The humerus allows a person to make many movements, the amplitude of which can vary. Any damage in this area negatively affects the activity of the shoulder, significantly complicating the usual rhythm of life. They can affect various parts of such a fragile structure. Most often, doctors diagnose a fracture of the neck of the shoulder. The features and main methods of treating such injuries will be discussed in today's article.
Anatomical reference
The humerus is a long tubular structure. It is located between the elbow and the shoulder girdle area, and consists of a diaphysis and two epiphyses. A kind of transitional zones between these parts are the metaphyses. The upper end of the bone is represented by the articular head, which resembles a ball. Immediately below it is the anatomical neck of the shoulder. Serious fractures in this area are extremely rare.
Slightly below the neck of the shoulder are largeand lesser tubercles, to which the tendons are attached. Under them there is a "border" separating the diaphysis of the bone and its upper end. The latter is otherwise called the "surgical neck of the shoulder." This is the area most commonly injured.
The division of the described fractures into two categories is very conditional. They are characterized by a common clinical picture. Therefore, the doctors decided to combine them into one group - a fracture of the surgical neck of the shoulder.
Top causes of injury
The main cause of fractures of this nature is considered indirect mechanical impact. For example, when falling on a hand or elbow. In this case, the humerus is flexed and a simultaneous increase in pressure on it along the axis occurs. In rare cases, damage is the result of direct physical impact.
Fracture of the surgical neck of the shoulder is especially common in elderly women. Women over 50 are at high risk of injury due to several factors:
- climacteric period and osteoporosis of bones developing against it;
- change in bone structure.
The nature of the damage is determined by the location of the limb directly at the time of the fall. With this in mind, a fracture of the neck of the shoulder can be impacted, adductive and abductive. Let's take a look at what each option is.
Compound fracture
Among all traumatic injuries, this type is the least common. When the hand is in a neutral position, but at the same timemechanical impact occurs, a transverse fracture is diagnosed. The peripheral element of the bone enters the articular head, forming an already impacted fracture of the shoulder neck. It is always closed.
Adduction fracture
This injury is usually the result of a fall on a bent arm. In this case, the elbow joint bears the greatest pressure. Due to the mobility of the lower ribs, the distal shoulder performs maximum adduction. The rest do not have similar mobility, therefore they serve as a kind of fulcrum in the upper shoulder zone. Thus, a lever is formed that loads the humerus. The articular head remains in its place, since the ligamentous-capsular apparatus prevents artificial dislocation. As a result, an adduction fracture of the neck of the shoulder occurs.
With an injury of this nature, the central bone fragment moves forward, and the peripheral one moves outward and upward. An angle is formed between them, which opens inwards.
Abduction fracture
Such damage is possible when falling on the outstretched hand. In this case, the pressure force increases simultaneously in two directions. The peripheral element of the bone moves inward. Its outer edge provokes a reversal of the central fragment into the adduction position. And the latter slightly deviates downward and forward. The result is an outward-opening corner.
Clinical picture
After receiving a fracture, you must immediately contact the trauma department of the nearest hospital. Injury to the neck of the shoulder, as a rule, indicates the corresponding clinicalpainting. First of all, the victim feels severe pain in the area of the fracture. It cannot be defeated by conventional analgesics. This requires the help of strong painkillers, which can only be obtained in a hospital.
In the area of the shoulder joint, the injured arm loses its functionality, but flexion movements in the elbow sometimes remain. The victim most often holds the diseased limb by the forearm. Every time he tries to move, he begins to experience excruciating pain.
The appearance of the joint does not change. With an abduction fracture, a "retraction" may be present, as with a dislocated shoulder. The injury site swells very quickly. After some time, a hematoma appears, the size of which sometimes reaches a significant size.
The displaced shoulder neck fracture is especially difficult. In this case, the edges of the bone can compress the surrounding tissues and vascular bundles, causing the following symptoms:
- pronounced swelling of the limb;
- paralysis;
- development of an aneurysm;
- soft tissue neurosis.
In the case of an impacted fracture, the clinical picture is usually blurred, and there is no pain syndrome. As a result, the victim may not be aware of the injury for several days and may not seek medical attention.
Diagnostic Methods
If you suspect a fracture, you should contact the trauma department of the nearest hospital. Initially, the doctor should examine the victim, clarifyexisting complaints and the circumstances of the damage. After that, a number of additional examinations are prescribed to make an accurate diagnosis.
The most informative is characterized by radiography of the shoulder girdle. Pictures must be taken in two projections: axial and direct. In case of doubtful results, additional CT may be required. If an intra-articular fracture is suspected, an ultrasound examination is prescribed.
