Traditional medicine

Proximal humerus fractures. Fracture of the proximal humeral head: successful and complicated treatment outcome Proximal humerus

RICARDO F. GAUDINEZ, MD

(RICARDO F. GAUDINEZ, MD)

VASANTHA L. MERSEY, MD

(VASANTHA L. MURTHY, MD)

STANLEY HOPPENFELD, MD

(STANLEY HOPPENFELD, MD)

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INTRODUCTION

Definition

Fractures of the proximal end of the humerus include fractures of the humeral head, anatomical neck and surgical neck of the humerus.

The Neer classification system characterizes these fractures as one-, two-, three-, or four-part fractures based on the displacement and angulation of fragments such as the head, shaft, major rotund eminence, and lesser rotund eminence of the humerus. When the fragment is displaced by 1 cm or more or angulated by 45 degrees or more, the fracture is classified as a fragmented or displaced fracture. If the fragments are not displaced or the angular displacement is less than 45 degrees, the fracture will be considered a single fragment. Fractures may be accompanied by dislocations.

A single-piece fracture can be an impacted or non-displaced fracture. A two-part fracture can be a displaced round eminence fracture or a displaced/angulated surgical neck fracture. A three-part fracture involves displacement/angulation of the head and shaft, including the greater or lesser tuberosity. A four-part fracture includes displacement/angular deformation of all four segments: the head, diaphysis, greater and lesser tuberosities.

Fractures of the greater rotundum eminence of bone with greater than 1 cm of displacement are usually associated with rotator cuff tears (Figures 11-1, 11-2, 11-3, 11-4, 11-5, 11-6, and 11-7).

FIGURE 11-1 (top left). An impacted fracture of the proximal humerus is also considered a single-piece fracture (Neer classification). A two-part fracture involves either a separation of the fragments by 1 cm or at an angle of 45 degrees.

FIGURE 11-2 (middle top). A fracture with displacement of the greater round eminence of the bone is also considered a two-part fracture. This type of fracture may also cause damage to the rotator cuff.

FIGURE 11-3 (top right). Three-fragment fracture of the proximal humerus: one fragment is the head, torn from the diaphysis on the surgical neck, the second – this is the diaphysis, and the third fragment is a large round prominence of bone.

FIGURE 11-4 (left). Four-part fracture of the proximal humerus. One fragment is the diaphysis, the second is the head, and the third and fourth fragments are the greater and lesser tubercles. The head is deprived of blood supply and is prone to avascular necrosis.

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FIGURE 11-5. Two-part fracture of the proximal humerus through the surgical neck with obvious displacement. One fragment is the head and anatomical neck, the second is the displaced diaphysis of the humerus.

FIGURE 11-7. Three-part fracture of the proximal humerus, with the head separated from the diaphysis and the large round eminence of the bone from the other two fragments.

FIGURE 11-6 The same two-part fracture as in Fig. 11-5, with partial reposition of the diaphysis to the surgical neck.

Mechanism of injury

Fractures of the proximal humerus occur when a fall occurs on the elbow joint or on a straight arm, especially in older people, or when the lateral surface of the shoulder joint is damaged. In rare cases, a fracture/dislocation of the shoulder joint may occur as a result of seizures.

Treatment Goals

Orthopedic purposes

Providing the correct position

Reduce the major and minor rotund eminence to preserve the function of the rotator cuff.

Achieve a neck-shaft angle of 130° – 150° and a posterior deviation of up to 30°.

Stability

Stability is achieved by external immobilization for stable nondisplaced fractures, by internal fixation (open or percutaneous) for displaced two- or three-part fractures, or by arthroplasty for four-part fractures.

Rehabilitation goals

Range of motion

Restore full range of motion of the shoulder in all directions. Often, there may be a residual loss in range of motion following a fracture (Table 11-1).

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Table 11-1. Shoulder range of motion

a One-third to one-half of the full range of motion is considered functional.

b To achieve maximum flexion or forward elevation, slight abduction and external rotation are required.

c To achieve maximum extension or posterior point, slight internal rotation is required.

Muscle strength

Build the strength of the following muscles and try to restore the resultant force with maximum resistance. Residual loss of strength, especially in the deltoids, is very common, 4/5 (5/5 is total strength) (see Chapter 4, Exercise Therapy and Range of Motion, Table 4-1) (Table 11-2).

