The humerus allows a person to make many movements, the amplitude of which can vary. Any damage in this zone 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, and consists of the diaphysis and two epiphyses. A kind of transitional zones between these parts are 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.
Just below the neck of the shoulder there are large and small tubercles, to which tendons are attached. Under them passes the "border" separating the diaphysis of the bone and its upper end. The latter is otherwise called the "surgical neck of the shoulder." It is this area that is most often injured.
The division of the described fractures into two categories is very arbitrary. They are characterized by an overall clinical picture. Therefore, doctors decided to combine them into one group - a fracture of the surgical neck of the shoulder.
The main causes of injury
The main cause of fractures of this nature is considered to be an indirect mechanical impact. For example, when falling on a brush or elbow. In this case, the humerus is bent and the pressure on it along the axis increases simultaneously. In rare cases, damage is the result of direct physical exposure.
Fracture of the surgical neck of the shoulder is especially common in elderly women. Ladies over 50 are at high risk of injury due to several factors:
- menopause and osteoporosis of bones developing against it;
- change in bone structure.
The nature of the damage is determined by the location of the limb immediately at the time of the fall. With this in mind, a fracture of the neck of the shoulder is hammered, adduction and abduction. Consider what each of the options is.
Impacted fracture
Among all traumatic injuries, this species is least likely to occur. When the hand is in a neutral position, but mechanical action occurs, a transverse fracture is diagnosed. The peripheral element of the bone enters the articular head, forming an already hammered fracture of the neck of the shoulder. It is always closed.
Adduction fracture
Such an injury is usually the result of falling on a bent arm. Moreover, the elbow joint has the greatest pressure. Due to the mobility of the lower ribs, the distal shoulder makes the maximum reduction. The rest do not have similar mobility, therefore, they serve as a kind of fulcrum in the upper zone of the shoulder. Thus, a lever is formed that loads the humerus. The joint head remains in place, since the ligament-capsule apparatus prevents artificial dislocation. As a result, an adductive fracture of the neck of the shoulder occurs.
With an injury of this nature, the central fragment of the bone moves forward, and the peripheral bone outward and upward. An angle forms between them, which opens inward.
Abduction fracture
Such damage is possible when falling on the designated arm. In this case, the pressure force increases simultaneously in two directions. The peripheral element of the bone moves inward. Its outer edge provokes a turn of the central fragment into the reduction position. And the latter deviates slightly downward and forward. The result is an angle open outward.
Clinical picture
After receiving the fracture, you must immediately contact the trauma department of the nearest hospital. Damage to the neck of the shoulder, as a rule, is indicated by the corresponding clinical picture. First of all, the victim feels severe pain in the fracture area. It is impossible to defeat it through conventional analgesics. This requires the help of potent painkillers, which can only be obtained in a hospital.
In the area of the shoulder joint, the injured arm loses its functionality, but the flexion movements in the elbow are sometimes preserved. The victim most often holds the affected limb by the forearm. With every attempt to make a movement, he begins to experience excruciating pain.
The appearance of the joint does not change. An abduction fracture may present a “retraction”, as with a shoulder dislocation. The injury site swells very quickly. After a while, a hematoma appears, the size of which sometimes reaches significant sizes.
A fracture of the neck of the shoulder with displacement is especially difficult. In this case, the edges of the bone can compress the surrounding tissues and bundles of blood vessels, causing the following symptoms:
- severe swelling of the limb;
- paralysis;
- the development of aneurysm;
- soft tissue neurosis.
In the case of a fractured fracture, the clinical picture is usually blurred, and there is no pain. As a result, the victim may not suspect injuries for several days and not seek medical help.
Diagnostic Methods
If you suspect a fracture, you must contact the trauma department of the nearest hospital. Initially, the doctor should examine the victim, clarify the complaints and circumstances of the damage. After this, a number of additional examinations are prescribed to make an accurate diagnosis.
The most informative is the radiography of the shoulder girdle. Pictures must be taken in two projections: axial and straight. In case of doubtful results, additional CT scans may be required. If an articular fracture is suspected, an ultrasound examination is prescribed.
First aid to the injured
The main purpose of providing first aid to the victim is the relief of 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 medicine cabinet has Keterol, Analgin or Nimesulide. The dosage of the drug should be selected in accordance with the instructions attached to the medication.
If it is not possible to take a paid X-ray and verify the seriousness of the injury, it is recommended that the limb be immobilized before going to the hospital. For this, a scarf dressing can be made from improvised materials. Any fabric or scarf, piece of clothing is suitable for her. In shape, it should resemble an isosceles triangle. The kerchief bandage should be applied so that it supports the arm at the elbow.
Therapy Features
What should be the treatment for a diagnosis of a “neck fracture”, the doctor decides. In this case, he must take into account the patient's age, the nature of his injury and the presence of displacement of fragments. Therefore, therapy can be conservative or surgical. Skeletal traction is recommended for some patients. The treatment of fracture in elderly patients is slightly different. This issue should be considered separately.
Fracture treatment 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 the application of a gypsum cast according to the Turner. Competent immobilization of a broken limb prevents the development of contractures. Wearing longs is 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 the static type. For direct impact on the fracture area, phonophoresis and electrophoresis with medications are used.
After four weeks of immobilization, they begin active rehabilitation. For this purpose, you can contact any rehabilitation treatment center, where specialists can choose an individual program of events. Typically, for an uncomplicated fracture, the following procedures are recommended:
- massage;
- laser therapy;
- applications with paraffin;
- Exercise therapy;
- UV irradiation;
- balneotherapy;
- DDT.
Disability after this kind of damage is restored after 2 months.
Displacement fracture treatment
With such damage, treatment is required in a hospital setting. In most cases, it is also carried out through conservative techniques. A doctor using local or general anesthesia first performs a closed manual reposition. 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 a prone position. The surgeon performs all the manipulations in stages and directs the actions of assistants. After their completion, a bandage or plaster cast is applied to the damaged limb .
The duration of immobilization in a fracture with a displacement is approximately 2 months. The doctor must monitor the recovery process. For this, the patient must periodically take pictures of the shoulder. Paid X-ray allows you to get instant results. In free medical facilities, the picture can be taken the next day. Disability usually returns to normal after 10 weeks.
Features of treatment of fractures in the elderly
In most cases, conservative methods are used to eliminate a neck fracture in elderly patients. With adduction injury, early fixation of the limb for 4 weeks is indicated. With abduction damage, traction measures are first performed, and then 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 lowest dose of anesthetic should be chosen. Otherwise, the likelihood of developing unwanted adverse reactions in the form of hypotension or dizziness increases. Treatment also implies the appointment of a number of medications to all patients, without exception. First of all, these are calcium preparations and medicines to improve blood circulation. The positive effect of them becomes noticeable when a fracture of the neck of the shoulder begins to heal.
In older people, 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 motor activity. This period is significantly increased if the victim has serious health problems. Among a large number of chronic pathologies, diabetes is the most dangerous.
Surgical intervention is rarely prescribed for elderly patients who have revealed a fracture of the neck of the shoulder. Rehabilitation in this case is quite long. As a rule, its term is about three months. With such interventions, the risk of developing infectious complications increases significantly. The occurrence of thromboembolism at this age often leads to death.
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 (improperly healed fracture, pseudoarthrosis). Sometimes the negative consequences of the injury are due to the impact on the shoulder area. For example, fractures often damage the ligaments and tendons, muscles and nerve endings. As a result, bleeding, functional or neurological disorders in the injured limb occur.
To exclude the high probability of these complications, it is necessary to seek qualified medical help immediately 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 for normalizing the work of the hand.