A fracture of the humerus is a fairly common injury and occurs in both the elderly and young people.

Anatomically, the humerus is divided into three sections:

Humeral head and surgical neck- these are parts that are located in the articular bag and are an integral part of the shoulder joint ("upper" part). In this area, a fracture of the large tubercle and a fracture of the surgical neck of the shoulder most often occur.

Body of the humerus- in medical sources called the diaphysis of the shoulder, the longest part of the humerus. Fractures in this area have the corresponding name - fractures of the body of the humerus (shoulder diaphysis).

Condylar region (distal part)- forms a connection with the forearm in the elbow joint ("lower" part). Fractures in this area are called transcondylar.

The most common is a fracture of the surgical neck of the humerus and a fracture of the constituent parts of the head, in particular a fracture of the greater tubercle. Fractures of the head and fractures of the condylar region are intra-articular injuries.

Together with the humerus, various nerves passing in the shoulder and the brachial artery can be damaged, and the muscles of the shoulder can also be damaged when the humerus is fractured.

Shoulder fracture symptoms

Symptoms of a fracture of the neck of the humerus

Pain at the fracture site;
Deformation of the shoulder, compared with a healthy limb, in the case of a fracture with a displacement;
Shoulder shortening;
Crepitus at the site of injury (when palpated, a crunch of fragments is heard).
Limitation of movements in the shoulder joint;
Swelling of soft tissues at the site of injury, bruising (“bruising”);
Sometimes with impacted fractures (in this case, one fragment is driven into another and a sufficiently reliable fixation is achieved), pain and other symptoms may be mild, a person who has been injured may not seek medical help for several days.

Fractures of the neck of the humerus are very rarely open, but can be complicated by nerve damage, which will manifest itself in a violation of sensitivity in the hand, difficulty in making movements in the wrist joint and fingers.

Symptoms of a fracture of the large tubercle of the humerus:

Pain over the shoulder joint;
Limitation of mobility, abduction of the shoulder to the side suffers the most. Abduction may be completely absent, indicating damage to the supraspinatus tendon;
The swelling at this fracture is less pronounced, visible deformities are rare;
Crunch at the fracture site on palpation.

Nerves and significant vessels in this fracture are extremely rarely damaged. Often there is damage to the supraspinatus muscle, which in the future can cause a sharp violation of movements in the shoulder joint.

Symptoms of a fracture of the body (diaphysis) of the humerus:

Strong pain;
When displaced, pronounced deformation;
Shortening of the limb;
Crepitus of fragments;
Severe swelling and bruising, may extend to the hand
Limitation of movements in the shoulder and elbow joints.

This type of fracture is characterized by damage to the nerves and blood vessels. If the nerves are damaged, movements in the fingers suffer, sensitivity is disturbed, the patient's hand hangs down.

Symptoms of transcondylar fractures:

Pain radiating to the elbow joint and forearm;
Swelling of the elbow joint;
Displacement deformation;
Limitations of movements in the elbow joint;
Crunch of fragments when probing.

With fractures in this area, the brachial artery is often damaged, which can lead to gangrene of the limb, the main symptom of damage to the brachial artery is the absence of a pulse in the forearm (in a typical place for probing the pulse).

Fractures of the upper part of the humerus must be distinguished from bruises, dislocations of the shoulder joint, lower from dislocations of the elbow joint and fractures of the ulna.

First aid for a broken shoulder

As with any fracture, the main task is anesthesia and immobilization of the limb. For pain relief, any medicines that are in the home medicine cabinet (ketorol, nimesulide, analgin) are suitable.

Immobilization of the limb is achieved by constructing a splint from improvised means. A plank, slats, strong rods or sticks are bandaged to the humerus, the arm is hung on a scarf and fixed to the body. In case of fractures in the upper part of the shoulder, it is not necessary to make a splint, it is enough to hang your hand on a scarf.

Shoulder Fracture Diagnosis

An x-ray is sufficient for diagnosis. In some cases, if there is a suspicion of damage to the supraspinatus muscle and fractures inside the joint, ultrasound is performed.

Shoulder fracture treatment

There are three methods of treating shoulder fractures: conservative, surgical and skeletal traction.

Shoulder fractures without displacement and fractures, the displacement of which can be corrected with the help of a one-stage reposition (reduction) are treated by applying a plaster cast and using special fixing splints and bandages.

Fractures of the greater tubercle of the humerus require, in most cases, treatment by applying a plaster cast. Additionally, an abduction splint can be used, which prevents the development of stiffness in the shoulder joint, and also provides fusion of the supraspinatus muscle (this muscle is often damaged when a large tubercle is fractured).

For fractures with displacement an operative method of treatment is used, the fragment is fixed with knitting needles or a screw, which are removed after a few months. Terms of general treatment range from 2 to 3 months, plaster immobilization - 4-6 weeks.

For fractures of the surgical neck without displacement a plaster cast is applied for 4 weeks, then the development of movements. If the fracture was displaced, and it was possible to set it, then plaster immobilization is extended up to 6 weeks.

For irreducible fractures operation is shown. The fracture, during surgical treatment, is fixed with plates. With impacted fractures of the surgical neck and fractures of the large tubercle without displacement, this type of conservative treatment is justified as functional, when the arm is fixed only with a bandage like a scarf or on an abductor cushion (in case of damage to the supraspinatus muscle), for a period of 4 weeks. Gypsum is not required in this case.

In the future, physiotherapy and physiotherapy exercises are used, a set of exercises for developing movements and general rehabilitation will be written below. The total duration of treatment is from 2 to 3 months.

Fractures of the body of the humerus without displacement treated with a plaster splint applied for up to 8 weeks.

Fractures of the body of the shoulder with displacement they operate and fix with plates, screws or special intraosseous rods, then plaster is applied for 4-6 weeks, with reliable fixation of the fracture, they can be limited to a bandage with a scarf. After removing the plaster, they begin rehabilitation. The total duration of treatment is 3-4 months

Also, with fractures of the body of the shoulder with displacement, apply the skeletal traction method. A needle is passed behind the olecranon, and the shoulder is reduced by means of traction. With a splint for skeletal traction, it is necessary to lie down for about 4 weeks, which is very difficult for the patient. Then a plaster cast is applied for another 4-6 weeks. The total duration of treatment is 3-4 months. Currently, skeletal traction is rarely used to treat fractures of the shoulder.

Fractures of the lower end of the humerus (transcondylar) very often accompanied by displacement of fragments. When the displacement is eliminated, by reduction under anesthesia, a plaster is applied for 6-8 weeks. If the displacement is unrecoverable, operate and install a plate and screws to fix the fracture. The total period of treatment with rehabilitation reaches 4 months. Plates, rods and screws are removed from the bone after several months, or even years, after complete recovery. For each patient, the timing for the removal of metal structures is set individually. In the elderly, metal structures may not be removed, which is associated with the risk of reoperation.

Complicated open fractures of the body of the humerus the setting of a complex structure of spokes and rings (Ilizarov apparatus) is used, the treatment time with this method can be extended up to 6 months, but movements in the joints are feasible from the first weeks.

Damage to nerves, blood vessels in fractures of the shoulder I require special operations (nerve suture, vascular suture) and a significant increase in the time of general treatment and restoration of hand function.

With any type of treatment, you need to take calcium supplements, painkillers and anti-inflammatory drugs.

Rehabilitation after a shoulder fracture

Perhaps the most important element in treating a shoulder fracture is rehabilitation. Rehabilitation includes the most important components - physiotherapy, physiotherapy exercises and massage. Physiotherapy treatment is prescribed in courses of 7-10 procedures a few weeks after the injury.

Physiotherapy exercises (exercises) must be started from the first days after the provision of medical care.

