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Fractures of the lower third of the humerus, according to various studies, occur in 1-3% of the number of skeletal bone fractures, and among the humerus their number ranges from 14 to 19%. With proper treatment, healing of the injury site occurs in 94-99% of cases. The closer the damage is to the elbow joint, the higher the frequency.

Conservative treatment of a non-displaced fracture involves fixing the limb with a plaster splint from the upper third of the shoulder to the fingers. A splint is different from plaster. It covers the limb with a plaster compound on three sides, and on one side it is covered only by a soft bandage. In this case, the plaster covers the limb in a circular manner.

For epicondyle fractures, the hand is fixed in a strictly defined position (Fig. 5). This allows you to avoid a number of complications that may arise during long-term fixation. The bandage is removed three weeks after repeated radiography is performed and the degree of consolidation (fusion) of bone fragments is assessed.

Reference. If the cast is applied incorrectly, the limb may be fixed in a non-physiological position. This not only leads to improper healing of the fracture site, but also causes complications such as impaired circulation in the limb, swelling, formation of bedsores, and gangrene.

If the fracture occurs with displacement of bone fragments, then after local anesthesia the doctor begins closed reduction.

After restoring the normal location of the bone fragments, a plaster cast is applied at the same level as the splint. After three weeks, the plaster cast is removed and a removable bandage is applied for one to two weeks.

Surgical treatment of an epicondyle fracture is required only when the elbow joint is dislocated along with the fracture and a bone fragment of the epicondyle becomes pinched in the damaged joint. Then, under general anesthesia, the joint capsule is opened, and the severed epicondyle with the tendons attached to it is carefully pulled out. The torn section of bone is then reattached with a metal pin or screw.

If a similar situation occurred at an early age (up to 7-10 years), when the bone tissue is softer and more elastic, the torn fragment is fixed by applying nylon interrupted sutures directly to the bone tissue (Fig. 6).

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2007 (Order No. 764)

Fracture of the upper end of the humerus (S42.2)

general information

Short description

Closed or open fracture of the proximal epimetaphysis, diaphysis and distal epimetaphysis of the humerus.

Protocol code: E-016 "Fracture of the humerus"
Profile: emergency

Purpose of the stage:

Prevention of the development of traumatic shock, especially with combined injuries;

Stopping bleeding in the presence of a wound and damage to the main vessel;

Prevention of damage to the ends of bone fragments of the neurovascular bundles of the shoulder;

Prevention of the development of wound infection;

Deliver the victim to a trauma hospital in the presence or absence of complications.

Code(s) according to ICD-10-10:

S42 Fracture at the level of the shoulder girdle and shoulder

S42.2 Fracture of the upper end of the humerus

S42.3 Fracture of the shaft [shaft] of the humerus

S42.4 Fracture of the lower end of the humerus

Classification

Fractures of the proximal end of the humerus

1. Intra-articular:

Fractures of the head of the humerus;

Anatomical neck fractures;

2. Extra-articular:

Subtubercular, transtubercular fractures;

Surgical neck fracture (adduction, abduction);

Isolated fractures of the greater and lesser tubercles.

Humeral shaft fractures:

Fractures of the distal end of the humerus:

Supracondylar fractures;

Humeral condyle fractures.

Risk factors and groups

1. Development of traumatic shock.

2. Development of hemorrhagic shock.

3. The occurrence of fat embolism.

4. Damage to the great vessels with the formation of a tense hematoma or external bleeding.

5. Damage to the nerve trunks of the shoulder.

Diagnostics

Diagnostic criteria

Intra-articular fractures (rare):

1. Pain in the shoulder joint.

2. Impaired function of the shoulder joint.

3. Swelling and hemarthrosis of the shoulder joint.

4. Sharp limitation of active movements, especially in the direction of abduction.

5. Passive movements are sharply painful.

6. Pressing on the head of the humerus causes pain.

7. Axial load (pressure on the elbow joint from bottom to top) is sharply painful.

Surgical neck fractures - adduction and abduction (very common, especially in old age)

An adduction fracture is the result of a fall on a bent and adducted arm at the elbow joint. The central fragment is displaced anteriorly and outward. The peripheral fragment deviates outward and moves upward. An angle open inwards is formed between the fragments.

An abduction fracture occurs when you fall on your abducted arm. The central fragment deviates anteriorly and downward. The peripheral fragment is located from the central one, forming an angle open outward.

