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Fracture of the surgical neck of the humerus is very common, especially in the elderly.
This fracture accounts for half of all humeral fractures.
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Shoulder fracture with offset
In case of fracture of the surgical neck of the shoulder, an expert can palpate to feel displaced bone fragments. In some cases, they can be seen visually, as they protrude from under the skin. In such patients, hematoma and severe edema appear almost instantly in the area of damage. The strongest pains cause painful suffering for the victims, therefore, they are anesthetized immediately upon admission to a medical facility. If a fracture of the humeral bone is suspected with an offset, radiography is necessarily carried out in several projections, thanks to which the specialist will be able to determine the real picture of the problem and choose the correct treatment technique. Sometimes there are cases in which during a fracture of the surgical neck of the shoulder, bone fragments begin to exert pressure on the neurovascular bundle.
This often results in severe complications:
strong puffiness of the upper limb,
necrosis of the injured limb
the appearance of aneurysm, etc.
Shoulder fracture without displacement
Today, a fracture of the surgical neck of the shoulder is not so common, in 7% of all cases of injuries to the bones of the musculoskeletal system.
Patients may have a fracture in any part of the humerus:
During fractures of the humerus without displacement of debris in patients in the area of injury, hemorrhage occurs. In all cases, without exception, edema appears, which increases greatly with time. In patients, the mobility of the injured upper limb is completely impaired, and with a slight movement, they begin to experience severe pain. If the fracture is classified as impacted, the patient will be able to perform passive movements with his hand. Against the background of such an injury, a deformity of the shoulder joint may occur, so you should immediately contact a medical institution for qualified help.
Treatment of a surgical neck fracture
A patient who has had a fracture of a surgical neck of the shoulder experiences severe pain and also observes a loss of mobility of the upper limb. These symptoms force him to go to a medical facility for expert help. At the reception, the specialist will first of all conduct a personal examination of the patient, collect a history of the disease.
To obtain a more accurate clinical picture, the doctor will prescribe an additional examination to the patient, which includes a number of diagnostic measures. In most cases, this category of patients is immediately sent to x-rays, through which you can determine the type of fracture.
If the X-ray did not give the doctor a complete picture of the disease, the patient is undergoing a computed or magnetic resonance imaging, which can reveal muscle damage in the area of the injured shoulder girdle.
If a surgical neck fracture is detected, patients can be treated on an outpatient basis. Specialist selects the method of treatment individually, depending on the complexity of the fracture. At the usual fracture, the upper limb of the patient is fixed in a certain position, after which a plaster splint is applied on it and on the torso. Wearing this cast should be for 4-8 weeks, depending on the complexity of the fracture.
In the case when at the fracture there is a displacement of bone fragments, the patient in the hospital will be replenished. This manipulation is accompanied by a strong pain syndrome, therefore, anesthesia of local action is administered to the patients. For very complex fractures, treatment is possible only by surgery. During surgery, the patient is immersed in general anesthesia, after which he is held open reposition and fixation of bone fragments.
As a fixture, surgeons use special constructions made of special medical alloys that do not undergo oxidation. Their main purpose is to bring together bone fragments (in which holes are pre-drilled) and their reliable fixation. With a qualitatively performed operation, the patient can do without external immobilization. All metal clamps are removed their bones after 4 months after their installation.
Repeated surgery is performed only when the specialist is satisfied that the bone debris merging was successful. The functions of the injured shoulder and upper limb will be restored gradually, after the patient has completed a full course of rehabilitation.
Immobilization at shoulder fracture
At the fracture of the shoulder, patients need to be fully immobilized, for which a thoraco bronchus bandage is used, for which specialists use traditional techniques to apply:
The patient should be on a hill in a sitting position (a high stool or table can be used).
Injured upper limb must be installed in a certain position:
at an angle of 70-80 ° C - for fractures of the upper third of the humerus,
at an angle of 45 ° C - for fractures of the lower third of the humerus.
The damaged shoulder must be bent (the angle must not be in the range of 45 to 80 ° C).
Around the torso of the patient (the shoulder girdle, on the crests of the iliac bones, as well as the elbow, shoulder, wrist joint) is laid vata, which is fixed by means of a bandage or gauze.
Gypsum splints are superimposed on the sides of the trunk and the injured limb, while the healthy shoulder is not fixed at all and remains completely free and mobile.
To prevent damage to the corset, a special strut is installed between it and the plastered upper limb, the function of which can be performed by an ordinary wooden stick.
