8030233
Description
Mind Map by Fatma Shwaylia, updated more than 1 year ago
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Created by Fatma Shwaylia
almost 8 years ago
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Fracture in the Arm
- Anatomy
- Muscles
- Biceps Brachii
- Origin : 1- long head:
supraglenoid tubercle of
the scapula within the
shoulder joint . 2- Short
head : Tip of the
coracoid process in
common with the
coracobrachialis
- Insertion : 1- by a strong
tendon into the posterior
rough part of the radial
tuberosity . 2- by the bicipital
aponeurosis arises from the
tendon of the biceps to blend
with the deep fascia of the
forearm .
- Action : Both heads Supination
of the flexed forearm Flexion of
the elbow joint The short head
is a weak flexor of the shoulder
joint The long head prevents
the upward dislocation of the
shoulder joint
- Nerve supply :
Musculocutaneous
nerve .
- Nerve supply :
Musculocutaneous
nerve .
- Action : Both heads Supination
of the flexed forearm Flexion of
the elbow joint The short head
is a weak flexor of the shoulder
joint The long head prevents
the upward dislocation of the
shoulder joint
- Insertion : 1- by a strong
tendon into the posterior
rough part of the radial
tuberosity . 2- by the bicipital
aponeurosis arises from the
tendon of the biceps to blend
with the deep fascia of the
forearm .
- Origin : 1- long head:
supraglenoid tubercle of
the scapula within the
shoulder joint . 2- Short
head : Tip of the
coracoid process in
common with the
coracobrachialis
- Coracobrachialis
- Origin : Tip of the coracoid
process , in common with the
short head of the biceps .
- Insertion : Middle of
medial border of the
humerus .
- Action : Flexion
and adduction
of the arm .
- Nerve supply :
Musculocutaneous
Nerve.
- Nerve supply :
Musculocutaneous
Nerve.
- Action : Flexion
and adduction
of the arm .
- Insertion : Middle of
medial border of the
humerus .
- Origin : Tip of the coracoid
process , in common with the
short head of the biceps .
- Brachilis
- Origin : Lower ½ of the
front of the humerus
Lateral and medial
intermuscular septa
- Insertion :
Ulnar
tuberosity
- Action : Flexion
of the elbow
- Nerve supply :
Musculocutaneous
nerve Radial nerve
supplies a small
lateral part
- Nerve supply :
Musculocutaneous
nerve Radial nerve
supplies a small
lateral part
- Action : Flexion
of the elbow
- Insertion :
Ulnar
tuberosity
- Origin : Lower ½ of the
front of the humerus
Lateral and medial
intermuscular septa
- Triceps Brachii
- Origin : Long head: infraglenoid tubercle of the
scapula Lateral head: upper ½ of the posterior surface
of the shaft of the humerus above the spiral groove
of the scapula Medial head : posterior surface of the
lower ½ of the shaft of the humerus below the spiral
groove , back of lateral and medial intermuscular
septa
- Insertion : The 3 heads
fuse together in a
common tendon . Into
the posterior part of
the upper surface of
the olecranon process
of the ulna
- Action : Powerful extensor of
the elbow joint Its main
function is to keep the elbow
extended when one is pushing
an object
- Nerve supply : Each
head receives a separate
branch from the radial
nerve
- Nerve supply : Each
head receives a separate
branch from the radial
nerve
- Action : Powerful extensor of
the elbow joint Its main
function is to keep the elbow
extended when one is pushing
an object
- Insertion : The 3 heads
fuse together in a
common tendon . Into
the posterior part of
the upper surface of
the olecranon process
of the ulna
- Origin : Long head: infraglenoid tubercle of the
scapula Lateral head: upper ½ of the posterior surface
of the shaft of the humerus above the spiral groove
of the scapula Medial head : posterior surface of the
lower ½ of the shaft of the humerus below the spiral
groove , back of lateral and medial intermuscular
septa
- Biceps Brachii
- Arteries
- Brachial artery
- Origin: continuation
of the axillary at the
lower border of the
teres major .