1. Pain and dysfunction in the shoulder joint.

2. The victim supports the injured arm under the elbow.

3. Active movements in the shoulder joint are extremely limited.

4. Passive movements are possible, but sharply painful.

5. Positive symptom of axial load.

6. Rotational movements of the humerus are performed in isolation from its head.

Humeral shaft fracture

Direct mechanism: hitting the shoulder or hitting a hard object with the shoulder.

Indirect mechanism: falling onto the hand or elbow joint with the abducted arm; excessive rotational rotation along the axis of the shoulder.

Type 1. The fracture line passes above the insertion of the pectoralis major muscle. The central fragment occupies the position of abduction outwards and anteriorly with outward rotation. The peripheral fragment is brought inward by contraction of the pectoralis major muscle, pulled upward and rotated inward.

Type 2. The fracture line passes below the attachment of the pectoralis major muscle, but above the attachment of the deltoid. The central fragment is adducted by contraction of the pectoralis major muscle and moderately rotated medially. The peripheral fragment is moderately retracted outward and pulled upward due to contraction of the deltoid muscle.

Type 3. The fracture line passes below the attachment of the deltoid muscle, which takes the central fragment outward and anteriorly. The peripheral fragment is pulled upward due to contraction of the muscle sheath of the shoulder.

1. Pain in the fracture area.

2. Impaired shoulder function.

3. Deformation of the limb.

4. Shortening of the limb.

5. Pathological mobility.

6. Crepitation of fragments.

7. Positive symptom of axial load.

Fractures of the distal humerus

Supracondylar fractures

A flexion fracture occurs when a person falls on an arm bent at the elbow. The central fragment is displaced posteriorly and inwardly, the peripheral fragment is displaced anteriorly and outwardly. The angle between the fragments is open anteriorly and medially.

An extension fracture occurs when a person falls on an arm extended at the elbow joint. The central fragment is displaced anteriorly and inwardly, the peripheral fragment is displaced posteriorly and outwardly. The shoulder muscles additionally shift the fragments along their length.

1. Pain in the distal shoulder and elbow joint.

2. Dysfunction of the elbow joint.

3. With active and passive movements, crepitus of the fragments is felt.

4. Deformation of the elbow joint.

5. Significant swelling of soft tissues in the area of ​​the elbow joint.

Fractures of the humeral condyle

Fractures of the epicondyles of the humerus

Indirect mechanism: excessive deviation of the forearm outward or inward (avulsion fractures).

Direct mechanism: a blow to the elbow joint or a fall on the elbow.

The internal condyle of the shoulder is most often affected.

1. Pain in the elbow joint.

2. Palpation reveals pain, a mobile bone fragment and crepitus.

3. Moderate limitation of movements in the elbow joint.

4. Marked limitation of rotational movements of the forearm.

5. Limitation of wrist flexion when the internal epicondyle is fractured.

6. Limitation of wrist extension when the lateral epicondyle is fractured.

Fractures of the head of the condyle and trochlea of ​​the humerus

They are very rare and are classified as intra-articular.

1. Pain and limited function of the elbow joint.

3. Significant swelling of the soft tissues in the area of ​​the elbow joint.

4. Positive symptom of axial load.

Marginal, T- and Y-shaped condyle fractures

Refers to complex intra-articular injuries.

Clinical signs are similar to those of a fracture of the head of the condyle and trochlea of ​​the humerus.

List of main diagnostic measures:

1. Determination of the presence of swelling, hemorrhage in the tissue, dysfunction and forced position of the limb.

2. Inspect the contours of the shoulder joint, humeral shaft and elbow joint to identify deformity, shortening of the limb, the presence of hemarthrosis or a wound.

3. Palpation to detect the place of greatest pain and swelling of the tissue, deformation of the bone axis, alignment and crepitus of fragments, pathological mobility*.

4. Study of the pulsation of the brachial and radial arteries to exclude compression or injury to the brachial artery by bone fragments of the shoulder.

5. Determination of the sensitivity of the distal parts of the limb.

*If there are obvious signs of a limb fracture, the examination should not be supplemented with detection of crepitus and pathological mobility of fragments!

Treatment abroad

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Treatment

Emergency aid tactics:

1. 20-30 ml of a 1% novocaine solution is injected into the fracture site (hematoma) (find out your allergic history!).

