Fractures of the humerus at the site of formation of the elbow joint

ICD-10 code

S42.4. Fracture of the lower end of the humerus.

[1], [2], [3]

Anatomy of the elbow joint

The ulnar joint is formed by the humerus, elbow and radius bones, which unite three pairs of articulating surfaces: a humerus - between the block of the condyle of the shoulder and a semilunar incision of the ulna; pelviculus - between the head of the condyle of the shoulder and the head of the radius; ray-radial - between the head of the radius and radial cutting of the ulna.

In the brachial joint, flexion and extension are possible, the amplitude of which is limited by the front coronary, and behind the ulnar process of the ulna. The pelvic joint is more mobile. In it, in addition to bending and unbending, it is possible to rotate outside and inside. In the radicoloured joint only rotational movements are possible.

All three joints are in a single closed cavity, limited by a bag of the elbow joint. The bag from the sides is thickened due to the collateral elbow and the radial ligament securing the condyles of the shoulder with the bones of the forearm. Of other powerful ligaments of the elbow joint, one should call a ring-shaped bundle of radius, which covers its neck and head without fusing with them. It is attached by both ends to the ulna and as a collar holds the radial-fibrous articulation.

On the front surface of the elbow joint pass the brachial vein and artery, which at the level of the neck of the radius is divided into the radial and ulnar arteries. Here, in the region of the elbow fold is the median nerve. On the posteromedial surface of the elbow joint, passing the inner epicondyle, passes the ulnar nerve.

Blood supply of the elbow joint is carried out from the network formed by branching of the brachial artery. The joint capsule is innervated by the median, radial and ulnar nerves.

[4], [5]

Fractures of the condyle of the shoulder

Possible damage to the following parts that make up the condyles of the humerus: the inner and outer musculoskeletal of the humerus, the head of the condyle of the humerus, the block, the condyle itself in the form of linear T- and Y-shaped fractures.

Fractures of the epicondylitis of the humerus

Fractures of the epicondyle of the humerus are classified as extra-articular lesions, most often they occur in children and adolescents.

The mechanism of an indirect injury is excessive forearm deflection to the inside or outward (tearing fractures), but it can also be direct - a blow to the area of the elbow joint or a fall on it. The inner epicondyle of the humerus suffers more often.

Symptoms and diagnosis of fracture of the epicondyle of the humerus

Anamnesis, examination and physical examination. Disturbs pain in the place of injury. Here you can see swelling, bruising. When palpation, tenderness, sometimes a moving bone fragment, crepitation is revealed. The external reference points of the joint are broken. Normally, the standing points of the epicondyles and the elbow process with a bent forearm form an isosceles triangle, and when they expand at the elbow joint the points diverge, forming a straight line-the triangle and the Güter line. The displacement of the epicondyle leads to the deformation of these conditioned figures. Movement in the elbow joint is moderately limited because of pain. For the same reason, but more pronounced limitation of rotational movements of the forearm and flexion of the wrist with a fracture of the internal epicondyle and extension of the wrist with trauma to the external epicondyle of the humerus.

Laboratory and instrumental research. Summarizes the diagnosis of the radiography of the elbow joint in a straight and lateral projections.

Treatment of fracture of epicondyle of humerus

With fractures without displacement or in those cases where the fragment is located above the joint slot, a conservative treatment is used.

After the procain blockade of the fracture zone, the limb is immobilized with a gypsum longus from the upper third of the shoulder to the head of the metacarpal bones with the forearm position, the average between supination and pronation. Flexion in the elbow joint 90 °, the wrist joint is bent at an angle of 30 °. The period of immobilization is 3 weeks. Then a restorative treatment is prescribed.

If a significant displacement of the fragment is detected, a closed manual reposition is performed. After anesthesia, the forearm is diverted to the side of the broken epicondyle and fingers are pressed onto the fragment to the mother box. The forearm is bent to the right angle. Apply a circular gypsum bandage from the upper third of the shoulder to the heads of metacarpal bones for 3 weeks, then the bandage is made detachable for 1-2 weeks. Assign restorative treatment.

Surgery. Sometimes with dislocations of the forearm, the inner epicondyle is detached and infringed in the joint cavity. That is why, after restoring the forearm, the functions of the elbow joint ("blockade" of the joint) are not restored and the pain syndrome remains. On the roentgenogram, a nascent capillary of the humerus is seen. An urgent surgical intervention is indicated. The elbow joint is opened from the inside, exposing the epicondylitis detachment zone. Open the articulation gap by diverting the forearm to the outside. A single-pronged crochet is used to remove the injured bone fragment with the muscles attached to it. Manipulation of this should be done very carefully, since the epicondyle may be trapped with the ulnar nerve. The severed bone fragment is fixed to the mother box with a spoke, a screw, and in children the epicondyle is sewn with transossal catgut sutures. The terms of immobilization are the same as for conservative treatment.

