Upper Extremity Injuries

Injuries of the upper extremity are very common. These are common work place injuries, sporting and just plain accidents. The treatment goal for almost all upper extremity injuries is to restore function and improve pain to allow return to functional use of the limb. Often this requires a simple cast, physiotherapy or occasional surgery to hold the injury back allowing the body to heal, or reconstruction or replacement of the injured structures. Talk to Dr Drynan and your primary care giver as to what are you options.

Whether it was skiing the slopes, falling from a bike, or walking along and tripping over, the distal radius fracture is the most common upper extremity fracture. It is managed in all ages and has relatively good results. 

In the paediatric setting, often the goal is to restore the bone back to a relatively normal anatomy alignment and allow the body to heal. This is common with growth plate injuries. The concern is for growth plate arrest and altered growth. This is an uncommon occurrence, and will be discussed with you primary care physician or with Dr Drynan.

In the adult population the aim is to restore the normal anatomy, in an acceptable fashion that will allow acceptable functional results in the future. Choices of casting and operative fixation, using a plate and screws to restore normal anatomy is a case by case discussion with the patient regarding fracture configuration, patient goals and health.

With all cases the aim will be to return to physiotherapy and movement within limits as soon as possible to allow an increased range of motion, improved pain control, lessen the chance of stiffness or nerve pain and return to function as soon as possible.

The elbow is a complex joint involving three joints, the ulno-humeral joint, radio-capitellar joint (humerus) and proximal radio-ulnar joint. Injuries to these joints and the adjacent bones often lead to stiffness and restrictions in motion. As such treatment is often started in a relatively quick fashion to allow rehabilitation and exercises to start to prevent stiffness and other complications of the injury. 

Simple dislocations:

Often treated in a back-slab / cast for 10 days if a primary dislocation, then started on a gradual range of motion protocol with physiotherapy guidance and moving to pronator and supinator strengthening muscles to improve the stability of the elbow whilst the torn ligaments heal. Holding the elbow in a cast for longer increases the risk of stiffness and ligaments healing at the incorrect tension.

Fractures into the joint:

These often require operative interventions to restore the joint to the anatomic position and allow rehabilitation, and support the bones whilst they heal. As such these are often dealt with in an emergent fashion with ideal fixation within 2 weeks. It is Dr Drynan's preference with some trauma and patients at higher risk for heterotopic ossification (abnormal bone deposition) after injury to give anti-inflammatories to assist in preventing this condition.

Dr Drynan will advise you of the rehabilitation requirements and communicate that to you local doctor, physiotherapist and if required your work cover case worker. Common injury rehabilitation sheets can be found by clicking the link.

Tears of the distal biceps are common in the active individual. Often in males reaching forward and having an unexpected load applied to the arm leading to a tear. Some patients may have a partial tear for some time with anterior vague elbow pain that may require physiotherapy or surgical intervention.

An acute distal biceps tear should be seen with relevant urgency in the rooms to have an open conversation regarding options for management, such as non operative and operative options. 

Operative options include reattaching the biceps to the bicipital tuberosity, area on the radius that it originally attached. The aim of this operation is to return the near normal strength with certain activities after the tear, although surgical risks are involved such as stiffness, scar and nerve injury. Rehabilitation after most tendon injuries is required.

Fractures of the clavicle are common injuries amongst active individuals. 

The clavicle bone is aimed at holding the scapular and shoulder girdle at a distance to allow the scapular to rotate around the chest wall and transmit forces to the chest and back. For this function the length and rotation of the clavicle is important, although compensation is possible.

The majority of clavicle fractures can be managed non operatively if undisplaced. The decision making for clavicle fractures takes into account the age of the patient, location of the fracture, displacement of the fracture, associated injuries and functional demands and goals. These will be discussed with you at your consultation with Dr Drynan. 

Regarding paediatric fractures, the union rate (chance of bone healing) in a pooled data looking at mainly adolescents, healing is 99% for mid shaft fractures non operatively and >99% with an operation. The time to union is slightly longer without operative intervention by approximately 10-14 days although this is usually not significant in the overall recovery. 

Approximately 30-40% of patients request for the clavicle plate to be removed in pooled data sets. This decision depends on the patient size, symptoms, risks for further fracture and growth, this will be discussed at your consultation with Dr Drynan.