2. For hemarthrosis - joint puncture, evacuation of blood and administration of 10-20 ml of 1% novocaine solution.

3. A roller is placed in the armpit, after which the arm is fixed with a simulated Kramer splint, Deso bandage or scarf bandage.

4. For psychomotor agitation, sedatives are used.

5. For unrelieved pain, use narcotic analgesics.

6. If there is perforation of the skin with a bone fragment, the wound is covered with an aseptic bandage, after which the limb is fixed.

7. In case of profuse bleeding from the brachial artery, the latter is pressed above and below the wound with fingers, then an elastic tourniquet is applied above the injury.

Under no circumstances should clamps be applied blindly to bleeding vessels deep in the wound! Such attempts lead to additional trauma to blood vessels, damage to nerve trunks and crushing of soft tissues.

Information

Head of the Department of Emergency and Emergency Medical Care, Internal Medicine No. 2, Kazakh National Medical University named after. S.D. Asfendiyarova - Doctor of Medical Sciences, Professor Turlanov K.M.

Employees of the Department of Ambulance and Emergency Medical Care, Internal Medicine No. 2 of the Kazakh National Medical University named after. S.D. Asfendiyarova: candidate of medical sciences, associate professor Vodnev V.P.; Candidate of Medical Sciences, Associate Professor B.K. Dyusembayev; Candidate of Medical Sciences, Associate Professor Akhmetova G.D.; candidate of medical sciences, associate professor Bedelbaeva G.G.; Almukhambetov M.K.; Lozhkin A.A.; Madenov N.N.

Head of the Department of Emergency Medicine of the Almaty State Institute for Advanced Medical Studies - Candidate of Medical Sciences, Associate Professor Rakhimbaev R.S.

Employees of the Department of Emergency Medicine of the Almaty State Institute for Advanced Medical Studies: Candidate of Medical Sciences, Associate Professor Silachev Yu.Ya.; Volkova N.V.; Khairulin R.Z.; Sedenko V.A.

Attached files

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Dislocation of the radial head in children under 3 years of age occurs quite often. Preschoolers are also in the risk category, however, after 5 years, such damage is much less common.

Constant visits to the doctor regarding subluxations of this type with the anatomical specificity of the heads of the radial bone in a child and the phenomenon when he pulls his hand towards the hand of a taller person, as well as any sudden movement, often provoke the appearance of a dislocation.

Therefore, this type of injury is also called dislocation from protrusion and painful pronation.

Preschoolers may suffer from this problem more than once. But how to recognize the symptoms of subluxation and what to do if the presence of an injury is confirmed?

The structure of the head of the radial bone and factors for the occurrence of dislocations

In comparison with the structure of the head of the radial bone in an adult, in a child such a bone element is cartilaginous tissue that has a round shape. Thus, children have a physiological tendency to subluxate the upper limb, since even a slight but sudden movement can cause the head of the bone to slip out of the annular ligament.

Moreover, it is possible that even the young fibers of the ligaments will rupture. Moreover, the muscle corset in children is poorly developed, and the articular cavity is thin.

Often, injuries to the head of the radius occur if the child’s arm is extended upward, that is, an adult holds the child’s hand and the latter falls sharply. At this moment, the parent tries to protect the child from falling and pulls his arm, which leads to dislocation of the radius.

Therefore, it is not at all surprising that such injuries occur in very “independent” children who are not yet completely confident on their feet. In addition, similar injuries can occur if you lift a baby by the arms when putting on clothes with narrow sleeves and even during outdoor games.

According to statistics, dislocations occur twice as often in girls as in boys. Moreover, the left limb is damaged much more often than the right.

However, when the child turns 6 years old, his anatomical defects will disappear by themselves. Therefore, the risk of similar injuries will be zero.

Symptoms and diagnosis

A dislocation of a child’s arm occurs as follows: the head of the radius, located in the annular ligament, due to a dislocation or other influences, flies out of its usual place as a result of which it is pinched by the surrounding tissues. At this time, a crunching or clicking sound may appear and the child begins to scream in pain.

In some cases, the symptoms of subluxation are almost invisible. Therefore, parents do not know about the problem and are in no hurry to seek medical help, wasting time. As a result, you need to carefully monitor the child and always take into account childhood hyperactivity and bone fragility.

