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Scapula Fractures

Introduction There has been a contemporary resurgence in the desire to understand scapula fractures in a way that aligns its diagnosis and treatment with other fractures considered by the orthopaedic surgeon. Perhaps this resurgence relates to the recognition that the significant deformity of scapula malunion leads to substantial dysfunction, supporting the well-known AO axiom that musculoskeletal function follows skeletal form. Additionally, rendering stability to the unstable…

Fractures and Dislocations of the Clavicle

Anatomy Key Points: Anatomy High variability in shape, length, curvature, and internal structure: Passing through the medullary canal applying a nail can be difficult. Anatomic plates do not fit properly. Functional unit of clavicle and scapula: Shoulder suspensory complex needs to be stable. High range of motion of the acromioclavicular joint: High biomechanical forces are required for implants with risk of failure. The extended mobility of…

Proximal Humeral Fractures and Glenohumeral Dislocations

Updated chapter based on the previous edition, written by Andrew Green and Tom R. Norris. Essential Principles for Treatment of Proximal Humeral Fractures and Glenohumeral Dislocations The shoulder has the widest range of motion (ROM) in the human body, allowing for positioning of the upper extremity in a variety of directions. This adaptation from a weight-bearing limb to working “instrument” is crucial for humans, and as…

Fractures of the Humeral Shaft

Introduction Fractures of the humeral shaft account for approximately 3% of all fractures and represent an incidence of 19 per 100,000 person-years. The occurrence shows a bimodal age distribution with a peak observed in the third decade, mainly in men as a result of violent high-velocity injuries, and a larger peak in the seventh decade, mainly occurring in women, generally resulting from simple falls and attributed…

Fractures of the Distal Humerus

Introduction Fractures of the distal humerus commonly occur in osteoporotic bone, accompanied by comminution in the metaphyseal and/or articular regions. Consequently, the surgical management of these injuries may be technically demanding. This chapter provides a review of these issues and others, as well as an up-to-date appraisal on the available evidence to guide management. Epidemiology Distal humerus fractures have been estimated to have an incidence in…

Trauma to the Adult Elbow

Introduction The elbow functions to facilitate positioning of the hand in space; it serves as a mechanical lever through the forearm for lifting and as a means of force transmission. Motion at the joint is a combination of flexion, extension, and pronosupination that facilitates activities of daily living. Trauma to the elbow can be challenging to treat. The anatomy is complex, and the stability of the…

Diaphyseal Fractures of the Forearm

Compared with fractures of the elbow and the wrist, diaphyseal fractures of the forearm are still underestimated. This is because whereas extension and flexion of the elbow and the wrist lead to an apparent movement of the hand, forearm rotation leaves the hand in place, and forearm rotation is performed more subconsciously. Therefore forearm rotation does not seem to be important to patients as long as…

Fractures of the Distal Radius

Fractures of the distal radius are extremely common, accounting for one-sixth of all fractures seen in emergency departments (EDs). The greatest frequency occurs in two age groups: those 6 to 10 years of age and those between 60 and 69 years old. These fractures occur more commonly in women than in men, increase in frequency with advancing age, and result from low-energy falls more often than…

Fractures and Dislocations of the Carpus

Fractures of the Scaphoid Introduction Almost exclusively, scaphoid fractures occur in young, active males. They account for 60% to 80% of all carpal bone fractures and are second only to fractures of the distal radius in the frequency of wrist fractures. The frequency of scaphoid fractures is approximately 21,500 per year in the United States. Nevertheless, the potential impact of these injuries is significant. The diagnosis…

Fractures and Dislocations of the Hand

This chapter discusses each unique anatomic region and its associated ligamentous and osseous injuries. Elucidation of the surgical anatomy, review of surgical techniques with associated pearls and pitfalls, and general postoperative rehabilitation protocols are presented. Evidence-based reviews of outcomes based on contemporary literature are provided. The Thumb Ray The position of the thumb ray and its unique local anatomy at the carpometacarpal (CMC) and metacarpophalangeal (MCP)…

