Fracture of the humerus with and without displacement
A fracture of the humerus is an injury that results from an applied force that the bone tissue was unable to withstand. This injury is widespread. It is often found in both young people and people of retirement age. But the latter still prevails.
Statistics depending on the location of the fracture are as follows:
- Proximal fractures account for the majority of injuries. Injuries to the bones of the upper sections occupy a leading position and account for about 7% of all fractures of the skeleton of the human body.
- Diaphyseal fractures are less common. The share of bone damage in the middle of the shoulder accounts for up to 3% of cases.
- The most rare fractures are distal fractures, that is, those that affect the lower parts of the shoulder. They account for about 1 - 2%.
If we refer to the anatomical structure, then the following bones are part of the shoulder:
- The surgical neck and head of the bone are located under the articular capsule and are its components, refer to the so-called "upper" part of the shoulder.
- The longest section of the shoulder is its body or diaphysis.
- The lower part of the shoulder, which is called the condylar or distal region, is responsible for the connection with the elbow joint.
Content:
- Closed and open fracture of the humerus
- Displaced humerus fracture
- Fracture of the humerus without displacement
- Fracture of the greater tubercle of the humerus
- Other types of fracture of the humerus
- Comminuted fracture of the humerus
- First aid for fracture of the humerus
- Humeral fracture treatment
- Immobilization for fracture of the humerus
- Rehabilitation after humerus fracture
Closed and open fracture of the humerus
Closed fracture
A closed fracture can occur in the upper shoulder. There, the head of the bone, the small and large tubercles, the surgical and anatomical neck are subject to injury.
The symptoms that bother a patient who have received a closed injury to this part are as follows:
- Joint pain.
- If the injury is impaired, then the edema is not too pronounced, it grows slowly. The pain increases when you try to actively move the limb. Passive movements are not too limited.
- If a displacement is observed with a closed fracture, then the deformity of the hand is more often visible, other symptoms, including pain, appear brighter.
If a closed shoulder fracture occurs in the middle section, then most often the cause is a fall or a blow to the shoulder. The injury can be comminuted, it can be oblique, transverse and helical. Fracture of this part often entails damage to the nerve bundle, namely the radial nerve. In addition, the brachial arteries and veins are affected.
The main symptoms that allow talking about a closed fracture of the shoulder body include:
- Strong pain.
- Deformation in the presence of displacement.
- Reducing the length of the limb.
- Fragment crepitation.
- Puffiness and hematoma, which can cover a large area, up to the hand.
- Movement is limited mainly in the elbow and shoulder joint.
- If the nerves were damaged, then there is a violation of the movements of the fingers and their sensitivity.
- The hand cannot be kept in a raised state; it hangs limply.
Open fracture
The main features of an open fracture include:
- An open wound will be visible on the surface of the skin. Most often, bone appears through it.
- There is severe bleeding, which must be stopped by applying a tourniquet. Its location is the upper third of the shoulder.
- The wound site is treated with any available antiseptic, after which a sterile dressing is shown.
- Only after processing and stopping the bleeding should the hand be immobilized.
Displaced humerus fracture
A displaced fracture has the following symptoms:
- The onset of sharp pain that appears when trying to move the arm or when probing the body of the humerus.
- Swelling, often with severe hematoma.
- Inability to perform active actions to abduct and raise a limb.
- With active palpation, crepitations are heard.
- The deformity is visible even when the bones have not broken through the soft tissue. Especially if the displacement of the fragments is pronounced.
The final diagnosis can be made only after the doctor sees the X-rays, which should be taken in two projections. If there is a pronounced displacement of the shoulder head, then the prognosis is poor. Since it will experience a nutritional deficiency, this will lead to its death or even resorption. Fractures, the line of which passes through the bumps, are also dangerous. Restoring the full functioning of a limb is rare.
When the surgical neck is injured, the displacement occurs according to the impacted type with the formation of a chip. The fragment can be displaced sideways (when the fracture occurs with the adducted shoulder) or towards the middle (with the abducted shoulder). In this case, the decisive factor in where it will be directed is not only the position of the shoulder when injured, but also the muscle contraction that occurs reflexively.
It is important not to confuse a fracture with displacement and dislocation of the shoulder. A distinctive feature of such fractures is the ability to freely move the shoulder (not in the place of the joint) using passive force. There will be no spring effect. These signs are especially relevant for obese people, since it can be difficult to conduct a full X-ray examination from a dense fat layer.
Fracture of the humerus without displacement
If no displacement occurred during the fracture of the shoulder bone, then the signs of the fracture may be somewhat blurred:
- Depending on the location of the injury, the person will feel pain: in the upper or lower arm. But its intensity is not as pronounced as in a fracture with displacement of fragments. It intensifies when trying to move.
- Edema may not form immediately, but within a few hours. This is due to the fact that the soft tissues around the bone will not be damaged by fragments.
- A hematoma is observed, but it also appears after a while, its size and severity depends on the cause of the fracture.
- Limb shortening is not noticeable without special measurements.
- There is no hand deformation.