As a rule, subluxation is characterized by symptoms such as sharp pain in the forearm area. In this case, the child presses his hand to his stomach or it is lowered vertically. Often the limb is pulled forward, but at the same time it is slightly bent at the elbow.

The child experiences intense pain, which is why he is often afraid to raise or bend his arm. But with the help of a doctor, he can perform flexion and extension, and the position of the forearm will not change.

By palpation, the doctor can sometimes determine the location of the pain in the head of the radius. Moreover, external visible changes are mostly invisible or slight swelling occurs.

During the diagnostic process, it is better to tell the doctor about the incident that caused the injury. Moreover, the traumatologist must make sure that the patient does not have the following diseases and injuries:

• osteomyelitis;
• congenital dislocation;
• nerve damage;
• fracture of the neck of the shoulder or collarbone;
• osteoarthritis, septic and juvenile rheumatoid arthritis;
• fracture of the ulna or wrist.

As a rule, other than medical history and examination, additional diagnostic methods are not used. Sometimes the doctor prescribes an X-ray examination (in case of an unsuccessful attempt to straighten the arm or in case of severe swelling of the limb and a suspected fracture).

To clarify the diagnosis, such studies are simply necessary; for these reasons, parents should not interfere with such examinations. If the presence of subluxation of the radius is confirmed, then the x-ray will not show significant changes in the joint.

When subluxation occurs repeatedly, then the doctor will likely order a magnetic resonance imaging or ultrasound examination to determine the condition of the annular ligaments.

Treatment of dislocation by closed reduction

If the diagnosis of dislocation of the head of the radial bone is confirmed, then the traumatologist can easily and quickly set the arm using a closed method. To carry out this procedure, you do not even need to use painkillers. It will be enough if the parents simply distract the child from realignment, for example, by getting him interested in a new toy.

With the closed method, the following sequence of actions is performed. First, the doctor carefully moves the forearm, which is fixed by his assistant. Afterwards, the doctor bends the patient’s elbow at a right angle.

In this case, the doctor covers the sore hand with one hand and fixes the wrist well, and with the other hand he holds the elbow, controlling the head of the radial bone with his thumb. Then the doctor makes a supination movement, that is, completely turns the arm.

If the procedure was performed correctly, then the doctor's controlling finger will feel a slight crunch. In this case, the child will feel pain, which will go away almost immediately, and then relief will come. After some time, the child will completely forget that his arm hurt and will begin to lead a normal lifestyle, actively using the dislocated arm.

Sometimes the doctor is not immediately able to carry out the reduction, so the procedure has to be repeated several times. After all, skillful correction of such an injury depends on the correctness of the diagnosis and the qualifications of the traumatologist.

After successful reduction, the arm must be kept in a fixed position for several days. In this case, the elbow should be bent 60-70 degrees. The bandage is applied softly; a scarf worn over the shoulder is also possible.

Prevention of recurrence of dislocations

If a child is just starting to walk and is completely unsure on his feet, then parents should help him in every possible way. For example, do not hold his hands, but use special children's reins.

1. In case of systematic repetition of such injuries, it is necessary to monitor the child’s actions, which become the cause of subluxation.
2. Moreover, it is possible that some mistakes of adults lead to such injuries, therefore, parents need to analyze their treatment of the child.
3. You should not lead a child holding him by the injured limb; you should not pull him by the arm or lift him by holding his wrists. Repeated injuries, that is, relapses, are often caused by deformation of the annular ligament, that is, congenital weakness.
4. If dislocations of the radial head recur after the next reduction procedure, then the doctor applies a plaster or cardboard splint, which must be worn for 14 days. Thus, the joint will be given rest, due to which its functionality will be restored.

In order to prevent relapses, it is advisable to perform passive or active joint exercises. Such physical therapy is necessary to strengthen the muscular system.

First aid at home

If a child hurts his arm, the first thing adults should do is to calm the child down, making sure he stops crying. Until medical attention is provided, the only thing parents can do if they suspect a sprain is to do everything possible to relieve the painful symptoms of the injury.

To do this, apply an ice compress or a towel soaked in cold water to the injured elbow. And if the pain is very severe, then the victim can be given a painkiller (Paracetamol or Ibuprofen).

However, the best option to alleviate children's suffering is still the timely provision of medical care. Parents should understand that self-reduction of a dislocation can lead to serious consequences.