Flexors:

Anterior part of the deltoid muscle (attached to the tubercle of the deltoid muscle).

Coracobrachialis muscle (weak flexor of the arm, attached to the medial surface of the humerus).

Biceps muscle (originates from the coracoid process of the scapula and passes through the intertubercular groove).

Pectoralis major muscle (clavicular head, attached to the lateral lip of the intertubercular groove).

Shoulder abductors:

Middle part of the deltoid muscle (attached to the round eminence of the deltoid muscle bone)

Supraspinatus (attaches to the greater rotundus eminence of the humerus - one of the muscles of the rotator cuff)

Adductor muscles of the shoulder:

Pectoralis major muscle (attached to the lateral lip of the intertubercular groove).

Latissimus dorsi muscle (attached to the lower part of the intertubercular groove).

Teres major muscle

Shoulder external rotators:

Infraspinatus muscle (attaches to the greater rotundum eminence of the humerus).

Teres minor (attached to the teres major eminence of the humerus).

Posterior part of the deltoid muscle (attached to the round eminence of the deltoid muscle bone).

Shoulder internal rotators:

Subscapularis muscle (attached to the lesser tubercle of the humerus).

Pectoralis major muscle.

Latissimus dorsi muscle.

Teres major muscle.

Shoulder extensors:

Posterior part of the deltoid muscle.

Latissimus dorsi muscle.

Rotator cuff:

Supraspinatus muscle.

Infraspinatus muscle.

Teres minor muscle.

Subscapularis muscle.

TABLE 11-2. Shoulder movement – Main engines

Functional Goals

Improving and restoring shoulder function for self-care, dressing and hygiene. Moreover, shoulder mobility and strength are very important in most sports.

Distinguish between fracture head, anatomical neck (intra-articular); transtubercular fractures and surgical neck fractures (extra-articular); avulsions of the greater tubercle of the humerus.

Fractures of the head and anatomical neck of the humerus.

Reasons: a fall on the elbow or a direct blow to the outer surface of the shoulder joint. When the anatomical neck is fractured, the distal part of the humerus usually becomes wedged into the head. Sometimes the humeral head becomes crushed and deformed. The head can be torn off, with its cartilaginous surface turning towards the distal fragment.

Signs. The shoulder joint is increased in volume due to swelling and hemorrhage. Active movements in the joint are limited or impossible due to pain. Palpation of the shoulder joint area and tapping the elbow are painful. During passive rotation movements, the greater tuberosity moves with the shoulder. With concomitant dislocation of the head, the latter cannot be felt in its place. Clinical signs are less pronounced with an impacted fracture: active movements are possible; with passive movements, the head follows the diaphysis. The diagnosis is confirmed by x-ray; an axial projection is required. Mandatory monitoring of vascular and neurological disorders is necessary.

Treatment. Victims with impacted anterior fractures of the head and anatomical neck of the shoulder are treated on an outpatient basis. 20-30 ml of a 1% solution of novocaine is injected into the joint cavity, the arm is immobilized with a plaster splint according to G.I. Turner in the position of abduction (using a roller, pillow) by 45-50°, flexion in the shoulder joint up to 30°, in the elbow - up to 80-90°. Analgesics and sedatives are prescribed, from the 3rd day they begin magnetic therapy, UHF on the shoulder area, from the 7-10th day - active movements in the wrist and elbow and passive movements in the shoulder joint (removable splint!), electrophoresis of novocaine, calcium chloride, UV irradiation, ultrasound, massage.

After 4 weeks, the plaster splint is replaced with a scarf bandage, and rehabilitation treatment is intensified. Rehabilitation - up to 5 weeks.

Working capacity is restored after 2 months.

Fractures of the surgical neck of the humerus.

Reasons. Fractures without displacement of fragments are usually impacted or pinched. Fractures with displacement of fragments, depending on their position, are divided into adduction (adduction) and abduction (abduction). Adduction fractures occur when falling with emphasis on the outstretched adducted arm. In this case, the fragment turns out to be abducted and rotated outward, and the peripheral fragment is displaced outward, forward and rotated inward. Abduction fractures occur when a fall occurs with the emphasis on the outstretched abducted arm. In these cases, the central fragment is adducted and rotated medially, and the peripheral fragment is medially and anteriorly displaced forward and upward. An angle is formed between the fragments, open outward and posteriorly.

