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Oct 28, 2014
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Fracturas del Extremo Proximal del Húmero
id4307234 pdfMachine by Broadgun Software - a great PDF writer! - a great PDF creator! - http://www.pdfmachine.com http://www.broadgun.com
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Cuatro Partes (Codman)
CabezaHumeral
Troquín
Troquiter
DiáfisisHumeral
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Clasificación de De Anquin
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Clasificación de NEER
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Clasificación de la AO
Tipo I
Tipo II
Tipo III
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Schatzker y Tile
� Trazo
� Estabilidad
Intracapsular
Extracapsular.
Estable
Inestable
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Tratamiento
� Fracturas estables.
� Fracturas inestables.
No se desplazan con las cargas fisiológicas
Los fragmentos se mueven
en forma independiente entre sí
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Fracturas inestables
� Con desplazamiento mínimo.
� Con desplazamiento mayor.
Desplazamiento menor de 1 cm.
y angulación inferior a 40°
En dos partesEn tres partes
En cuatro partesFractura-luxación
Articulares
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Fracturas diafisarias de húmeroClasificación AO
A. Fr. Simples: A1 espiraladasA2 oblicuas mayor a 30°A3 transversa menor a 30°
B. Fr. en cuña: B1 cuña en espiralB2 cuña por inclinaciónB3 cuña fragmentada
C. Fr. Complejas: C1 en espiralC2 segmentariaC3 irregular
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Fractura de la Escápula
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Clasificación Anatómica
� 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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ClasificaciónZdraukovic y Damholt
� Fracturas del cuerpo.
� Fracturas de las apófisis (acromion-coracoides-espina).
� Fracturas del ángulo superoexterno (cuello-glenoides).
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Anillo osteofibrosoComplejo Suspensorio Superior del Hombro
Thomas Goss� Cavidad glenoidea.
� Coracoides.
� Ligamentos coracoclaviculares.
� Tercio distal de la clavícula.
� Ligamentos acromioclaviculares.
� Acromion.
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Anillo osteofibrosoComplejo Suspensorio Superior del
HombroThomas Goss
� Pilar anterosuperior: tercio medio de la clavícula.
� Pilar posteroinferior: cuello-espina-bordelateral de la escápula.
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Anillo osteofibrosoComplejo Suspensorio Superior del Hombro
Thomas Goss
Lesión aislada Lesión combinada(ruptura doble o triple)
hombro flotante
Baja energía Alta energía
Tratamiento funcional Tratamiento quirúrgico
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Fracturas del Cuello
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Clasificación
� 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 desplazadastraslación <1 cm.Angulación <40°
DesplazadasTraslacion > 1 cm.Angulación > 40°
Tratamiento funcional Tratamiento quirúrgico
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Fracturas del Acromion
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ClasificaciónKuhn
� Tipo I: desplazamiento mínimo.
� Tipo II: con desplazamiento sin reduccióndel espacio subacromial.
� Tipo III: con desplazamiento con reduccióndel espacio subacromial.
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Tratamiento
Fracturas del Acromion
Tratamiento funcional Tratamiento quirúrgico
DesplazadasEscalón >1 cm.Reducción del espaciosubacromialFracturas de la base del acromionPseudoartrosis sintomáticas
No desplazadasEscalón <1 cm.Sin reducción del espaciosubacromial
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Fracturas de la Coracoides
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ClasificaciónEyres
� Tipo I: de la punta.
� Tipo II: del cuerpo.
� Tipo III: de la base.
� Tipo IV: incluye la porción 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 desplazadasDiastasis <5mm.
Tratamiento funcional Tratamiento quirúrgico
DesplazadasDiastasis >5mm.
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Fracturas Glenoideas(intraarticulares)
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ClasificaciónIdeberg
� Tipo I: fracturas del reborde (A:anterior, B:posterior).
� Tipo II: transversal a través de la fosa, con fragmentoinferior desplazado con la cabeza humeral.