For complex (abduction) fractures, accompanied by displacement of bone debris, the patients, after reposition, apply the Whitman-Gromov bandage. In the event that a fracture occurred in the lower third of the humerus, a plaster cast is applied to the injury site, which covers the patient's upper limb as a gutter.
Physical therapy at the fracture of the shoulder
For fractures of the surgical neck of the humerus, patients are prescribed a course of physical therapy. The patient will be able to perform special exercises already for 2-3 days from the moment of receiving such an injury.
This course of physical therapy is divided into several periods:
The first period of physical therapy (lasts for 2 weeks) includes a set of exercises that patients must perform, tilting the torso in the direction of the injured upper limb. All exercises are based on the flexion and extension of the arms, the performance of various movements by them.
The second period of physiotherapy exercises (on average, it lasts for 4 weeks) includes exercises that involve bending the body, various movements of the upper limbs (swinging, breeding, etc.), the use of sports equipment, etc. The third period of physiotherapy exercises lasts throughout 3-4 weeks. During a set of exercises, patients use various sports equipment and equipment: balls, dumbbells, clubs, sticks, etc. For this category of patients, occupational therapy is very useful, during which they can do household chores, work in the garden, etc.
The third course of physical therapy includes exercises, during which patients do swinging, flexion and extension of the arms, strength exercises. Patients are encouraged to visit the swimming pool, as water procedures have a positive effect on the musculoskeletal system as a whole and help the body recover from injuries. After completing each set of exercises, the patient must relax the muscles and do breathing exercises. Thanks to a specially developed set of exercises in patients who have undergone a fracture of the surgical neck of the humerus, the range of movements is fully restored, and they can lead an active lifestyle. Muscle tissues in the area of the injured limb come to tone and can fully function as before.
Rehabilitation for fracture of the neck of the shoulder
After a constructive treatment of a fracture of the neck of the shoulder, patients need a rather lengthy rehabilitation. The program of rehabilitation activities begins with the restoration of physical activity of patients. For them, a special set of exercises is developed, separately for the upper and lower extremities.
Without fail, this category of patients is recommended to perform:
set of exercises for the fingers,
movements of the upper limbs in different planes,
strain the muscles of the shoulder girdle, etc.
Patients can undergo rehabilitation both at home and in medical institutions, where there are specially equipped classrooms. Each exercise should be repeated 8-10 times, and you should carefully “listen” to your own body and immediately stop training when you experience pain. A set of physical exercises must be performed daily. It is recommended to do 3-4 approaches, each of which lasts at least 15 minutes.
In addition to physical education, rehabilitation includes a complex of physiotherapeutic procedures, which include:
An x-ray examination of the joint allows the doctor to establish a diagnosis. X-rays are carried out in horizontal (axial) and direct projection. For an axial snapshot, the shoulder is at a distance of 30–40 ° from the body. If you take the 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 is quite difficult to diagnose impacted metaphysis fractures (the area in which the diaphysis turns into the epiphysis) of the shoulder bone. This is due to the fact that such an injury has almost no clinical symptoms. In the process of examination it is important to be able to distinguish a bruise or dislocation of a bone from a shoulder neck fracture.
The diagnosis of an open or closed fracture of the surgical neck of the humerus should be carried out very carefully, otherwise the axillary nerve located behind the humerus is easily damaged. In addition, there is a risk of paralysis of the limb, over-stretching of the muscles and nerve endings.
When a fracture is impacted, moderate pain occurs in the area of the shoulder joint, which is greatly enhanced by movement. The area of the fracture swells, hematomas can be observed. The victim may move his arm in the area of the hand and the elbow, but when trying to lift a limb, a sharp pain occurs. While pressing on the head of the shoulder, pain also appears. The symptoms of a fracture of the surgical neck of the humerus with a shift are even brighter: the spherical shape of the joint is disturbed, the acromion process begins to bulge, and the head sinks. The axis of the shoulder is broken, it passes somewhat obliquely, the elbow joint is shifted back. The victim cannot move, because even with slow movements there is a strong pain and crunch in the bones. When the doctor probes the surgical neck at the fracture site, acute localized pain appears. In the armpit in people with asthenic physique, you can palpate the end of the distal fragment.
With such fractures, there is a high risk of squeezing of blood vessels and the nerve bundle of a bone fragment. As a result, the venous outflow is disturbed, the blueness of the skin manifests itself, the limb swells, there is a tingling or numb feeling.
