Fracture of the surgical neck of the humerus: types, treatment, recovery period

A 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, directly under the shoulder joint. A similar trauma in most cases is observed in women after fifty years. This damage occurs if during the fall 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 restriction of arm movements in the area of ​​the shoulder joint, severe pain occurs. In order to clarify the diagnosis, radiological diagnosis should be made. Conservative therapy consists of reposition of bone fragments, anesthesia, immobilization of the limb (immobilization). If bone reduction (closed reposition) is not possible, then surgical treatment is performed.

Anatomy

The shoulder bone is long tubular, it consists of two end sections (pineal gland) and middle (diaphysis), as well as transitional sections between the pineal gland and the middle. In the upper zone of the bone is a spherical head, under which the anatomical neck is located. Fractures in this area are quite rare. Directly under the anatomical neck there are large and small tubercles, to which muscle tendons are attached. Between them, as well as over the area to which the pectoralis major muscle is attached, is located the surgical neck of the shoulder. Trauma to this site is most common.

Causes

Elderly people, especially women, are susceptible to a large degree of illness. You can lose balance, hit your shoulder, take the wrong posture, all this leads to serious damage. The risk is increased due to brittle bones, impaired coordination of movements, and chronic diseases. The main causes of fracture of the surgical neck of the humerus are:

• a fall;
• extraneous physical impact;
• swipe;
• 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 bone marrow space.

Kinds

A common cause of a fracture of the surgical neck of the humerus is indirect trauma, when the bone is bent and pressure is exerted on it at the same time. Damage largely depends on the position of the limb during injury. If it hangs freely, then the fracture line is localized laterally. When a bone fragment is wedged into the head, this is called a hammered 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 rear.

So, depending on the position that the bone occupies, two types of fracture are distinguished:

1. An adduction fracture of a surgical neck of the left humerus or the right, which forms when it falls onto a bent limb. During such an incident, the elbow joint remains in the adduction position, and in this case, the highest influence is exerted on it. Due to the mobility of the lower ribs, the distal zone of the shoulder is the maximum cast. The upper ribs help stop the distal end in the upper third of the shoulder bone. As a result of this, a lever is formed that presses on the long shoulder, however, the dislocation of the head does not occur, since the ligament-capsular apparatus acts as an obstacle to this. As a result, a fracture occurs in the weakest point of the bone, which is the surgical neck. The median fragment shifts forward and begins to turn outward. There is also a displacement of the peripheral fragment in an upward direction and its deviation to the outside. An angle is formed between the fragments, open inward.
2. Abduction fracture of the surgical neck of the humerus with a displacement that occurs when falling on the shoulder. Due to the simultaneous action of pressure in two directions, the peripheral fragment begins to shift inward. Its outer edge causes a reversal of the median bone fragment in the reduction position. The result is that the central fragment deviates forward and down. The peripheral fragment located inside from the central one forms an outward angle.

Fracture of the surgical neck of the humerus, in addition to the main types, is: open and closed, with and without displacement. Despite the different versions of this injury, such features are not fundamental in the treatment, since only the main two types of this fracture play an role - abduction or adduction.

Diagnostics

A doctor can be diagnosed with an X-ray of the joint. X-ray is carried out in horizontal (axial) and direct projection. To obtain an axial image, the shoulder is retracted 30–40 ° from the trunk. If you take your shoulder to a larger angle, there is a high risk of displacement of bone fragments. If necessary, computed tomography of the shoulder joint is performed. It’s quite difficult to diagnose metaphysical fractures (the area in which the diaphysis passes into the pineal gland) of the shoulder bone. This is due to the fact that such an injury has virtually no clinical symptoms. During the examination, it is important to be able to distinguish between a bruise or dislocation of the bone from a fracture of the shoulder neck.

Diagnosis of an open or closed fracture of the surgical neck of the humerus should be very careful, otherwise the axillary nerve located behind the humerus is easily damaged. In addition, there is a risk of limb paralysis, muscle overstrain and nerve endings.

Symptomatology

With a fractured fracture, moderate pain occurs in the area of ​​the shoulder joint, which increases significantly with movement. The fracture area swells, hematomas can be observed. The victim can move his hand in the area of ​​the hand and elbow, but when trying to raise a limb there is a sharp pain. During pressing the head of the shoulder pain also appears. Symptoms of a fracture of the surgical neck of the humerus with a shift are even more vivid: the spherical shape of the joint is disrupted, the acromial process begins to protrude, and the head sinks. The axis of the shoulder is violated, it passes somewhat obliquely, the elbow joint is shifted back. The victim cannot move, because even with slow movements there is severe pain and a crack in the bones. When the doctor probes 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 compression of the vessels and nerve bundle of the bone fragment. As a result, the venous outflow is disturbed, cyanosis of the skin is manifested, the limb swells, a sensation of tingling or numbness is noted.

