Shoulder fracture ( humerus ) - Causes, Symptoms and Treatment .MF .
fracture of the humerus is a fairly common injury, and occurs as the elderly and young patients.
Anatomically humerus is divided into three sections:
humeral head and neck surgical - it is part of, which are located in the joint capsule and are an integral part of the shoulder joint ( "upper" part).In this area most likely to occur fracture of the greater tuberosity fracture of the surgical neck and shoulder.
humerus bone body - medical sources called diaphysis shoulder, the longest part of the humerus.Fractures of this area are appropriate name - the body of the humerus fracture (shoulder diaphysis).
condylar region (distal portion) - forms a connection with the forearm at the elbow ( "lower" part).Fractures in the area called transcondylar.
most common fracture of the surgical neck of the humerus and a fracture of the component parts of the head, in particular the greater tuberosity fracture.Fractures of the condylar head and fractures related to the field of intra-ar
At the humerus can be damaged by various nerves in the shoulder and brachial artery, and fracture of the humerus can be damaged shoulder muscles.
Symptoms of shoulder fracture
Symptoms of cervical humerus fracture
• pain at the fracture site;
• Deformation shoulder, compared with the healthy limb when the fracture offset;
• Shortening the shoulder;
• Crepitus at the site of injury (when probing is heard the crunch of bone fragments).
• Restriction of movement in the shoulder joint;
• soft tissue swelling at the site of injury, bruising ( "black eye");
• Sometimes when impacted fractures (in which case one otlomok peg to another, and achieved quite reliable fixation), pain and other symptoms may be mild, the person may be injured a few days not to seek medical help.
neck of humerus fractures are rarely open, but may be complicated by damage to the nerves that will manifest itself in violation of the sensitivity on the hand, the difficulty of committing movements in the wrist and fingers.
Symptoms fracture greater tuberosity of the humerus:
• Pain of the shoulder joint;
• Mobility limitation, most affected shoulder abduction aside.Diversion may be completely absent, indicating that the damage to the supraspinatus tendon;
• Swelling at the turn of this less pronounced, visible deformation are rare;
• Crunch at the fracture site at a palpation.
Nerves and blood vessels at this important turning point rarely damaged.Often there is damage to the supraspinatus muscle, which can then cause a severe disruption of the movements of the shoulder joint.Symptoms
body fracture (diaphysis) of the humerus:
• Severe pain;
• Shifting pronounced deformation;
• Shortening of the limbs;
• Crepitus fragments;
• Severe swelling and bruising may be subject to
brush • Restriction of movement in the shoulder and elbow joints.
In this type of fracture is characterized by damage to the nerves and blood vessels.When you suffer from nerve damage in the fingers movement, impaired sensitivity, brush the patient hangs.
transcondylar fracture Symptoms:
• Pain radiating to the elbow and forearm;
• Swelling of the elbow;
• deformation during displacement;
• Restrictions on movements in the elbow joint;
• The crunch of bone fragments at a palpation.
When fractures in this area is often damaged brachial artery, 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 probing pulse).
Fractures of the upper part of the humerus must be distinguished from bruises, dislocations of the shoulder joint, the bottom of the elbow joint dislocations and fractures of the ulna.
First aid for fractures shoulder
As with any fracture, the main task is analgesia and immobilization of a limb.For pain you can use any drugs that are in the home medicine cabinet (ketorol, nimesulide, analgin).
Immobilization of limbs is achieved by the construction of bus improvised.Boards, slats, solid rods or sticks pribintovyvayut to the humerus, the arm is suspended on a scarf and is fixed to the body.When fractures in the upper part of the shoulder bus do not necessarily enough to hang a hand on the scarf.
shoulder fracture Diagnosis To diagnose
sufficient that the X-ray.In some cases, if you suspect damage to supraspinatus and fractures within the joint, ultrasound is performed.
shoulder fracture treatment
There are three methods of treatment of shoulder fractures: conservative and operative method of skeletal traction.
shoulder fractures and fractures without displacement, the displacement of which it is possible to fix with the help of simultaneous repositioning (reposition) are treated by applying a plaster cast, and by means of special fixing tires and bandages.
Fractures of the greater tuberosity of the humerus require, in most cases, the treatment by applying a cast.In addition to that tapping can be used tire that prevents the development of stiffness in the shoulder joint, and also provides a fusion of the supraspinatus muscle (this muscle is often damaged at the turn of the greater tuberosity).
When fractures with displacement used operative method of treatment, otlomok fixed spokes or screw, which a few months later removed.the total duration of treatment ranged from 2 to 3 months, plaster immobilization - 4-6 weeks.
