According to statistics, 7% of fractures occur in the humerus. Similar damage occurs mainly due to falls and bumps. Fractures of the humerus are possible in different parts of it, which is accompanied by various 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 shoulder. The upper section is also called proximal, and the lower is called distal. The diaphysis is divided into thirds: upper, middle and lower.
In turn, the pineal glands have a complex structure, since they enter the joints and hold the muscles. In the upper part of the humerus there is a semicircular head and an 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 that serve as a place for muscle attachment. They are called their large and small tubercle. The bone narrows even further, making up the so-called surgical neck of the shoulder. The lower part of the humerus is immediately represented by two articular surfaces: the head of the condyle, which has a rounded shape, is joined with the radial bone of the forearm, and the block of the humerus leads to the ulnar.
The main types of fractures
Fractures are classified according to several parameters. On the one hand, fractures of the humerus are grouped by location, i.e., by departments. So, a fracture is distinguished:
- in the proximal (upper) section;
- diaphysis (middle section);
- in the distal (lower) section.
In turn, these classes are further subdivided into varieties. In addition, a fracture can occur at once in several places 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 to distinguish fragmented (comminuted) fractures. There are also open injuries (with damage to soft tissues and skin) and closed injuries. Moreover, the latter prevail in everyday life.
Specification of the type of fracture by department
Fracture in the proximal can be divided into intraarticular or extraarticular. In case of intra-articular (supramorphic) the head itself or the anatomical neck of the bone may be damaged. Extraarticular is divided into a fracture of the tubercle of the humerus and a fracture of the underlying surgical neck.
If the diaphysis is damaged, several subspecies are also distinguished: a fracture of the upper third, middle or lower. The nature of the bone fracture is also important: oblique, transverse, helical, comminuted.
The distal region can also suffer in many ways. It is possible to distinguish a supracondylar extraarticular fracture, as well as fractures of the condyles and block, which are intraarticular. A deeper classification distinguishes the flexor and extensor supracondylar, as well as the supracondylar, intercondylar U- or T-shaped and isolated condyle fractures.
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 simultaneously (more often within the same department).
Fracture of the head of the humerus, anatomical and surgical neck is most often in older people. The lower section often suffers in children after an unsuccessful fall: intercondylar and supracondylar fractures are not uncommon in them. The body of the bone (diaphysis) is prone to fractures quite often. They occur when striking the shoulder, as well as when falling on the elbow or straightened arm.
Proximal Fractures
Intra-articular include a fracture of the head of the humerus and the anatomical neck located immediately behind it. In the first case, a comminuted fracture may occur or an additional dislocation can be observed. In the second case, a hammered fracture can occur when a fragment of the anatomical neck is introduced into the head and can even destroy it. With direct injury without separation, the fragment can also be fragmented, but without significant displacement.
Also, damage to the proximal region includes a fracture of the large tubercle of the humerus and small: trans-tubercle and detachments of the tubercles. They can occur not only when falling on the shoulder, but also with too strong a sharp contraction of the muscles. Fracture of the tubercle of the humerus can be accompanied by fragmentation without significant displacement of the fragment or moving it under the acromedial process or down and out. Such damage can occur with direct injury or dislocation of the shoulder.
The most common fracture is a surgical neck of the shoulder. The reason most often becomes a fall. If the arm was withdrawn or brought back at the time of the injury, then an abduction or adduction fracture of the bone is noted, with an average position of the limb, a fractured fracture may occur when the distal fragment is introduced into the superior division.
A fracture can occur simultaneously in several places. The bone is then divided into two to four fragments. For example, a fracture of the anatomical neck can be accompanied by a separation of one or both tubercles, a fracture of the surgical neck is supplemented by a fracture of the head, etc.
Symptoms of a fracture in the upper shoulder
An intraarticular fracture is accompanied by edema of the department or even hemorrhage in the joint. Visually, the shoulder increases in volume. Pressure on the head is painful. A fracture of the neck of the humerus gives pain during circular movements and palpation. With a fractured surgical neck fracture, movements in the shoulder joint may not be impaired. If there is an offset, then the axis of the limb may change. In the area of the joint, hemorrhage, swelling, or simply swelling is possible. When a characteristic bony protrusion appears on the anterior external surface of the shoulder, we can speak of an adduction fracture, and if there is a retraction, this indicates abduction.
Also, a surgical fracture of the humerus can cause pathological mobility. Fractures with a large displacement or fragmentation can block active movements, and even a slight axial load and passive movements cause sharp pain. The most dangerous is the option in which a fracture of the neck of the humerus occurs with additional damage, pinching, pressing the neurovascular bundle. Squeezing this bundle causes swelling, decreased sensitivity, venous congestion, and even paralysis and paresis of the arm.
