Fracture in the Arm

Fracture in the Arm

1. Anatomy

   • Bones
     • Humerus
   • Muscles
     • posterior muscles
       • triceps
         • extends the forearm
           • supported by anconeus
     • anterior muscles
       • brachialis
         • main flexor of the elbow joint
       • coracobrachialis
         • flexion and adduction
       • biceps brachii
         • flexing while supinated
         • supination while flexed
   • Nerves
     • radial
       • innervates
     • ulnar
     • median
     • musculocutaneous
       • innervates
   • Arteries
     • brachial artery
       • profunda brachii
       • ulnar collateral
         • superior
         • inferior

2. Classifying fractures

   • exposure to atmosphere
     • no
       • closed fractures
     • yes
       • open fractures
   • pieces
     • comminuted
       • more than 2 pieces
     • simple
       • 2 pieces
   • relation between fragments of bone
     • fractures display more than one relation
     • shortening
     • displacement
     • rotation
     • angulation
   • shape
     • longitudinal
     • diagonal/oblique
     • transverse
     • spiral fracture

3. Demography

   • age: 50 years old
   • occupation: house wife
   • name: Radwa
     • fell in the toilet causing
     • clinical presentation
       • inability to bear weight
       • deformity
       • swelling
       • parasthesia
       • loss of function
         • later solutions
           • physiotherapy
             • laser therapy
             • magnetotherapy
             • kinetic therapy
             • electrostimulation
               • electroacupuncture
               • PNT
               • TENS
       • pain
     • Son: Ahmed
       • performed first aid for fractures
         • check for consciousness
         • call for help
           • 998
         • stop bleeding
         • check circulation
         • immobilize the injured area
         • prevent unnecessary movements
         • If an open fracture prevent infection by placing a damp cloth
         • in case of amputation
           • reserve the amputated part
             • place it in a plastic bag
               • place bag in an ice containing bag/container
     • she developed fear from the toilet due to the accident
       • conditioning
         • operant
           • individual is active
             • makes decisions
         • classic
           • individual is passive
             • no decisions are made

4. Comlications

   • infections
   • delayed/mal/non union
   • nerve injury
   • vascular injury
   • myositis ossificans
   • compartment syndrome

5. Management

   • Reduction of bone
     • then fixation
       • external
         • POP
         • splints
         • external fixator
         • casts
       • internal fixation
         • wires and pins
         • plates and screws
         • nails or rods
       • immobilizes the bone to aid healing
         • healing
           • indirect
             • includes
               • endochondral ossification
                 • involves
                   • 3) callus formation
                     • 4) revascularization
                       • VEGF dependent
                       • angiopoietin dependent
                       • 5) remodeling
                     • from
                       • granulation tissue
               • intramembraneous ossification
             • starts with
               • 1) acute inflammation
                 • 2) calling mesenchymal cells
                 • causes coagulation of hematoma
                   • forms
           • direct
             • includes only
             • rare
             • Requires specific anatomical reduction and rigid fixation
             • it's the aim in
     • closed reduction
       • Return bone to anatomical position without making an incision
     • open reduction
       • for protruding bone from the skin
       • Surgery to return the bone to anatomical position