Fracturas del Extremo Proximal del Hmero

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Cuatro Partes (Codman)

Troquiter Cabeza Humeral

Troqun Difisis Humeral

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Clasificacin de De Anquin

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Clasificacin de NEER

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Clasificacin de la AO
Tipo I

Tipo II

Tipo III
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Schatzker y Tile
Intracapsular

Trazo
Extracapsular. Estable

Estabilidad
Inestable
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Tratamiento
Fracturas estables.
No se desplazan con las cargas fisiolgicas

Fracturas inestables.
Los fragmentos se mueven en forma independiente entre s
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Fracturas inestables
Con desplazamiento mnimo.
Desplazamiento menor de 1 cm. y angulacin inferior a 40

Con desplazamiento mayor.

En dos partes En tres partes En cuatro partes Fractura-luxacin Articulares
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Fracturas diafisarias de hmero Clasificacin AO

A. Fr. Simples: A1 espiraladas A2 oblicuas mayor a 30 A3 transversa menor a 30 B. Fr. en cua: B1 cua en espiral B2 cua por inclinacin B3 cua fragmentada C. Fr. Complejas: C1 en espiral C2 segmentaria C3 irregular
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pdfMachine A pdf writer that produces quality PDF files with ease! Produce quality PDF files in seconds and preserve the integrity of your original documents. Compatible across nearly all Windows platforms, simply open the document you want to convert, click print, select the Broadgun pdfMachine printer and thats it! Get yours now!

Fractura de la Escpula

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Clasificacin Anatmica
Fracturas del cuerpo (cerca del 50%). Fracturas del cuello (25%). Fracturas glenoideas (10%). Fracturas del acromion. Fracturas de la coracoides. Fracturas de la espina.

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Clasificacin
Zdraukovic y Damholt
Fracturas del cuerpo. Fracturas de las apfisis (acromioncoracoides-espina). Fracturas del ngulo superoexterno (cuelloglenoides).

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Anillo osteofibroso
Complejo Suspensorio Superior del Hombro
Thomas Goss
Cavidad glenoidea. Coracoides. Ligamentos coracoclaviculares. Tercio distal de la clavcula. Ligamentos acromioclaviculares. Acromion.

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Anillo osteofibroso
Complejo Suspensorio Superior del Hombro
Thomas Goss

Pilar anterosuperior: tercio medio de la clavcula. Pilar posteroinferior: cuello-espina-borde lateral de la escpula.

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Anillo osteofibroso
Complejo Suspensorio Superior del Hombro
Thomas Goss

Lesin aislada

Lesin combinada (ruptura doble o triple) hombro flotante Alta energa

Tratamiento quirrgico

Baja energa

Tratamiento funcional

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pdfMachine A pdf writer that produces quality PDF files with ease! Produce quality PDF files in seconds and preserve the integrity of your original documents. Compatible across nearly all Windows platforms, simply open the document you want to convert, click print, select the Broadgun pdfMachine printer and thats it! Get yours now!

Fracturas del Cuello

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Clasificacin
Tipo I: No desplazada ni angulada. Tipo II A: Acortada o desplazada > 1 cm. Tipo II B: Angulada > 40.

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Tratamiento
Fracturas del Cuello
No desplazadas traslacin <1 cm. Angulacin <40 Desplazadas Traslacion > 1 cm. Angulacin > 40

Tratamiento funcional

Tratamiento quirrgico

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Fracturas del Acromion

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Clasificacin Kuhn
Tipo I: desplazamiento mnimo. Tipo II: con desplazamiento sin reduccin del espacio subacromial. Tipo III: con desplazamiento con reduccin del espacio subacromial.

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Tratamiento
Fracturas del Acromion
No desplazadas Escaln <1 cm. Sin reduccin del espacio subacromial Desplazadas Escaln >1 cm. Reduccin del espacio subacromial Fracturas de la base del acromion Pseudoartrosis sintomticas

Tratamiento funcional

Tratamiento quirrgico

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Fracturas de la Coracoides

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Clasificacin Eyres
Tipo I: de la punta. Tipo II: del cuerpo. Tipo III: de la base. Tipo IV: incluye la porcin adyacente del cuerpo. Tipo V: fr. articular que comprende la parte superior de la glenoides.
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Tratamiento
Fracturas de la Coracoides
No desplazadas Diastasis <5mm. Desplazadas Diastasis >5mm.