First aid to the victim
The main goal of providing first aid to the victim is to relieve pain. It is also necessary to try to immobilize the injured limb. In the first case, you can not do without the help of analgesics. Almost every home first aid kit has Keterol, Analgin or Nimesulide. The dosage of the medicine should be selected in accordance with the instructions attached to the medication.
If it is not possible to make a paid X-ray and verify the severity of the injury, it is recommended to immobilize the limb before going to the hospital. To do this, you can make a scarf bandage from improvised materials. Any fabric or scarf, piece of clothing is suitable for her. In shape, it should resemble an isosceles triangle. The kerchief should be applied in such a way that it supports the arm at the elbow.
Features of therapy
What should be the treatment for a fracture of the neck of the shoulder, the doctor decides. In this case, it should take into account the age of the patient, the nature of his injury and the presence offragment displacement. Therefore, therapy can be conservative or surgical. For some patients, skeletal traction is recommended. Treatment of a fracture in elderly patients is slightly different. It is advisable to consider this issue separately.
Treatment of a fracture without signs of displacement
For uncomplicated fractures, outpatient therapy is recommended. First, the doctor injects an anesthetic into the site of the hematoma, and then proceeds to apply a plaster cast according to Turner. Competent immobilization of a broken limb prevents the development of contractures. Splints are recommended for 4 weeks.
The next stage of therapy involves the appointment of painkillers and UHF. During the first month, the patient is recommended a set of exercises of a static type. For direct impact on the fracture area, phonophoresis and electrophoresis with medications are used.
After four weeks of immobilization, active rehabilitation begins. For this purpose, you can contact any rehabilitation treatment center, where specialists can choose an individual program of events. The following procedures are usually recommended for an uncomplicated fracture:
- massage;
- laser therapy;
- paraffin applications;
- exercise therapy;
- UV irradiation;
- balneotherapy;
- DDT.
Working ability after this kind of damage is restored after 2 months.
Treatment of a displaced fracture
This kind of damage requires treatment inhospital conditions. In most cases, it is also carried out through conservative techniques. The doctor, using local or general anesthesia, first performs a closed manual reduction. It is carried out in the opposite direction from the mechanism of injury. In this case, the peripheral element of the bone is compared with the central fragment.
The procedure itself is carried out in the supine position. The surgeon performs all the manipulations step by step and directs the actions of the assistants. After their completion, a bandage or a plaster splint is applied to the injured limb.
The duration of immobilization for a displaced fracture is approximately 2 months. The doctor must supervise the recovery process. To do this, the patient needs to periodically take pictures of the shoulder. Paid x-ray allows you to get instant results. In free medical institutions, the picture can be picked up the next day. Working capacity usually returns to normal after 10 weeks.
Features of treatment of fractures in the elderly
In most cases, conservative techniques are used to repair a fracture of the neck of the shoulder in elderly patients. In case of adduction injury, early fixation of the limb for 4 weeks is indicated. In case of abduction injury, traction measures are first performed, after which they proceed to immobilization. In some cases, surgery is required.
As for the anesthesia of the affected area, there are also some restrictions. For example, the dose of anesthetic should be the smallest. Otherwise, the probability increasesdevelopment of undesirable side reactions in the form of hypotension or dizziness. Treatment also involves the appointment of all patients, without exception, a number of medications. First of all, these are calcium preparations and drugs to improve blood circulation. The positive effect of them becomes noticeable when the fracture of the shoulder neck begins to heal.
In the elderly, the recovery time after an uncomplicated injury is approximately 2-3 months. The duration of the rehabilitation period is largely determined by the general condition of the patient, sufficient physical activity. This period is significantly increased if the victim has serious he alth problems. Among a large number of chronic pathologies, diabetes mellitus poses the greatest danger.
Surgery is rarely indicated for elderly patients who have been diagnosed with a humeral neck fracture. Rehabilitation in this case is quite long. As a rule, its period is about three months. With such interventions, the risk of developing infectious complications increases significantly. The occurrence of thromboembolism at this age is often fatal.
Fracture of the neck of the shoulder and its consequences
Complications after injuries of this kind are very common. They can be the result of inadequate treatment (incorrectly healed fracture, pseudarthrosis). Sometimes the negative consequences of an injury are due to the impact on the shoulder area itself. For example,fractures often damage ligaments and tendons, muscles and nerve endings. As a result, bleeding, functional or neurological disorders occur in the injured limb.
To exclude the high probability of these complications, it is necessary to immediately seek qualified medical help if you suspect an injury. After passing the examination, the doctor will be able to prescribe adequate treatment, if necessary. Particular attention should be paid to the rehabilitation process. In case of complicated fractures, it is better to contact a specialized rehabilitation treatment center, whose specialists will be able to choose the most effective program to normalize the work of the hand.