After 2-3 days from the moment of injury (operation), we begin active, but without load, movements in the fingers of the diseased hand, as well as active movements in the healthy hand.
A week after the injury (surgery), we isometrically strain the muscles of the diseased shoulder. Isometrically - this is without making movements in the joints; for starters, you need to train on a healthy hand. For a day, 10 visits, we start with 20 voltages, gradually increasing their number. These exercises are necessary to maintain muscle tone and improve blood supply, which contributes to the fastest healing of the fracture.
After removing the plaster cast, we begin to develop movements in the shoulder and elbow joints.

Approximate exercises for developing movements for shoulder fractures after plaster removal:

1. Pendulum movements with both hands, legs are shoulder-width apart, torso in an inclined position.
2. Circular movements in the same position.
3. Taking the arm to the side is perhaps the most important exercise. If it is impossible to immediately perform this exercise, we help the hand by moving the fingers along the wall.
4. We wave our arms in front of the chest.
5. Reduction of hands with a "lock" to the chest and subsequent straightening.
6. Extension, flexion in the elbow joints
7. Throwing hands behind the head.
8. In the future, you can use a gymnastic stick for exercises.

Each exercise is performed 10-15 times several times a day. Take breaks when pain occurs. After 2-4 weeks, it is possible to use dumbbells and other gymnastic equipment. The total period of rehabilitation and restoration of movements, in the absence of complications, is from 3 to 6 weeks. With persistent difficulties in movement in the shoulder joint - contractures, special devices for the development of movements, located in rehabilitation centers, are applicable.

Already upon returning to work and with a strong union of the fracture, you can gradually move on to active rehabilitation: swimming, tennis, exercising in the gym.

Shoulder Fracture Prognosis

With uncomplicated fractures of the shoulder, the return to normal activity occurs 2-3 months after the injury. The terms of rehabilitation and treatment can be significantly delayed in the presence of various complications. The most common complications include: contracture of the shoulder joint (restriction of movement), nerve damage during trauma, infection in the bone.

Traumatologist-orthopedist Voronovich N.A.

Fractures of the medial epicondyle of the humerus are avulsion in nature and account for 35% of all fractures of the distal part of this bone. They are the result of an indirect mechanism of injury and occur during a fall with an emphasis on the hand of an extended arm with a deviation of the forearm outward. Muscles attached to the medial epicondyle tear it off.

In this case, a significant rupture of the capsule of the elbow joint occurs. The mechanism of occurrence of a fracture of the medial epicondyle corresponds to the mechanism of dislocation of the bones of the forearm. Quite often at dislocation of a forearm there is an infringement of this epicondyle in an elbow joint. According to our statistics, 62% of dislocations of both bones of the forearm were accompanied by detachment of the medial epicondyle.

There are the following types of fractures of the medial epicondyle of the humerus:

fractures without displacement;

fractures with displacement in width;

fractures with rotation;

fractures with infringement in the elbow joint;

fractures with nerve damage;

fractures in combination with dislocation of the forearm;

repeated breaks.

Clinical and radiological diagnostics

Limited tissue swelling along the anteromedial surface of the elbow joint, extensive bruising, and local pain are expressed. On palpation, a mobile epicondyle can be determined. This resembles the symptoms of a transcondylar fracture with displacement of the distal fragment to the lateral side. However, with the latter, the swelling extends to the entire elbow joint, and the sharp edge of the central fragment is determined on the medial side of the elbow joint. When the medial epicondyle is torn off, extension in the elbow joint with the deviation of the extended fingers to the back causes pain in the projection of this epicondyle, fluid is determined in the cavity of the elbow joint, and signs of nerve damage are detected. With a dislocation of the bones of the forearm, deformation of the elbow joint is observed. The nature of the deformation is determined by the type of dislocation. With repeated detachments of the medial epicondyle, which occur with fibrous fusion of the false joints, the symptoms are “blurred”, the swelling is small and limited, there is no bruising, on the anteromedial surface of the elbow joint, soft tissue compaction associated with the humerus is palpated.

Difficulties in X-ray diagnostics arise mainly in children under 6 years of age, in whom the ossification nucleus has not yet appeared, and in the absence of displacement of the epicondyle.

The combination of separation of the medial epicondyle and dislocation of both bones of the forearm is characteristic, therefore, when studying radiographs, it is necessary to pay attention to the area of ​​the medial epicondyle. Sometimes it is difficult to distinguish a repeated fracture from a primary one. Only the presence of ossification indicates re-injury.

In children, avulsion of the medial epicondyle occurs as apophyseolysis or osteoapophyseolisis. There are detachments of only part of the apophysis. Sometimes it is a cartilage plate that is not radiopaque. Separations of a muscular leg with a periosteum are observed. The muscle leg is sometimes infringed in the elbow joint, dragging the ulnar nerve with it, and signs of damage to it are determined. The latter cases are rare and difficult to recognize, but should always be kept in mind. There are detachments at the same time and the lateral epicondyle of the humerus. Separation of the medial epicondyle is often combined with other fractures in the elbow joint.

The fragment under the influence of muscle traction is displaced downward and to the radial side. Infringement of the epicondyle in the elbow joint is of two types:

when it is all in the joint cavity;

when only its edge is infringed.

The joint space is expanded from the medial side. With a cartilaginous epicondyle, this x-ray sign becomes especially valuable. Be sure to pay attention to the degree of rotation of the fragment, the shape and size of the ossification nucleus. In children 6-7 years old, the ossification nucleus has a rounded shape and at first its shadow appears in the form of a dot.

Treatment

If there is no displacement of the bone fragment, then treatment is limited to immobilization of the posterior plaster splint for 15-20 days. With a displacement of more than 5 mm, rotational displacement, infringement of the epicondyle, surgical treatment is indicated. In case of dislocation of the bones of the forearm, the dislocation is first reduced and only then the question of surgical treatment is decided. The operation is technically simple and, if performed correctly, leads to a complete recovery.

Open reduction is sought to be performed as soon as possible after injury. In the first 1-3 days, the operation is performed with minimal soft tissue trauma, and it is not associated with any difficulties. The skin incision is made along the anteromedial surface of the elbow joint. Stupidly separate the soft tissues and approach the fracture site. This removes blood clots. The wound surface of the humerus is freed from the soft tissues covering it, which are retracted medially along with the ulnar nerve. Determine the position of the epicondyle, the degree of damage to the capsule and joint. If a fragment is infringed in the joint cavity, it is removed. Be sure to evacuate blood clots from the joint cavity. To compare the fragment, it must be shifted upwards and slightly backwards. In the center of the epicondyle, a needle with a thrust platform or an awl with a removable handle is injected so that it runs perpendicular to the plane of the fracture. The end of the needle is brought out above the wound surface by 0.5-1 cm. With the help of a needle, the epicondyle is pulled up. Then the end of the spoke is placed in the center of the facet on the humerus and, acting on the principle of a lever, reposition is achieved. The needle is introduced into the condyle of the humerus, pressing the epicondyle against it with a persistent platform. This technique greatly facilitates reduction, especially with stale fractures. Visually check the accuracy of the reduction. The wound is sewn up tightly. Be sure to produce x-ray control, bearing in mind that when the epicondyle is torn off, there is a tendency to dislocation of the forearm. Impose a back plaster bandage from the bases of the fingers to the upper third of the shoulder. The elbow joint is immobilized at an angle of 140°. Practice shows that from this position of the joint, its function is restored faster. In order to avoid the formation of conflicts, the edges of the splint are bent. In the postoperative period, a UHF field is prescribed. Immobilization is continued for at least 3 weeks. The fixing needle is removed and exercise therapy is prescribed. Movements in the elbow joint are carried out within the amplitude that does not cause pain. Forced restoration of function, violent movements lead to a reflex closure of the elbow joint, the formation of ossifications and, ultimately, to a prolongation of the restoration of the function of the elbow joint. Massage of the elbow joint area, warming it up also have a negative effect.

