low energy trauma.
· In case of humeral shaft fractures there is a risk of radial nerve injury – clnical signs.
· Surgical
treatment of intraarticular fractures of distal humerus is very
difficult, there is a risk of ulnar nerve lesion.
· Distal humeral fractures in child’s age are specific.
· Elbow dislocation is associated with risk of nerves and vessels injuries and the urgent treatment is required.
· „Pronatio dolorosa“ is typical diagnosis for child’s age.
· Essential knowledge of non-operative treatment techniques, immobilisation.
· Essential knowledge of upper extremity fractures surgical treatment indications and technics.
Summary:
· Summary of upper extremity traumatology from shoulder to elbow including ligament injury.
· Principles of treatment of basic upper limb trauma (non-operative, surgical)
Literature:
Clinical Surgery: With Student Consult Access, 3e Paperback – 13 Feb 2012
Schwartz's Principles of Surgery, 10th edition,2015, Brunicardi F.CH et al. ISBN 978-0-07179674-3
Ashcraft's Pediatric Surgery: 6th edition, 2014, Holcomb G.W. et al. ISBN : 9781455743339
Rockwood and Green's Fractures in Adults, 8th Edition, 2015 Lippincott Williams & Wilkins
Rockwood and Wilkins’ fractures in children, 9th edition. | Philadelphia : Wolters Kluwer, [2020] ISBN 9781496386540
Campbell’s operative orthopaedics, twelfth edition, 2013 by Mosby, an imprint of Elsevier Inc.ISBN: 978-0-323-07243-4