Fracture of the neck of the shoulder: causes, symptoms, diagnosis and treatment
The humerus bone allows a person to perform many movements, the amplitude of which can vary. Any damage in this zone negatively affects the activity of the shoulder, significantly hampering the habitual rhythm of life. They can affect different parts of such a fragile structure. Most often, doctors diagnose a fracture of the neck of the shoulder. About features and the basic methods of treatment of similar traumas speech will go in today's article.
The humerus is a long tubular structure. It lies between the elbow and the region of the foreleg, but consists of a diaphysis and two epiphyses. Metaphyses are peculiar transitional zones between these parts. The upper end of the bone is represented by an articular head that resembles a ball. Just beneath it is the anatomical neck of the shoulder. Serious fractures in this zone are extremely rare.
Just below the neck of the shoulder are the large and small tubercles, to which the tendons are attached. Under them, the "border" separates the diaphysis of the bone and its upper end. The latter is otherwise called the "surgical neck of the shoulder".It is this area that is most often injured.
The division of the described fractures into two categories is rather conditional. They are characterized by a common clinical picture. Therefore, the doctors decided to combine them into one group - a fracture of the surgical neck of the shoulder.
The main causes of injury
The main cause of fractures of this nature is considered to be an indirect mechanical effect. For example, if you fall on a wrist or elbow. In this case, the humerus bends and the pressure on it increases along the axis. In rare cases, damage is a consequence of direct physical impact.
Fracture of the surgical neck of the shoulder is especially common in women of old age. Ladies over the age of 50 are at high risk of injury due to several factors:
- menopause and bony osteoporosis that develops against it;
- change in bone structure.
The nature of the injury is determined by the location of the limb immediately at the time of the fall. In view of this, the fracture of the neck of the shoulder is punctured, adduction and abduction. Let's consider what each of the options represents.
fracture Among all traumatic injuries this species is the least common. When the hand is in a neutral position, but the mechanical effect occurs, a transverse fracture is diagnosed. The peripheral bone element enters the articular head, forming a fractured neck of the shoulder. It is always closed.
Such an injury is usually the result of falling on a bent arm. The elbow joint has the greatest pressure. Due to the mobility of the lower ribs, the distal shoulder section performs the maximum reduction. The rest do not have similar mobility, and therefore serve as a kind of fulcrum in the upper zone of the shoulder. Thus, a lever is formed, which loads the humerus. The joint head remains in its place, since the ligament capsule device prevents artificial dislocation. As a consequence, there is an adduction fracture of the neck of the shoulder.
In a trauma of this nature, the central bone fragment is shifted forward, and the peripheral one is outward and upward. Between them an angle is formed that opens inward.
Abduction fracture of
Such damage is possible when falling on a withdrawn arm. In this case, the pressure force grows simultaneously in two directions. The peripheral bone element is shifted inwards. Its outer edge provokes the turning of the central fragment into a position of reduction. And the latter slightly deviates downward and forward. As a result, an open angle is formed.
After getting a fracture, you should immediately go to the trauma department of the nearest hospital. As a rule, the corresponding clinical picture indicates damage to the neck of the shoulder. First of all, the victim feels a strong pain in the area of the fracture. It can not be defeated through conventional analgesics. It requires the help of strong painkillers, which can be obtained only in the hospital.
In the area of the shoulder joint, the injured hand loses its functionality, but the flexion movements in the elbow are sometimes preserved. The victim most often holds a sick limb by the forearm. With every attempt to make a move, he begins to experience painful pain.
The appearance of the joint does not change. With an abduction fracture, there may be a "zapping", as with a dislocation of the shoulder. The site of the injury swells very quickly. After a while there is a hematoma, the size of which sometimes reaches a considerable size.
The shoulder neck fracture with displacement is especially severe. In this case, the edges of the bone can squeeze the surrounding tissues and bundles of vessels, causing the following symptoms:
- marked swelling of the limb;
- development of aneurysm;
- is a soft tissue neurosis.
In the case of a punctured fracture, the clinical picture is usually blurred, and there is no pain syndrome. As a consequence, the victim may not suspect for several days the presence of an injury and not seek medical help.
If you suspect a fracture, you should contact the trauma department of the nearest hospital. Initially, the doctor should examine the victim, clarify the existing complaints and the circumstances of the damage. After this, a number of additional examinations are appointed to establish an accurate diagnosis.
The most informative is the radiography of the shoulder girdle. Pictures must be performed in two projections: axial and direct. In case of doubtful results, an additional CT scan may be required. If suspected intraarticular fractures, ultrasound is assigned.