Estimated period of incapacity for work. With fractures without displacement, work capacity is restored after 5-6 weeks. In other cases, the return to labor after fracture of the external epicondyle of the humerus is resolved after 5-6 weeks, internal - after 6-8 weeks.

Fractures of the head of the condyle and humerus block

Fractures of the head of the condyle and humerus block, as separate nosological forms of trauma, are very rare.

Symptoms and diagnosis of fracture of the head of the condyles and humerus block

Anamnesis, examination and physical examination. Fractures are intraarticular, which determines their clinical picture: pain and restriction of the elbow joint functions, hemarthrosis and a significant articulation edema, a positive symptom of the axial load.

Laboratory and instrumental research. The diagnosis is confirmed radiographically.

Treatment of fracture of the head of the condyle and humerus block

Conservative treatment. In fractures without displacement, puncture the elbow joint, eliminate hemarthrosis and inject 10 ml of 1% solution of procaine. The limb is fixed with a plaster bandage in a functionally advantageous position from the upper third of the shoulder to the metacarpophalangeal joints for 2-3 weeks. Then they start developing the movements, and immobilization is used as a removable one for another 4 weeks. Restorative treatment is continued even after removal of the plaster bandage.

In fractures with displacement, a closed manual reposition is performed. After anesthesia, the arm is unbent at the elbow joint, the traction along the longitudinal axis is created behind the forearm and re-bend it, trying to maximally widen the elbow joint gap. A severed fragment, usually located on the front surface, the surgeon adjusts the pressure of his thumbs. The limb is bent to an angle of 90 ° with a forearm forearm and fixed with a plaster bandage for 3-5 weeks. Prescribe curative gymnastics of active type, and immobilization is retained for another month.

Surgical lung. If it is not possible to close the fragments, an open reposition and fixation of fragments by Kirschner's knitting needles. It is necessary to hold at least two spokes to exclude the possible rotation of the fragments. The limb is immobilized with a gypsum lint. The spokes are removed after 3 weeks. From the same time immobilization is converted into removable and retains another 4 weeks. In multi-fracture fractures, good functional results are obtained after resection of the fractured head of the condyle of the shoulder.

Estimated period of incapacity for work. With fractures without displacement, working capacity is restored after 8-12 weeks. With fractures with displacement and subsequent conservative treatment, the period of incapacity for work is 12-16 weeks. After surgical treatment the work capacity is restored in 10-12 weeks.

Linear (marginal), T- and Y-shaped fractures of the humerus of the humerus

Such fractures are complex intraarticular lesions, fraught with the restriction or loss of functions of the elbow joint.

The mechanism of injury can be direct or indirect.

Symptoms and Diagnosis

Symptoms are characterized by pain, loss of limb functions, significant edema and deformity of the elbow joint. Violated, and in some cases, the triangle and the Güter line, the sign of Marx, are not determined. The diagnosis is refined according to the radiograph.

Treatment

Conservative treatment. In fractures without displacement of fragments, treatment consists in eliminating hemarthrosis and anesthetizing the articulation. The finiteness is fixed by a trough-shaped gypsum longus from the upper third of the shoulder to the heads of metacarpal bones. The forearm is bent to an angle of 90-100 ° and gives the middle position between supination and pronation. After 4-6 weeks, immobilization is converted into removable for 2-3 weeks. Assign a comprehensive treatment. Proceed to work in 8-10 weeks.

Treatment of fractures with displacement of fragments is reduced to a closed reposition. It can be either one-stage manual or gradual with the help of skeletal traction beyond the elbow process or an external fixation device. The main thing is that the restoration of anatomical interrelations of bone fragments should be as accurate as possible, since inaccurate comparison and excessive callus grossly violate the functions of the elbow joint. The method of repositioning is non-standard, its stages are selected individually for each specific case. Its principle is to stretch the forearm bent at right angles for the purpose of relaxing the muscles, deflecting the forearm outside or inside to eliminate angular displacement, modeling (eliminating the displacement along the width). The forearm is set in the middle position between supination and pronation.

Anesthesia is better to apply the general. Successful comparison of fragments, confirmed by X-ray control, is completed by imposing gypsum longi from the shoulder joint to the heads of the metacarpal bones at flexion in the elbow joint to 90-100 °. In the area of the elbow fold, a lump of loose cotton wool is placed. Tight bandaging, constrictions in the articulation area should be excluded, otherwise a growing edema will lead to compression and development of ischemic contracture. The term of permanent immobilization is 5-6 weeks, removable - 3-4 weeks.

Surgical treatment is used for the unsuccessful conservative attempts to compare. Open reposition is carried out as sparingly as possible. It is impossible to separate from the bone fragments the joint capsule and muscles. This will result in a malnutrition and aseptic necrosis of bone patches. Correlated fragments are fixed in one of the ways.

After suturing the wound, the limb is fixed with a gypsum longus, the same as with conservative treatment. The term of permanent immobilization - 3 weeks, removable - 4 weeks.

Estimated period of incapacity for work. With a favorable outcome, work capacity is restored in 10-12 weeks from the moment of injury.