Fracture of the shoulder
A shoulder fracture is a common injury. After an injury disrupted the integrity of the bones of the shoulder. Depending on the nature of the deformity a person is injured with an offset or without him, but injured in any type of need of skilled surgical care. After the necessary manipulations, the long-term rehabilitation to restore lost functions of the upper limb. Complex rehabilitation exercises therapeutic exercises includes actions such as the development of hands on special rockets.
The statistics of medical practice indicate that a large percentage of the superiority of this type of injury over other types of fractures. This injury affects all age group of patients: young people with strong bone and elderly patients. Cause of fracture of the shoulder is traditionally the kick or the fall of man on the elbow or outstretched arm.
From what part is subjected to injury depends on the severity, nature of deformation, and estimated recovery time. The fault affects the lower, middle or upper part of the bone of the shoulder, often a fracture of the surgical or anatomic neck and a hip replacement. From the place of deformation on the characteristic symptoms.
The anatomical structure of the Department
The humerus has an upper, middle and lower division. The end of the top bone – smooth hemispherical head, passing through the coupling joint of the blade cavity. This forms the structure of the shoulder joint. In the upper section also includes a convex formation of two bone protrusions, the greater and lesser tubercle. The projections are for the body the cervix, the narrow portion of the bone, separating the head. Muscles attached to the tubercles of the connective tendons, and under the bumps is the body of the surgical neck. Fractures occur predominantly near the surgical neck. In medical practice is called the upper section of the proximal epiphysis.
The longest part of the shoulder Department, the body middle part of the bone. It provides innervation to the presence of the radial nerve in the spiral groove extending around and along the humerus. The upper section of the bone body has a circular shape, the lower shape of the triangle. The medical name for the middle region of the diaphysis.
At the lower part of the bone flat and wide form, attached to the surface of the joints provide articulation with the forearm. Doctors call this part of the distal epiphysis. A cylindrical block on the inner side joins the ulna. The sides at the bottom are elevated projections of outer and inner epicondyle, joined by muscle fibers.
Outside there is a spherical head bone of small size. Together with the body of the radius, it forms a joint.
Types of injuries
If a person has limited movement in the shoulder joint, under the skin emerges hematoma in the shoulder joint area swelling, the patient experiences a sharp pain, there is suspicion of a serious damage to the top of the division. These symptoms may indicate a fracture:
- head (deformation, detachment from the humerus, turn 180 degrees, crushed body);
- surgical journals (impacted fracture, the occurrence of one bone fragment into another);
- anatomical neck;
- tubercle, small or large (separation or break off the handle).
So it is possible to be injured when a person falls awkwardly on the elbow or receives a direct blow to the upper region of the hand. After articular dislocation of the attached muscles begin to strongly and dramatically reduced, which often provokes the separation of the tubercles. All of these injuries can have serious consequences, so it is advisable immediate treatment in the emergency room for emergency treatment. After the initial manipulation and treatment followed by long-term rehabilitation.
If the result of a fall on the elbow, outstretched arm, blow to the bone appear painful symptoms in the middle of the hand, possible fracture of the middle Department. The patient’s shoulder is deformed, changing its shape, in comparison with the healthy hand the patient seems to be cropped. Blocked motor function of the joint, it becomes impossible for the flexor and extensor movements. The displacement of bone fragments leads to an external change in the form of a shoulder, severe pain, bleeding and swelling. Hindered hand movements are accompanied by characteristic sounds of bursting bubbles or crunchy snow, called crepitus. In such cases, require anesthesia, treatment and further rehabilitation.
The symptoms of injuries of the lower division due to its complex structure can be varied. Passing the fracture line may localizability near holowecki, internal or external epicondyle, passing through the bone of the shoulder block. Injury to the lower part represent a serious danger to humans, especially for children. In childhood, the damage leads to irreversible deformation of the elbow joint and a violation of its functions because of the violation points of growth. When receiving a fracture victim experiences severe pain, he has swelling and a hematoma near the elbow joint deformed, missing its mobility.
Often due to damage to the nerves and blood vessels there is a marble painting of hand and forearm, the sensation of crawling ants, tingling, numbness. It is urgent to restore blood flow to avoid partial loss of the hand. If there is displacement, the patient will have a long recovery and painful rehabilitation.
Distinguish intra-articular, extra-articular forms of fracture, with displacement, without closed or open (in which is formed the wound with visible bits of bone inside).