Signs. In non-displaced fractures, local pain is detected, which intensifies with load along the axis of the limb and rotation of the shoulder; the function of the shoulder joint is possible, but limited. During passive abduction and rotation of the shoulder, the head follows the diaphysis. The x-ray determines the angular displacement of the fragments. In fractures with displaced fragments, the main symptoms are severe pain, dysfunction of the shoulder joint, pathological mobility at the level of the fracture, shortening and disruption of the axis of the shoulder. The nature of the fracture and the degree of displacement of the fragments are clarified radiographically.

Treatment. First aid includes the administration of analgesics (Promedol), immobilization with a transport splint or Deso bandage (Fig. 41), hospitalization in a trauma hospital, where a full examination is carried out, anesthesia of the fracture site, reposition and immobilization of the limb with a splint (for impacted fractures) or a thoracobrachial bandage with mandatory radiographic control after the plaster has dried and after 7-10 days.

Feature of reposition : for adduction fractures, the assistant raises the patient's arm forward by 30-45° and abducts it by 90°, bends the elbow joint to 90°, rotates the shoulder outward by 90° and gradually smoothly extends it along the axis of the shoulder. The traumatologist controls the reposition and performs corrective manipulations in the area of the fracture. The traction along the axis of the shoulder should be strong; sometimes for this, an assistant applies counter support with the foot in the armpit area. After this, the arm is fixed with a thoracobrachial bandage in the position of shoulder abduction to 90-100°, flexion at the elbow joint to 80-90°, extension at the wrist joint to 160°.

For abduction fractures, the traumatologist corrects the angular displacement with his hands, then reposition and immobilization are carried out in the same way as for adduction fractures.

The duration of immobilization is from 6 to 8 weeks; from the 5th week, the shoulder joint is released from fixation, leaving the arm on the abductor splint.

Rehabilitation time is 3-4 weeks.

2 1 /G months

From the first day of immobilization, patients should actively move their fingers and hand. After turning the circular bandage into a splint (after 4 weeks), passive movements in the elbow joint are allowed (with the help of a healthy arm), and after another week - active ones. At the same time, massage and mechanotherapy are prescribed (for dosed load on the muscles). Patients practice exercise therapy daily under the guidance of a methodologist and independently every 2-3 hours for 20-30 minutes. After the patient is able to repeatedly raise his arm above the splint by 30-45° and hold the limb in this position for 20-30 seconds, the abduction splint is removed and rehabilitation begins in full. If closed reposition of the fragments fails, then surgical treatment is indicated.

Fractures of the tubercles of the humerus.

Reasons. A fracture of the greater tuberosity often occurs with a dislocated shoulder. Its separation with displacement occurs as a result of a reflex contraction of the supraspinatus, infraspinatus and teres minor muscles. An isolated nondisplaced fracture of the greater tuberosity is primarily associated with shoulder contusion.

Signs. Limited swelling, tenderness and crepitus on palpation. Active abduction and external rotation of the shoulder are impossible, passive movements are sharply painful. The diagnosis is confirmed by x-ray.

Treatment. For fractures of the greater tubercle without displacement after blockade with novocaine, the arm is placed on an abductor pillow and immobilized with a Deso bandage or scarf for 3-4 weeks. Rehabilitation - 2-3 weeks.

Working capacity is restored after 5-6 weeks.

Feature of reposition : In case of avulsion fractures with displacement, after anesthesia, reposition is carried out by abduction and external rotation of the shoulder, then the limb is immobilized on an abduction splint or with a plaster cast. In case of large swelling and hemarthrosis, it is advisable to use shoulder traction for 2 weeks. Abduction of the arm on the splint is stopped as soon as the patient can freely lift and rotate the shoulder.

Rehabilitation - 2-4 weeks.

Working capacity is restored after 2- I X Ig months

Indications for surgery. Intra-articular supra-tubercle fractures with significant displacement of fragments, failed reduction in a fracture of the surgical neck of the humerus, entrapment of the greater tubercle in the joint cavity. Osteosynthesis is performed with a screw.