Tratamiento funcional

Tratamiento quirrgico

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Fracturas Glenoideas (intraarticulares)

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Clasificacin
Ideberg
Tipo I: fracturas del reborde (A:anterior, B:posterior). Tipo II: transversal a travs de la fosa, con fragmento inferior desplazado con la cabeza humeral.

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Clasificacin Ideberg
Tipo III: oblicua con fragmento articular superior que incluye la coracoides ya que el trazo termina en el borde superior. Tipo IV: horizontal con trazo que llega al borde medial. Tipo V: combina los tipo II y IV.

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FRACTURAS ARTICULARES (Glenoideas)

No desplazadas Sin inestabilidad

Desplazadas Escaln o diastasis > 2mm. Con inestabilidad GH.

Tratamiento funcional

Tratamiento quirrgico

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Fracturas de la Clavcula

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Clasificacin
Grupo I: fractura del tercio medio

Craig EV: Fractures of the clavicle, 1990

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Clasificacin
Grupo II: fractura del tercio distal Tipo I: desplazamiento mnimo (interligamentoso)

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 Tipo II: con desplazamiento secundario a una fractura medial a los ligamentos coracoclaviculares
A. Conoide y trapezoide intactos

B. Conoide desgarrado, trapezoide intacto

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 Tipo III: fracturas de la superficie articular

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 Tipo IV: ligamentos hacia el periostio intactos (nios, con desplazamiento del fragmento proximal) seudoluxacion acromioclavicular

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 Tipo V: conminuta: sin ligamentos adheridos en la porcin proximal o distal, sino hacia un fragmento conminuto inferior.

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Grupo III: fracturas del tercio proximal Tipo I: desplazamiento mnimo Tipo II: desplazamiento (rotura ligamentos) Tipo III: intraarticular Tipo IV: separacin epifisaria (nios y adultos jvenes) Tipo V: conminuta
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Fracturas supracondileas de Codo

A extrarticulares A1 avulsion metafisaria A2 simple metafisaria A3 metafisaria multifragmentaria B articulares B1 articular parcial lateral sagital B2 articular parcial medial sagital B3 articular parcial frontal C suprainterart. C1 articular y metafisaria simple C2 articular simple metafisaria compleja C3 multifragmentaria

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Fracturas supracondileas de Codo

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Fractura de la Cpula Radial

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Clasificacin (Mason)
Tipo 1: No desplazada o mnimo desplazamiento. Tipo 2: Desplazada, en general por cizallamiento con un solo fragmento. Tipo 3: Conminuta.

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Mason Tipo IV

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Clasificacin (Duparc)
Tipo 1: Fractura no desplazada. Tipo 2: Fractura-separacin de dos (tipo 2a) o tres (tipo 2b) fragmentos. Tipo 3: Fractura-hundimiento subcapital, encajada (tipo 3a) o desencajada (tipo 3b). Tipo 4: Fractura mixta (separacinhundimiento, encajada (tipo 4a) o desencajada (tipo 4b). Tipo 5: Estallido de la cabeza del radio.
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Tratamiento conservador Indicaciones

Fracturas tipo 1, no desplazadas(Duparc). Fracturas tipo 3a, fractura-hundimiento encajada (Duparc), con desplazamiento menor de 20.

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Tratamiento Conservador
Artrocentesis evacuadora. Yeso Braquiopalmar. Movimientos activos y pasivos autocontrolados. Evitar durante las primeras semanas la flexin en pronacin. Controles radiogrficos peridicos.

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Tratamiento quirrgico Indicaciones

Fracturas tipo 2a (fractura-separacin de dos fragmentos). Fracturas tipo 2b (fractura-separacin de tres fragmentos). Fracturas tipo 3a (fractura-hundimiento encajada) desplazada ms de 20. Fracturas tipo 3b (fractura-hundimiento desencajada). Fracturas tipo 4a (fractura separacin-hundimiento encajada).

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Tratamiento quirrgico
Escisin de fragmentos separados. Osteosntesis. Cupulectoma. Artroplasta.

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Fractura del Olcranon

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Clasificaciones
Colton. Schatzker. AO/ASIF. OTA. Criterios - Desplazamiento. - Direccin del trazo fracturario. - Conminucin articular. - Porcentaje involucrado. - Lesiones asociadas.

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Clasificacin (Morrey)
Tipo 1: no desplazada. a: no conminuta, b:conminuta. Tipo 2:desplazada-estable. a: no conminuta, b:conminuta. Tipo 3: inestable. a: no conminuta, b:conminuta.

