Upper Extremity Fracture Management

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Upper Extremity Fracture Management

• Andrew Marshall
• MD, FRCSC
• Dip. Sport Med.

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Overview

• Sternoclavicular Fractures
• Clavicle Fractures
• Proximal Humeral Fractures
• Periarticular Fractures
• Scapholunate Instability

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Sternoclavicular Injuries

• Infrequently dislocated
• direct force or indirect through shoulder
• Most frequent cause MVA followed by sports

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Sternoclavicular Injuries

• Present with severe pain with any movement of
  arm.
• Anterior can be obvious
• Posterior develop congestion of neck or upper
  extremity, breathing difficulty, SOB or trouble
  swallowing

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Sternoclavicular Injuries

• Plain x-rays difficult to assess for dislocation
• CT is modality of choice if patient clinically
  stable

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Clavicle Fractures

• One of the most common fractures
• Classified as proximal, middle and distal thirds
• 80 middle third, occur from fall on end of
  shoulder or direct blow
• Usually easily diagnosed, neurovascular exam in
  comminuted fractures

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Clavicle Fractures

• Can treat vast majority with figure of 8 and pain
  control
• Middle/Distal third with shortening of gt2cm
  100displacement may benefit from surgery
• Complications include nonunion and shoulder
  dysfunction from the shortening, cosmetic from
  the callus

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Clavicle Fractures

• In immature athlete non operative treatment is
  always done and nonunion is rare

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Proximal Humeral Fractures

• Elderly women with osteoporosis
• 80 minimally displaced
• Make sure not pathological fracture
• Four part classification
• Greater tuberosity
• Lesser tuberosity
• Head
• shaft

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Proximal Humeral Fractures

• Look for associated brachial plexus injury or
  vascular injury, dislocation of head
• Can treat most with sling and pain control
• Displaced two part(more than 1 cm), three part
  and four part should be referred
• Periarticular plates have made operative results
  more reliable

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Periarticular Fractures

• Recent release of specialized periarticular
  plates have lead to more ORIF of fractures of
  wrist, elbow and proximal humerus

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Scapholunate Instability

• Usually from fall on hyper extended hand
• Present with pain, weakness and clunk with use
• Diagnosis by Watson test and x-rays showing Terry
  Thomas sign

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Scapholunate Instability

• Treatment is by conservative treatment with
  splinting and NSAIDS can be used to provide
  symptomatic relief if minimal injury
• If significant injury closed/open reduction with
  repair of ligaments and ORIF any bony injury