The elbow joint consists of three bones. There are several types of elbow fractures, one of which is a fracture of the lower part of the humerus, which forms the superior articular surface of the elbow joint.

This type of fracture in the elbow joint is quite rare (only 2% of all fractures in adults).

The structure of the elbow joint is complex. Like the humerus, both bones in the forearm can be broken.

Fractures of the distal humerus often result in several fragments; such fractures are called fragmented or comminuted. Fractures of the lower humerus are rare and can occur either alone or in combination with another type of injury to the elbow joint.

Treatment

Surgical treatment

Surgical treatment of fractures of the distal humerus in most cases involves the comparison of displaced fragments. For this they use metal implants (plates and screws), fixing bone fragments until their complete fusion.

Indications for surgical treatment:

fracture with displacement of fragments;
open fracture (in cases of an open fracture, the risk of infectious complications increases, and therefore the doctor prescribes intravenous antibiotics and a tetanus vaccination to the patient; the operation is performed urgently; during the operation, the wound and protruding bone fragments are thoroughly cleaned; during the operation, they can also be compared or bone fragments are fixed).

In more serious cases of open fractures, in which the soft tissue is significantly damaged, external fixation is possible (using a rod or Ilizarov-type device).

During the operation they use general or local anesthesia, which requires the use of local anesthetics such as novocaine. Also, these types of anesthesia can be combined.

During the operation, the patient may be in the following position:

lying on your back;
lying on your side;
lying on your stomach.

If the patient lies face down, then the lips and eyelids may remain swollen for several hours after surgery. You should not be afraid of such a phenomenon, because... this is quite normal and temporary.

In most cases, broken bones are aligned and fixed in the desired position. plates and screws.

To reach the fragments, the doctor often makes an incision along the back of the elbow joint.

There are several options for fastening bone fragments:

knitting needles/wire;
screws;
plates and screws;
suturing bones and tendons;
a combination of the above methods.

During the operation, some complications may occur. Taking this into account, the doctor recommends surgery to the patient only if he is absolutely sure that this operation will bring benefits that exceed any possible risks.

A humerus fracture is an injury that occurs as a result of a blow that the bone tissue is unable to withstand. This injury is widespread. Fractures of the capitate eminence of the humerus and other parts are much less common in young people than in older people; treatment and symptoms depend on the location and complexity of the injury.

Anatomy

The long tubular bone of the upper limb is the humerus, which performs a motor function and plays the role of a lever.

The humerus is divided into three parts:

Proximal epiphysis - located in the upper part of the body and is a rounded and adjacent part of the bone.
The diaphysis is the middle part or body.
The distal epiphysis is the lower part of the humerus, which is removed from the body.

Proximal epiphysis

The proximal epiphysis most often suffers from trauma to the greater tuberosity and neck. It consists of:

The head and articular cavity of the scapula.
Anatomical neck, which serves as a dividing groove between the head and the rest of the parts.
Small and large tubercle located behind the neck.
Intertubercular groove, which is the point of passage of veins the length of the head.
The surgical neck is considered the thinnest place of the humerus and is one of the leaders in damage.

Diaphysis

The longest part of the humerus is called the diaphysis. The length of the body exceeds all other sections. Injury to this area is called a fracture of the diaphysis of the humerus. The diaphysis is:

The upper part of the body is similar to a cylinder, and in section the distal epiphysis resembles a triangular figure.
Along the perimeter of the diaphysis there is a spiral-shaped hollow, inside of which there is the radial nerve, which provides communication between the limb and the center of the entire nervous system.

Distal epiphysis

The distal or condylar section is the connector of the lower ulnar section with the forearm area. As a result of injuries, a transcondylar fracture of the humerus, which refers to intra-articular fractures, can occur. Even in this segment, supracondylar injuries can occur due to a careless fall or blow - a fracture of the epicondyle of the humerus. Description of the distal area:

The lower part of the humerus is much wider and flatter than the diaphysis.
The elbow joint includes two articular planes that connect the humerus with the ulna and radius.
The block of the humerus has the shape of a cylinder and articulates with the bony areas of the elbow.
On the outer plane of the shoulder there is a head that connects to the radius.
The internal and external epicondyles, which hold the hand and separately the fingers, are attached to the side of the epiphysis.
Extensor muscles are attached to the lateral condyle.
The flexor muscles attach to the medial condyle.