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Fracturas de la Coronoides
Clasificacin Regan y Morrey
Tipo 1: Avulsin simple. Tipo 2: Fragmento nico o conminuto que afecta al 50%. Tipo 3: Fr. que afecta a mas del 59%.

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Fracturas del Extremo Proximal del Hmero

Cuatro Partes (Codman)

Troquiter Cabeza Humeral

Troqun Difisis Humeral

Clasificacin de De Anquin

Clasificacin de NEER

Clasificacin de la AO
Tipo I

Tipo II

Tipo III

Schatzker y Tile
Intracapsular

Trazo
Extracapsular. Estable

Estabilidad
Inestable

Tratamiento
Fracturas estables.
No se desplazan con las cargas fisiolgicas

Fracturas inestables.
Los fragmentos se mueven en forma independiente entre s

Fracturas inestables
Con desplazamiento mnimo.
Desplazamiento menor de 1 cm. y angulacin inferior a 40

Con desplazamiento mayor.

En dos partes En tres partes En cuatro partes Fractura-luxacin Articulares

Fracturas diafisarias de hmero Clasificacin AO

A. Fr. Simples: A1 espiraladas A2 oblicuas mayor a 30 A3 transversa menor a 30 B. Fr. en cua: B1 cua en espiral B2 cua por inclinacin B3 cua fragmentada C. Fr. Complejas: C1 en espiral C2 segmentaria C3 irregular

Fractura de la Escpula

Clasificacin Anatmica
Fracturas del cuerpo (cerca del 50%). Fracturas del cuello (25%). Fracturas glenoideas (10%). Fracturas del acromion. Fracturas de la coracoides. Fracturas de la espina.

Clasificacin
Zdraukovic y Damholt
Fracturas del cuerpo. Fracturas de las apfisis (acromioncoracoides-espina). Fracturas del ngulo superoexterno (cuelloglenoides).

Anillo osteofibroso
Complejo Suspensorio Superior del Hombro
Thomas Goss
Cavidad glenoidea. Coracoides. Ligamentos coracoclaviculares. Tercio distal de la clavcula. Ligamentos acromioclaviculares. Acromion.

Anillo osteofibroso
Complejo Suspensorio Superior del Hombro
Thomas Goss

Pilar anterosuperior: tercio medio de la clavcula. Pilar posteroinferior: cuello-espina-borde lateral de la escpula.

Anillo osteofibroso
Complejo Suspensorio Superior del Hombro
Thomas Goss

Lesin aislada

Lesin combinada (ruptura doble o triple) hombro flotante Alta energa

Tratamiento quirrgico

Baja energa

Tratamiento funcional

Fracturas del Cuello

Clasificacin
Tipo I: No desplazada ni angulada. Tipo II A: Acortada o desplazada > 1 cm. Tipo II B: Angulada > 40.

Tratamiento
Fracturas del Cuello
No desplazadas traslacin <1 cm. Angulacin <40 Desplazadas Traslacion > 1 cm. Angulacin > 40

Tratamiento funcional

Tratamiento quirrgico

Fracturas del Acromion

Clasificacin Kuhn
Tipo I: desplazamiento mnimo. Tipo II: con desplazamiento sin reduccin del espacio subacromial. Tipo III: con desplazamiento con reduccin del espacio subacromial.

Tratamiento
Fracturas del Acromion
No desplazadas Escaln <1 cm. Sin reduccin del espacio subacromial Desplazadas Escaln >1 cm. Reduccin del espacio subacromial Fracturas de la base del acromion Pseudoartrosis sintomticas

Tratamiento funcional

Tratamiento quirrgico

Fracturas de la Coracoides

Clasificacin Eyres
Tipo I: de la punta. Tipo II: del cuerpo. Tipo III: de la base. Tipo IV: incluye la porcin adyacente del cuerpo. Tipo V: fr. articular que comprende la parte superior de la glenoides.

Tratamiento
Fracturas de la Coracoides
No desplazadas Diastasis <5mm. Desplazadas Diastasis >5mm.

Tratamiento funcional

Tratamiento quirrgico

Fracturas Glenoideas (intraarticulares)

Clasificacin
Ideberg
Tipo I: fracturas del reborde (A:anterior, B:posterior). Tipo II: transversal a travs de la fosa, con fragmento inferior desplazado con la cabeza humeral.