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ClasificaciónIdeberg
� Tipo III: oblicua con fragmento articular superior queincluye la coracoides ya que el trazo termina en el bordesuperior.
� 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 desplazadasSin inestabilidad
Tratamientofuncional
DesplazadasEscalón o diastasis > 2mm.Con inestabilidad GH.
Tratamientoquirúrgico
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Fracturas de la Clavícula
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Clasificación
Grupo I: fractura del tercio medio
Craig EV: Fractures ofthe clavicle, 1990
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Clasificación
Grupo II: fractura del tercio distal
� Tipo I: desplazamiento mínimo (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 (niños, con desplazamiento del fragmento proximal)
�seudoluxacion acromioclavicular�
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� Tipo V: conminuta: sin ligamentos adheridos en la porción proximal o distal, sino hacia un fragmento conminuto inferior.
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Grupo III: fracturas del tercio proximal
� Tipo I: desplazamiento mínimo
� Tipo II: desplazamiento (rotura ligamentos)
� Tipo III: intraarticular
� Tipo IV: separación epifisaria (niños y adultos jóvenes)
� Tipo V: conminuta
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Fracturas supracondileas de Codo
A extrarticulares A1 avulsion metafisariaA2 simple metafisariaA3 metafisaria multifragmentaria
B articulares B1 articular parcial lateral sagitalB2 articular parcial medial sagitalB3 articular parcial frontal
C suprainterart. C1 articular y metafisaria simpleC2 articular simple metafisaria complejaC3 multifragmentaria
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Fracturas supracondileas de Codo
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Fractura de la Cúpula Radial
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Clasificación (Mason)
� Tipo 1: No desplazada o mínimo 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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Clasificación(Duparc)
� Tipo 1: Fractura no desplazada.� Tipo 2: Fractura-separación 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 (separación-
hundimiento, encajada (tipo 4a) o desencajada (tipo 4b).
� Tipo 5: Estallido de la cabeza del radio.
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Tratamiento conservadorIndicaciones
� Fracturas tipo 1, no desplazadas(Duparc).
� Fracturas tipo 3a, fractura-hundimiento encajada (Duparc), con desplazamiento menor de 20º.
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Tratamiento Conservador
� Artrocentesis evacuadora.
� Yeso Braquiopalmar.
� Movimientos activos y pasivos autocontrolados.
� Evitar durante las primeras semanas la flexión en pronación.
� Controles radiográficos periódicos.
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Tratamiento quirúrgicoIndicaciones
� Fracturas tipo 2a (fractura-separación de dos fragmentos).
� Fracturas tipo 2b (fractura-separación de tres fragmentos).
� Fracturas tipo 3a (fractura-hundimiento encajada) desplazada más de 20º.
� Fracturas tipo 3b (fractura-hundimiento desencajada).
� Fracturas tipo 4a (fractura separación-hundimiento encajada).
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Tratamiento quirúrgico
� Escisión de fragmentos separados.
� Osteosíntesis.
� Cupulectomía.
� Artroplastía.
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Fractura del Olécranon
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Clasificaciones
� Colton.
� Schatzker.
� AO/ASIF.
� OTA.
Criterios
- Desplazamiento.- Dirección del trazo fracturario.- Conminución articular.- Porcentaje involucrado.- Lesiones asociadas.
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Clasificación (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 CoronoidesClasificación Regan y Morrey
�Tipo 1: Avulsión simple.
�Tipo 2: Fragmento único o conminuto que afecta al 50%.
�Tipo 3: Fr. que afecta a mas del 59%.
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Fracturas del Extremo Proximal del Húmero
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Cuatro Partes (Codman)
CabezaHumeral
Troquín
Troquiter
DiáfisisHumeral
Clasificación de De Anquin
Clasificación de NEER
Clasificación de la AO
Tipo I
Tipo II
Tipo III
Schatzker y Tile
� Trazo
� Estabilidad
Intracapsular
Extracapsular.