Fractures of the humerus can occur in any part of the humerus. Sometimes injuries can affect two adjacent areas of the humerus. Damage to the shoulder is often combined with pathologies around the bone - nerve endings, brachial vein, part of the vascular system, skin. A person who falls unsuccessfully on the upper part of the humerus with emphasis can receive a transcondylar fracture of the humerus or a fracture of the condyle of the humerus.

Damage factors

The causes of a humerus fracture are as follows:

Falling on an elbow or outstretched arm.
A fall on a hyperextended outstretched arm leads to an extension fracture.
A fall on the elbow with the forearm strongly bent causes a flexion fracture.
Hit to the upper shoulder area.
Severance of the tuberosities can occur due to dislocation of the shoulder joint. This happens due to a sharp and strong contraction of the muscles attached to it.

Types of fracture

To describe the clinical picture of injuries, various classifications of humerus fractures are used.

Main types:

Traumatic – caused by a strong mechanical load at an angle or perpendicular to a part of the skeletal system relative to the bone axis.
Pathological - appears against the background of chronic pathologies that reduce the strength of bone tissue up to destruction at the slightest load.

Based on the type and direction of destruction, shoulder fractures are divided into:

Transverse - caused by damage to bone tissue perpendicular to the axis of the bone.
Longitudinal - bone damage runs along the perimeter of the tissue.
Oblique - a bone fracture at an acute angle relative to the axis.
A helical fracture occurs due to a circumferential injury. The debris moves in a circle.
A comminuted fracture of the humerus is characterized by the fact that in it the fracture line is completely blurred, and the bone tissue turns into splinter fragments.
Wedge-shaped occurs when one bone is pressed into another and this type of injury is typical for spinal fractures.
Impacted fracture of the humerus - one bone is wedged inside the other.
A depressed or impression fracture of the head of the humerus occurs when it is pressed into the bone tissue.

Shoulder fractures according to the severity of damage to the skin and muscle tissue:

Closed fracture of the humerus - without breaking the skin.
Open fracture - muscles and skin are injured, bone fragments are visible in the resulting wound.

Fractures according to the placement of fragments:

Non-displaced humerus fracture.
A displaced fracture of the humerus is a complex fracture; before treatment, it is necessary to combine all bone fragments.

Surgical intervention is possible to accurately align the fragments.

Fractures are also classified by location relative to the joints:

Extra-articular.
Intra-articular - affects the part of the bone that forms the joint and is covered by the articular capsule.

In all injuries of the humerus, a closed fracture of the humerus predominates, and most often it is displaced. It should be noted that several types of fractures can be combined simultaneously, but within the same department.

Fractures of the humeral head, anatomical, and surgical neck most often occur in elderly people. Fracture of the humerus in children occurs after an unsuccessful fall and most often these are intercondylar and transcondylar injuries. The body of the bone or diaphysis is quite often susceptible to injury. Fractures occur when the shoulder is bruised, as well as from falling on the elbow or straightened arm.

Symptoms of damage

Due to the strong innervation of the shoulder girdle, a glenohumeral fracture brings with it changes in the general condition of the patient. Symptoms of a shoulder fracture may vary depending on the type of injury:

Upper shoulder fracture

Sharp pain syndrome.
Tissue swelling in the area of the fracture of the upper end of the humerus.
Hemorrhage under the skin.
Restriction in joint mobility is partial or complete immobilization due to the fact that a fracture of the upper third or another part has occurred.

Mid-humeral fracture

Deformation of the arm due to the displacement of bone fragments and the reduction of the damaged shoulder relative to the healthy one.
Intense pain.
Hand dysfunction - volumetric movements in the joints of the elbow and shoulder are limited due to a violation of bone integrity.
Edema.
There is bleeding under the skin in the fracture area.

Fracture of the lower shoulder

Supracondylar

Swelling in the area of the elbow joint.
The deformity is displacement and sinking of the elbow, a protrusion is visible on the front surface of the joint. These signs of a fracture appear only during the first hours of injury; then swelling hides these pathologies.
Sharp pain syndrome.
Restriction in joint mobility.
Subcutaneous hemorrhages.