- Course; Passes
downwards and
laterally from the
medial side of the
humerus to the front
of the arm .
- Termination
Opposite the
neck of the
radius by dividing
into radial and
ulnar arteries.
- Branches
- Profunda
brachii
- Superior
ulnar
colllateral.
- Inferior
ulnar
collateral
- Muscular
- Nutrient
artery
- Terminal
- Profunda
brachii
- Branches
- Termination
Opposite the
neck of the
radius by dividing
into radial and
ulnar arteries.
- Course; Passes
downwards and
laterally from the
medial side of the
humerus to the front
of the arm .
- Origin: continuation
of the axillary at the
lower border of the
teres major .
- Brachial artery
- Nerves
- Anterior
compartment
of
the
arm
- AXILLARY
- passes infront the subscapular muscle,
to the quadritriangular space into the
posterior side of humerus where is
meets it companion posterior
circumflex humaeral artery and
surrounds surgical neck of humerus. so
any fracutre will not only lead to
hemorrhage but also to damage to this
nerve therefore damage to deltoid and
teres minor movements. while the
radial nerve will move backword
through the lower quadrangular
space.
- passes infront the subscapular muscle,
to the quadritriangular space into the
posterior side of humerus where is
meets it companion posterior
circumflex humaeral artery and
surrounds surgical neck of humerus. so
any fracutre will not only lead to
hemorrhage but also to damage to this
nerve therefore damage to deltoid and
teres minor movements. while the
radial nerve will move backword
through the lower quadrangular
space.
- Radial
- Origin: arises
from lower
anterior half
of humerus
.insertion:ulna
tuberosity
- posterior cord
of brachial
plexus
- sensory
- innervates the
posterior side of
forearms and
arms.
- innervates the
posterior side of
forearms and
arms.
- motor
- extension
of triceps
- Arises from brachial plexus in
root of neck and under the cervix
to behind the humerus forming
circumflex by passing through
the lower triangular spaceand
then goes anteriorly into the
lateral side of brachialis muscle
then continous into the forearms
as superficial radial nerve to
supply foramrs muscles like
brachioradialis muscle and more
- Arises from brachial plexus in
root of neck and under the cervix
to behind the humerus forming
circumflex by passing through
the lower triangular spaceand
then goes anteriorly into the
lateral side of brachialis muscle
then continous into the forearms
as superficial radial nerve to
supply foramrs muscles like
brachioradialis muscle and more
- extension
of triceps
- sensory
- posterior cord
of brachial
plexus
- Origin: arises
from lower
anterior half
of humerus
.insertion:ulna
tuberosity
- Musculocatanous
- root value: c5-c6-c7 (lateral cord)
- no circumflex unlike the radial
and axillary.
- supplying: bbc muscles : first branch
–coracobrachialis second branch-biceps
third and last branch-brachials. and then
supplies the lateral skin or cutanous of
forearms as it continous. not seen only
when biceps are removed!!
- supplying: bbc muscles : first branch
–coracobrachialis second branch-biceps
third and last branch-brachials. and then
supplies the lateral skin or cutanous of
forearms as it continous. not seen only
when biceps are removed!!
- no circumflex unlike the radial
and axillary.
- root value: c5-c6-c7 (lateral cord)
- Ulnar
- ulnar nerve is in very
dangerous site cuz its
exactly in the elbow joint.
so if u had any frature of
dislocation of elbow joint
then u ulnar nerve is
most prone to any sort of
damage like hemorrhage.
- Supplies the
last two
fingers of
the hand
- Supplies the
last two
fingers of
the hand
- ulnar nerve is in very
dangerous site cuz its
exactly in the elbow joint.
so if u had any frature of
dislocation of elbow joint
then u ulnar nerve is
most prone to any sort of
damage like hemorrhage.