Treatment

After carrying out diagnostic measures and establishing the type of fracture, treatment begins. Therapy of open or closed fracture of the surgical neck of the left humerus is inpatient and outpatient. In a conventional fracture, specialists fix the hand 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) under stationary conditions is prescribed. Such a procedure, as a rule, is accompanied by acute soreness, therefore, it is carried out using local anesthesia techniques.

Surgical intervention

Complex injuries are treated exclusively in an operational way. During surgery for a fracture of the neck of the shoulder, general anesthesia is used, the ends of the bone fragments are exposed, juxtaposed and fixed. Then their bones are connected using metal structures. In this case, various medical alloys, which are not characteristic of oxidation processes, are used as the main material.

Holes are made in the bone fragments, after which the bones are connected using metal devices. After about 4 months, the fixation devices are removed, but only on condition that the bone fragments are fused. Most often, due to a fracture of the neck of the shoulder, the victim needs to apply a thoracobronchial plaster cast.

For the treatment of a fracture, the surgical neck of the humerus with complex (abduction) injuries, when bone fragments are displaced, the Whitman-Gromov dressing is applied, applied after the fragments have been repositioned.

Recovery period

The main task of rehabilitation measures is the restoration of the physical activity of a sick limb. To this end, victims must undergo a course of physiotherapy exercises. The recovery period is approximately 2–4 weeks.

In addition to exercise therapy for a fracture of the surgical neck of the shoulder, physiotherapy is prescribed:

1. Magnetotherapy - treatment with an alternating or permanent (low or high frequency) magnetic field.
2. Phonophoresis is a complex effect of drugs and ultrasound.
3. Diadynamic therapy - the use of current, the recommended frequency is 50-100 Hz.
4. Ultra-high-frequency therapy - the action of a magnetic field with a high frequency on a damaged area of ​​the body.
5. Salt baths.
6. Mud therapy.
7. Electrophoresis is a combined effect on the body of medicines and low current strength.
8. Massage, which should be performed exclusively by a professional who knows the technique of intermittent vibration. To implement this technique, the masseur gently taps a plaster cast with a wooden hammer or fingers.

Exercise therapy for fracture of the surgical neck of the humerus

Physiotherapy exercises is an essential component of the recovery period. Some exercises begin to be performed 3 days after the injury. The course can be divided into 4 periods:

1. The duration of 1 period is 2 weeks. At this stage, the patient tilts the body towards the affected arm. Exercises at this stage also involve flexion and extension of the limb, a variety of hand movements.
2. In the next period, the use of light sports equipment is permissible.
3. Over a period of 3 months, lasting about a month, the victim during the exercises uses such sports equipment: dumbbells, ball, sticks, etc. It will be useful to do simple housework in the garden. Before starting physical activity of this kind, you should consult with a specialist.
4. During the 4th period, the patient performs various movements with his hands (flexion, swing, extension), as well as strength exercises.

Doctors recommend visiting the pool regularly during rehabilitation, since swimming favorably affects the muscle system and quickly restores the body. Muscle during swimming comes in tone, the range of movements expands, and, as a result, a person quickly returns to a normal lifestyle.

Exercise exercises can be performed in medical institutions or at home. The execution frequency is no more than 10 times. All exercises should be performed carefully, carefully listening to your feelings, and when pain occurs, stop the workout. Fracture of the surgical neck of the humerus without displacement, of course, heals faster, however, in this case there are complications.

Possible complications

Painful complications that occur after a fracture of the surgical neck of the shoulder are common, they can occur during inadequate therapy. They are in most cases incorrectly fused bones, pseudoarthrosis. A high risk of complications exists directly during a fracture: a violation of the integrity of nerve endings, blood vessels, tendons, muscles. As a result, this leads to bleeding, functional or neurological disorders in the injured arm. For example, as a result of a fracture of the surgical neck, the fragments load the vessels and nerve endings, which can cause the following unpleasant consequences:

1. Paresthesia (violation of skin sensitivity: tingling, numbness).
2. Severe swelling of the hands.
3. Hematoma due to compression of blood vessels and pathology of blood circulation processes.
4. Necrosis of damaged tissue.
5. Paralysis of the limb.
6. Stretching and protrusion of the walls of blood vessels.

To reduce the risk, self-medication procedures should not be taken. This applies to the acute period after an open or closed fracture of the surgical neck of the right humerus or left, and the rehabilitation phase, which should proceed under close supervision of the attending physician. Follow the recommendations of the latter should be rigorously and regularly.