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Fractures of the head and anatomical neck of the shoulder: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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What causes a fracture of the head and anatomical neck of the shoulder?
The mechanism of a straight trauma is a blow to the outer surface of the shoulder joint, but it can also be indirect - when the withdrawn hand is dropped on the elbow joint. The head of the shoulder is wrinkled, and more often it splits into several fragments. Sometimes the entire proximal epimetaphysis is destroyed.
Symptoms of fracture of the head and anatomical neck of the shoulder
Affected people are concerned about pain and impaired function in the shoulder joint.
Diagnosis of fracture of the head and anatomical neck of the shoulder
Anamnesis
In the history - an indication of an appropriate injury.
Examination and physical examination
The humerus is enlarged in size due to edema and hemarthrosis. Its contours are smoothed. Active movements are severely restricted, especially in the direction of diversion. Passive movements are possible, but painful. Pressing on the head of the humerus causes pain. A positive symptom of the axial load - the pressure on the elbow joint from below upwards causes pain in the humeral articulation. A distinctive feature of the epigastric fractures is the absolute impossibility of active retraction of the shoulder (after anesthesia!), As the support against the articular surface of the scapula disappears.
Laboratory and instrumental research
Confirms the diagnosis of the roentgenogram of the shoulder joint, performed in two projections: direct and axial. Without an axial projection, it is impossible to accurately determine the presence of a fracture and the nature of the displacement of fragments.
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What do need to examine?
Treatment of fracture of the head and anatomical neck of the shoulder
Indications for hospitalization
In outpatient conditions, treatment of patients with punctured fractures of the anatomical neck and head of the shoulder is acceptable. For more complex injuries, patients are referred to a hospital.
First aid
Before transporting the victim to hospital, anesthetics are administered and transport immobilization is imposed.
Conservative treatment of fracture of the head and anatomical neck of the shoulder
Begin the treatment of punctured fractures with a puncture of the shoulder joint and insertion into its cavity of 20 ml of a 1% solution of procaine. The limb is immobilized with a gypsum longure on the Turner - from a healthy shoulder-strap to the heads of metacarpals. The arm is bent at the elbow joint, somewhat inclined anteriorly and withdrawn at 40-50 °. In the armpit is placed a wedge-shaped pillow filling the space. Inside appoint metamizol sodium. UHF is also shown on the fracture area from day 3 and exercise therapy for the hand.
On the 7-10th day, the gypsum bandage is turned into a removable bandage, active movements begin in the wrist and elbow joints, passive - in the shoulder joint. After gymnastics and physiotherapy procedures (electrophoresis of procaine, further - preparations of calcium and phosphorus, ozokerite applications, etc.), the longette is put on again (completely removed after 3 weeks). The hand is suspended on a kerchief and continues to be restored.
If fractures without displacement, if they are even multi-lobed, produce joint puncture, eliminate hemarthrosis and inject 20 ml of 1% solution of procaine. The limbs are attached to the position with the retraction of the shoulder to an angle of 45-50 °, the front deviation from the frontal axis of the trunk is 30 ° and fixed with a gypsum thoracic-bandage dressing or a TSITO bus.
For fractures with displacement of fragments, reposition should be performed under local anesthesia or, better, under general anesthesia. The essence of the comparison consists in traction along the length in a functionally advantageous position with manual modeling of fragments of the head of the shoulder. After manipulation, the limb is fixed with a gypsum thoracobrachial bandage or a discharge line.
With comminuted fractures with a small displacement of fragments or with a failed attempt at closed manual reposition, the method of skeletal traction beyond the elbow on the TSITO bus should be applied.
The term of permanent immobilization for fractures with displacement of fragments is 6-8 weeks, removable - 2-3 weeks.
Surgical treatment of fracture of the head and anatomical neck of the shoulder
Surgical treatment for intraarticular fractures of the proximal end of the humerus is indicated in the following cases:
- damage to the neurovascular bundle;
- open fracture, comminuted fracture fracture;
- Interposition of soft tissues between fragments (most often this is the tendon of the long head of the biceps brachium);
- a large-fragmented fracture with a displacement of the fragments, when it is possible to restore the anatomical shape of the bones;
- unsuccessful closed reposition.
The operation consists in an open reposition and fixation of the fragments by one of the methods: long screws or metal spokes held crosswise. In case of fractures along the anatomical neck line of the shoulder, the head can be fixed with the transossal sutures or the Klimov beam.
After the intervention, the limb is fixed with a gypsum thoracobrachial bandage for 6 weeks.