Fracture of the surgical neck of the humerus is an injury in which there is a violation of the integrity of the bone in the upper part, just below the shoulder joint. A similar injury in most cases occurs in women after fifty years. This damage occurs if, in the process of falling, a person puts his hand back or presses it to the body. After a fracture of the surgical neck of the right humerus, there is a limitation of hand movements in the area of the shoulder joint, and severe pain occurs. In order to clarify the diagnosis, it is necessary to make an x-ray diagnosis. Conservative therapy consists of reduction of bone fragments, anesthesia, immobilization of the limb (immobilization). If the reduction of the bones (closed reduction) is not possible, then surgical treatment is performed.
Anatomy
The bone of the shoulder is long tubular, it consists of two terminaldepartments (epiphysis) and the middle (diaphysis), as well as transitional departments between the epiphyseal plates and the middle. In the upper zone of the bone there is a spherical head, under which the anatomical neck is located. Fractures in this area are rare. Directly under the anatomical neck are the large and small tubercles, to which the muscle tendons are attached. Between them, and also above the area to which the pectoralis major muscle is attached, is the surgical neck of the shoulder. Traumatization of this area is the most common.
Reasons
People in old age, especially women, are prone to illness to a large extent. You can lose your balance, hit your shoulder, take the wrong posture, all this leads to serious damage. The risk increases due to bone fragility, impaired coordination of movements, chronic diseases. The main causes of fracture of the surgical neck of the humerus are:
- fall;
- extraneous physical impact;
- strong blow;
- bone depletion (osteoporosis);
- violation of the structure of the metaphysis - a decrease in the number of bone beams, thinning of the outer walls at the border between the diaphysis and metaphysis, an increase in the bone marrow space.
Views
A common cause of a fracture of the surgical neck of the humerus is indirect trauma, when the bone is bent and at the same time it ispressure. The injury largely depends on the position of the limb at the time of injury. If it hangs freely, then the fracture line is localized transversely. When a bone fragment weds into the head, it is called an impacted fracture of the surgical neck of the humerus. In such a case, it is possible that the longitudinal axis has been preserved or an angle has formed that is open at the back.
So, depending on the position that the bone occupies, there are two types of fracture:
- Adduction fracture of the surgical neck of the left or right humerus, which is formed by a fall on a bent limb. During such an event, the elbow joint is in the adduction position, and at the same time it is most affected. Due to the mobility of the lower ribs, the distal zone of the shoulder achieves maximum adduction. The superior ribs help stop the distal end in the upper third of the shoulder bone. As a result, a lever is formed that puts pressure on the long arm, but the head does not dislocate, since the ligamentous-capsular apparatus acts as an obstacle to this. As a result, the fracture occurs at the weakest point of the bone, which is the surgical neck. The median fragment is displaced forward and begins to turn outward. There is also a displacement of the peripheral fragment in the upward direction and its deviation outward. An angle is formed between the fragments, open inward.
- Displaced abduction fracture of the surgical neck of the humerus that occurs when falling onto an abducted shoulder. Due to the simultaneousthe action of pressure in two directions, the peripheral fragment begins to move inward. Its outer edge causes a turn of the median bone fragment to the adduction position. The result is that the central fragment deviates forward and downward. The peripheral fragment, placed inside from the central one, forms an outwardly open corner.
Fracture of the surgical neck of the humerus, in addition to the main types, can be: open and closed, with and without displacement. Despite the different variants of this injury, such features are not fundamental in the treatment, since only the main two types of this fracture play a role - abduction or adduction.
Diagnosis
The doctor can establish the diagnosis by X-ray examination of the joint. X-ray is carried out in a horizontal (axial) and direct projection. To obtain an axial image, the shoulder is retracted 30–40° from the body. If the shoulder is retracted to a greater angle, there is a high risk of displacement of bone fragments. If necessary, computed tomography of the shoulder joint is performed. It is quite difficult to diagnose impacted fractures of the metaphysis (the area where the diaphysis meets the epiphysis) of the shoulder bone. This is due to the fact that such an injury has practically no clinical symptoms. During the examination, it is important to be able to distinguish a bruise or dislocation of the bone from a fracture of the humeral neck.
Diagnosis of an open or closed fracture of the surgical neck of the humerus should be done very carefully, otherwise the axillary nerve located behindshoulder bone. In addition, there is a risk of developing paralysis of the limb, overstretching of muscles and nerve endings.
Symptomatics
When an impacted fracture occurs, moderate pain occurs in the area of the shoulder joint, which increases significantly with movement. The area of the fracture swells, hematomas can be observed. The victim can move his hand in the area of the hand and elbow, but when trying to raise the limb, acute pain occurs. When pressing on the head of the shoulder, painful sensations also appear. The symptoms of a displaced fracture of the surgical neck of the humerus are even more pronounced: the spherical shape of the joint is broken, the acromial process begins to protrude, and the head sinks. The axis of the shoulder is disturbed, it passes somewhat obliquely, the elbow joint is displaced back. The victim cannot move, because even with slow movements there is severe pain and a crunch in the bones. When the doctor palpates the surgical neck at the fracture site, acute localized pain appears. In the axillary fossa in people with an asthenic physique, the end of the distal fragment can be palpated.