- Median
- (lateral and medial cord)
- no single branch in the arm
- it does supply or innervate
the first 2 fingers on
lateral side (thumb). the
last 2 fingers by ulner
nerve. it is anterior to the
medial epicondyl or it sits
on the coronoid fossa
while the ulner nerve is
posterior to medial
epicondyl or postrior to
coronoid fossa. (it will
enter coronoid fossa most
medially)
- it does supply or innervate
the first 2 fingers on
lateral side (thumb). the
last 2 fingers by ulner
nerve. it is anterior to the
medial epicondyl or it sits
on the coronoid fossa
while the ulner nerve is
posterior to medial
epicondyl or postrior to
coronoid fossa. (it will
enter coronoid fossa most
medially)
- no single branch in the arm
- (lateral and medial cord)
- AXILLARY
- Anterior
compartment
of
the
arm
- Muscles
- Bones
- Bone cells
- Osteocyte
- Maintains bone
tissue +play a role
in deposition of
calcium
- Maintains bone
tissue +play a role
in deposition of
calcium
- Osteoblast
- Forms bone matrix+ have
receptors for the
parathyroid hormone and
found where active bone
is being formed.
- Forms bone matrix+ have
receptors for the
parathyroid hormone and
found where active bone
is being formed.
- Osteogenic
- stem cell
- In low O2 tension they
may change into
chondrogenic cells
- stem cell
- Osteoclast
- resorbs bone
- resorbs bone
- Osteocyte
- Humerus
- Head of the
humerus
- surgical
neck and
anatomical
neck
- Shaft
- Medial and
lateral
epicondyle
- Olecranon and
coronoid fossa
- greater
and lesser
tubercles
- intertubercle groove
between those 2
- intertubercle groove
between those 2
- Head of the
humerus
- Bone healing
- 1-Formation of fracture hematoma
- Complications of healing process
- Compartment syndrome
- Neurovascular injury
- Infection
- Post-traumatic arthritis
- Growth abnormalities
- Delayed union
- Nonunion
- Malunion
- Compartment syndrome
- Complications of healing process
- 3-Bony callus formation
- 2- Fibro-cartilaginous callus
formation (soft tissue
callus)
- 4-Bone remodelling
- 1-Formation of fracture hematoma
- Bone cells
- Exposure
therapy
- Helping people to confront their fears
- Graded Exposure
- an exposure
fear hierarchy
- Starting with mildly or
moderately difficult
exposures, then progress to
harder ones.
- Starting with mildly or
moderately difficult
exposures, then progress to
harder ones.
- an exposure
fear hierarchy
- Flooding
- Person is immersed in the fear
reflex until the fear itself fades
away
- Graded Exposure
- Helping people to confront their fears
- Fractures
- A break in the structural
continuity of the bone
tissue
- Mechanism
- single
traumatic
event
- Repetitive
stress
(stress
fracture)
- Abnormal
weakening
- Osteoporosis
- Pathological
Cause
- Osteoporosis
- single
traumatic
event
- How does a
fracture occur?
- Clinical
Picture
- Loss of
function
- Pain
- Deformity
- Swelling
- Hematoma,
Echymosis
- Wound
- Loss of
function
- Types
- Open
- bony fragments are
exposed to external
environment by means
of a wound (through a
skin wound)
- bony fragments are
exposed to external
environment by means
of a wound (through a
skin wound)
- Closed
- fracture fragments
are not exposed to
outside
- fracture fragments
are not exposed to
outside
- Open
- Mechanism
- Can damage
nerves
- NEURAPRAXIA
- Chronic mechanical
pressure
- Demyelination
of axon
- Spontaneous recovery
after few days or
weeks
- Spontaneous recovery
after few days or
weeks
- Demyelination
of axon
- Chronic mechanical
pressure
- AXONOTMESIS
- disruption of axons
and myelin
- axons degenerate proximally
and distally from the area of
injury . Distal degeneration
is Wallerian degeneration
- Intact neural tube
- Recovery:
18 months
- Recovery:
18 months
- Intact neural tube
- axons degenerate proximally
and distally from the area of
injury . Distal degeneration
is Wallerian degeneration
- disruption of axons
and myelin
- NEUROTMESIS
- Division of the
nerve trunk
- disruption of
axons and
endoneurial tubes
- A Neuroma is formed
(regenerating fibers +
Schwann cells +
fibroblasts)
- function is never normal
- function is never normal
- A Neuroma is formed
(regenerating fibers +
Schwann cells +
fibroblasts)
- disruption of
axons and
endoneurial tubes
- Division of the
nerve trunk
- NEURAPRAXIA
- Different Imaging Modalities
- x-rays
- Radiography “plain films”
- using broad beam
ionizing radiation
- using broad beam
ionizing radiation
- Computed axial
tomography “CT”
- three-dimensional
images of body tissues
and organs
- three-dimensional
images of body tissues
and organs
- Positron Emission
Tomography (PET):
- to create images of the inside of
the body by measuring the
metabolic activity of the soft
tissue adjacent to a fracture site.