It is important to provide first aid to the victim correctly so that the fragments do not move and the injury does not become more serious. More often, fractures of the shoulder bones without displacement are observed in children, which is due to the peculiarities of the structure of their bone tissue.
Fracture of the greater tubercle of the humerus
Fractures of the greater tubercle of the humerus are not uncommon. If it was damaged in isolation, then the injury occurs in a tear-off type. Often, the separation of the tubercle is accompanied by a dislocation of the shoulder. Due to the fact that the muscles responsible for the abduction of the shoulder and its rotation are attached to it, the detached fragment is always displaced due to their tension force.
Signs of separation of a large tubercle are as follows:
- Swelling of the site of injury.
- Pain that occurs locally over the shoulder joint.
- Impaired mobility of the shoulder joint.
- Due to muscle retraction, external rotation of the shoulder is impaired. This is one of the main symptoms indicating damage to the tubercle.
- If it is absolutely impossible to remove the arm, then this is a sign of damage to the tendons.
After a fracture of the greater tubercle, there is a risk that movement disorders in the shoulder joint may be expressed. This is due to damage to the supraspinatus muscle. Sometimes there is no full recovery option.
Other types of fracture of the humerus
Separately, it should be said about the fracture of the surgical neck, transcondylar and comminuted fracture. Each of them has certain characteristics. In their treatment, you need to adhere to certain tactics.
Surgical fracture of the humerus
If the mechanism of injury is indirect, then the surgical neck of the shoulder often suffers. Fractures are divided into adduction and abduction, depending on the position of the hand at the time of injury. The first occurs if the limb is adduced, and the second, if it is abducted. When the hand is in the middle position, then the insertion of the distal fragment into the proximal one occurs more often. This is called a surgical puncture fracture.
If we consider the symptoms of this type of injury, then it is as follows:
- The pain will be localized at the site of the fracture, it becomes more intense when trying to make circular movements.
- It is uncomfortable for a person to hold a limb on weight, he tries to support it under the elbow.
- If attempts are made to move, the large tubercle will move towards the head.
- Swelling occurs and a hematoma is observed.
- With displacement, crepitations will be heard.
- There is pathological mobility.
- The shoulder will become shorter compared to the healthy one.
A surgical fracture of the neck of the shoulder is dangerous because at the time of injury, the integrity of the neurovascular bundle is often violated. The same damage can occur with incorrect reduction. This violation will lead to the fact that the function of the hand will not be fully restored.
Percondylar fracture of the humerus
Such injuries are rare because of the location of the bone. The damage is considered intra-articular, which means that the fracture line runs along the joint cavity. It runs transversely, from one condyle towards the other.
Symptoms of transcondylar fractures include:
- Painful sensations that radiate to the elbow and forearm.
- The presence of swelling. Sometimes the swelling is pronounced.
- If there is an offset, then the deformation of this area will be visible.
- When you try to feel, a crunch is heard.
- Elbow movement, if not completely blocked, is largely limited.
A characteristic feature of a transcondylar fracture is trauma to the brachial artery. This increases the risk of hand gangrene. If the artery is damaged, the pulse on the forearm cannot be felt.
In order for both condyles to be broken, an impressive force is needed. This can be a fall on the elbow from a height, industrial accidents, for example, a mine collapse. X-ray shows more often fractures that form the letter V or T.
The outer condyle is more likely to break in children. The offset will be directed outward and upward. The inner and outer epicondyle is rarely affected and is accompanied by a dislocation of the elbow.
Comminuted fracture of the humerus
The most severe of all shoulder fractures is comminuted, displaced. The difficulty lies in the fact that not only the nerves are damaged, but also the blood vessels. Therefore, for treatment, surgical intervention is required.
Such trauma is typical for the adult population.
Depending on the nature and location of the fracture, the following types of comminuted shoulder damage are distinguished:
- Fracture of the upper part, it is accompanied by swelling and deformation of the joint. Recovery requires surgery, which can be hindered by either old age or the presence of a serious illness.
- A fracture of the shoulder in the middle part is dangerous because the fragments can damage the radial nerve, veins and arteries. To fix them, it is necessary to use metal pins or plates, or the Ilizarov apparatus.
- If the injury has occurred in the lower part of the humerus and there is no displacement of the fragments, then it is advisable to apply a plaster cast. With significant displacements of the fragments, an operation is needed.
First aid for fracture of the humerus
First aid for injury is as follows:
- To begin with, a person must be reassured and offered an anesthetic. As an analgesic can act: analgin, nimesulide, ketorol. If a person has panic, then you can give him a tincture of valerian, 20 drops will be enough, or one tablet of tazepam or triocazine. Valocordin or cordiamine can be used as a cardiovascular agent.
- Then you need to limit your hand movements as much as possible. For this purpose, immobilization is carried out. You can use small boards as improvised means. One of them should be tightly bandaged to the shoulder and the other to the forearm. If there are not even plaques, then it is advisable to put your hand on a kerchief bandage. It is thrown over an intact shoulder. In this case, the bend of the arm should be carried out at a right angle at the elbow. To avoid displacement, it is best to tie such a bandage to the body as tightly as possible.
