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Fracture Clavicle Middle 1/3 ** Distal 1/3 Medial 1/3 อนุพงษ์ เลาหพูนรังษี Middle 1/3 Clavicle fracture Reduction of Middle 1/3 clavicle fracture Treatment of middle third clavicle fracture Figure of eight bandage Indication for ORIF - Vascular injury - Associate certain type yp of scapular fracture - Pathologic fracture - Impending open fracture Treatment of displaced distal 1/3 clavicle fracture Distal 1/3 clavicle fracture Conservative treatment Shoulder harness Operative treatment Acromioclavicular joint injury Acromioclavicular ligament C Coracoclavicular l i l liligamentt Grade 1 AC ligament sprain Grade 2 AC ligament g rupture p CC ligament g sprain p Grade3 Grade 3 AC ligament g rupture p CC ligament g rupture p Stress film both shoulders Treatment : Conservative treatment Operative treatment Shoulder dislocation Anterior dislocation *** Posterior dislocation Superior dislocation Inferior dislocation Anterior shoulder dislocation D ’ test Duga’s t t -ve D ’ test Duga’s t t +ve + Treatment Transcapular view Treatment Closed reduction Modified Stimson AP. view Closed reduction Traction Traction--counter traction Zero position : Abduction 160 , Forward flexion 45 degre Treatment Immobilization after closed reduction Cl d reduction Closed d i Aft reduction After d ti - Neurovascular status - X ray - Immobilization I bili ti Vl Velpeau bandage b d Fracture Proximal Humerus Stable fracture : Impact fracture Unstable fracture : Minimal displaced Di l d Displaced Displacement > 1 cm. Angulation g > 45 degrees g Sli & swathe Sling th Fracture dislocation Fracture humerus Operative treatment when - Failure conservative treatment - Bilateral humerus fracture -Displaced transverse transverse midshaft fx j y - Vascular injury - Multiple fractures or injuries - Pathologic fracture - Ipsilateral forearm fracture - Iatrogenic radial nerve palsy Conservative treatment of Humeral shaft fracture F t Di Fracture Distal t l humerus h Fracture Distal humerus Medial epicondyle fracture Supracondylar p y fracture Medial condyle fracture Lateral condyle y fracture Extraarticular fracture I Intraarticular i l ffracture F t Di Fracture Distal t l Humerus H Intraarticular fracture Supracondylar fracture Intercondylar fracture Treatment : ORIF Intercondylar fracture Elbow dislocation Treatment : ORIF Elbow dislocation Treatment Cl d reduction Closed d i Aft Reduction After R d ti - Neurovascular status - X ray - Immobilization I bili ti T t t Treatment Closed reduction Fracture Olecranon Nondisplaced fracture Displaced p fracture 1 Displacement < 2 mm. 1. 2 No difference in displacement of the fracture at 2. 0 and 90 degrees g elbow flexion in lateral film 3. Able to perform active elbow extension against gravity Non--displaced Olecranon fracture Non C Conservative ti treatment t t t Monteggia ’s Fracture Displaced Olecranon fracture Operative treatment Nightstick Fracture Fracture proximal 1/3 of ulnar and dislocation of radial head Treatment Closed reduction of radial head ORIF ulnar ORIF when Displacement > 50 % Angulation > 10 degrees Galeazzi ’s fracture F t Radius Fracture R di Fracture distal 1/3 of radius with dislocation of DRUJ. Treatment : Closed reduction of DRUJ. ORIF radius Treatment : ORIF Fracture Radius & Ulnar Treatment : ORIF Why ORIF in most forearm fractures