Estable
Inestable
Tratamiento
� Fracturas estables.
� Fracturas inestables.
No se desplazan con las cargas fisiológicas
Los fragmentos se mueven
en forma independiente entre sí
Fracturas inestables
� Con desplazamiento mínimo.
� Con desplazamiento mayor.
Desplazamiento menor de 1 cm.
y angulación inferior a 40°
En dos partesEn tres partes
En cuatro partesFractura-luxación
Articulares
Fracturas diafisarias de húmeroClasificación AO
A. Fr. Simples: A1 espiraladasA2 oblicuas mayor a 30°A3 transversa menor a 30°
B. Fr. en cuña: B1 cuña en espiralB2 cuña por inclinaciónB3 cuña fragmentada
C. Fr. Complejas: C1 en espiralC2 segmentariaC3 irregular
Fractura de la Escápula
Clasificación Anatómica
� Fracturas del cuerpo (cerca del 50%).
� Fracturas del cuello (25%).
� Fracturas glenoideas (10%).
� Fracturas del acromion.
� Fracturas de la coracoides.
� Fracturas de la espina.
ClasificaciónZdraukovic y Damholt
� Fracturas del cuerpo.
� Fracturas de las apófisis (acromion-coracoides-espina).
� Fracturas del ángulo superoexterno (cuello-glenoides).
Anillo osteofibrosoComplejo Suspensorio Superior del Hombro
Thomas Goss� Cavidad glenoidea.
� Coracoides.
� Ligamentos coracoclaviculares.
� Tercio distal de la clavícula.
� Ligamentos acromioclaviculares.
� Acromion.
Anillo osteofibrosoComplejo Suspensorio Superior del
HombroThomas Goss
� Pilar anterosuperior: tercio medio de la clavícula.
� Pilar posteroinferior: cuello-espina-bordelateral de la escápula.
Anillo osteofibrosoComplejo Suspensorio Superior del Hombro
Thomas Goss
Lesión aislada Lesión combinada(ruptura doble o triple)
hombro flotante
Baja energía Alta energía
Tratamiento funcional Tratamiento quirúrgico
Fracturas del Cuello
Clasificación
� Tipo I: No desplazada ni angulada.
� Tipo II A: Acortada o desplazada > 1 cm.
� Tipo II B: Angulada > 40°.
Tratamiento
Fracturas del Cuello
No desplazadastraslación <1 cm.Angulación <40°
DesplazadasTraslacion > 1 cm.Angulación > 40°
Tratamiento funcional Tratamiento quirúrgico
Fracturas del Acromion
ClasificaciónKuhn
� Tipo I: desplazamiento mínimo.
� Tipo II: con desplazamiento sin reduccióndel espacio subacromial.
� Tipo III: con desplazamiento con reduccióndel espacio subacromial.
Tratamiento
Fracturas del Acromion
Tratamiento funcional Tratamiento quirúrgico
DesplazadasEscalón >1 cm.Reducción del espaciosubacromialFracturas de la base del acromionPseudoartrosis sintomáticas
No desplazadasEscalón <1 cm.Sin reducción del espaciosubacromial
Fracturas de la Coracoides
ClasificaciónEyres
� Tipo I: de la punta.
� Tipo II: del cuerpo.
� Tipo III: de la base.
� Tipo IV: incluye la porción adyacente del cuerpo.
� Tipo V: fr. articular que comprende la parte superior de la glenoides.
Tratamiento
Fracturas de la Coracoides
No desplazadasDiastasis <5mm.
Tratamiento funcional Tratamiento quirúrgico
DesplazadasDiastasis >5mm.
Fracturas Glenoideas(intraarticulares)
ClasificaciónIdeberg
� Tipo I: fracturas del reborde (A:anterior, B:posterior).