Therefore, to prevent the child’s hand from being further injured, only a traumatologist should treat the dislocation. After all, only an experienced doctor will carry out the reduction procedure as correctly, quickly and painlessly as possible.

How does a clavicle fracture occur in a newborn during childbirth? A pediatrician will answer this question. According to the International Code of Classification of Diseases, a clavicular fracture in a newborn occurs in only 3% of babies. The essence of the pathology is that the baby has a violation of the integrity of the clavicular bone. The disease is diagnosed in young children immediately after birth, although sometimes it is discovered only a few days later.

This is due to the fact that newborns experience severe swelling in the collarbone area and a hematoma forms. It is impossible to prevent this disease in advance, but the pathology is corrected after rehabilitation, and no physical traces remain.

This disease has its own international code according to the disease classifier. A clavicle fracture according to ICD-10 is called shoulder dystonation. It occurs in the following cases:

• The baby's shoulders cannot be born when the head comes out. Typically, this condition is observed within 60 seconds after the baby’s head appears, so doctors are forced to use special tools;
• the baby's shoulder girdle does not pass through the mother's pelvis, which causes vaginal injuries during childbirth;
• The shoulder is delayed at birth, located behind the pubic symphysis.

The international classification under code 10 lists several types of this disease. In particular, this is a prolonged labor; providing medical care to the mother if the fetus is lying incorrectly; maternal pelvic abnormalities; skeletal injury to a newborn; receiving a birth injury that affects the central or peripheral nervous system.

A clavicle fracture during childbirth causes the following injuries of varying degrees in a woman in labor:

• bleeding after childbirth;
• ruptures of the perineum and cervix;
• vaginal ruptures.

In newborns, in turn, pathology of the brachial plexus, paralysis of varying degrees of severity, fractures, and injuries to the skull and brain are observed.

The clavicle consists of a long bone that is connected to the scapula (via the acromion process) and the sternum. The bone fragment moves under the weight of the muscle mass, causing various damage. A fracture of the humerus is caused by the following reasons:

• large fruit;
• narrow pelvis of a woman in labor;
• bone fragility;
• rapid labor;
• influence of mechanical tools;
• careless actions of doctors during childbirth;
• The fruit is lying incorrectly.

This shoulder pathology in newborns occurs in the middle part of the clavicle, although other areas can also be injured.
Features of a shoulder fracture include a broken bone, which remains in this condition. At the same time, the second clavicle remains intact, since the periosteum holds it. Thanks to this, there is no displacement of the fracture or it will be quite insignificant. Sometimes the inner bone breaks, but the periosteum holds the fracture and there is no complete displacement. This condition is typical for both closed and open types of pathology.

Newborns can also have much more severe forms of clavicular fracture, the complications of which appear at an older age.
Thus, the classification of pathology includes the following types:

• open fracture;
• closed;
• displaced;
• no offset;
• longitudinal;
• transverse;
• ringed;
• oblique;
• helical.

Symptoms that a bone may be broken or damaged are primarily swelling and mild hematoma. Swelling indicates that the damage has affected deep tissues. In this case, the functionality of the limb is not impaired; the baby can move the arm.

Another sign of the disease is that a cracking and crunching sensation is felt at the site of a possible dislocation. This is due to the so-called phenomenon of crepitation. Doctors diagnose a noticeable deformity that will cause discomfort to the newborn baby.

After a fracture, which is diagnosed by a doctor, the period of first aid begins. First, immobilization is carried out, and if there is bleeding and a hematoma forms, then vitamin K is injected into the vein. At the same time, rubbing in pain-relieving ointments may be prescribed. These include Traumeel S ointment, which can relieve pain, eliminate swelling, and increase tissue regeneration. The trapezius muscle and clavicle are lubricated.

For two weeks, the mother should ensure that the baby does not lie on the side where the bone is broken. When the baby is discharged from the hospital, treatment continues at home. Within 20 days the bone will heal. There should be no consequences of pathology.

The sooner help is provided, the faster the bone can heal. The hands of small children are fixed in two ways, which mothers should know in case they discover a pathology at home.

First, after folding the baby’s arms on his chest, you should bend them at the elbows. Gradually, the damaged limb is brought behind the head, and a stick is placed under the back. It is fixed in the bends of the elbows.