First aid to the injured
The primary goal of providing first aid to the victim is to stop the pain syndrome. Also it is necessary to try to immobilize the injured limb. In the first case, you can not do without the help of analgesics. Almost every home medicine cabinet has "Keterol", "Analgin" or "Nimesulid."Dosage of the drug should be selected in accordance with the instructions attached to the medication.
If it is not possible to make a paid X-ray and to verify the severity of the injury, it is recommended to immobilize the limb before going to the hospital. To do this, you can make a bandage bandage from improvised materials. For her, any fabric or shawl, a piece of clothing, will do. In form it should resemble an isosceles triangle. The bandage bandage should be applied in such a way that it supports the arm at the elbow.
Features of therapy
What should be the treatment for the diagnosis of "neck fracture of the shoulder" treatment, the doctor decides. In this case, he must take into account the patient's age, the nature of his injury and the presence of displacement fragments. Therefore, therapy can be conservative or surgical. Some patients are recommended skeletal traction. Treatment of fracture in elderly patients is slightly different. This issue should be considered separately.
Treatment of fracture without signs of displacement
In case of uncomplicated fracture, outpatient therapy is recommended. First, the doctor introduces an anesthetic into the hematoma site, and then proceeds to apply a gypsum loom on the Turner. Competent immobilization of the broken limb prevents the development of contractures. Wearing longots is recommended for 4 weeks.
The next stage of therapy involves the appointment of painkillers and UHF.During the first month, the patient is recommended a set of static exercises. For direct exposure to the fracture area, phonophoresis and electrophoresis with medications are used.
After four weeks of immobilization, they begin active rehabilitation. To this end, you can contact any rehabilitation center where specialists can select an individual program of events. Usually, with uncomplicated fracture, the following procedures are recommended:
- laser therapy;
- applications with paraffin;
- exercise therapy;
- UV irradiation;
Work after such damage is restored after 2 months.
Treatment of fracture with bias
This type of injury requires hospital treatment. In most cases, it is also implemented through conservative methods. A doctor using local or general anesthesia first performs a closed manual reposition. It is carried out in the opposite direction from the mechanism of injury. In this case, the peripheral bone element is compared with the central fragment.
The procedure itself is performed in a prone position. The surgeon gradually performs all manipulations and directs the actions of the assistants. After their completion, a bandage or gypsum lingeta is applied to the injured limb.
The duration of immobilization for a fracture with a bias is approximately 2 months. The doctor must monitor the recovery process. For this, the patient should periodically take pictures of the shoulder. Paid X-ray allows you to get instant results. In free medical institutions, a photo can be taken the next day. Workability usually comes back to normal in 10 weeks.
Features of fracture treatment in the elderly
In most cases, conservative techniques are used to eliminate fracture of the shoulder neck in elderly patients. In adduction injury, early fixation of the limb is shown for 4 weeks. In case of abnormal damage, the traction measures are first performed, and then they start immobilization. In some cases, surgical intervention is required.
As for the anesthesia of the affected area, there are also some restrictions. For example, the dose of anesthetic should be chosen the least. Otherwise, the likelihood of unwanted side effects in the form of hypotension or dizziness increases. Treatment also implies the appointment of all patients without exception a number of medications. First of all, these are calcium supplements and medicines to improve blood circulation. The positive effect from them becomes noticeable when the fracture of the neck of the shoulder begins to grow together.
In the elderly, the recovery period after an uncomplicated injury is approximately 2-3 months. The length of the rehabilitation period is largely determined by the general condition of the patient, sufficient motor activity. This period is significantly increased if the victim has serious health problems. Among a large number of chronic pathologies, the greatest danger is diabetes mellitus.
Surgical intervention is rarely prescribed for elderly patients who have a fractured neck of the shoulder. Rehabilitation, and in this case, quite a long time. As a rule, its term is about three months. With such interventions, the risk of developing infectious complications increases substantially. The onset of thromboembolism at this age often leads to death.
Fracture of the neck of the shoulder and its consequences
Complications after injuries of this kind are very common. They can serve as a consequence of inadequate treatment( incorrectly fused fracture, pseudoarthrosis).Sometimes the negative consequences of trauma are due to the very effect on the shoulder area. For example, fractures often damage ligaments and tendons, muscles and nerve endings. As a consequence, bleeding, functional or neurological disorders occur in the injured limb.
To exclude the high probability of these complications, it is necessary to immediately seek qualified medical help if you suspect a trauma. After passing the examination, the doctor will be able to prescribe adequate treatment, if required. Particular attention should be paid to the rehabilitation process. In case of complicated fractures, it is better to contact a specialized center of rehabilitation treatment, whose specialists will be able to select the most effective program for normalizing the work of the hand.