According to statistics, 7% of fractures occur in the humerus. Such damage occurs mainly due to falls and bumps. Humerus fractures are possible in different parts of the humerus, which is accompanied by different symptoms and sometimes requires separate approaches to treatment.
Anatomical structure
The humerus is divided into three parts: the body or diaphysis is the middle part, and the ends are called epiphyses. Depending on the location of the damage, they speak of fractures of the upper, middle or lower part of the shoulder. The upper section is also called the proximal, and the lower is called the distal. The diaphysis is divided into thirds: upper, middle and lower.
In turn, the epiphyses have a complex structure, since they enter the joints and hold the muscles. In the upper part of the humerus is a semicircular head and anatomical neck - the area immediately below the head. They and the articular surface of the scapula enter the shoulder joint. Under the anatomical neck there are two tubercles, which serve as a place for muscle attachment. They are called large and small tubercle. Even further, the bone narrows, making upcalled the surgical neck of the shoulder. The lower part of the humerus is represented by two articular surfaces at once: the head of the condyle, which has a rounded shape, articulates with the radius of the forearm, and the block of the humerus leads to the ulna.
Main types of fractures
Classification of fractures is carried out according to several parameters. On the one hand, fractures of the humerus are grouped by location, that is, by department. So, a fracture is isolated:
- in the proximal (upper) section;
- diaphysis (mid section);
- in the distal (lower) section.
In turn, these classes are further divided into varieties. In addition, a fracture may occur in several places at once within the same department or in neighboring ones.
On the other hand, it is possible to divide injuries into fractures with and without displacement, as well as distinguish comminuted (comminuted) fractures. There are also open injuries (with damage to soft tissues and skin) and closed ones. At the same time, the latter prevail in everyday life.
Specifying the type of fracture by department
Fracture in the proximal section can be divided into intra-articular or extra-articular. With intra-articular (supra-tubercular), the head itself or the anatomical neck of the bone may be damaged. The extra-articular is divided into a fracture of the tubercle of the humerus and a fracture of the inferior surgical neck.
When the diaphysis is damaged, several subspecies are also distinguished: a fracture of the upper third, middle orbottom. The nature of the bone fracture is also important: oblique, transverse, helical, comminuted.
The distal can also be affected in different ways. It is possible to distinguish a supracondylar extra-articular fracture, as well as fractures of the condyles and block, which are intra-articular. A deeper classification distinguishes flexion and extensor supracondylar, as well as transcondylar, intercondylar U- or T-shaped and isolated fracture of the condyles.
Prevalence
In everyday life, due to falls and bumps, the surgical neck of the upper section, the middle third of the diaphysis, or the epicondyle of the lower part of the humerus, mainly suffer. Closed fractures predominate, but very often they can be displaced. It should also be noted that several types of fractures can be combined at the same time (more often within the same department).
Fracture of the head of the humerus, anatomical and surgical neck most often occurs in the elderly. The lower section often suffers in children after an unsuccessful fall: intercondylar and transcondylar fractures are not uncommon in them. The body of the bone (diaphysis) is subject to fractures quite often. They occur when hitting the shoulder, as well as when falling on the elbow or straightened arm.
Proximal fractures
Intra-articular fractures include a fracture of the head of the humerus and the anatomical neck immediately behind it. In the first case, a comminuted fracture may occur or a dislocation may additionally be observed. In the second case, an impacted fracture may occur whena fragment of the anatomical neck is introduced into the head and can even destroy it. With direct trauma without avulsion, the fragment can also be crushed, but without significant displacement.
Also, damage to the proximal section includes a fracture of the large tubercle of the humerus and the small one: transtubercular and detachment of the tubercles. They can occur not only when falling on the shoulder, but also when the muscles contract too strongly. A fracture of the tubercle of the humerus can be accompanied by fragmentation without significant displacement of the fragment, or by moving it under the acromedial process or down and outward. Such damage can occur with direct trauma or dislocation of the shoulder.
The most common is a fracture of the surgical neck of the shoulder. The most common cause is a fall. If the arm was abducted or adducted at the time of the injury, then an abduction or adduction fracture of the bone is noted, with the middle position of the limb, an impacted fracture may result when the distal fragment is introduced into the superior section.
Fracture can be in several places at the same time. The bone is then divided into two to four fragments. For example, a fracture of the anatomical neck may be accompanied by a detachment of one or both tubercles, a fracture of the surgical neck may be accompanied by a fracture of the head, etc.
Upper Shoulder Fracture Symptoms
Intra-articular fracture is accompanied by swelling of the department or even hemorrhage into the joint. Visually, the shoulder increases in volume. Painful is pressure on the head. A fracture of the neck of the humerus gives pain with circular movements and palpation. With an impacted fracture of the surgical neck, movements in the shoulder joint may not be disturbed. If there is an offset, then the axis of the limb may change. In the area of the joint, hemorrhage, swelling or just swelling is possible. When a characteristic bone protrusion appears on the anterior surface of the shoulder, one can speak of an adduction fracture, and if a retraction appears there, then this indicates an abduction fracture.
Also, a surgical fracture of the humerus can cause abnormal mobility. Fractures with a large displacement or fragmentation can block active movements, and even a slight load along the axis and passive movements cause sharp pain. The most dangerous is the variant in which a fracture of the neck of the humerus occurs with additional damage, pinching, pressing of the neurovascular bundle. Squeezing this bundle causes swelling, decreased sensitivity, venous stasis, and even paralysis and paresis of the hand.
