Surgical Care at the District Hospital
Part 1 2 3 4 5 6 Primary Trauma Care Manual
Traumatology and orthopaedics
Acute Trauma Management
Trauma in perspective
Principles of Primary Trauma Care
Six phases of Primary Trauma Care
Procedures
Orthopaedic Techniques
Traction
Casts and Splints
Application of external fixation
Diagnostic imaging
Physical therapy
Crania burr holes
Orthopaedic Trauma
Upper extremity injuries
The hand
Fractures of the pelvis and hip
Injuries of the lower extremity
Spine injuries
Fractures in children
Amputations
Complications
War related trauma
General Orthopaedics
Congenital and developmental problems
Bone tumours
Infection
Degenerative conditions
Trauma in Perspective
 

> CLAVICLE FRACTURES
> ACROMIAL-CLAVICULAR JOINT SEPARATION
> SHOULDER DISLOCATION
> PROXIMAL HUMERUS FRACTURES
> HUMERAL SHAFT FRACTURES
> SUPRACONDYLAR FRACTURES OF THE HUMERUS
> OLECRANON FRACTURES
> FRACTURES OF THE RADIAL HEAD AND NECK
> ELBOW DISLOCATION
> FOREARM FRACTURES
> DISTAL RADIUS FRACTURES
> CARPAL FRACTURES AND FRACTURE DISLOCATIONS





PROXIMAL HUMERUS FRACTURES


Fractures of the proximal humerus result from direct or indirect trauma and are classified by the anatomical region injured:

:: Greater tuberosity (Figure 18.10)
Figure 18.10
Figure 18.10

:: Surgical neck (Figure 18.11)
Figure 18.11
Figure 18.11

:: Anatomic neck
:: Humeral head.

Evaluation

Suspect the diagnosis from the history and the physical findings of pain, swelling and loss of motion of the shoulder joint. You will need X-rays to confirm the type of fracture and to direct treatment.

Treatment

:: Immobilize non-displaced fractures in a sling and swath. Begin mobilization of the shoulder joint within a few days.
:: Treat displaced fractures and fracture dislocations by closed manipulation under anaesthesia. If the reduction is not acceptable, consider surgical treatment.
:: Begin motion as soon as the patient can tolerate hanging arm exercises (Figure 18.3). Begin active motion against gravity or with weights when the fracture has healed. This is usually at 6-–8 weeks.

> CLAVICLE FRACTURES
> ACROMIAL-CLAVICULAR JOINT SEPARATION
> SHOULDER DISLOCATION
> PROXIMAL HUMERUS FRACTURES
> HUMERAL SHAFT FRACTURES
> SUPRACONDYLAR FRACTURES OF THE HUMERUS
> OLECRANON FRACTURES
> FRACTURES OF THE RADIAL HEAD AND NECK
> ELBOW DISLOCATION
> FOREARM FRACTURES
> DISTAL RADIUS FRACTURES
> CARPAL FRACTURES AND FRACTURE DISLOCATIONS



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  Kep Points  
The anatomical location of the fracture defines the treatment


X-rays are needed to evaluate the injury



 
Treat displaced fractures with closed manipulation


 
The major complication is shoulder stiffness.