Fracture of the humerus: causes, symptoms, diagnosis, treatment

ICD-10 code

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

Epidemiology of humeral fracture

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

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Anatomy of the humerus

The humerus is classified as a long tubular bone, with proximal and distal ends, and the body of the humerus between them.

The proximal end of the humerus consists of a hemispherical head that passes into a circular groove called the anatomical neck. Outwardly and in front of the head are two tubercles with ridges. The outer tubercle, larger, is called the greater tubercle, the inner one is called the lesser tubercle. Between them is the intertubercular groove, in which the tendon of the long head of the biceps muscle lies. The part of the bone lying below the tubercles is called the surgical neck of the humerus (the site of the most frequent fractures).

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

The distal end is represented by the condyle of the humerus. Surprisingly, some, even modern (2004) monographs, divide the distal humerus into two condyles: medial and lateral. According to the anatomical nomenclature, there is one humeral condyle! Its articular surface consists of the head of the condyle and the block of the humerus. In front and behind, the condyle has depressions called the coronoid fossa and the fossa of the olecranon, respectively. On the outer and inner surfaces of the condyle are bony protrusions - the epicondyles of the humerus. The medial epicondyle is significantly larger than the lateral one, in addition, there is a depression outside it - the groove of the ulnar nerve.

The shoulder muscles are divided into anterior and posterior. The former include the forearm flexors (biceps and brachialis), the latter - the extensors (triceps and ulna).

Blood supply occurs through the brachial artery and its branches. Innervation of the extensors is carried out by the radial nerve, and the flexors of the forearm by the musculocutaneous nerve.

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Classification of humeral fracture

In the domestic classification, the following types of fractures of the proximal end of the humerus are distinguished: supratubercular or intra-articular fractures of the humeral head; fractures of the anatomical neck; subtubercular or extra-articular transtubercular fractures; isolated fractures of the greater and lesser tubercles; fractures of the surgical neck.

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Mistakes, dangers and complications in humeral fractures

In case of humeral fractures, it is necessary to check the vascular pulsation, skin sensitivity and limb functions in the innervation zone of the axillary, radial, ulnar and median nerves. The most frequently damaged nerves are the axillary nerve, which encircles the surgical neck area from behind, the radial nerve, which spirally encircles the middle of the posterior surface of the humeral body, and the ulnar nerve - in case of fractures of the medial epicondyle.

In case of damage to the axillary nerve, regardless of the method of treating the fracture of the surgical neck of the humerus, it is necessary to exclude the effect of the weight of the limb. This is achieved by a sling or Desault bandage with a well-tightened tour of the bandage, going under the elbow joint and then upward. Without this, deltoid muscle paresis will never resolve, even against the background of intensive medication (monophosphate, pyridoxine, neostigmine methylsulfate, etc.) and physiotherapy (longitudinal galvanization of nerves, electrical stimulation of muscles, etc.).

If a fracture is suspected, especially of the proximal or distal end of the humerus, radiography in two projections is mandatory.

When repositioning fractures of the humeral condyle, no more than two or three attempts should be made. If unsuccessful, it is necessary to use the method of skeletal traction or hardware reposition. If this is impossible, then (as an exception) a plaster splint should be applied, and after 2-3 days, a reposition attempt should be repeated or the patient should be operated.

If the victim's limb is immobilized with a circular plaster cast, especially with repeated attempts at repositioning, the patient must be hospitalized for dynamic observation - the development of Volkmann's ischemic contracture is possible.

In cases where a circular plaster cast is to be applied after surgery, the skin is sutured with catgut.

After suturing the skin, maintaining sterility, an X-ray is taken. After making sure that the retainer is in place, a plaster cast is applied. If the position of the fragments on the X-ray does not satisfy the surgeon, it is possible to dissolve the sutures and correct the defect.

Comparison of fragments and their fixation by closed or open means the completion of only the first stage of treatment. It is necessary to immediately prescribe medication and physiotherapy, as well as exercise therapy until the end of the immobilization period. After removing the plaster, it is necessary to prescribe a treatment complex aimed at relieving pain, reducing swelling, normalizing blood circulation, tissue elasticity, preventing the formation of scars and ossifications, and restoring the range of motion in the joint.

In order to avoid ossifying periarthritis and the development of severe persistent contractures, one should not prescribe exercise therapy before the prescribed time, increase the period of limb immobilization, massage the elbow joint, or get carried away in the early stages of injury (during the consolidation process) with the use of thermal procedures: paraffin applications, warming compresses, etc.

In case of intra-articular fractures of the humeral condyle, one should be careful with the prognosis and take all necessary measures to preserve the functions of the joint. It is known that the elbow joint is the most "capricious" of all joints, as a result of which the functional outcome is not always predictable. Sometimes, even with bruises, persistent severe contractures of the elbow joint occur.

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