When surgical neck fracture without displacement applied a plaster cast for 4 weeks, followed by the development of movements.If the fracture has been offset, and it managed to right the plaster immobilization is extended up to 6 weeks.
shows operations at nevpravimyh fractures .The turning point, the surgical treatment of fixed plates.When impacted fractures of the surgical neck and greater tuberosity fractures without displacement justified this type of medical treatment, as a function, when the arm is fixed only by the type of bandage scarves or abductor cushion (in case of damage of the supraspinatus muscle), for a period of 4 weeks.Gypsum in this case is not required.
Later applied physiotherapy and therapeutic exercise, exercise on the complex for the development of movements and general rehabilitation will be written below.The total duration of treatment from 2 to 3 months.
body fractures of the humerus treated without bias plaster splint, superimposed, for up to 8 weeks.
shoulder body fractures with displacement operate and fix the plates, screws or special intraosseous pins, subsequently applied plaster for 4-6 weeks with a reliable fixation of fracture may be limited bandage scarf.After removing the plaster commence rehabilitation.The total period of treatment of 3 4 months
Also, body at shoulder fractures with offset, apply the method of skeletal traction.Held spoke of the olecranon, and thereby reduce a shoulder thrust.On the bus to skeletal traction necessary to lie about 4 weeks, it is very difficult for the patient.Then applied a plaster cast for another 4-6 weeks.The total duration of treatment 3-4 months.At present, for the treatment of shoulder fractures method of skeletal traction is rarely used.
Fractures of the lower end of the humerus (transcondylar) very often accompanied by the displacement of bone fragments.By eliminating the offset by reposition under anesthesia, applied plaster for 6-8 weeks.If the offset is not removable, operate and set a plate and screws to fix the fracture.The total duration of treatment with rehabilitation comes up to 4 months.Plates, rods and screws are removed from the bone after a few months, or even years, after complete recovery.Each patient timeline for the removal of metal structures set individually.Older people may be metal and not flee because of the risk of re-operation.
In complicated open fractures shoulder bone body used staging elaborate design of the spokes and rings (Ilizarov apparatus), the period of treatment in this method can be extended to 6 months, but the first weeks feasible motion in the joints.
damage nerves, blood vessels at shoulder fractures require special operations (nerve suture, vascular suture) and a significant increase in the total time of treatment and rehabilitation of hand function.
For any type of treatment requires the use of calcium, painkillers and anti-inflammatories.
Rehabilitation after shoulder fracture
Perhaps the most important element in the treatment of shoulder fractures is rehabilitation.Rehabilitation includes major components - a physiotherapy treatment, physiotherapy and massage.Physiotherapy treatment is prescribed courses of treatments 7-10 weeks after injury.
physiotherapy (physical exercises) should begin in the first days of medical care.
• After 2-3 days from the time of injury (surgery) begins active but no load movement in the fingers sore hand, and active movement in his good hand.
• A week after the injury (surgery) isometric straining muscles of the patient's shoulder.Isometric - it is without performing motion in joints, to start to work out on a good hand.During the day, 10 visits, starting with the 20-stress, gradually increasing their number.These exercises are necessary to maintain muscle tone and improve blood circulation, which contributes to more rapid fracture healing.
• After removing the cast begin to develop the movements of the shoulder and elbow joints.
Sample exercises for the development of movements at shoulder fractures after the removal of plaster:
1. pendulum motion with both hands and feet are shoulder-width apart, torso in the inclined position.
2. Circular motion in the same position.
3. Lead hands aside, perhaps the most important exercise.If unable to immediately perform this exercise, helping hand by finger movements on the wall.
4. waving his hands in front of chest.
5. Reduction of hand "locked" to the breast and the subsequent rectification.
6. Extension, bending at the elbows
7. Casting hands behind his head.
8. In the future, can be used for exercises gymnastic stick.
Each exercise is performed 10-15 times several times a day.When the pain to take breaks.After 2-4 weeks of possible applications of the dumbbell, and other gymnastic equipment.The total period of rehabilitation and reconstruction of movements, in the absence of complications, from 3 to 6 weeks.With persistent difficulties of movement in the shoulder joint - contracture apply special aids for the development of movements that are in rehabilitation centers.
early to return to work and a sturdy fracture healing can gradually move to active rehabilitation: swimming, tennis, training in the gym.
forecast at the turn of the shoulder
In uncomplicated fractures of the arm to return to normal activity occurs within 2-3 months after injury.Dates rehabilitation and treatment can significantly delayed in the presence of various complications.The most common complications include: contracture of the shoulder joint (movement restrictions), nerve damage, trauma, infection in the bone.
doctor traumatologist Varanovich NA