Fracture of shoulder( humerus) - Causes, symptoms and treatment. MF.
Fracture of the humerus is a fairly common trauma and occurs in the elderly and in young people.
Anatomically, the humerus is divided into three sections:
The head of the humerus and the surgical neck of the are the parts that are located in the joint bag and are part of the shoulder joint( the "upper" part).In this area, most often a fracture of a large tubercle and a fracture of the surgical neck of the shoulder.
The body of the humerus - in medical sources is called the diaphysis of the shoulder, the longest part of the humerus. Fractures of this area are appropriately named - fractures of the body of the humerus( diaphysis of the shoulder).
Cavity area( distal part) - forms a connection to the forearm in the elbow joint( "lower" part).Fractures of this region are called overconscious.
Anatomy of humerus
The most common fracture of the surgical neck of the humerus and fracture of the component parts of the head, in particular, the fracture of the large tubercle. Fractures of the head and fractures of the condylar region refer to intra-articular lesions.
Along with the humerus, various nerves passing through the shoulder and the brachial artery can be damaged, and shoulder muscles can also be damaged in case of fracture of the humerus.
Symptoms of a shoulder fracture
Symptoms of a fracture of the neck of the humerus
• Pain in a fracture site;
• Deformed shoulder, compared to a healthy limb, in case of fracture with displacement;
• Shortening of the shoulder;
• Crepitation at the site of the injury( the crunch of the fragments is heard during the probing).
• Restriction of movements in the shoulder joint;
• Swelling of soft tissues at the site of injury, bruising( "bruise");
• Sometimes, with punctured fractures( in this case, one piece is pounded into the other and a reliable fixation is achieved), pain and other symptoms may be mild, the person injured may not seek medical help for several days.
Fractures of the neck of the humerus are very rarely open, but can be complicated by damage to the nerves, which will be manifested in a violation of sensitivity on the wrist, difficulty in making movements in the wrist joint and fingers.
Symptoms of a fracture of the large tubercle of the humerus:
• Pain over the shoulder joint;
• Limitation of mobility, the shoulder shoulder is most affected. Leaching can be completely absent, which indicates damage to the tendon of the supraspinatus;
• Swelling in this fracture is less pronounced, visible deformities are rarely observed;
• Crunch at the site of fracture when probing.
Nerves and significant vessels in this fracture are damaged very rarely. Often there is damage to the supraspinous muscle, which in the future can cause a sharp violation of movements in the shoulder joint.
Symptoms of fracture of the humerus( diaphysis) of the humerus:
• Severe pain;
• When shifting, severe deformation;
• Shortening of the limb;
• Crepitation of fragments;
• Severe swelling and bruising, can spread to the
brush • Limitation of movements in the shoulder and elbow joints.
This type of fracture is characterized by damage to the nerves and vessels. If the nerves are damaged, the movements in the fingers suffer, the sensitivity is disturbed, the brush hangs in the patient.
Symptoms of overcondition fractures:
• Pain giving to the elbow joint and forearm;
• Swelling of the elbow joint;
• Deformation at offset;
• Restrictions of movements in the elbow joint;
• Crunch of fragments during palpation.
In fractures in this area, the brachial artery is often damaged, which can lead to gangrene of the limb; the main symptom of damage to the brachial artery is the absence of a pulse on the forearm( in a typical place for palpation of the pulse).
Fractures of the upper part of the humerus should be distinguished from bruises, dislocations of the shoulder joint, lower from the dislocations of the elbow joint and fractures of the ulna.
First aid for fracture of the shoulder
As with any fracture, the main task is anesthesia and immobilization of the limb. For anesthesia, any medications in the home medicine cabinet( ketorol, nimesulide, analgin) will work.
Limb immobilization is achieved by constructing a tire from improvised means. The board, slats, sturdy bars or sticks are bandaged to the humerus, the hand is suspended on the headscarf and fixed to the trunk. With fractures in the upper part of the shoulder, the tire does not have to be done, it is enough to hang your hand on the kerchief.
Diagnosis of shoulder fracture
For diagnosis it is sufficient to perform radiography. In some cases, if there is a suspicion of damage to the supraspinatus and fractures inside the joint, ultrasound is performed.
Treatment of shoulder fracture
There are three methods of treatment of shoulder fractures: conservative, operative and skeletal traction.
Shoulder fractures without bias and fractures, the displacement of which can be corrected using the one-step repositioning ( correction) is treated by applying a cast strip and using special fixation tires and dressings.
Fractures of the large bump of humerus require, in most cases, treatment by imposing a plaster bandage. In addition to this, a diverting bar can be used that prevents the development of stiffness in the shoulder joint, and also provides a fusion of the supraspinatus( this muscle is often damaged by fracture of the large tubercle).
Retracting tire
For fractures with displacement, the surgical method of treatment is applied, the fragment is fixed with spokes or a screw, which are removed after a few months. Terms of general treatment range from 2 to 3 months, gypsum immobilization - 4-6 weeks.