- When transporting, it is desirable that a person sit.
Humeral fracture treatment
Three methods are used to treat a shoulder fracture: operative, conservative, and skeletal traction. If the fracture is not complicated by displacement or it is possible to correct it by performing a one-stage reduction, then the imposition of a plaster of Paris or another fixing agent is sufficient.
If we consider therapy at the fracture site, then the following features can be distinguished:
- Treatment of a large tubercle occurs by applying a plaster cast, sometimes it can be supplemented with an abduction splint. This is necessary in order to prevent the development of stiffness in the joint and to ensure proper fusion of the supraspinatus muscle. If the fragment of the tubercle has moved from its place, then it must be fixed in the correct position with knitting needles or a screw. After about 1.5 months, the structure will be removed.
- If the surgical neck was injured, but there was no displacement, then you can do with the imposition of a plaster cast for a month. When reduction was required, and it was successful, then the gypsum will have to be carried for two weeks more. If it was not possible to correct the bone fragments, then surgical intervention is necessary. Fixation inside the bone is carried out using plates. If the fracture occurs in a hammered-in type, then it is advisable to use either an abduction pillow or a special kerchief. The treatment period can be extended up to 3 months.
- When a fracture is localized on the body of the shoulder and displacement is observed, then the most common method of treatment was skeletal traction. In an immobilized position, a person will have to spend up to a month. After that, a plaster cast will be applied for the same time period. Recently, the method of skeletal traction has receded into the background, it is being replaced by osteosynthesis, which does not confine a person to bed for such a long time.
- Percondylar fractures are almost always accompanied by displacement of fragments. Their comparison is carried out under anesthesia, and then it is advisable to apply a plaster cast for up to two months.
If the vessels or nerves were damaged as a result of fractures, then a special operation is required, which consists in suturing them. This increases the duration of treatment and it is not always possible to fully restore the functionality of the limb. As for medicines, it is advisable to use calcium preparations, as well as analgesics and antibiotics.
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Immobilization for fracture of the humerus
When complete immobilization of the limb is required, it is advisable to apply a thoraco-brochial bandage.
The technique is as follows:
- The victim should sit on a high stool or on a table. His limb should be bent to 80 ° C for upper shoulder injuries and 45 ° C for lower bones fracture.
- A layer of cotton wool should be applied to the body, which is attached with bandages.
- The joints of the hand, such as the wrist, elbow and shoulder joints, are also covered with cotton wool.
- Plaster splints are applied horizontally to the body, and on the sides they are attached vertically.
- One splint must be placed over the injured shoulder. It should be attached to the body with bandages.
- Then additional splints are applied over the body, shoulder girdle, forearm, up to the hand. All this is again fixed with bandages.
- A special spacer is inserted between the hand, which will be in the cast and the body, so that the limb cannot adhere to the body.
Thus, the limb will be immobilized, and the bone fusion will go right.
Rehabilitation after humerus fracture
After the bandage is removed, it is necessary to proceed to rehabilitation measures. They are an integral part of bone repair and are just as important as adequate therapy.
Rehabilitation necessarily includes:
- Physiotherapy treatment - it will be necessary to undergo several courses, which consist of 10 procedures. Electrophoresis with novocaine, calcium chloride can be recommended. Ultrasound treatment has proven itself well.
- Massage, which, if it is impossible to visit a specialized office, can be performed independently. To speed up healing and stimulate blood circulation, you can use specialized ointments and oils.
- Performing a set of special exercises.
Exercise therapy for a fracture of the humerus
It is advisable to carry out exercises from the very first days of treatment, while the plaster cast has not yet been removed.
They are as follows:
- After waiting a couple of days, from the moment of the fracture, you need to start moving your fingers. Do not perform actions that cause pain.
- When the week has passed, the first attempts can be made to strain the shoulder muscles. This should be done in such a way that the joint remains motionless. Approaches need to be done at least 10 per day, while each of them should have 15 voltages. The healthy hand should not be left unattended, as it also needs to maintain muscle tone.
- When the cast is removed, you can move on to active movements in the area of the joints: shoulder and elbow.
There are certain exercise therapy that has been developed by traumatologists.
They include the following exercises:
- Move your arms like a pendulum. In this case, it is necessary to stand, legs apart shoulder-width apart, and tilt the body forward.
- Without changing position, you need to rotate your hands in a circle.
- Swing limbs in front of the chest.
- Exercise "lock" behind the shoulder blades.
- Throwing hands back behind the head.
- Using a gymnastic stick for exercise.
Exercises can vary and should be done daily. The number of times - up to 15. When the muscles are strengthened, you can start using dumbbells. But not earlier than 1.5 months after removing the plaster. If contractures are formed, or the function of the hand is restored with difficulty, then it is advisable to undergo rehabilitation courses in specialized centers or in sanatoriums.
Author of the article: Kaplan Alexander Sergeevich | Orthopedist
Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.