Transcondylar

Swelling in the elbow area.
Severe pain.
Hemorrhage into the joint.
Restricted movement.

First aid

First aid for a fracture of the humerus or displaced shoulder joint should be provided to the victim in a timely and correct manner. The speed of action determines how long the injury will be treated, as well as the result of all therapeutic and surgical procedures, regardless of the patient’s age. Help should be provided correctly, by a person who knows the algorithm of actions.

The main help for a fractured shoulder to a victim consists of the following measures:

Pain relief with medications and injections.
Immobilization of the injured limb using available means - a board, a stick, a scarf - will make the arm motionless, which will prevent the bone fragments from moving.
During the transfer, it is important that the victim sits and does not stand. If necessary, you can support it on the side opposite to the injury - right or left.

Important! If a fracture occurs in a child, the people accompanying him need not to panic, so as not to frighten the child and not strain the situation. Under no circumstances should you palpate the fracture site yourself while providing assistance. It is necessary to avoid any rough and sudden movements, this will help to avoid displacement of fragments, damage to blood vessels and nerves.

First aid is the key to a quick recovery while minimizing negative consequences.

Diagnostics

The victim should be taken to the emergency room as quickly as possible, where he will be examined by a specialist. He will palpate the area where the shoulder fracture occurred and identify specific symptoms of the injury:

When tapping or pressing in the elbow area, the pain increases significantly.
When you feel the joint, a characteristic sound appears, reminiscent of bursting bubbles - the sharp edges of the fragments touch each other.
The doctor performs various manipulations with the victim’s shoulder, while he tries to feel with his fingers which bones are displaced and which remain in place.
If a dislocation is present simultaneously with a bone fracture, then when palpating the shoulder joint, the traumatologist does not find the humeral head at its anatomical location.
In the area of the elbow joint, protrusions and depressions can be felt in front and behind. They are located in the direction of displacement of the fragments.
Shoulder deformity—the epicondyles deviate from their normal position.

Only a specialist doctor should check all these indicators. Inept actions can cause damage to blood vessels and nerves, resulting in serious complications.

The final diagnosis is made only after an X-ray examination. The image will show at what level the humerus is broken and in which direction the displacement occurred.

What therapeutic measures will be prescribed by the doctor and how long the treatment lasts.

Treatment

Treatment of a humerus fracture consists of three methods: surgical therapy, conservative treatment, and traction. If the fracture of the shoulder joint is not displaced or can be corrected by performing a one-stage reduction, then it will be enough to apply a plaster cast or other fixation agent.

Conservative therapy

It is based on complete immobilization of the injured arm with fixation with special pads and is used for injuries:

Greater tuberosity, where in addition to the fixing tape, a special splint is used to prevent immobilization of the joint and ensure fusion of the supraspinatus muscle. If the tubercle fragment has moved out of place, it is necessary to fix it in the correct position with knitting needles or screws. After 1.5 months, the structure should be removed.
A non-displaced fracture of the shoulder joint is treated with a splint, which is applied to the injury for a period of two months. If there is displacement, then resort to skeletal traction. The victim will have to spend a month in an immobilized position. After this, plaster will be applied for the same period. Recently, the therapeutic method of skeletal traction has been replaced by osteosynthesis, which does not confine the patient to bed for such a long period.
Treatment of the surgical neck without displacement is carried out using a plaster retainer. They put it on for a month. If reduction was carried out, and it was successful, then the plaster is worn for two more weeks. When it is not possible to straighten bone fragments, surgical intervention is prescribed, where they are fixed inside the bone using plates. If an impacted fracture occurs, it would be correct to use abductor pillows or special scarves. How long does this therapy last? The treatment period for a shoulder fracture can be extended by three months until the bones heal completely.
Transcondylar injuries are always accompanied by displacement of debris. Their comparison is carried out under anesthesia, followed by the application of plaster for up to two months.

A fracture of the shoulder joint can result in injury to blood vessels or nerves. In this case, an operation is necessary, which involves suturing. This increases the duration of therapy.

Important! It is not always possible to fully restore the functions of the injured limb with this type of damage.