- to create images of the inside of
the body by measuring the
metabolic activity of the soft
tissue adjacent to a fracture site.
- Ultrasound
- transmitting and receiving high
frequency sound waves Image
“slices” reconstructed by
computer
- transmitting and receiving high
frequency sound waves Image
“slices” reconstructed by
computer
- Magnetic Resonance
Imaging (MRI):
- generate detailed
images of internal
organs and tissues
- generate detailed
images of internal
organs and tissues
- x-rays
- Management
- Emergency orthopaedic
management (day 1)
- Life and complication
saving
- Closed reduction of
a fractured bone
- to set (reduce) a
broken bone
without surgery.
- Anatomical
- Direct
- Direct clamp application
- Push-pull technique
- “Shoehorn technique”
- Direct clamp application
- Direct
- Functional
- Indirect
- Traction table with image intensifier
- Distractor and joysticks
- Frames
- Traction table with image intensifier
- Indirect
- Anatomical
- Help in healing
- Decrease pain+infection of a bone
- Sedation+ local anesthetic
- Anesthetics
- To relieve pain
- Simple
- Paracetamol
- Aspirin
- Paracetamol
- NSAIDS
- Ibuprofen
- Ibuprofen
- Weak opioids
- Combinations
including codeine
phosphate
- Combinations
including codeine
phosphate
- Strong opioids
- Morphine sulphate
- Morphine sulphate
- Simple
- To relieve pain
- Anesthetics
- to set (reduce) a
broken bone
without surgery.
- Closed reduction of
a fractured bone
- Life and complication
saving
- Monitoring of fracture (days to weeks)
- Casts and splints
- plaster cast
- made from plaster or fiberglass,
encasing a limb
- orthopedic cast
- orthopedic cast
- made from plaster or fiberglass,
encasing a limb
- synthetic cast
- made from
fiberglass or
plastic strips.
- made from
fiberglass or
plastic strips.
- cast brace
- made of hard plastic.
Inside the brace , soft
pads compress or push
against the injury
- made of hard plastic.
Inside the brace , soft
pads compress or push
against the injury
- A splint
- made from slabs of plaster
or fiberglass that hold the
injury still
- back splint
- A back splint keeps the
area immobilized but
not compressed
- Helps in healing
- Helps in healing
- A back splint keeps the
area immobilized but
not compressed
- back splint
- made from slabs of plaster
or fiberglass that hold the
injury still
- plaster cast
- Casts and splints
- Rehabilitation and
treatment of
complications (weeks
to months)
- Physiotherapy
- Helps shoulder, elbow
and wrist to regain full
ranges of motion
- Swiss ball exercise
- Swiss ball exercise
- Strengthening
exercises to improve
muscle strength and
endurance
- Resistive exercises
- Resistive exercises
- Improve hand grip
function
- Shoulder, elbow and wrist
proprioception exercises
- Push up against a wall
- Push up against a wall
- Helps shoulder, elbow
and wrist to regain full
ranges of motion
- Physiotherapy
- Nutrition
- Calcium rich food
- Magnesium rich food
- Calcium and vitamin D supplements
- Zinc rich food
- Vitamin C rich food
- Calcium rich food
- Emergency orthopaedic
management (day 1)
- A break in the structural
continuity of the bone
tissue
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