Fracture of a large tubercle of the humerus gives pain in the shoulder, especially when turning the arm inward. Movements in the shoulder joint are disturbed, become painful.
Symptoms of a diaphysis 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 damage. Fragments can shift in different directions. Hand movements are disturbed. Hemorrhages are possible. Fractures with a strong displacement are visible even to the naked eye by deformation of the shoulder. If the radial nerve is damaged, then 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 flexor) and intraarticular (condylar, supracondylar, fractures of the capitate elevation or humerus block). Violations in this section lead to deformation of the elbow joint itself. Pain and swelling also appear, and movements become limited and painful.
Supracondylar flexion occurs after falling on a bent arm, leading to edema, swelling above the site of injury, pain, and elongation of the forearm noticeable to the naked eye. Extensor appear when the arm is over-bent when dropped, visually shorten the forearm and are also accompanied by pain and swelling. Such fractures can also be combined with a simultaneous dislocation in the joint.
Fractures of the external condyle more often accompany a fall on a straight outstretched arm or direct injuries, while the internal condyle breaks when dropped onto an elbow. There is swelling in the elbow, pain, and sometimes bruising or hemorrhage in the joint itself. Movement in the elbow joint is limited, especially with hemorrhage.
A fracture of capitate elevation may occur when falling on a straight arm. Joint movements are also limited and pain occurs. As a rule, this is a closed fracture of the humerus.
First Aid and Diagnostics
If a fracture is suspected, the limb must be correctly fixed to prevent the situation from worsening. You can also use analgesics for pain relief. After this, the victim should be taken to the hospital as soon as possible for accurate diagnosis and professional assistance.
The fracture can be diagnosed by the above symptoms, but the final results can only be obtained after radiography. Usually pictures are taken in different projections to clarify the full picture. Fractures of the humerus are sometimes implicitly expressed, then it is difficult to distinguish them from dislocations, sprains and bruises that require other treatment.
Treatment of minor fractures
Fracture of the humerus without displacement requires the immobilization of the limb with plaster or abduction splint. Complications are extremely rare here. If a slight bias is observed, then reposition is performed with subsequent immobilization. In some cases, the installation of a removable span is sufficient, in others a complete fixation is required.
Minor proximal fractures allow UHF and magnetotherapy to be performed within three days, and after 7-10 days to begin the development of the elbow and wrist joints, electrophoresis, ultraviolet irradiation, massage and ultrasound. After 3-4 weeks, gypsum, span or special fixators are replaced with a bandage, continuing exercise therapy and procedures.
Recovery of displaced fragments without operation
More serious injuries, such as a surgical neck fracture or a displaced humerus fracture, require reposition, plaster cast and regular x-ray monitoring in a hospital setting. Plaster can be applied for 6-8 weeks. In this case, it is necessary to move the brush and fingers from the next day, after 4 weeks you can perform passive movements of the shoulder joint, helping with a healthy hand, then move on to active movements. Further rehabilitation includes exercise therapy, massage and mechanotherapy.
The need for surgery
In some cases, reposition is not possible due to the strong fragmentation or simply does not give the desired results. If there is such a fracture of the humerus, treatment is required with surgery to achieve the combination of fragments. Strong displacements, comminution or fragmentation, instability of the fracture site may require not just repositioning, but also osteosynthesis - fixing fragments with knitting needles, screws, plates. For example, a fracture of the neck of the humerus with a complete divergence of fragments requires fixing with a Kaplan-Antonov plate, knitting needles, a Vorontsov or Klimov beam, a pin or a rod, which avoids the appearance of angular displacement during fusion. The fragments are held to fusion with screws or Ilizarov apparatus. Skeletal and adhesive plaster traction are additionally used for fragmented lower fractures, after which a splint is applied and therapeutic exercises are performed.
Fractures of the epicondyle without displacement require the wearing of a plaster cast for 3 weeks. Displacement may require surgery. Condylar (intercondylar and transcondylar) fractures are often accompanied by displacement of fragments and are operated on. Reposition in this case is done open to make sure that the correct position of the articular surfaces is restored and osteosynthesis is performed. Next, apply rehabilitation treatment in the complex.
Treatment of Complicated Fractures
A fracture of the humerus with a shift, accompanied by damage to the radial nerve, requires a 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 several months, then surgery is performed.
In the most difficult cases, when the bones are too fragmented, the fragments can be removed, after which prosthetics are required. An endoprosthesis is used instead of the head in the shoulder joint. With excessive damage to the tubercle, the muscles can be sewn directly to the humerus.
The 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 over time are replaced by certain loads. Physiotherapy, physiotherapy, massage and the like procedures can be prescribed repeatedly with some interruptions until complete recovery. It is also important to faithfully comply with all the requirements for rehabilitation at home and to avoid repeated injuries.