Types of humerus fractures
Fractures are divided by level. Proximal ones affect the upper end of the bone - the head, tubercles and surgical neck; they are typical for the elderly and are often impacted, that is, the fragments are driven into each other and are relatively stable. Diaphyseal fractures occur in the middle third, and they are the ones that are dangerous for damaging the radial nerve. Distal fractures are located above the elbow joint and often involve the joint, making treatment more difficult and requiring precise reconstruction of the anatomy. Separately, pathological fractures are distinguished against the background of a tumor or bone cyst.
- Fracture of the surgical neck of the humerus is the most common in the elderly
- Avulsion of the greater tubercle of the humerus
- Fracture of the diaphysis (body) of the humerus
- Supracondylar and intra-articular fractures at the elbow
- Impacted fractures without displacement
- Pathological fractures due to a cyst or tumor
Causes and mechanism of injury
In older people, the leading factor is osteoporosis: bone strength is reduced, and a simple fall on an outstretched arm or on the side is enough to fracture the neck of the humerus. In young people and children, fractures are associated with more serious impacts: a fall from a height, a road injury, an impact. Diaphyseal fractures sometimes occur during sudden twisting, such as during an unsuccessful throw or wrestling, when the muscles create a strong torque. If a fracture occurs without adequate trauma, the doctor must rule out a tumor process in the bone.
- Falling onto an outstretched arm or shoulder
- Direct hit to the shoulder
- Torsional load when throwing or wrestling
- Road traffic injury
- Osteoporosis and age over 60 years
- Bone tumor or cyst in a pathological fracture
Symptoms and nerve damage
Immediately after the injury, sharp pain, swelling and inability to use the arm appear; the man supports it with his healthy hand. When displaced, deformity is visible and the shoulder may appear shortened. The bruising often travels down the shoulder to the elbow after a few days. Particular attention is paid to the radial nerve: if it is damaged, the hand hangs, the fingers and wrist do not straighten, and sensitivity on the back of the hand is impaired. This condition is most often reversible, but requires mandatory recording and observation.
- Sharp pain and inability to move your arm
- Shoulder swelling and deformity
- Bruising extending down the arm
- Crunching and pathological mobility
- Drooping hand due to damage to the radial nerve
- Numbness on the back of the hand
Diagnostics
The diagnosis is confirmed by x-rays of the shoulder and shoulder joint in at least two projections; for fractures of the upper end, special placements are performed to assess the position of the head and tubercles. Computed tomography is needed for intra-articular and comminuted fractures, as well as for planning surgery. An obligatory part of the examination is checking the pulse, color and temperature of the hand, as well as movements and sensitivity, so as not to miss damage to blood vessels and nerves. In the elderly, after a fracture, the risk of osteoporosis is assessed and its treatment is planned.
- X-ray of the humerus and shoulder joint
- CT scan for intra-articular and comminuted fractures
- Assessment of pulse and blood supply to the hand
- Checking the function of the radial, ulnar and median nerves
- Screening for osteoporosis in the elderly
- Control shots in dynamics
Treatment and rehabilitation
Many humerus fractures heal without surgery. Impacted humeral neck fractures and shaft fractures without significant displacement are treated with a bandage or a functional orthosis that allows slight movement and promotes healing. Movement in the elbow and hand begins almost immediately, in the shoulder - as the pain decreases. Surgery is needed in cases of significant displacement, intra-articular fractures, open injuries, vascular damage, and in case of failure of conservative treatment: plates, intramedullary rods are used, and in case of a damaged head in the elderly, endoprosthetics is used. Rehabilitation is mandatory: without it, shoulder stiffness develops.
- Bandage or functional orthosis
- Early movements of the hand and elbow
- Gradual development of the shoulder joint
- Osteosynthesis with a plate or rod during displacement
- Endoprosthetics for destruction of the humeral head
- Treatment of osteoporosis to prevent new fractures