Clasificacin Ideberg
Tipo III: oblicua con fragmento articular superior que incluye la coracoides ya que el trazo termina en el borde superior. Tipo IV: horizontal con trazo que llega al borde medial. Tipo V: combina los tipo II y IV.

FRACTURAS ARTICULARES (Glenoideas)

No desplazadas Sin inestabilidad

Desplazadas Escaln o diastasis > 2mm. Con inestabilidad GH.

Tratamiento funcional

Tratamiento quirrgico

Fracturas de la Clavcula

Clasificacin
Grupo I: fractura del tercio medio

Craig EV: Fractures of the clavicle, 1990

Clasificacin
Grupo II: fractura del tercio distal Tipo I: desplazamiento mnimo (interligamentoso)

 Tipo II: con desplazamiento secundario a una fractura medial a los ligamentos coracoclaviculares
A. Conoide y trapezoide intactos

B. Conoide desgarrado, trapezoide intacto

 Tipo III: fracturas de la superficie articular

 Tipo IV: ligamentos hacia el periostio intactos (nios, con desplazamiento del fragmento proximal) seudoluxacion acromioclavicular

 Tipo V: conminuta: sin ligamentos adheridos en la porcin proximal o distal, sino hacia un fragmento conminuto inferior.

Grupo III: fracturas del tercio proximal Tipo I: desplazamiento mnimo Tipo II: desplazamiento (rotura ligamentos) Tipo III: intraarticular Tipo IV: separacin epifisaria (nios y adultos jvenes) Tipo V: conminuta

Fracturas supracondileas de Codo

A extrarticulares A1 avulsion metafisaria A2 simple metafisaria A3 metafisaria multifragmentaria B articulares B1 articular parcial lateral sagital B2 articular parcial medial sagital B3 articular parcial frontal C suprainterart. C1 articular y metafisaria simple C2 articular simple metafisaria compleja C3 multifragmentaria

Fracturas supracondileas de Codo

Fractura de la Cpula Radial

Clasificacin (Mason)
Tipo 1: No desplazada o mnimo desplazamiento. Tipo 2: Desplazada, en general por cizallamiento con un solo fragmento. Tipo 3: Conminuta.

Mason Tipo IV

Clasificacin (Duparc)
Tipo 1: Fractura no desplazada. Tipo 2: Fractura-separacin de dos (tipo 2a) o tres (tipo 2b) fragmentos. Tipo 3: Fractura-hundimiento subcapital, encajada (tipo 3a) o desencajada (tipo 3b). Tipo 4: Fractura mixta (separacinhundimiento, encajada (tipo 4a) o desencajada (tipo 4b). Tipo 5: Estallido de la cabeza del radio.

Tratamiento conservador Indicaciones

Fracturas tipo 1, no desplazadas(Duparc). Fracturas tipo 3a, fractura-hundimiento encajada (Duparc), con desplazamiento menor de 20.

Tratamiento Conservador
Artrocentesis evacuadora. Yeso Braquiopalmar. Movimientos activos y pasivos autocontrolados. Evitar durante las primeras semanas la flexin en pronacin. Controles radiogrficos peridicos.

Tratamiento quirrgico Indicaciones

Fracturas tipo 2a (fractura-separacin de dos fragmentos). Fracturas tipo 2b (fractura-separacin de tres fragmentos). Fracturas tipo 3a (fractura-hundimiento encajada) desplazada ms de 20. Fracturas tipo 3b (fractura-hundimiento desencajada). Fracturas tipo 4a (fractura separacin-hundimiento encajada).

Tratamiento quirrgico
Escisin de fragmentos separados. Osteosntesis. Cupulectoma. Artroplasta.

Fractura del Olcranon

Clasificaciones
Colton. Schatzker. AO/ASIF. OTA. Criterios - Desplazamiento. - Direccin del trazo fracturario. - Conminucin articular. - Porcentaje involucrado. - Lesiones asociadas.

Clasificacin (Morrey)
Tipo 1: no desplazada. a: no conminuta, b:conminuta. Tipo 2:desplazada-estable. a: no conminuta, b:conminuta. Tipo 3: inestable. a: no conminuta, b:conminuta.

Fracturas de la Coronoides
Clasificacin Regan y Morrey
Tipo 1: Avulsin simple. Tipo 2: Fragmento nico o conminuto que afecta al 50%. Tipo 3: Fr. que afecta a mas del 59%.