With such fractures, there is a high risk of squeezing the vessels and the nerve bundle of the bone fragment. As a result, the venous outflow is disturbed, the cyanosis of the skin appears, the limb swells, there is a feeling of tingling or numbness.
Treatment
After the implementation of diagnostic measures and the establishment of a type of fracturetreatment begins. Therapy of an open or closed fracture of the surgical neck of the left humerus is inpatient and outpatient. With an ordinary fracture, specialists fix the arm in the required position, a plaster splint (tire) is applied to the body and limb. Remove this bandage only after a month or two. If a displacement of bone fragments occurs during a fracture, reduction (reposition) is prescribed in stationary conditions. This procedure is usually accompanied by acute pain, so it is performed using local anesthesia techniques.
Surgery
Complex injuries are treated exclusively in an operative way. During the intervention for a fracture of the neck of the shoulder, general anesthesia is used, the ends of the bone fragments are exposed, compared and fixed. Then their bones are connected using metal structures. Various medical alloys are used as the main material, which are not characterized by oxidation processes.
Holes are made in bone fragments, after which the bones are connected by means of metal devices. After about 4 months, the fixing devices are dismantled, but only if the bone fragments have grown together. Most often, due to a fracture of the neck of the shoulder, the victim needs the imposition of a thoracobronchial plaster cast.
For the treatment of a fracture of the surgical neck of the humerus in case of complex (abduction) injuries, when bone fragments are displaced, a Whitman-Gromov bandage is used, which is applied after the reduction of the fragments.
Recovery period
The main objective of rehabilitation measures is the restoration of the physical activity of the diseased limb. To this end, the victims must necessarily undergo a course of physical therapy. The recovery period is approximately 2-4 weeks.
In addition to exercise therapy, physiotherapy is prescribed for a fracture of the surgical neck of the shoulder:
- Magnetotherapy - treatment with alternating or constant (low or high frequency) magnetic field.
- Phonophoresis is a complex effect of drugs and ultrasound.
- Diadynamic therapy - the use of current, the recommended frequency is 50-100 Hz.
- Ultra-high frequency therapy - the action of a magnetic field with a high frequency on the damaged area of the body.
- S alt baths.
- Mud treatment.
- Electrophoresis is a combined effect on the body of medicines and a low current.
- Massage to be performed exclusively by a professional with intermittent vibration technique. To implement this technique, the massage therapist gently taps the plaster cast with a wooden mallet or fingers.
Exercise therapy for fracture of the surgical neck of the humerus
Therapeutic exercise is an essential component of the recovery period. Some exercises begin to be performed already 3 days after the injury. The course can be divided into 4 periods:
- The duration of 1 period is 2 weeks. At this stage the patienttilts the body towards the injured arm. The exercises of this stage also involve flexion and extension of the limb, a variety of hand movements.
- In the next period, the use of light sports equipment is allowed.
- For 3 periods, lasting about a month, the victim during exercise uses the following sports equipment: dumbbells, ball, sticks, etc. Simple housework, in the garden will be useful. Before starting this kind of physical activity, you should consult with a specialist.
- During the 4th period, the patient performs various arm movements (flexions, swings, extensions), as well as strength exercises.
Doctors recommend regularly visiting the pool during rehabilitation, as swimming has a positive effect on the muscular system and quickly restores the body. The muscles during swimming come into tone, the range of motion expands, and, as a result, a person quickly returns to a normal lifestyle.
You can perform exercise therapy exercises in medical institutions or at home. Frequency of execution - no more than 10 times. All exercises should be performed carefully, carefully listening to your feelings, and if pain occurs, stop training. A fracture of the surgical neck of the humerus without displacement, of course, heals faster, but in this case there are complications.
Possible Complications
Painful complications after a fractureof the surgical neck of the shoulder are common phenomena, they can appear during inadequate therapy. In most cases, they are incorrectly fused bones, pseudoarthrosis. A high risk of complications exists directly during the fracture: violation of the integrity of nerve endings, blood vessels, tendons, muscles. As a consequence, this leads to bleeding, functional or neurological disorders in the injured hand. For example, as a result of a fracture of the surgical neck, fragments load the vessels and nerve endings, which may cause the following unpleasant consequences:
- Paresthesia (impaired skin sensitivity: tingling, numbness).
- Severe swelling of the hand.
- Hematoma due to compression of blood vessels and pathology of circulatory processes.
- Necrosis of damaged tissues.
- Paralysis of a limb.
- Stretching and protrusion of the walls of blood vessels.
To reduce your risk, do not self-medicate. This also applies to the acute period after an open or closed fracture of the surgical neck of the right or left humerus, and the stage of rehabilitation, which should proceed under the close supervision of the attending physician. Follow the latter's recommendations strictly and regularly.