When treating a fracture, medications containing calcium, analgesics and antibiotics are prescribed.

Surgical intervention

If there are prerequisites for operations, they are performed using modern techniques and are prescribed when conventional therapy does not give a positive result for a fracture:

Displaced shoulder fracture - the fragments are secured with special rods, and after a while, until the fracture heals, they are removed from the bone.
If there is a damage that cannot be reduced in the usual way, then plate fixation without plaster is used, followed by removal.
Displaced body fracture - during surgery, intraosseous rods are inserted into the bones for a period of about a month. During rehabilitation, treatment for a fracture of the humerus is extended for the same period.
Trauma to the transcondylar ends, accompanied by displacement of the fragments, is reduced under anesthesia with the application of a plaster cast for two months. If the displacement cannot be eliminated, then an operation is performed during which screws and plates are used. They are installed for several years
Fractures of complex, open body injuries are treated using the Ilizarov design, which allows movement of the arm from the very beginning of therapy. This design stays on the limb for about six months.
If the injury to the humerus causes damage to the nerve endings and veins, then urgent surgical intervention is prescribed.

The duration and treatment of healing for a displaced fracture of the humerus directly depends on the severity of the injury. The plaster is applied for 2-3 months.

Skeletal traction

It is used if there is a displaced fracture of the humerus. During this method, a special pin is inserted into the elbow to help realign the bones. The patient lies in bed with the suction device for about a month. This type of therapy is rarely used.

Rehabilitation

After the bones heal and the bandage is removed, you should move on to rehabilitation measures aimed at developing the injured arm.

Rehabilitation includes:

Physiotherapeutic treatment of a fracture of the shoulder joint - it is necessary to complete several courses consisting of 10 procedures. Electrophoresis with novocaine and calcium chloride may be prescribed. Ultrasound treatment gives good results.
Massage. If it is not possible to visit a specialist in the office, then you can do it yourself. To speed up the healing time and stimulate blood circulation, it is recommended to use special ointments and oils.
A set of therapeutic exercises.

Important! Development of the shoulder joint after a fracture is an integral part of bone restoration and plays no less important role than adequate therapy.

Complications

Upper shoulder fracture

Deltoid muscle dysfunction occurs as a result of nerve damage. Paresis or partial disturbance of movements, complete paralysis may appear. It is difficult for the victim not to move his shoulder to the side and raise his arm high.

Arthrogenic contracture is a violation of movements in the shoulder joint due to pathological changes in it. This occurs due to the destruction of articular cartilage and the growth of scar tissue. The joint capsule and ligaments become very dense and their elasticity is lost.

Habitual shoulder dislocation a consequence that develops after a fracture-dislocation. This is when a shoulder fracture and dislocation occurs. If therapy is carried out incorrectly or untimely, then repeated dislocation from any effort can easily occur in the future.

Fracture of the middle part of the humerus

This nerve runs along a spiral groove located on the humerus and innervates the muscles of the shoulder, forearm, and hand, which leads to paresis or complete paralysis.

The complication is treated by a neurologist. The damaged nerve is restored with the help of medications, vitamins, and physiotherapy.

False joint. If a piece of muscle or other soft tissue is pinched between the fragments, they cannot heal. Abnormal mobility persists, as if a new joint has appeared. Surgery required.

Fracture of the lower part

Volkmann's contracture represents a decrease in mobility in the elbow joint due to circulatory disorders. Vessels can be damaged by bone fragments or compressed when wearing an incorrectly applied fixator for a long time. Nerves and muscles stop receiving oxygen, resulting in impaired movement and sensitivity.

Arthrogenic contracture in the elbow joint develop after pathological changes in the joint itself, as with arthrogenic contracture of the shoulder joint during fractures of the shoulder in the upper part.

Impaired forearm muscle function is caused by damage to the radial and other nerves.

Conclusion

Treatment of any fracture requires compliance with all instructions of specialists. Immobilization and complete rest of the injured surface is eventually replaced by a certain load. Courses of physiotherapy, physical therapy, and massage can be prescribed repeatedly with breaks until all functions are fully restored. It is also important to follow all recommendations for recovery at home.

Do not delay diagnosis and treatment of the disease!