For fractures of the surgical neck without bias , a plaster bandage is applied for 4 weeks, then development of movements. If the fracture was offset, and it managed to be fixed, the gypsum immobilization is extended to 6 weeks.
In the case of irreparable fractures , the operation is shown. Fracture, with surgical treatment is fixed by plates. With punctured fractures of the surgical neck and fractures of the large tubercle without displacement, this type of conservative treatment, such as functional, is justified, when the hand is fixed only by a bandage by the type of kerchief or on the discharge cushion( with damage to the supraspinatus) for a period of 4 weeks. Gypsum is not required in this case.
In the future, physiotherapy and exercise therapy will be used, a set of exercises for developing movements and general rehabilitation will be written below. The general term of treatment is from 2 to 3 months.
Fractures of the humerus body without bias are treated with a plaster tire applied for up to 8 weeks.
Shoulder fractures with displacement of are operated and fixed with plates, screws or special intraosseous rods, then gypsum is applied for 4-6 weeks, with reliable fixation of the fracture, can be limited to a bandage with a scarf. After removing the gypsum, they start rehabilitation. Total duration of treatment is 3 to 4 months
Also, for shoulder fractures with displacement, we apply the skeletal traction method. A needle is used for the elbow process, and the shoulder is adjusted by traction. With a tire for skeletal traction, it is necessary to lie about 4 weeks, which is very difficult for the patient. Then the plaster bandage is applied for another 4-6 weeks. The general term of treatment is 3-4 months. At present, the method of skeletal traction is rarely used to treat shoulder fractures.
Fractures of the lower end of the humerus( overcrossing) are very often accompanied by a displacement of the fragments. When removing the displacement, by adjusting under anesthesia, the plaster is applied for 6-8 weeks. If the displacement is unremovable, operate and install a plate and screws to fix the fracture. The general term of treatment with rehabilitation comes to 4 months. Plates, rods and screws are removed from the bone after several months, and even years, after full recovery. For each patient, the deadlines for the removal of metal structures are set individually. In the elderly, metal structures may not be removed, which is associated with the risk of a second operation.
In complicated open fractures of the humerus body , the complex design of the spokes and rings( Ilizarov's apparatus) is applied, the treatment time for this method can be extended up to 6 months, but from the first weeks of the movement in the joints.
Damage to nerves, vessels in fractures of the shoulder require special operations( nerve seam, vascular suture) and a significant increase in the time of general treatment and restoration of the function of the hand.
In any of the types of treatment you need to take calcium supplements, analgesics and anti-inflammatory drugs.
Rehabilitation after a shoulder fracture
Perhaps the most important element in the treatment of shoulder fractures is rehabilitation. Rehabilitation includes the most important components: physiotherapy, physiotherapy and massage. Physiotherapeutic treatment is prescribed by courses of 7-10 procedures a few weeks after the injury.
Physiotherapy( exercises) should start from the first days after the medical care.
• After 2-3 days from the moment of injury( operation) we begin active, but without load, movements in the fingers of a sick hand, as well as active movements in a healthy hand.
• A week after the injury( operation) isometrically strain the muscles of the affected shoulder. Isometrically - this is without making movements in the joints, to train for the beginnings you need on a healthy arm. For a day for 10 visits, we start with 20 voltages, gradually increasing their number. These exercises are necessary to maintain muscle tone and improve blood supply, which contributes to the fastest fracture fusion.
• After removing the plaster bandage, we proceed to develop the movements in the shoulder and elbow joints.
Exemplary exercises for the development of movements in fractures of the shoulder after the removal of gypsum:
1. Pendulum movements with both hands, the legs are on the width of the shoulders, the trunk is in an inclined position.
2. Circular motion in the same position.
3. Leaving the hand to the side is perhaps the most important exercise. If you can not immediately perform this exercise, we help the hand by moving your fingers along the wall.
4. We swing our arms in front of the chest.
5. Conduction of hands "lock" to the chest and subsequent straightening.
6. Extension, flexion in the elbow joints
7. Hand throwing behind the head.
8. In the future, for exercises you can apply a gymnastic stick.
Each exercise is performed 10-15 times several times a day. When you have pain, take breaks. After 2-4 weeks, it is possible to use dumbbells and other gymnastic equipment. The general term of rehabilitation and restoration of movements, in the absence of complications, from 3 to 6 weeks. With persistent difficulties in movements in the shoulder joint - contractures, special devices for developing movements located in rehabilitation centers are applicable.
Already on your return to work and with a strong union of fracture, you can gradually move on to active rehabilitation: swimming, tennis, classes in the gym.
Prognosis for shoulder fracture
In uncomplicated fractures of the shoulder, a return to normal activity occurs 2-3 months after the injury. The terms of rehabilitation and treatment can be significantly delayed in the presence of various complications. The most frequent complications are: contracture of the shoulder joint( restriction of movements), nerve damage in case of trauma, infection in the bone.
Physician traumatologist-orthopedist Voronovich NA