Surgical Treatment of Acetabular Fractures

Acetabular fractures are uncommon and complex injuries usually resulting from high-energy traumatic events or lower energy mechanisms associated with osteopenia. The rarity of these fractures makes it difficult for most physicians to become familiar with them. These injuries challenge even the most experienced physicians because of their deep and complex anatomy and associated primary organ system injuries. There have been many advances in the knowledge of…

Pelvic Ring Injuries

Introduction The pelvis is a key component of the axial skeleton that links the lower extremities with the rest of the body through the lumbosacral spine. Its ringlike structure allows it to surround and protect important inner organs, such as the urinary bladder, the lower intestines, and the reproductive organs, as well as major nerves and blood vessels. In patients with healthy bone, high-energy injuries are…

Principles of Orthotic Management

Introduction Spinal orthotics are used to immobilize the spine, to stabilize the spinal column, to protect the neural elements, and to assist in fracture healing. There are many orthotic options available depending on the type of spinal injury and location. To select the most appropriate orthosis, it is important to know which spinal levels need to be immobilized, as different type of prosthetics target different spinal…

Avoiding Complications in Spine Trauma Patients

Introduction Complications and adverse events in the management of spinal trauma can occur in any organ system. Avoidance and prevention of these complications requires multidisciplinary knowledge in spine and spinal cord injury (SCI) management. Unfortunately, there is no consensus in the literature regarding the true incidence of complications, which have been reported to be between 10% and 20%. Nasser et al. reported the incidence of complications in…

Osteoporotic Spinal Fractures

Introduction Osteoporosis is a common disease that is characterized by structural deterioration of bone architecture and manifests as fragility fractures occurring at multiple skeletal sites, most commonly involving the spine, hip, or wrist. It is increasingly recognized that osteoporosis is an important health problem because of the large affected population and the devastating impact of osteoporotic fractures on patient morbidity and mortality, as well as on…

Fractures in the Ankylosed Spine

Introduction In general, nonosteoporotic spinal fractures are the result of high-impact trauma and may be associated with spinal cord injuries. However, trauma physicians should be extra aware of the ankylotic spine because stiff ankylotic spines can fracture with lower forces, are associated with a fourfold increased risk for fractures, and have a high risk up to 58% of spinal cord injury, and the fractures can be…

Thoracolumbar Trauma

The transition from the kyphotic, rigid thoracic spine to the mobile, lordotic lumbar spine creates a biomechanically favorable location for burst fractures. Thoracolumbar burst fractures are a common injury, and there exists a broad range of classifications and treatment algorithms to aid surgeons in clinical decision making. The treatment goal of burst fractures is to optimize bony healing, maximize preservation of neurologic function, and allow early…

Subaxial Cervical Spine Trauma

Introduction The subaxial cervical spine is composed of the C3 through C7 vertebrae. Epidemiologic studies have shown that cervical spine fractures or dislocations occur in 2% to 3% of trauma patients. However, injuries to the subaxial cervical spine account for 65% of all cervical spine fractures and more than 75% of dislocations, with C6 being the most commonly fractured subaxial vertebra and C5–C6 being the most…

Craniocervical Injuries: C2 Fractures

Introduction Fractures of the axis are diverse with many patterns having varying prognoses; they include odontoid or dens fractures, traumatic spondylolisthesis of the axis (better known as the hangman's fracture), and poorly characterized axis body fractures. Fractures of the odontoid process are frequent spine injuries, occurring in 10% to 20% of all cervical spine injuries. The atlantoaxial articulation provides important stability for the upper cervical spine;…

Craniocervical Injuries: Atlas Fractures, Atlanto-Occipital Injuries, and Atlantoaxial Injuries

Introduction The craniocervical junction (CCJ) is a complex articulation, involving the occipital bone, the occipitoatlantal articulation, the atlas, the axis, and the ligaments that span from the occiput to the axis. The susceptibility of the CCJ to injury is related to (1) the large lever arm induced by the mass and immobility of the cranium combined with (2) the relative freedom of movement more caudally with…