Proximal Humerus Fracture

The shaft of the bone which surrounds the medullary cavity. In this patients case the diaphysis (shaft) of the humerus has been fractured

In elderly patients and high risk patients, physicians may consider a more conservative treatment option using splints/casts rather than surgery

The clinical signs of this fracture are swelling and pain in the scaphoid region, tenderness in the “anatomical snuffbox”, pain on axial compression, pain while pronating the hand, and painful pinch grip2. Radiological diagnosis consists of a scaphoid series of X-rays: Anterior-Posterior, lateral, semipronated and semisupinated views2. In cases of so-called "occult" fractures, the fracture is not visible on the radiographs, if the clinical signs are highly suggestive of fracture a 2 week period of cast immobilization is recommended, followed by a repeat X-ray series2. If further investigation is required, CT and MRI scans can also be implemented.

The injuries of Med. Collateral Lig. are divided into grades: grade one tears that involve a few MCL fibers with localized tenderness. Grade two tears involve disruption of more MCL fibers with generalized tenderness . Grade three tears are complete tears resulted in laxity of the medial joint to valgus stress. (FIG.14) ( 69

Proper positioning of patient is one of the most significant components of physical therapy. Safe and comfortable position is recommended by health care professional. This process should apply immediately after accident and continue during all phases of recovery. Suitable positioning assists in stimulating motor function, raises sensory awareness, improve respiration and can help normal range of motion in trunk and extremities. One of the most important effects of positioning is to prevent pressure ulcers. Mostly patients lie on back, involved side of non-affected side. The body points that should be considered are shoulder and pelvis. Gluteus maximus and rhomboid muscles become stiff retract shoulder and pelvis. Due to this, shoulder and pelvis must be positioned in a bit protraction in order to decrease spasticity and tightness.(Mehrholz, 2012)

Posterior malleolar fractures (PMF) are relatively common injuries with an incidence of 7%-44% among rotational ankle fractures (1-3). It can occur in settings of tri malleolar fractures or in association with pilon fractures as a distinguished posterior column fracture ( 4…….). It can also be presented as an isolated posterior malleolar farcture (5 ). Less satisfactory clinical outcomes and a high risk of degenerative osteoarthritis are reported in literature with posterior malleolus involvement (6-10). Biomechanically, the displaced posterior malleolar fragment causes a decrease in the joint contact area and predisposing the ankle to degenerative changes (11-13). Fixation of the posterior malleolar fractures remains an area of controversy in orthopaedic surgery.

Therefore, numerous spectrums of instability types and associated lesions affecting capsuloabral, ligamentous, and osseous structures can be identified (Stayner et al., 2000). The pathophysiology of an anterior shoulder dislocation involves violent external rotation in abduction levers causing the humerus to be dislodged from the glenoid socket, tearing the shoulder capsule and detaching the labrum from the glenoid (the Bankart lesion) (Farber et al., 2006). Additionally, the posterior part of the humeral head exits the joint, colliding with the anterior rim of the glenoid, producing a bony depression at the back of the humeral head (the Hill Sachs lesion) (Farber et al., 2006). Furthermore, anterior dislocation can occur when people fall with a combination of abduction, extension, and a force directed posteriorly on the arm; this is a common mechanism in the elderly (Stayner et al. 2000). A fracture of the humeral head, neck or greater tuberosity can occur with a dislocation (Stayner et al., 2000). In contrast, a posteriorly dislocated shoulder is less common. It is commonly caused by external forces acting on the shoulder when the shoulder is held in internal rotation and adduction caused by direct trauma experienced during sporting activities (Hegedus et al., 2008). Additionally, it may be result from an epileptic fit,

The studies have shown that one of the most seen cause of the death, immobility among the elderly population is the proximal femoral fractures. A notable number of the patients who had femoral fracture won’t be able to return to their pre-fracture functional condition. Within a year after surgery, less than 50% of the patients can walk without help, and only 40% can perform their ADLs activities independently.

The emergence of bipedalism modified the skeletal features of modern man [1]. As a consequence, the humerus tends to be shorter, lighter and straighter by losing its role of bearing bone [2]. It can be loaded in tension as in compression depending on the function of the upper extremity (uplift loads or distal support). At the opposite and from an evolutionary perspective in the human primate, femur evolved morphological and mechanical in order to bear different postures (standing, walking, running) [3,4].

The glenohumeral (shoulder) joint involves three bones: the scapula (shoulder blade), the clavicle (collar bone) and the humerus (upper arm bone). The humeral head rests in a shallow socket on the scapula called the glenoid. The humeral head is much larger than the glenoid, so a soft fibrous tissue called the labrum surrounds the glenoid to help deepen and stabilize the joint. The labrum deepens the glenoid by up to 50% so that the head of the humerus fits better.1 It also serves as an attachment site for several ligaments, such as the inferior glenohumeral ligament. It is the primary stabilizer of the shoulder beyond 60° of abduction.1 Superior labrum anterior-to-posterior (SLAP) tears have been found to occur from increased strain in the inferior glenohumeral ligament complex and a decreased ability to resist external rotation forces.

My interest in veterinary medicine stems from over fifteen years of involvement in the performance horse industry, but it was my own orthopedic complications that ignited my interest in surgery. A compound fracture of my tibia failed to heal properly, resulting in a complex diaphyseal malunion. It was surgically corrected via a new technique called a clamshell osteotomy. I was the twelfth patient to undergo the operation. Aside from the significant improvement in comfort and resolution of my angular deformities, I regained at least 2cm of limb length that I had lost after the original incident. The only negative was that because I no longer leaned to one side, my middle name (Eileen) suddenly became less humorous. Because of their dedication to advancing the medical profession, this team of surgeons created a technique that not only simplifies the correction of these

In older people, along with the dislocated shoulder there is also risk of fractures or breakage of some shoulder tendons occur.

Olecranon fracture is a common injury and constitutes 10% of upper extremity fractures (1, 2). It commonly occurs due to a direct impact or a fall onto an outstretched hand. Management of olecranon fractures with tension band wire fixation is indicated in simple displaced fractures and was first introduced by Weber and Vasey in 1963 (4). There is a high prevalence of metalwork removal due to metalwork irritation. Metalwork irritation may be caused by Kirschner-wires loss of fixation and backing out of the insertion site (5).

Balci, A., Basara, I., Çekdemir, E. Y., Tetik, F., Aktas, G., Acarer, A., & ... Acarer, A. (2015). Wrist fractures: Sensitivity of radiography, prevalence, and patterns in MDCT. Emergency Radiology, 22(3), 251-256. doi:10.1007/s10140-014-1278-1

The use of a tourniquet is an effective means of arresting life-threatening external hemorrhage from a limb injury. The use of tourniquets has been documented in the annals of historical medicine as far back as 6th century BC. “The Hippocratic body of work mentions in passing tight bandaging and distal limb gangrene without noting hemorrhage control, probably because hemorrhage and death, although linked empirically, were not linked philosophically by the ancient Greeks. (Kragh, Swan, Smith, Mabry, & Blackbourne, 2012, para. 6)” The first reported use of a battlefield tourniquet was by French army surgeon, Etienne Morel in 1674 (Welling, McKay, Rasmussen, & Rich, 2011). The device included a belt that went through a wood block (with a hole at each end), and a stick was used in the loop of the belt around the limb to twist as a windlass; this was known as a block tourniquet. The actual word tourniquet originated from the French word toner, meaning to turn.