After the implementation of diagnostic measures and the establishment of the type of fracture begins treatment. Therapy of an open or closed fracture of the surgical neck of the left humerus is inpatient and outpatient. At a normal fracture, experts fix the arm in the required position, a plaster splint (splint) is applied to the body and limb. Remove this bandage only after a month or two. If at the fracture a displacement of bone fragments has occurred, a reduction (reposition) is prescribed in stationary conditions. Such a procedure, as a rule, is accompanied by acute pain, so it is carried out using local anesthesia techniques.
Complicated injuries are treated exclusively by surgery. During an intervention for a fracture of the neck of the shoulder, general anesthesia is used, the ends of the bone fragments are exposed, matched and fixed. Then their bones are joined with metal structures. As a base material, various medical alloys are used, which are not peculiar to oxidation processes.
In the fragments of bones, holes are made, after which the bones are joined by means of metal devices. After about 4 months, the fixing devices are dismantled, but only under the condition that the bone fragments have grown together. Most often, due to a fracture of the neck of the shoulder, the victim needs to apply a thoraco bronchial plaster cast.
For the treatment of a fracture of the surgical neck of the humerus in case of complex (abduction) injuries, when the bone fragments are displaced, the Whitman-Gromov bandage is applied, applied after the fragments are reduced.
Causes of damage
Injuries happen under the influence of external and internal causes:
- a fall with the arm pulled back or pressed to the body,
- bounce on the shoulder
- the presence of osteoporosis (changes in bone tissue).
Older people, especially women, are vulnerable to a large extent. Loss of balance, a blow to the shoulder, and an incorrect posture for the upper limb lead to serious injuries in the area of the surgical neck of the shoulder.
The risk of damage to the brachial region is associated with the fragility of bones, impaired coordination of movements, and chronic diseases.
Fracture types and symptoms
In practice, the injury of the surgical neck is closed. The open form of the fracture is extremely rare.
Damage is classified according to the position factor of the bone fragments:
Fracture without displacement occurs when a bone is wedged into the head, a large knoll is damaged, and a crack is formed in the neck. Otherwise, it is called an impacted fracture.
Typical symptoms of damage:
- pain in the shoulder joint with increased movement
- gradually increasing edema
- hemorrhage (hematoma),
- impaired limb mobility.
The victim may move his arm, but this increases the risk of deformity of the shoulder joint.An urgent request for the help of qualified professionals is required. Attempts to push the fingers on the head of the shoulder lead to sharp pain.
Displaced fractures are distinguished by type:
The mechanism of the adduction (adductive) injury manifests itself as a result of the mechanical effect on the arm bent at the elbow. Under the influence of a blow falling on a joint, a lever is formed with pressure on the long arm, a fracture occurs in the most fragile place - the surgical neck. The displacement of fragments creates an angle open inward.
The mechanism of abduction (abducted) injury is revealed in the impact on an extended arm with an abstracted shoulder. The action of the force in two directions leads to a reversal of the central fragment to the position of the cast. The displacement of bone fragments creates an open outward angle.
Symptoms of fractures with displacement appear in a bright and acute form:
- the spherical shape of the shoulder is broken,
- there is a shortening of the shoulder,
- perhaps a visual definition of a protruding fragment,
- the axis of the shoulder changes, the elbow joint moves backward,
- manifest severe pain
- instant hematoma is formed,
- there is a big swelling,
- limited movement
- Crepitus occurs.
Traumatologist by palpation can determine the displaced bone fragments. Severe hemorrhage, overweight of the victim often make it difficult to diagnose.
The real picture with great accuracy is obtained as a result of X-ray, made in several projections. The choice of a medical technique depends on the obtained data. Shift fracture is associated with a high risk of compression of the neurovascular bundle. The patient needs urgent help from trauma specialists.
In a medical institution, after the arrival of the victim, a primary anesthesia is performed for diagnosis. The type and complexity of the fracture affect the nature of the treatment: outpatient or inpatient.
Therapy of fractures without displacement (impacted) is carried out in a closed way, is as follows:
- fixation in a bent state with a lead (a roller is placed in the axillary zone),
- the imposition of gypsum splints (tires) for 4−8 weeks.
When the displacement of the bone parts is assigned reposition (reposition). The task is to install a peripheral fragment along the central fragment. Mandatory local anesthesia. Surgical treatment is carried out in difficult cases under general anesthesia, mainly in young patients.
The surgical method is as follows:
- the installation of the head of the shoulder through the opening of the joint capsule,
- carrying out osteosynthesis by pinning or other fixation.
Metal devices are made of medical alloys that are not subject to oxidation. After 2–4 months, fixing devices are dismantled, if the intergrowth of fragments is confirmed. External immobilization in such cases is not carried out.