During the first week, the first signs of recovery of movements are already noted. During this period, the child and his parents master the basic principles of exercise therapy quite well and, after discharge from the hospital, carry it out at home under the supervision of an exercise therapy methodologist.

The most common complication is the formation of a false joint. With non-surgical treatment, this complication is observed in 40% of cases, which is mainly associated with soft tissue interposition. In surgical treatment, it is rare and is associated with errors in the surgical technique, as well as in the treatment of stale fractures.

Avulsion fractures of the lateral epicondyle of the humerus are very rare. Usually, only its outer plate is torn off, to which the radial collateral ligament of the elbow joint and muscle is attached. The displacement is usually insignificant and easily eliminated. Fixation of the lateral epicondyle is carried out with a thin needle. Outcomes are favorable. Indications for surgical treatment are very rare.

Fractures of the head of the condyle of the humerus

Among all fractures of the bones that make up the elbow joint, fractures of the head of the condyle of the humerus occupy the first place in terms of the frequency of adverse outcomes. This is a violation of the function of the elbow joint, delayed consolidation, the formation of pseudarthrosis and other complications. These fractures account for 8.2% of all fractures in the elbow joint. They arise from an indirect mechanism of injury, when falling on an outstretched, slightly bent arm; more often occur in children aged 5-7 years.

There are several types of these fractures:

epimetaphyseal fracture of the outer part of the condyle;

osteoepiphyseolysis;

pure epiphysiolysis;

fracture of the nucleus of ossification of the head of the condyle;

subchondral fractures;

fracture or epiphysiolysis in combination with dislocation in the elbow joint.

Fractures of the head of the condyle of the humerus are sometimes combined with fractures of the medial epicondyle, olecranon, and neck of the radius. Fractures of the head of the condyle of the humerus in combination with dislocations in the elbow joint occur in 2% of cases. Anterior-medial dislocation predominates, posterior-medial dislocation is less common.

Clinical and radiological characterization

There is swelling of the lateral side of the elbow joint, sharp pain on palpation of the lateral surface of the distal part of the humerus. In the joint cavity fluid, hemarthrosis are determined. Sometimes the mobility of a broken bone fragment is determined. Difficulties in radiographic diagnosis may arise in the absence of displacement. Usually, a broken bone fragment is displaced laterally and downward, anteriorly or posteriorly, as well as at an angle open posteriorly or anteriorly. Quite often, rotation of the fragment is observed, due to the traction of the muscles attached to it. Typically, rotation occurs in more than one plane and is often quite significant. In such cases, the articular surface of the head of the condyle may be directed towards the wound surface of the humerus. It loses contact with the head of the radius and is in a position of subluxation or dislocation.

In osteoepiphysiolysis, a fragment of the metaphysis can be of various sizes and shapes. Its crescent shape is characteristic. It occurs at the time of injury with displacement laterally and posteriorly. In this case, only a compact plate breaks off from the lateral or posterior surface of the metaphysis of the humerus. On radiographs, it is defined as a sickle, which at one end approaches the lateral surface of the nucleus of ossification of the head of the condyle of the humerus.

By the nature of the fracture plane and the degree of displacement, the depth of the blood supply disturbance of the broken fragment is determined with a sufficient degree of certainty. To the greatest extent, it suffers from pure epiphyseolysis. The state of blood supply largely determines the choice of treatment tactics.

Treatment

The method of treatment is chosen on the basis of studying all the features of the fracture. In the absence of displacement, a posterior plaster splint is applied from the bases of the fingers to the upper part of the shoulder. If there is a slight displacement, then it is preferable to fix the fragment with knitting needles. This eliminates the possibility of slow consolidation.

When the fragment is displaced along the width, at an angle and slightly rotated, a closed reposition is used. It is carried out with very careful movements. At the same time, the direction of displacement and the localization of unbroken soft tissues that bind the fragments and give them a certain stabilization are taken into account. When the fragment is displaced laterally and downwards, the forearm is deflected medially and by pressing the fingers on the fragment from the outside up and inward, it is brought closer to the humerus, introducing it between the condyle of the humerus and the head of the radius. When displaced backwards, they press on the fragment from behind and bend the limb at the elbow joint. Then the fragment is percutaneously fixed with pins with thrust pads to the humerus. Produce x-ray control. The terms of immobilization are 4-5 weeks.

Fractures of the head of the condyle of the humerus in combination with dislocation in the shoulder joint

The study of such injuries showed that at the time of injury, the head of the condyle of the humerus is fractured, then dislocation occurs. As a result, the broken fragment retains its connection with a part of the epicondyle of the humerus through soft tissues. There is a displacement in one ligament of the forearm with the head of the condyle of the humerus. This explains the possibility of bloodless reduction in such injuries. In the course of surgical interventions, it was found that in children with similar fracture-dislocations, there was an infringement of soft tissues in the humeroulnar joint or there was a significant rupture of the articular capsule and other soft tissues. After elimination of the infringement of soft tissues in the joint cavity, free reduction of the bone fragment occurred.

Treatment options

Based on the clinical and radiological study of patients, as well as the analysis of surgical findings, a technique for bloodless reduction of fractures of the head of the condyle of the humerus in combination with dislocation in the glenohumeral joint was developed. Its principle is that the fracture and dislocation are reduced simultaneously. At the same time, all manipulations should be reasonable, purposeful and as sparing as possible in order to avoid additional rupture of soft tissues. Otherwise, the reduction becomes ineffective. The result of reduction is controlled by radiography, osteosynthesis is carried out with pins with thrust pads.

In children, as a rule, there are many cartilaginous elements in the elbow joint, so the correct assessment of the position of the broken fragment can be difficult. It is especially difficult to determine the degree of rotation. Therefore, in doubtful cases, open reposition is preferred.

Of fundamental importance is the question of the timing of immobilization for all fractures of the head of the condyle of the humerus. Experience convinces us that the reduction of terms, even in the absence of displacement, unacceptably showed that the complication was often in those in whom the displacement was either absent at all, or was insignificant. Guided by this, doctors stopped immobilization in patients of this category already 2 weeks after the injury, which was the reason for nonunion of the bone.

The period of immobilization depends on a number of factors and, especially, on the age of the patient, the degree of adaptation of the fragments and the violation of the blood supply to the broken fragment. With epiphysiolysis, in connection with this, the fixation time should be large. On average, rest of the fracture area should last at least 4-5 weeks. Of decisive importance in deciding whether to remove the plaster cast are the data of the control radiographs. The fear of the occurrence of post-immobilization contractures in children is not justified. With delayed consolidation, immobilization is extended until the fracture heals.

With a significant rotational displacement, an open reduction is resorted to without attempting a closed reduction. The operation is performed with gentle techniques. Fixation is carried out with spokes with thrust pads, which create a certain compression between the fragments.

Due to the peculiarities of the blood supply to the distal end of the humerus in its fractures, especially the lateral part, often there is a delayed consolidation, a false joint of the head of the condyle, the phenomena of its avascular necrosis. These complications are facilitated by ineffective and short-term immobilization. Delayed consolidation and false joints often occur with non-displaced fractures. In such cases, doctors erroneously shorten the immobilization period, which is the cause of the noted complications. For their treatment, closed fixation of fragments is used using a specially designed screw that allows it to be inserted using a removable handle. If the fragment is displaced simultaneously with the movements of the forearm, then the latter is set in the position in which the head of the condyle of the shoulder is set in the correct position. Fragments are fixed with a needle. Then, with a scalpel, an incision is made up to 5 mm in the direction of the head of the condyle of the humerus. A canal is made through the incision with an awl through the head of the condyle into another fragment. A screw is passed through the channel using a removable handle. The screw creates compression between fragments. Apply a plaster cast. After healing the fracture with a removable handle, the screw is removed on an outpatient basis.