Make an appointment with a doctor!

They are rare, more often in older people, and are intra-articular fractures.

Mechanism: a fall on the elbow or a fall on the anterior outer surface of the shoulder joint.

Clinic.

Smoothness of the configuration of the shoulder joint, hemorrhage, swelling, severe pain when moving the shoulder joint and when loading along the axis of the shoulder, disruption of its function. Differential diagnosis is made on the basis of radiographs.

Treatment.

Impacted fractures - 20 ml of a 1% novocaine solution is injected into the fracture area, the limb is suspended on a scarf or a plaster splint is applied. The arm is bent at the elbow joint and abducted by 45-50°.

A cotton-gauze roll is placed in the armpit. Painkillers are prescribed, and from the third day of UHF, exercise therapy for the hand. Active exercises are prescribed in the wrist and elbow joints and passive exercises in the shoulder. After 3 weeks, the plaster cast is removed, the arm is suspended on a scarf, and rehabilitation treatment is continued. Working capacity is restored after 6-10 weeks.

Surgical treatment is indicated for young and middle-aged patients. If the head is crushed, economical resection is performed; if the head is torn off and there is a connection with the capsule, the fracture is formed by juxtaposing the fragments and striking the bent elbow in the direction of the axis of the shoulder.

Subtubercular(extra-articular):

a) transtubercular,

b) surgical neck,

c) epiphysiolysis.

A fracture of the surgical neck of the humerus is more common in women. There are: adduction, abduction, impacted fractures of the surgical neck. Often, surgical neck fractures are combined with shoulder dislocation.

Mechanism: direct and indirect injury.

Adduction fracture - a fall on the elbow or outstretched arm in a position brought to the body.

Abduction fracture - a fall on the elbow or outstretched arm in an abducted position.

Symptoms the same as in the first group. Possible damage to the axillary nerve and compression of the neurovascular bundle. The final diagnosis of the type of fracture is established radiologically.

Treatment.

Patients with displaced fractures of the surgical neck of the humerus are treated in the hospital. Under local anesthesia, they compare the fragments. The limb is placed on an abductor splint, skeletal traction is applied to the olecranon process (4-5 weeks), followed by immobilization on a wedge-shaped pillow (2-3 weeks) after the skeletal traction is removed.

In young and middle-aged patients, after effective manual reposition of fragments, a thoracobrachial plaster cast is applied. For elderly and senile patients, a functional method of treatment is indicated: immobilization with a snake bandage, pain relief, early mechanotherapy.

Treatment of fractures of the surgical neck of the humerus with dislocation of the head, with failed reposition, as well as with compression or danger of damage to the neurovascular bundle, is surgical, which consists of eliminating the dislocation and comparing the fragments with subsequent osteosynthesis (allografts, wires, pins, etc.). In the postoperative period, immobilization with a plaster splint for 4-6 weeks is indicated. The metal pin is removed after 3 months.

Isolated fractures and avulsions of the greater and lesser tubercles.

They occur more often as concomitant fractures of the surgical neck and shoulder dislocation. An isolated fracture of the greater tubercle occurs with direct trauma (a fall on the shoulder area), as well as with a sharp contraction of the supraspinatus, infraspinatus and teres minor muscles. Fractures and especially avulsions of the lesser tubercle are very rare and are caused by contraction of the subscapularis muscle.

Clinic.

Pain in the fracture area, limitation of movements in the shoulder joint. Local swelling, pain, hemorrhage. The diagnosis is confirmed after radiography.

Treatment.

Anesthetize the fracture area with a solution of novocaine (1% solution 10 ml). For fractures of the tubercles without displacement, a DEZO bandage is applied or the arm is suspended on a scarf. Exercise therapy, massage, and thermal procedures are prescribed. Working capacity is restored after 5-6 weeks. For displaced avulsion fractures of the tubercles, the limb is placed on an abduction splint or a plaster thoraco-bronchial cast is applied for a period of 6 weeks. Then - restorative treatment. Working capacity is restored after 6-10 weeks. If conservative treatment fails, surgical treatment is indicated after 2-4 days. The tubercle is fixed in its original place with sutures or using a screw or knitting needles. For 3-4 weeks, the limb is placed on an abduction splint.