Cases of crushing the shoulder section are particularly severe. Removal of cartilage, arthrodesis of the joint, the installation of a transplant, the use of endoprosthetics - the selection of treatment methods depends on the age and condition of the patient. The success of the subsequent rehabilitation course affects the future prognosis.
During the period of treatment and the subsequent stages of recovery, the patient needs to sleep on the back or side of the healthy side. This measure will protect against re-displacement of fragments, other injuries to the damaged area.
Restoration of functions of the damaged shoulder (full or partial) requires time and great effort by the patient.
The rehabilitation course is the most important stage of the recovery period.
The program must include:
- therapeutic exercises
Nutrition during the recovery phase should be balanced, rich in vitamins and minerals, contain enough calcium to strengthen the bone system.
Gypsum longuit or bandage, designated for wearing, can be removed during classes or procedures.
Therapeutic gymnastics includes a special complex with exercises:
- on the development of joints (elbow, wrist),
- for fingers,
- by activating hand movements in different planes,
- to normalize breathing
- to develop the muscles of the shoulder girdle, etc.
You can conduct physical exercises from the first days in the living conditions, exercise therapy halls. Daily kneading of the injured hand improves blood circulation, prevents the appearance of edema, the formation of blood clots.
It is important to feel the state of the body, to control the load (repeats 8−10 times), so as not to cause pain. A 3-4 day approach is enough for a class of 15 minutes.
During the rehabilitation period, physiotherapy is prescribed:
- laser therapy
- magnetic therapy
- salt baths
- mud treatment
- ozocerite applications,
Particular attention is paid to the massage, which should be done by a professional using techniques of intermittent vibrations. Manipulations with fingers, a wooden hammer are carried out on the fixing bandage.
Massage is important on the surrounding areas to prevent muscle contractures, stimulate tissue nutrition.
The rehabilitation period can be divided into several stages:
- The first. Bending in the direction of damage, slight flexion and extension of the limb. Duration - 2 weeks.
- Second. Exercises of the first stage are repeated with an increase in the range of motion, using light sports equipment (a stick, a ball). Duration - 4 weeks.
- Third. The load increases with the use of new sports equipment (dumbbells, weights, mace, expander, etc.), the inclusion of simple domestic work (wiping mirrors, cleaning dust, washing dishes). An important achievement of the period is keeping the hand on the weight, performing active movements. Duration - 3-4 weeks.
- Fourth. The inclusion of strength exercises to enhance muscle tone, restore volume and amplitude of movements. A visit to the swimming pool, sports, gym helps strengthen the muscles of the shoulder, shoulder girdle, return to active life. The development of the deltoid muscle surrounding the shoulder joint subsequently protects against the effects of mechanical stress, traumatic factors.
The final phase of recovery is aimed at the return of coordination, stretching, agility, strength of the patient for a full-fledged professional and household activities.
Bone fracture - trauma associated with bleeding, vascular damage, nerve endings, tendons, muscles. In most cases, the prognosis of treatment is favorable - full restoration of the functions of the damaged joint.
But the risk of complications is always present and depends on a number of factors:
- difficulty injury:
- age of the victim
- state of the patient's body,
- adequate and timely treatment,
- compliance with the doctor's recommendations
The consequences are expressed in the manifestations:
- accretion of fractures
- formation of habitual dislocation,
- destruction of articular cartilage,
- necrosis of damaged tissues
- paresthesias (skin sensitivity disorders),
- paralysis of the injured limb,
- bulging of blood vessel walls,
- neurological, functional disorders of the limb.
Elderly patients who are at particular risk due to frequent osteoporosis require special attention. In parallel with the main treatment, older people are prescribed the means to activate the blood supply and calcium.
The forecast of full recovery depends on the age, state of the body’s internal reserves, the type of fracture and the development of complications.
A simple fracture of the surgical cervix, not complicated by dislocation, displacement, grows together after 1-2 months. Surgical intervention significantly increases the duration of treatment and recovery of the victim. Fusion of the bone after surgery occurs after 3 months. This is followed by the removal of metal clamps connecting the fragments. Rehabilitation after surgery will require another 3-4 months.
It is important to avoid infection of the wound, blood poisoning and other postoperative complications.
It should be noted that success in treatment and rehabilitation always depends on the coordinated actions of the doctor and the patient, faith in the resources of the body and their own strength.
You can learn more about exercise exercises for the shoulder joint from the video.
What causes fracture of the surgical neck of the humerus?
There is a fracture of the surgical neck of the humerus mainly from indirect violence, but it is also possible with a direct injury mechanism.
Depending on the mechanism of injury and displacement of fragments, adduction and abduction fractures are distinguished.