Fracture of the greater tubercle of the humerus gives pain in the shoulder, especially when turning the arm inward. Movements in the shoulder joint are disturbed and painful.
Symptoms of a shaft fracture
Fractures of the humerus in the area of the diaphysis are quite common. There is swelling, pain and uncharacteristic mobility at the site of injury. Fragments can move in different directions. Hand movements are impaired. Hemorrhages are possible. Highly displaced fractures are visible evennaked eye for shoulder deformity. If the radial nerve is damaged, it is impossible to straighten the hand and fingers. However, an x-ray is needed to investigate the nature of the damage.
Distal fractures and their symptoms
Distal fractures are divided into extra-articular (supracondylar extensor or flexion) and intra-articular (condylar, transcondylar, capitate or humerus block fractures). Violations in this department lead to deformation of the elbow joint itself. There is also pain and swelling, and movement becomes limited and painful.
Supracondylar flexion occurs after a fall on a bent arm, leading to edema, swelling over the injury site, pain and noticeable lengthening of the forearm with the naked eye. The extensor muscles appear when the arm is overextended during a fall, visually shorten the forearm and are also accompanied by pain and swelling. Such fractures can also be combined with simultaneous dislocation in the joint.
Fractures of the outer condyle often accompany a fall on a straight outstretched hand or direct injuries, and the inner one breaks when falling on the elbow. There is swelling in the elbow area, pain, and sometimes bruising or bleeding into the joint itself. Movement in the elbow joint is limited, especially with hemorrhage.
Fracture of the capitate can appear when falling on a straight arm. Joint movement is also limited and pain occurs. Typically, this is a closed fracture of the humerus.bones.
First aid and diagnostics
If a fracture is suspected, the limb must be properly fixed in order to prevent the situation from worsening. You can also use analgesics for pain relief. After that, the victim should be taken to the hospital as soon as possible for accurate diagnosis and professional help.
A fracture can be diagnosed by the above symptoms, but the final results can only be obtained after x-rays. Usually, pictures are taken in different projections to clarify the full picture. Humeral fractures are sometimes subtle and difficult to distinguish from dislocations, sprains, and bruises that require other treatment.
Treatment of minor fractures
Fracture of the humerus without displacement requires immobilization of the limb with a cast or abduction splint. Complications are extremely rare here. If there is a slight displacement, then reposition is performed followed by immobilization. In some cases, it is sufficient to install a removable splint, in others, complete fixation is required.
Minor fractures of the proximal section allow UHF and magnetotherapy to be performed in three days, and after 7-10 days to begin the development of the elbow and wrist joints, conduct electrophoresis, ultraviolet radiation, massage and ultrasound exposure. After 3-4 weeks, the cast, splint or special fixatives are replaced with a bandage, continuing exercise therapy and procedures.
Recovery of displaced fragments without surgery
More serious injuries such as a surgical neck fracture or fractureof the humerus with displacement, require reposition, a plaster cast and regular x-ray control in a hospital setting. Plaster can be applied for 6-8 weeks. In this case, it is necessary to move the hand and fingers from the next day, after 4 weeks you can perform passive movements of the shoulder joint, helping with a he althy hand, then move on to active movements. Further rehabilitation includes exercise therapy, massage and mechanotherapy.
Need for surgery
In some cases, repositioning is not possible due to strong fragmentation or simply does not give the desired results. If such a fracture of the humerus is present, treatment is required with surgery to achieve alignment of the fragments. Strong displacements, fragmentation or fragmentation, instability of the fracture site may require not only reduction, but also osteosynthesis - fixing the fragments with knitting needles, screws, plates. For example, a fracture of the neck of the humerus with complete divergence of fragments requires fixation with a Kaplan-Antonov plate, pins, Vorontsov or Klimov beam, pin or rod, which avoids the appearance of angular displacement during fusion. The fragments are held until fusion with screws or the Ilizarov apparatus. Skeletal and adhesive traction is additionally used for comminuted fractures of the lower section, after which a splint is applied and therapeutic exercises are performed.
Fractures of the epicondyle without displacement require a cast for 3 weeks. displacement may require promptintervention. Condylar (intercondylar and transcondylar) fractures are often accompanied by displacement of fragments and are operated on. Reposition in this case is performed open to make sure that the correct position of the articular surfaces is restored and osteosynthesis is performed. Further, rehabilitation treatment is used in the complex.
Treatment of complicated fractures
Fracture of the humerus with displacement, accompanied by damage to the radial nerve, requires comparison of bone fragments and conservative treatment of the nerve itself. The fracture is immobilized, supplemented with drug therapy so that the nerve can regenerate itself. Later, exercise therapy and physiotherapy are connected. But if the functionality of the nerve is not restored after a few months, then surgery is performed.
In the most difficult cases, when the bones are too severely crushed, fragments can be removed, after which prosthetics are required. In the shoulder joint, an endoprosthesis is used instead of the head. If the tubercle is excessively damaged, the muscles can be sutured directly to the humerus.
Treatment of any fracture requires compliance with all the recommendations of specialists, as well as a serious approach to rehabilitation. Immobilization and complete rest of the damaged surface are replaced by certain loads over time. Courses of physiotherapy, physiotherapy exercises, massage and similar procedures can be prescribed repeatedly with some interruptions until full recovery. It is also important to conscientiously fulfill all prescriptions for rehabilitation inat home and avoid re-injury.