Damage to the upper division is found as a trauma surgeon by probing the top of the arm and the joint. When gripping the doctor’s shoulder and the patient work of mechanical movements of the patient appear sharp pain. The doctor examines the outward symptoms, listens to the sounds of a friction the friend about the friend of the fragments and relates them to the external manifestations of trauma. If the humeral head is not detected at the right place at palpation, the physician diagnoses the dislocation, obtained simultaneously with the fracture. After probing the patient sent for x-rays. X-ray shows the localization of the fracture, the possible offset, the location and number of fragments, the condition of the cervix.
Diagnosis of secondary Department is the same principle. Hand injury examined by a trauma surgeon, performs palpation of the affected area, studying the symptoms. The possible displacement of existing fragments is determined by probing zapodeni, projections of the front part of the elbow joint. To reveal symptoms pain under axial loading, trauma produces flexion of the elbow, pressing elbow, parallel to the axis of the shoulder, a tap on the shoulder. Fragments sharp edges touch each other, it can be felt on palpation. The final result shows the x-ray where you can see the level of deformation of the bone, the exact location of damage, number of fragments and the direction in which there has been a shift.
Exploring the lower part of the trauma is similar. Method of probing hands identified the symptoms of damage. At the violated the shape of the shoulder tap is offset from the normal arrangement epicondyles, the characteristic of crepitate and pathological mobility make preliminary conclusions about the complexity and the nature of the injury. The final stage of the confirmation of the diagnosis – radiography.
Diagnosis should be carried out only by experienced trauma. The external symptoms should be investigated with caution. After an awkward action possible serious damage to the blood vessels or nerves. This is often the cause of severe complications, leading to disability.
Methods of treatment of pathology
Compound fracture of the shoulder joint with damage to the cervix require surgery followed by rehabilitation period. Rehabilitation includes treatment by ultrasonic waves, improves blood circulation, enhancing the regenerative processes that give anti-inflammatory effect. After UFO and electrophoresis subsides swelling, are residual pain.
Other types of injuries require different treatment measures.
|Crack the upper division of the bone.||Require drug anesthesia, after which overlaps the fixing bandage of plaster. The patient wears it at least two months. The overlapping region from the scapula to the forearm with ensuring immobility of the elbow and shoulder joint.||If there is damage cervical or displacement is held closed reposition under General anesthesia, after which a valid fixation hands. In 10 days begins the rehabilitation. The exercises of physiotherapy, massages, physical therapy, development of shoulder, wrist, elbow.|
|Trauma to the middle part of the bone.||Requires closed reduction, apply the bandage from the forearm to the chest. In order to avoid displacements of the patient is skeletal traction with simultaneous radiography. Removing the plaster appointed in 2-3 months, followed by six weeks of rehabilitation.||If you are not able to return to the place of the displaced fragments closed reduction, showed symptoms of damage to the radial nerve, the neck, pinching the muscles, surgery will be scheduled. In surgical practice used incisions, the combination of metal screws, plates, pins of bone fragments, the application of Ilizarov. After the treatment standard is rehabilitation and development of motor functions of the hand.|
|Damage to the lower part of the humerus.||Without displacement – is treated by the imposition of a plaster Longuet from the shoulder to the base of the fingers. After a month of fixing off the bandage and begin physiotherapy. Function restored in two or two and a half months.||If there is offset is performed a closed reduction and subsequent rehabilitation, eliminating the residual symptoms.|
When you fail when you reposition back to its original position, fragments, apply skeletal traction devices, designed for the type of Ilizarov.
In the result of damage to the body bone, neck, muscle, joint or nerve may have serious consequences:
- paralysis of the deltoid muscle;
- arthrogenic contracture;
- habitual dislocations;
- the formation of false joints;
- contracture Volkmann;
- impaired function of the muscles of the forearm.
Compound fracture of the shoulder joint can be accompanied by nerve damage, which occurs after a paresis or a complete paralysis of the upper limb. Pathological changes of the articular structures is fraught with the destruction of articular cartilage, seal the neck, ligaments, joint capsules, the growth of scar tissue. Muffled the condition of the blood vessels due to prolonged wearing of a plaster, damage displaced fragments lead to disrupted circulation. Oxygen flows to the muscles and the nerves weak, begin disturbance of sensitivity and movements. Muscle atrophy, difficulty in movement, joint pain require examination of neurologist.
In order to avoid severe complications later strictly forbidden when injuries occur independently verify the symptoms and to probe the damaged areas. Fragments can damage vital systems of innervation and blood supply. It leads to irreversible paralysis.
Bring the patient to the nearest emergency room is necessary with caution. Hand tie the weight to the torso, placing the tire and without making sudden movements. The victim during a trip to the doctor should sit.