Subchondral fractures of the head of the condyle of the humerus.

A special group of fractures of the head of the condyle are subchondral fractures. We are talking about the separation of articular cartilage with areas of bone substance. They are not so rare, but, as a rule, are not diagnosed. They are usually referred to the group of epiphyseolysis. Subchondral fractures are observed only in children 12-14 years old. Displacement only anteriorly is characteristic. They are unfamiliar to practitioners, since the mention of them is very rare. Meanwhile, they require a special approach in the diagnosis and choice of treatment.

Clinical and radiological signs

The clinical manifestations of subchondral fractures depend on the time elapsed since the injury and the degree of displacement. In recent cases, marked pain in the elbow joint, aggravated by movement. The contours of the joint are smoothed, local pain is detected with pressure on the head of the condyle. In the cavity of the elbow joint in fresh and stale cases, fluid is determined.

X-ray examination is of decisive diagnostic value. The radiological picture of the damage depends on the size of the broken articular cartilage and bone plates, as well as on the steppes and its displacement. In most cases, the fracture extends only to the head of the condyle, but it often passes to the lateral surface of the shaft of the block. In one patient, articular cartilage was removed from the entire distal epiphysis of the shoulder.

Since plates of bone substance of various sizes break off with articular cartilage, the contours of the separated fragment are quite clearly visible on radiographs.

It should be noted that in a number of patients, the cortical plate and bone substance break off from the outer surface of the head of the condyle of the humerus. Further, the fracture plane goes inward, separating only the articular cartilage. Therefore, on the lateral radiograph, when the fragment is displaced anteriorly, a picture of the displacement of the entire epiphysis of the humerus in the form of a hemisphere is revealed.

In practice, it is advisable to distinguish 5 groups of subchondral fractures:

fractures without displacement and with slight displacement; they are visible only on the lateral radiograph; at the same time doubling of a contour of a head of a condyle comes to light; treatment consists in immobilization of the elbow joint for 3-4 weeks;

fractures with displacement, but only at an angle open anteriorly; reposition consists in pressure on the head of the condyle from front to back and full extension in the elbow joint; in this position, a plaster splint is applied; as a rule, reposition leads to the desired result;

fractures with displacement not only at an angle, but also in width anteriorly; at the same time, the wound surfaces of the fragments from behind are still in contact; reposition is also carried out by the same methods as for fractures of the previous group;

complete displacement of the fragment anteriorly; while its wound surface is adjacent to the anterior surface of the distal part of the humerus; closed reduction fails, surgical treatment is indicated;

displacement of the fragment into the anterior torsion of the elbow joint; in such cases, movements in the elbow joint are restored completely without eliminating the displacement; with uncorrected displacements of the 3rd and 4th groups, the function of the elbow joint is sharply disturbed, primarily extension suffers.

With stale fractures without displacement, clinical symptoms are not very pronounced. Patients complain of moderate pain in the elbow joint, extension in it is limited. There is fluid in the joint cavity.

Palpation is not painful. On the lateral radiograph, fragmentation of one of the contours of the head of the condyle of the humerus is sometimes revealed. Treatment begins with immobilization of the joint. Then use exercise therapy, FTL.

Humeral block fractures

Fractures of the block of the humerus in children are very rare and arise from an indirect mechanism of injury, when falling on an adducted and slightly bent arm at the elbow joint. They are typical for children of the older age group. There are metaepiphyseal fractures of the medial part of the condyle of the humerus, vertical fractures of the medial edge of the block with the medial epicondyle, and epiphysiolysis.

Clinical and radiological picture

A fracture of the block of the humerus is characterized by swelling of the elbow joint, sometimes significant, but more localized on its medial side. With full extension of the fingers and in the wrist joint, pain also appears on the medial side of the joint.

On palpation, a sharp pain is detected here, sometimes the mobility of a bone fragment. In the joint cavity, fluid is determined, which is regarded as hemarthrosis.

On radiographs, a block fracture of a different nature is detected. Difficulties in interpreting radiographs may arise in children in whom the block is represented by several ossification nuclei. The fragment is displaced inwards and downwards. Quite often, rotation of the fragment is observed, sometimes it is significant, due to the traction of the muscles attached to the medial epicondyle.

Treatment

Treatment of block fractures without displacement is limited to immobilization of the posterior plaster splint for 3 weeks.

Displacement of fractures of the block of the humerus leads to restriction of movements in the elbow joint, so they must be eliminated. When offset in width, an accurate comparison is usually possible in a closed way by direct pressure with fingers on the fragment. In order to avoid secondary displacement, osteosynthesis with wires is used. Fragment rotation, as a rule, cannot be eliminated closed, therefore an open reduction is used.

Apply medial access to the fracture site. The ulnar nerve is isolated and retracted medially. Under the control of the eye, an accurate comparison of the fragments is achieved. They are fixed with knitting needles with persistent platforms. After layer-by-layer suturing of the wound, the arm is fixed with a posterior plaster splint for 4 weeks. The spokes are removed and the movement in the elbow joint is restored according to the principles outlined earlier. Proper use of exercise therapy guarantees complete restoration of the functions of the elbow joint.

shoulder fracture- a fairly common injury, during which there is a violation of the integrity of the humerus.

Fracture of the humerus in numbers and facts:

• According to statistics, a shoulder fracture is 7% of all other types of fractures (according to various sources, from 4% to 20%).
• Trauma is common among both the elderly and young people.
• A typical mechanism for the occurrence of a fracture is a fall on an outstretched arm or elbow.
• The severity of the fracture, the nature and timing of treatment strongly depend on which part of the shoulder is damaged: the upper, middle or lower.

Features of the anatomy of the humerus

The humerus is a long tubular bone that connects at its upper end to the scapula (shoulder joint), and at its lower end to the bones of the forearm (elbow joint). It consists of three parts:

• upper - proximal epiphysis;
• middle - body (diaphysis);
• lower - distal epiphysis.

The upper part of the humerus ends with a head, which has the shape of a hemisphere, a smooth surface and articulates with the glenoid cavity of the scapula, forming the shoulder joint. The head is separated from the bone by a narrow part - the neck. Behind the neck are two bony protrusions - large and small tubercles, to which muscles are attached. Below the tubercles is another narrow part - the surgical neck of the shoulder. This is where the fracture most often occurs.

The middle part of the humerus - its body - is the longest. In the upper part it has a circular cross section, and in the lower part it is triangular. A groove runs along and around the body of the humerus in a spiral - it contains the radial nerve, which is important in the innervation of the hand.

The lower part of the humerus is flattened and has a large width. On it are two articular surfaces that serve for articulation with the bones of the forearm. On the inside there is a block of the humerus - it has a cylindrical shape and articulates with the ulna. On the outside, there is a small head of the humerus, which has a spherical shape and forms a joint with the radius. On the sides on the lower part of the humerus are bone elevations - the outer and inner epicondyles. Muscles are attached to them.

Types of fractures of the humerus

Depending on location:

• fracture in the upper part of the humerus (head, surgical, anatomical neck, tubercles);
• fracture of the body of the humerus;
• fracture in the lower part of the humerus (block, head, internal and external epicondyles).

Depending on the location of the fracture line in relation to the joint:

• intra-articular - a fracture occurs in the part of the bone that takes part in the formation of the joint (shoulder or elbow) and is covered by the articular capsule;
• extra-articular.

Depending on the location of the fragments:

• without displacement - easier to treat;
• with displacement - fragments are displaced relative to the original position of the bone, they must be returned to their place, which is not always possible without surgery.

Depending on the wound:

• closed- the skin is not damaged;
• open- there is a wound through which bone fragments can be seen.

