Fracture of humerus: causes, symptoms, diagnosis, treatment

ICD-10 code

• S42.2. Fracture of the upper end of the humerus.
• S42.3. Fracture of the body [diaphysis] of the humerus.
• S42.4. Fracture of the lower end of the humerus.

Epidemiology of fracture of humerus

In the practice of a traumatologist, fractures of the proximal end of the humerus are quite common and account for 5-7% of all fractures of the skeleton and almost half of the fractures of the humerus. 80% or more of the affected people are over 60 years old.

[1], [2], [3], [4], [5], [6], [7], [8],

Anatomy of the humerus

The humerus is referred to as long tubular bones, it distinguishes the proximal and distal ends, and between them the humerus body.

The proximal end of the humerus consists of a head of a hemispherical shape, turning into a circular groove, called the anatomical neck. Outside and anterior to the head are two tubercles with scallops. The outer tubercle, larger, is called large, internal - a small tubercle. Between them there is a mezhbugorkovaya furrow, in which lies the tendon of the long head of the biceps muscle. The part of the bone lying below the tubercles is called the surgical neck of the shoulder (the site of the most frequent fractures).

On the anterior surface of the humerus body there is a deltoid tuberosity, and next to it, but behind it is a furrow of the radial nerve. The body of the humerus acquires a triangular shape and forms a medial anterior, lateral anterior and posterior surfaces.

The distal end is represented by the condyle of the humerus. Surprisingly, in some, even modern (2004) monographs, division of the distal humerus into two condyles occurs: medial and lateral. According to the anatomical nomenclature - the condyle of the shoulder is one! The articular surface of it consists of the head of the condyle and the block of the humerus. Front and back in the condyle there are grooves, called respectively coronary fossa and pit of the elbow process. On the external and internal surfaces of the condyle are the bony projections - the epicondyle of the shoulder. The medial epicondyle considerably exceeds the lateral dimension, in addition, outside it there is a depression - a groove of the ulnar nerve.

The muscles of the shoulder are divided into the front and rear. The first include flexors of the forearm (biceps and brachial muscles), to the second - extensors (the three-headed muscle and the elbow).

Blood supply is due to the brachial artery and its branches. The innervation of the extensor is radial, and the flexor of the forearm is performed by the musculocutaneous nerve.

[9], [10]

Classification of fracture of humerus

In the domestic classification, the following types of fractures of the proximal end of the humerus are distinguished: superimposed or intraarticular fractures of the head of the shoulder; fractures of the anatomical neck; podugugkovye or extra-articular ugibug fractures; isolated fractures of large and small tubercles; fractures of the surgical neck.

[11], [12]

Errors, dangers and complications in fractures of the humerus

In fractures of the humerus, it is necessary to check the pulsation of vessels, skin sensitivity and limb functions in the zone of innervation of the axillary, radial, ulnar and median nerves. Most often, the axillary nerve is wound around the back of the surgical neck, the radial nerve that spirals around the posterior surface of the humerus body, and the ulnar nerve - in fractures of the internal epicondyle.

If the axillary nerve is damaged, regardless of the way the fracture of the surgical neck of the shoulder is treated, the weight of the limb must be excluded. Reach this with a bandage bandage or Dezo bandage with a well-tightened bandage tour, going under the elbow joint and then upward. Without this, the paresis of the deltoid muscle will never be resolved, even against the background of intensive medication (monophostiamine, pyridoxine, neostigmine methyl sulfate, etc.) and physiotherapy (longitudinal galvanization of the nerves, electrical stimulation of muscles, etc.).

If a fracture is suspected, especially the proximal or distal end of the humerus, x-rays in two projections are mandatory.

When repositioning fractures, the humerus of the humerus should be made no more than two or three attempts. If you fail, you must use the method of skeletal traction or hardware repositioning. If this is not possible, then (as an exception) it is necessary to impose a plaster longure, and after 2-3 days to repeat the attempt of reposition or to operate the patient.

If the limb of the victim is immobilized by a circular cast strip, especially with repeated attempts at repositioning, the patient must be hospitalized for dynamic observation - it is possible to develop Folkmann's ischemic contracture.

In those cases where after the operation a circular bandage is supposed to be applied, the skin covers with catgut.

After suturing the skin, keeping the sterility, perform radiography. After making sure that the retainer is in place, a plaster bandage is applied. If on a radiograph the standing of fragments does not satisfy the surgeon, it is possible to dissolve the seams and fix the defect.

Comparison of fragments and fixing them in a closed or open way means the completion of only the first stage of treatment. Immediately it is necessary to prescribe drug treatment and physiotherapy, as well as exercise therapy before the end of the immobilization period. After removal of gypsum, it is necessary to appoint a complex of treatment aimed at relieving pain, reducing edema, normalizing blood circulation, elasticity of tissues, preventing scarring and ossification, restoring the volume of movements in the joint.

To avoid ossifying periarthritis and the development of severe persistent contractures, it is not necessary to prescribe exercise therapy before the deadlines, increase the limb immobilization time, perform an elbow joint massage, get involved in the early stages of trauma (in the process of consolidation) using thermal procedures: paraffin applications, warming compresses, etc. .

With intraarticular fractures, the condyle of the shoulder should be careful with the prognosis and take all the necessary measures to preserve the function of the joint. It is known that the elbow joint is the most "whimsical" of all joints, as a result of which the functional outcome is not always predictable. Sometimes, even with bruises, there are persistent heavy contractures of the elbow joint.

[13], [14], [15]