An adduction fracture is the result of a fall on the arm bent and given at the elbow joint. The elbow joint accounts for the main action of force. Due to the mobility of the lower edges of the distal end of the shoulder makes the maximum cast. The true edges (especially the upstream V-VII) are connected to the sternum and not so flexible that they create a foothold on the border of the upper third of the shoulder. There is a lever, the continuation of the load on the long shoulder of which should dislocate the head of the shoulder outwards. A powerful capsular apparatus prevents this, resulting in a fracture in a weak point of the bone - at the level of the surgical cervix.
The central fragment is displaced outwards and anteriorly, rotated outwards due to the mechanism of injury and traction of the supraspinatus, subosseous, and small circular muscles. Peripheral fragments as a result of the mechanism of damage deviates outward and is displaced upward under the action of the deltoid, biceps, and other muscles, which are thrown over the joint. Between the fragments formed an angle open inwards.
Abduction fracture occurs when falling on the withdrawn hand. It would seem that at the same level of fracture and the action of the same muscles, the displacement of fragments during adduction and abduction fractures should be the same. But the mechanism of injury makes its own adjustments. The simultaneous action of forces in two directions leads to the fact that the peripheral fragment is displaced inwards and with its outer edge turns the central one in the direction of alignment. As a result, the central fragment deviates somewhat anteriorly and downwards. Peripheral, located inwards from him, forms an angle open outwards.
The main objective of rehabilitation measures is the restoration of physical activity of the diseased limb. To this end, the victims must undergo a course of physical therapy. The duration of the recovery period is approximately 2-4 weeks.
In addition to exercise therapy at the fracture of the surgical neck of the shoulder, physiotherapy is prescribed:
- Magnetotherapy is a treatment with a variable or constant (low or high frequency) magnetic field.
- Phonophoresis - the combined effects of drugs and ultrasound.
- Diadynamic therapy - the use of current, the recommended frequency of 50-100 Hz.
- Ultrahigh-frequency therapy - the effect of a magnetic field with a high frequency on the damaged area of the body.
- Salt baths.
- Mud therapy
- Electrophoresis is the combined effect on the body of medicines and low-current currents.
- A massage that must be performed exclusively by a professional with a technique of intermittent vibration. To accomplish this, the massage therapist gently taps a plaster cast with a wooden mallet or fingers.
Exercise therapy at the fracture of the surgical neck of the humerus
Physical therapy is an essential component of the recovery period. Some exercises begin to perform 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 patient tilts the body in the direction of the injured hand. Exercises of this stage also involve flexion and extension of the limb, various movements of the arms.
- In the next period, the use of light sports equipment is acceptable.
- During the 3 period, which lasts about a month, the injured person during the exercises uses such sports equipment: dumbbells, a ball, sticks, etc. Simple work on the house, in the garden plot will be useful. Before starting this kind of physical activity, you should consult with a specialist.
- During the 4th period, the patient performs various movements with his hands (flexion, swing, extension), as well as strength exercises.
Doctors recommend during the rehabilitation to regularly visit the pool, because swimming has a positive effect on the muscular system and quickly restores the body. The muscles during swimming come to a tone, the volume of movements extends, and, as a result, the person returns to a normal lifestyle quicker.
Exercise exercises can be performed in medical institutions or at home. Execution frequency - no more than 10 times. All exercises should be carried out carefully, carefully listening to your feelings, and when you experience pain, stop training. Fracture of the surgical neck of the humerus without displacement, of course, heals faster, but even in this case there are complications.
Painful complications that occur after a fracture of the surgical neck of the shoulder are common and can occur during inadequate therapy. They in most cases are incorrectly accrete bones, pseudoarthrosis. A high risk of developing complications exists directly during a fracture: a violation of the integrity of nerve endings, vessels, tendons, and muscles. As a result, this leads to bleeding, functional or neurological disorders in the injured hand. For example, as a result of a fracture of a surgical neck, fragments load vessels and nerve endings, which can cause the following unpleasant consequences:
- Paresthesia (violation of skin sensitivity: tingling, numbness).
- Severe swelling of the arm.
- Hematoma due to compression of blood vessels and pathology of blood circulation processes.
- Necrosis of damaged tissues.
- Paralysis of the limb.
- Stretching and bulging of the walls of blood vessels.
To reduce the risk, self-treatment procedures should not be undertaken. This also applies to the acute period after an open or closed fracture of the surgical neck of the right humerus or the left bone, and the rehabilitation stage, which must take place under the close supervision of the attending physician. Follow the recommendations of the latter should be strictly and regularly.