Fractures at the top of the humerus

Types of fractures in the upper part of the humerus:

• fracture of the head - it can be crushed or deformed, it can break away from the humerus and turn 180 °;
• fracture of the anatomical neck;
• fracture of the surgical neck - fractures of the anatomical and surgical neck of the shoulder are most often driven in, when one part of the bone enters another;
• fractures, separations of the large and small tubercle.

Causes

• fall on the elbow;
• blow to the upper part of the shoulder;
• tubercles detachments most often occur with dislocations in the shoulder joint, due to a sharp strong contraction of the muscles attached to them.

Symptoms of shoulder fractures in the upper part:

• Swelling in the shoulder joint.
• Hemorrhage under the skin.
• Sharp pain.
• Depending on the nature of the fracture, movement in the shoulder joint is completely impossible or partially possible.

Diagnostics

The victim must be immediately taken to the emergency room, where he is examined by a traumatologist. He feels the area of ​​the damaged joint and reveals some specific symptoms:

• When tapping on the elbow or pressing it, the pain increases significantly.
• During the palpation of the joint area, a characteristic sound occurs, resembling bursting bubbles - these are the sharp edges of the fragments touching each other.
• The traumatologist takes the victim's shoulder with his own hands and performs various movements. At the same time, he tries to feel with his fingers which parts of the bone are displaced and which remain in place.
• If there is a dislocation at the same time as the fracture, when the doctor feels the shoulder joint, the doctor does not find the head of the shoulder in its usual place.

The final diagnosis is established after performing x-rays: they show the fracture site, the number and position of fragments, and the presence of displacement.

Treatment

If there is a crack in the bone, or the fragments are not displaced, usually the doctor simply administers anesthesia and applies a plaster cast for 1-2 months. It starts from the shoulder blade and ends on the forearm, fixing the shoulder and elbow joints.

If there is a displacement, before applying a plaster cast, the doctor performs a closed reposition - returns the fragments to the correct position. Most often this is done under general anesthesia, especially in children.

On the 7-10th day, physiotherapy exercises begin (movements in the elbow, wrist, shoulder joint), massage, physiotherapy treatment:

Procedure	Purpose	How is it carried out?
Electrophoresis with novocaine	Pain relief. The anesthetic penetrates directly through the skin into the joint area.	For the procedure, two electrodes are used, one of which is placed on the front surface of the shoulder joint, and the other on the back. The electrodes are wrapped in a cloth soaked in a drug solution.
Electrophoresis with calcium chloride	Reduce swelling and inflammation, accelerate bone regeneration.
UV - ultraviolet irradiation	Ultraviolet rays promote the release of biologically active substances in the tissues, enhance regeneration processes.	A device that generates ultraviolet radiation is placed opposite the shoulder joint. The distance from the device to the skin, the intensity and duration of irradiation are selected depending on the sensitivity of the skin.
Ultrasound	Ultrasonic waves carry out tissue micromassage, improve blood flow, enhance regeneration processes, and provide an anti-inflammatory effect. Irradiation with ultrasound is completely safe for the body.	Use a special device that generates ultrasonic waves. It is directed to the region of the shoulder joint and irradiated.

All these procedures are not used simultaneously. For each patient, the doctor draws up an individual program, depending on his age, condition, the presence of concomitant diseases, the severity of the fracture.

Indications for surgical treatment for fractures of the humerus in the upper part:

Type of operation	Indications
Fixation of fragments with a metal plate and screws. Application of the Ilizarov apparatus.	Severe displacement of fragments that cannot be eliminated with closed reduction. Infringement between the fragments of tissue fragments, which makes it impossible for the fragments to heal.
Fixation of fragments with steel spokes and wire.	In older people with osteoporosis of the bones.
Fixation with a steel screw.	Separation of the tubercle of the humerus with displacement, rotation.
Endoprosthetics– replacement of the shoulder joint with an artificial prosthesis.	Severe damage to the head of the humerus when it is split into 4 or more fragments.

Possible Complications

Dysfunction of the deltoid muscle. Occurs as a result of nerve damage. Paresis is noted, - a partial violation of movements, - or complete paralysis. The patient cannot move his shoulder to the side, raise his arm high.

Arthrogenic contracture- violation of movements in the shoulder joint due to pathological changes in it. Articular cartilage is destroyed, scar tissue grows, the joint capsule and ligaments become excessively dense, lose their elasticity.

Habitual shoulder dislocation- a complication that develops after a fracture-dislocation (when a fracture and dislocation occur simultaneously). If the treatment was carried out incorrectly or out of time, then in the future a dislocation occurs easily, from a slight effort.

Fracture of the humerus in the middle

Causes

• falling on an outstretched arm or elbow;
• blow to the humerus.

  Symptoms

  • Shoulder deformity. Fragments are almost always displaced relative to each other, so the shape of the shoulder changes.
  • Shortening of the injured shoulder compared to the healthy one.
  • Impairment of function: movement in the shoulder and elbow joint becomes impossible due to bone damage and pain.
  • Edema in the area of ​​the fracture.
  • Strong pain.
  • Hemorrhage under the skin.

  Diagnosis of fractures of the shoulder in the middle part

  Symptoms that are determined by the traumatologist during the examination of the victim in the emergency room:
  • Pathological mobility. Bone fragments can be displaced relative to each other.
  • Soreness with axial load. To check it, the doctor bends the arm of the victim in the elbow joint and presses the elbow parallel to the axis of the shoulder, or taps on it. This intensifies the pain.
  • Crepitus. This is a characteristic sound, reminiscent of bursting bubbles or snow crunching underfoot.
  Occurs during the palpation of the injured hand, due to the fact that the sharp edges of fragments touch each other.
  You need to check all these symptoms very carefully, this can only be done by a specialist doctor. Inept actions can lead to damage to blood vessels and nerves, severe complications.

  The final diagnosis is established after an X-ray examination. The picture shows at what level the humerus was broken, in which direction the displacement occurred.
  

  Treatment

  Most often, fractures of the humerus in the middle part are treated without surgery.:
  • First, a closed reposition is carried out - elimination of the displacement of fragments.
  • When the displacement is eliminated, a plaster cast is applied. It starts from the forearm and continues to the shoulder, chest.
  • Skeletal traction is applied to prevent displacement of fragments. A steel needle is passed through the elbow, to which a bracket is attached and a load is suspended from it.
  • During the application of plaster and skeletal traction, x-rays are taken, making sure that the fragments do not move again. If one fragment is displaced by 1/3 of the diameter relative to the other, such a displacement is considered acceptable: as a result, the bone will still grow evenly.
  • After 2-3 months, the plaster is removed.
  • After that, rehabilitation is carried out for 1-1.5 months. The patient is prescribed physical therapy, massage, physiotherapy (see above). Quickly restore the function of the shoulder and elbow joints helps to perform movements in the water (in the bathroom, swimming pool).
  • After 3-4 months, the working capacity is completely restored.
  
  Indications for surgical treatment:
  • It is not possible to eliminate the displacement of fragments with the help of a closed reposition.
  • After reposition, the displacement of the fragments occurs again.
  • Damage to the radial nerve (see below).
  • Infringement of a fragment of a muscle or other tissue between fragments, as a result of which their fusion becomes impossible.
  During the operation, the surgeon makes an incision, gains access to the fragments and connects them with a metal rod or plates and screws. After that, plaster is no longer necessary. Sometimes used Ilizarov apparatus.

  Immediately after the operation, the patient is prescribed physiotherapy exercises. Working capacity is restored approximately 1 month faster than in the treatment with a plaster cast and traction.

  Complications

  Radial nerve injury. This nerve runs along a spiral groove located on the humerus and innervates the extensor muscles of the shoulder, forearm, and hand. Most often, paresis occurs - a partial dysfunction. Complete paralysis may develop.
  