� Tipo II: transversal a través de la fosa, con fragmentoinferior desplazado con la cabeza humeral.
ClasificaciónIdeberg
� Tipo III: oblicua con fragmento articular superior queincluye la coracoides ya que el trazo termina en el bordesuperior.
� Tipo IV: horizontal con trazo que llega al borde medial.
� Tipo V: combina los tipo II y IV.
FRACTURAS ARTICULARES
(Glenoideas)
No desplazadasSin inestabilidad
Tratamientofuncional
DesplazadasEscalón o diastasis > 2mm.Con inestabilidad GH.
Tratamientoquirúrgico
Fracturas de la Clavícula
Clasificación
Grupo I: fractura del tercio medio
Craig EV: Fractures ofthe clavicle, 1990
Clasificación
Grupo II: fractura del tercio distal
� Tipo I: desplazamiento mínimo (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 (niños, con desplazamiento del fragmento proximal)
�seudoluxacion acromioclavicular�
� Tipo V: conminuta: sin ligamentos adheridos en la porción proximal o distal, sino hacia un fragmento conminuto inferior.
Grupo III: fracturas del tercio proximal
� Tipo I: desplazamiento mínimo
� Tipo II: desplazamiento (rotura ligamentos)
� Tipo III: intraarticular
� Tipo IV: separación epifisaria (niños y adultos jóvenes)
� Tipo V: conminuta
Fracturas supracondileas de Codo
A extrarticulares A1 avulsion metafisariaA2 simple metafisariaA3 metafisaria multifragmentaria
B articulares B1 articular parcial lateral sagitalB2 articular parcial medial sagitalB3 articular parcial frontal
C suprainterart. C1 articular y metafisaria simpleC2 articular simple metafisaria complejaC3 multifragmentaria
Fracturas supracondileas de Codo
Fractura de la Cúpula Radial
Clasificación (Mason)
� Tipo 1: No desplazada o mínimo desplazamiento.
� Tipo 2: Desplazada, en general por cizallamiento con un solo fragmento.
� Tipo 3: Conminuta.
Mason Tipo IV
Clasificación(Duparc)
� Tipo 1: Fractura no desplazada.� Tipo 2: Fractura-separación 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 (separación-
hundimiento, encajada (tipo 4a) o desencajada (tipo 4b).
� Tipo 5: Estallido de la cabeza del radio.
Tratamiento conservadorIndicaciones
� Fracturas tipo 1, no desplazadas(Duparc).
� Fracturas tipo 3a, fractura-hundimiento encajada (Duparc), con desplazamiento menor de 20º.
Tratamiento Conservador
� Artrocentesis evacuadora.
� Yeso Braquiopalmar.
� Movimientos activos y pasivos autocontrolados.
� Evitar durante las primeras semanas la flexión en pronación.
� Controles radiográficos periódicos.
Tratamiento quirúrgicoIndicaciones
� Fracturas tipo 2a (fractura-separación de dos fragmentos).
� Fracturas tipo 2b (fractura-separación de tres fragmentos).
� Fracturas tipo 3a (fractura-hundimiento encajada) desplazada más de 20º.
� Fracturas tipo 3b (fractura-hundimiento desencajada).
� Fracturas tipo 4a (fractura separación-hundimiento encajada).
Tratamiento quirúrgico
� Escisión de fragmentos separados.
� Osteosíntesis.
� Cupulectomía.
� Artroplastía.
Fractura del Olécranon
Clasificaciones
� Colton.
� Schatzker.
� AO/ASIF.
� OTA.
Criterios
- Desplazamiento.- Dirección del trazo fracturario.- Conminución articular.- Porcentaje involucrado.- Lesiones asociadas.
Clasificación (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 CoronoidesClasificación Regan y Morrey
�Tipo 1: Avulsión simple.
�Tipo 2: Fragmento único o conminuto que afecta al 50%.
�Tipo 3: Fr. que afecta a mas del 59%.
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