  Signs of dysfunction of the radial nerve:
  • violation of extension in the elbow, wrist joint, in the joints of the fingers;
  • the hand has a characteristic position: it is constantly bent;
  • unable to grasp various objects with fingers;
  • impaired skin sensitivity on the back of the shoulder, forearm, hand;
  • if nothing is done, over time, atrophy begins to develop in the muscles innervated by the affected nerve.
  This complication is treated by a neurologist. They try to restore the damaged nerve with the help of medicines, vitamins, physiotherapy.

  false joint. If a piece of muscle or other soft tissue is infringed between the fragments, they cannot grow together. Pathological mobility is preserved, as if a new joint has appeared. Requires surgical treatment.
  

  Shoulder fractures at the bottom

  

  Causes

  • A fall on an overextended outstretched arm is an extensor fracture.
  • A fall onto the elbow when the forearm is strongly bent is a flexion fracture.
  Depending on how the injury occurred, bone fragments are displaced in different ways.

  Types of fractures

  The lower part of the shoulder has a complex structure, so the fractures here have a variety of shapes. The fracture line can pass through the block of the humerus, external, internal epicondyle, head.

  This type of injury is especially dangerous in children, since they have bone growth points in the lower part of the shoulder. If one of them is damaged, the corresponding part of the bone will stop growing. As a result, the elbow joint will be deformed, its function will be impaired.
  

  Signs of a fracture of the humerus in the lower part

  
  • deformity of the elbow joint;
  • strong pain;
  • swelling, hemorrhage under the skin;
  • impossibility of movements in the elbow joint.
  Sometimes fractures in the lower part of the humerus cause damage to blood vessels and nerves. At the same time, the forearm and hand turn pale, acquire a marble color, numbness, unpleasant sensations are noted: tingling, “goosebumps”. It is necessary to deliver the victim to the hospital as soon as possible and restore blood flow, otherwise he will lose part of his arm.
  

  Diagnostics

  The victim is examined by a traumatologist. He feels the damaged part of the arm, determines the symptoms:
  • protrusions and depressions are felt in front and behind in the area of ​​the elbow joint, in accordance with the direction of displacement of the fragments;
  • pathological mobility- during palpation, the fragments are displaced relative to each other;
  • shoulder deformity- the epicondyles are displaced relative to their normal location;
  • crepitus- a characteristic sound during palpation, which resembles the crunch of snow.
  After examining the victim, an x-ray is performed, during which the nature of the fracture, the number and position of fragments, and the presence of displacement are established.

  Treatment

  If fragments are not displaced, then the doctor applies a plaster splint from the bases of the fingers to the shoulder joint. After 3-4 weeks, it is removed, they begin to do physiotherapy. After 2-2.5 months, the function of the damaged hand is completely restored.

  If there is an offset, then the traumatologist tries to eliminate it - performs a closed reposition.

  Average treatment time:

  • 6-8 weeks the hand is placed on a special abductor splint;
  • then a plaster splint is applied for 3-4 weeks;
  • The splint is removed, the doctor prescribes physical therapy, physiotherapy.
  
  If the displacement cannot be corrected during closed reduction undergoing surgical treatment. Fragments are fixed with steel spokes, screws, plates. Various designs are used according to the type of Ilizarov apparatus.

  If during a closed reposition it is not possible to eliminate the displacement, and there are contraindications for the operation, then skeletal traction is applied to the shoulder.

  Terms of treatment:

  • 3-4 weeks traction for the ulna is carried out;
  • then a plaster splint is applied for 8 weeks;
  • after removing the gypsum, physiotherapy exercises, physiotherapy treatment (electrophoresis with calcium chloride, see above) are carried out.

  Complications

  Volkmann's contracture. Decreased mobility in the elbow joint as a result of circulatory disorders. Vessels can be damaged by fragments of the humerus or compressed by prolonged wearing of an incorrectly applied plaster cast. Nerves and muscles no longer receive enough oxygen, resulting in impaired movement and sensitivity.

  Arthrogenic contracture in the elbow joint. It develops as a result of pathological changes in the joint itself, as in arthrogenic contracture of the shoulder joint with fractures of the shoulder in the upper part (see above).

  Dysfunction of the muscles of the forearm. Occurs as a result of damage to the radial and other nerves.
  

  How to provide first aid to the victim with a fracture of the humerus?

  
  • Inject painkiller. If there is nothing else on hand, you can give the victim a painkiller tablet. If there is a person nearby who knows how to inject, then it is better to inject the drug intramuscularly.
  • Give a sedative. You can use drops of infusion of valerian or motherwort.
  • fix injured hand. To do this, you can use improvised materials: planks, pieces of dense plywood, fittings. One plank is bandaged to the forearm, the other to the shoulder, and then the whole arm is bandaged to the body. If there is nothing suitable at hand, you can simply hang the limb on a scarf.
  • Get the victim to the hospital as soon as possible. An ambulance must be called immediately.
  Transportation is carried out sitting.

  In no case should one, without a doctor, forcefully feel the fracture site, “check the symptoms”, “reset”. Avoid any rough and abrupt movements. Displacement of fragments, damage to blood vessels and nerves can occur - in the future this will lead to serious complications.

I never thought that I would break anything. And even more so, I could not imagine that fractures received in everyday life may require surgical treatment. However, there is a first time for everything.

If you found this article, then you probably also experienced a fracture, or you are about to have surgery. I practically did not find any practical information before the operation, although I intensively blew up the Internet. I sincerely hope that this article will help someone find answers to questions, calm someone down and not be so scary.

how i broke my arm

Slippery country porch after the rain, hands busy with things - I did not hold on to the railing. A fraction of a second - and I'm already sitting on the steps. It hurts somewhere in the hip area. I try to get up, but I understand that my left hand does not obey me. I hear some grinding inside (these are the edges of a broken bone rubbing against each other). There is no pain in my arm, it's because I'm in shock. Almost lost consciousness. When I was lifted up and seated on a chair, I noticed that I intuitively support my sick hand with a healthy one. The hope for a dislocation of the joint quickly disappeared when I tried to move my left hand and bend it - it hung like a whip, and inside the fragments were shaking, unnaturally inflating my arm from one side to the other. From this sight I felt sick, my head was spinning, and my legs were wadded.

As I understood later, I fell on my hip, but my hands went to the sides during my inglorious flight, and one of them hit the railing with all its might, and therefore broke.

An hour later I was in the emergency room of the city of Solnechnogorsk. On a first-come, first-served basis, they took pictures of me and put on a plaster splint. The pictures showed a helical fracture of the humerus in the lower third (closer to the elbow) with a displacement. The local traumatologist immediately told me that an operation would be required and asked which hospital to refer me to. Thus, on the same evening, I was brought to the hospital at the place of residence, where at 11 p.m. I was hospitalized, and I fell asleep almost exhausted on the newfound bed of the 36 hospital in Moscow.

X-ray immediately after the fracture (without plaster)

First hospital

I got to the hospital on Saturday night, and, of course, no one began to urgently deal with me, they only took new pictures. On Sunday, they took tests from me, they injected me with analgin a couple of times. I could not understand where my doctor was, whether there would be an operation and when, for how long I was stuck in this institution, where they supposedly treat me. When they came to do an ECG, I was already almost sure that this was a sure sign of preparation for the operation. But everything turned out differently: in the afternoon my attending physician appeared, who doubted the expediency of the operation. He said that he would discuss this situation with the head of the department and return to me. The manager looked a little later and was also full of doubts. According to him, "the bone in the cast stood up straight and will heal itself," so the operation is not necessary in my case. However, the doctors themselves could not make such a decision, they began to wait for the professor. The professor gathered a council and all these people came to my ward. They examined me, checked whether my fingers were working and said that they would not operate, they say I was lucky, and this should grow together. And the next day I was discharged home. So I spent 4 days in the hospital without any treatment.

It is clear that nothing is clear

Then I was recommended to be observed in the emergency room at the place of residence. The first time I went there without photographs, only with an epicrisis. When it came time to redo the picture, 2 weeks had already passed since the fracture, and the traumatologist, seeing a fresh picture, said that I needed an operation and would have done it as soon as possible. I was at a loss: some traumatologist against the opinion of the whole council? However, the latest picture and I myself seemed scary.

X-ray 10 days after the fracture in a cast

A couple more days passed, I again remade the picture out of fright but in a different projection, and what I saw there scared me wildly. Because SUCH bone will definitely not grow together.

It was clear that the bone did not stand as before, the fragments moved despite the plaster splint. And I began to collect the opinions of other doctors. They all said one thing: an operation is needed, do not delay, the longer the time passes, the harder it will be for the surgeon.

I had to take all the tests again, take a picture of the lungs and an ECG. At that time, I already knew that I was going to have an operation at 83 hospital. Through acquaintances of acquaintances, I was recommended to contact Dr. Gorelov. At the consultation, he seemed reasonable and even somewhat pessimistic (in fact, he just warned me honestly about the risks), but a qualified doctor. I couldn't find any reason not to trust him. I liked the hospital in the hospital - double and single clean rooms with a TV, Wi-Fi and even air conditioning. In general, everything suited me.

I was operated on on September 14, and 2 days after the operation they were already discharged, taking a promise from me to come for dressings. In general, I liked all the staff in this hospital - both the doctors and my anesthesiologist and attentive nurses. I want to thank everyone for their professionalism and help.

I. V. Gorelov is a very kind, competent, calm and patient doctor, he answers all questions in detail, reassures and encourages. No familiarity or attempts to tease the patient, make bad jokes, etc. Such qualities of a doctor are very important for me, because you listen to every word and to some extent the doctor for the patient is an authority that you need to fully trust and follow all the instructions. And if the person himself or communication with him is unpleasant to you, then this complicates everything and there is no positive attitude at all.

Displaced fracture of the humerus and treatment options

Doctors say that breaking the humerus is not so easy - it is one of the largest and strongest human bones. Very rarely, displaced fractures are treated conservatively. This is both a rather long fusion of the bone and a high probability that after a couple of months in a plaster the bone will grow crookedly. But the most unpleasant thing is that it may not heal at all, and a false joint may form at the fracture site, which is very, very bad.

Operative intervention can be risky for the reason that the radial nerve passes along the humerus to the elbow. In simple terms, this nerve is responsible for the work of the hand. If you damage it during the operation, then the brush can simply "hang" for a long time. But doctors do not give guarantees, each person is individual, someone may not be lucky.

The operation itself is the installation of a titanium periosteal plate, which is fixed to the bone with screws screwed into the bone. The difficulty is that the radial nerve passes directly along the bone, so in order to get to it, it is necessary to isolate the nerve and put "shock-absorbing" muscle tissue under it (between it and the plate). This operation is not considered simple, I personally did it for about 2.5 hours. What a relief it was to see that the fingers were moving, that the nerve had not been damaged. After the operation, the doctor said that the muscle began to wrap around the bone fragment, which made it impossible to heal. Therefore, the decision to undergo surgery was the right one.

In my case (the operation was complicated by the statute of limitations of the fracture), general anesthesia with a mask and tube was suggested. And fresh fractures of such a plan can be operated on under local anesthesia (anesthesia in the neck, which turns off the sensitivity of the hand). Personally, I think general anesthesia is better because you can't see your blood and you can't hear your bones being drilled. Not every person can stand it. And I liked mask anesthesia much more than intravenous anesthesia (I also had such an experience) - it was easier to move away.

Preparation for osteosynthesis with a titanium plate and the first days after it

Discuss the treatment with your surgeon. If the fracture happened recently and the bone broke not at the joint itself, you may be offered to put a pin - a metal rod that is driven into the bone, which will fix it from the inside. Less risk to the radial nerve and small scars on the arm. The insertion of the plate is a big scar preceded by a big stitch (I'm already slowly thinking about a tattoo). In my case, it was too late and difficult to use the pin, so we agreed on the plate.

The patient acquires this accessory himself, through a doctor or looks for it on his own. My German plate cost 103 thousand rubles. No matter how you buy a plate, ask for checks and documents for it. We bought from a supplier. Nobody showed us the plate itself, arguing that it will be delivered directly to the doctor, and it is not recommended for mere mortals to touch this sterile device. But a bunch of certificates were issued on hand. Yes, the price turned out to be high, and it depends on the length of the plate. Mine - almost the entire humerus. Some may be more lucky and find cheaper.

Before the operation, it is necessary to undergo a standard medical examination. examination by a therapist, have on hand a fresh fluorography as well as an ECG, blood and urine tests. With this pile of papers, you come to the hospital, and the longest day of your life begins. After dinner, they will no longer feed you, and in the evening they will completely clean the intestines and forbid you to drink after midnight. In the morning, on an empty stomach, you will be stripped naked, given an antibiotic injection into a vein, and taken to the operating room.

I was taken to surgery with a cast on my arm. I have no idea how it was filmed - it was already under anesthesia. In the operating room, a catheter is placed in the arm and a mask is applied. I passed out after 15 seconds to the music of Spleen, sounding at ease in a cold operating room.

When I woke up, I saw people in bathrobes, they calmly spoke to me, they said that they had lost only half a liter of blood, which was not much. Then I was taken to the ward. Around the operated arm, sealed with a bandage, they laid out a stonehenge made of ice in bags, and a dropper was connected to a healthy arm. On this the worst was behind.

For the first 2 days, blood flowed from the stitches, so I had to put special diapers on the bed. This is absolutely normal, although it looks creepy. Also, after the operation, fever (up to 37.5 during the week) and severe swelling of the arm are normal. My hand has become 2 times larger, the sight is unsightly and scary. However, this is normal given the damage to the muscles and tissues of the arm - the blood supply needs time to recover, and this is not a couple of days.

While the stitches are bleeding, dressings are done daily, then as directed by the doctor. Dry seams are better not to disturb once again. They are removed on the 12th day after the operation.

It is necessary to try to bend the operated arm (slowly develop), massage the hand to remove swelling and wear the hand in such a position that the hand is above the elbow - this will reduce swelling. In a dream, I put my hand on my stomach - in the morning the swelling is much less than in the evenings.

At discharge, I was prescribed a course of antibiotics and painkillers (if needed).

All bandages-kerchiefs-longettes from pharmacies seemed uncomfortable to me, they put pressure on the seams, so I wear my arm freely, slightly bending it at the elbow. It's not difficult, don't be afraid not to support her. For the first 2 days I tied my hand with a Pavloposad scarf, and now I just walk (a week after the operation) without holding it in any way. I use my hand minimally - open the lid, take a mug. So far, there is almost no strength in the arm, but it will return with the development and recovery of injured muscles.

With this I want to end the first part of my story. The next post will be devoted to the rehabilitation and development of arm muscles.

If you have any questions - be sure to ask in the comments. I know for myself that in such a difficult situation you cling to every review, collect information literally bit by bit, and this ignorance is frightening and disorienting.

Hello to all our readers!

Displaced fracture of the humerus is the most common injury of the shoulder girdle, resulting from excessive mechanical stress on this area of ​​the body, during a fall, a strong blow. Occurs equally in middle-aged and elderly people, children. Shoulder injury occurs mainly when the body falls in an outstretched arm position. The terms of recovery and complete fusion of the shoulder bones depend on the severity of the injury and the age of the victim.

In older people, shoulder injury is more common than in young people, which is associated with physiological, age-related changes in the body, due to a decrease in the content of calcium and other trace elements responsible for bone mineralization. Children, whose bones have not yet grown strong and have not developed the skills to properly group when falling, are also susceptible to injury.

Another cause of a fracture of the humerus is a dislocation in the area of ​​the shoulder joint with an accompanying sharp contraction of muscle fibers. This pathological picture occurs due to excessive load in athletes in the process of active physical exercise.

A fracture in the region of the humerus is classified into types, in accordance with the location and associated complications:

The most severe types of injury are open, displaced and comminuted fractures of the humerus. With an open fracture, the damaged part of the bone with a sharp end breaks the soft tissues and skin, a wound with bleeding is formed.

Without timely assistance with proper wound care, there is a risk of infection entering the wound with further blood poisoning.

In a displaced shoulder fracture, the sharp edges of the debris can damage blood vessels and nerve roots. In the first case, there is a risk of opening bleeding, in the other, a violation of the function of the nerve ending can provoke a violation of the sensitivity of the limb and further lead to complete immobility.

A comminuted fracture is difficult to treat. Before fixing the shoulder girdle with plaster, an operation is performed to restore the original position of the bone fragments. If parts of the bone are too small or completely damaged, prosthetics will be required.

According to the fracture line, they distinguish:

• spiral fracture;
• Transverse;
• oblique;
• splintered.

An open and closed fracture of the shoulder is often complicated by damage to the head of the humerus, into which a sharp bone fragment cuts. This type of injury is called an impacted fracture of the humerus, without timely treatment leading to the complete destruction of the head of the shoulder.

How is it manifested?

The symptoms of injury vary and depend on the type and location of the injury. Common clinical manifestations are as follows:

• strong pain;
• redness in the area of ​​injury;
• puffiness;
• restriction of mobility.

Traumatologists, according to the location of the injured area, distinguish the following signs:

Neck	Large tubercle	Fracture of the diaphysis of the humerus	Transcondylar fracture of the shoulder
- pain in the area of ​​damage; - deformity of the shoulder girdle; - shortening of one part; - crunch on palpation; - immobility; - with an open type - bleeding, impaired sensitivity of the hand; - inability to bend fingers.	- pain in the upper part of the shoulder above the injury site; - lack of mobility; - there is no deformation; - swelling; - crunch on palpation; - rupture of blood vessels and roots of nerve endings occurs in extremely rare cases.	- a strong pain symptom; - pronounced articular deformity on the injured side; - bruising; - immobility of the joints in the shoulder and elbow; - drooping of the hand due to damage to the nerve endings.	- pain extending to the elbow and shoulder area of ​​the joint; - deformity of the joint (if accompanied by displacement); - immobility of the elbow.

A transcondylar fracture of the humerus is dangerous with high risks of damage to the artery, resulting in blood poisoning. Damage to the coronary blood vessel is manifested, as a rule, in the absence of pulsation in the forearm region.

Providing first aid

A fracture, regardless of the location of the injury, leads to serious consequences in cases where assistance is not provided in time. Immediately after an injury, especially if a fracture is suspected, it is recommended to immediately call an ambulance team. And before the arrival of doctors, help the victim.

With a closed traumatic injury, the victim can be taken to a hospital on their own. First aid for a fracture of the humerus includes the following manipulations:

1. To relieve pain, give the victim a drug with an analgesic effect. If possible, enter the drug by injection.
2. Take a sedative drug, for example, valerian, motherwort.
3. Put a splint on the damaged part of the shoulder girdle. Due to the lack of a medical splint, improvised means can be used - sticks, boards, pieces of fabric, fittings. The tire is superimposed as follows - one stick is fixed from the side of the forearm, the other from the side of the shoulder, the boards are wound between themselves and to the shoulder with a piece of cloth or bandages. After applying the splint, it is necessary to fix the injured arm to the body with bandages or cloth in order to completely immobilize it, thereby reducing the risk of displacement of broken bones.

It is strictly forbidden to independently probe the damaged area, try to set the bone. The victim must hold the limb statically, since any sudden movement can provoke displacement of the bones and damage to blood vessels, nerve roots.

With an open injury, it is strictly forbidden to touch the protruding bone, to try to set it back. First aid measures involve the mandatory treatment of the wound with antiseptic preparations, the application of a sterile dressing that will protect the wound from contact with other objects.

Before treating the wound, the hand must be freed from clothing. It is forbidden to remove the sleeve, this can only damage the bone, leading to its displacement. The sleeve of the garment is cut or torn.

Diagnostic methods

Timely seeking medical help can be complicated by a blurred symptomatic picture, in which the pain symptom has a weak intensity, and the person thinks that he just hurt his hand badly. This happens most often with a closed fracture without displacement. Only a doctor can make an accurate diagnosis after examining the patient and conducting a medical examination.

To make an accurate diagnosis, the patient is examined with careful palpation of the injury site. If a crunch is heard on palpation, this is a sign that the edges of the broken bone are rubbing against each other. The examination is carried out by a traumatologist, who, by moving the shoulder to different positions, determines which bones are broken and whether there is any displacement.

To clarify the diagnosis, an x-ray is performed. This research method allows you to identify the nature of the injury, the type of fracture (comminuted, linear, screw fracture), the condition of the head of the shoulder.

Therapy Methods

Medical care for a fracture of the shoulder is the introduction of an anesthetic drug. With a closed type of damage without displacement of bone fragments, the injured limb is fixed with a plaster cast. The patient stays in a cast for 1 to 2 months, it all depends on the intensity of bone tissue fusion. Plaster is applied to the shoulder girdle, descending to the elbow or hand, depending on the type of injury.

Treatment and healing time for a displaced fracture of the humerus varies from 2 to 4 months. Before plastering, a repositioning procedure is performed - folding the displaced bones in their original position. In accordance with the severity of the clinical case, reposition is carried out using a closed or open method:

1. Open reposition is a full-fledged surgical operation, performed in the presence of a large number of bone fragments or due to their large displacement.
2. Closed reposition is performed under general anesthesia and under X-ray control.

After removing the plaster bandage, an x-ray is taken, on which the doctor determines the degree of bone fusion. The patient may experience swelling and swelling of the damaged area of ​​the shoulder, for the relief of which drugs of the local spectrum of action are used - ointments and creams.

Not always the treatment of a fracture is carried out only by a conservative technique. In some cases, surgery is the only treatment.

Surgery is prescribed in such cases:

• Inability to conduct a closed reduction;
• Departure of bone fragments after reposition;
• Violation of the functioning of the root of the nerve ending;
• Infringement of muscle tissue by a bone fragment;
• Violation of the integrity of blood vessels;

To restore the normal position of a broken bone and its fragments, an operation is performed with a plate, with its help, parts of the bone tissue are fixed until they begin to grow together in a normal position. Gypsum is not applied when using medical devices for bone fusion.

About rehabilitation

If the bones have grown together completely, proceed to the recovery period. Rehabilitation includes the passage of physiotherapy and the implementation of a complex of physiotherapy exercises. The duration of the recovery period is 1-2 months. The return of full working capacity occurs in 3-4.5 months.

Rehabilitation is based on physiotherapy procedures:

• electrophoresis;
• Ultrasound treatment.

These techniques allow you to relieve pain, stop swelling, accelerate the process of regeneration of bone and cartilage tissue. Mandatory massage aimed at restoring tendons and muscle tissue. If there is a tense shoulder girdle due to muscle hypertonicity, massage helps to relax and relieve the feeling of numbness.

To restore the motor function of the shoulder, a course of physiotherapy exercises is carried out. Exercises are performed carefully, without sudden movements, as this can be dangerous for fused bones. It is impossible to strain the shoulder during physical education; when pain appears, the procedures are temporarily suspended.

Humerus fractures are injuries that need to be treated immediately. Injury is especially dangerous in a child during the period of intensive growth of bone tissue. Even if the signs of a fracture do not appear immediately, after a fall or impact, it is necessary to seek medical help in order to make a correct diagnosis, preventing complications.