Secondly, the baby’s hand is immobilized, for which a loose bandage is used. And then the limb is fixed with a scarf, which is attached to the neck.

It is worth closely monitoring the baby's condition, since in some cases a fracture of the surgical neck of the humerus can provoke vascular insufficiency. Signs of this will be the appearance of pallor, cold sweat, and increased heart rate. After letting your baby smell ammonia, you need to call an ambulance or take the small child to a medical facility yourself.

During treatment, the hand must be immobilized at all times. Several types of dressings are used for this:

1. Deso, who ties her arm to her chest with bandages covering her shoulder and chest. It is very elastic and soft, which helps to painlessly fix the baby's hand.
2. Delbe rings are excellent for fixing a displaced shoulder fracture.
3. A figure-of-eight bandage that perfectly fixes a dislocation.
4. Crutch-plaster cast.

Recovery period

Children must undergo a special rehabilitation course to restore damaged tissue and strengthen the collarbone. Newborns are prescribed magnetic therapy to use frequencies to influence the damaged area of ​​the shoulder. At the same time, light pen exercises are prescribed.

These are very light bends from side to side with gradual bending. Massage is also mandatory, but only from an experienced and qualified specialist. He is able to choose a set of activities that will not harm the fused bone.

Moms can watch his actions to repeat the exercises at home. Electrophoresis is also useful, helping to restore tissue and bones using current and medication. This has a beneficial effect on the baby’s body, helping to speed up blood flow and healing the injury.

A humerus fracture is a fairly common injury. It accounts for approximately 7% of all possible fractures and occurs due to the impact of a large force that the bone tissue is unable to withstand.

The structure of the humerus

Between the elbow and shoulder joints is a bone called the humerus. It has a tubular structure. According to the anatomical structure, several sections of the bone are distinguished: the body or diaphysis, the proximal epiphysis (upper end) and the distal epiphysis (lower end).

At the proximal end there is a head that serves to connect to the scapula. Immediately behind it is a narrowing called the anatomical neck. Next there are tubercles to which the muscles are attached. Just behind the tubercles there is another narrowing called the surgical neck. It is she who is the most vulnerable point.

The body of the bone is round at the top and becomes triangular at the bottom. The diaphysis has a groove in which the radial nerve runs.

On the lower part of the bone there are 2 articular surfaces, through which it connects to the bones of the forearm. For connection with the ulna there is a block at the distal end. The projections on the sides of the lower end of the bone are called epicondyles. They serve to attach muscles.

Causes of fractures and their types

Fractures are classified according to several characteristics. The main one among them is the location of bone damage, as this affects the choice of treatment tactics. A fracture of the humerus has a code according to ICD 10, which means that this injury in the international classification of diseases belongs to the section “injuries of the shoulder girdle and shoulder.”

Depending on the location of the bone injury, a fracture of the diaphysis, a fracture of the lower and upper end of the humerus are distinguished. Within each of these varieties, subspecies are distinguished depending on the characteristics of the damage.

Upper section

Fractures of the upper end of the humerus include violations of the integrity of the surgical and anatomical neck, greater tubercle, upper epiphysis and proximal end. The cause of their appearance is a blow directly to the bone or a fall on the elbow or abducted arm. A fracture of the tubercle can occur due to very strong muscle contraction.

Middle section

Fractures of the body of the humerus are distinguished by location: upper, middle and lower third. This damage occurs if you fall on a straight arm, elbow, or due to a strong blow.

By nature, these fractures are open, closed, comminuted, displaced, helical, oblique or transverse.

In the lower section

In this department, violations of the integrity of the articular process, lower epiphysis, supracondylar region, internal epicondyle and the condyles themselves can occur. This type of injury occurs due to poor landing on the palm or elbow.

Supracondylar humerus fractures

This is the most common humerus fracture in children. The integrity of the bone is broken along an oblique or transverse line slightly above the epicondyles. There are extension and flexion fractures of this type. The first ones occur when falling on an extended arm, therefore they are called extension ones, and the second ones are flexion ones, as they are formed when an unsuccessful fall on an arm bent at the elbow.

Condylar fractures

With such fractures, both the condyles themselves and pieces of the block along with them can be separated. The fracture usually runs obliquely and penetrates the elbow joint, which becomes very swollen, deformed and increases in size.

Transcondylar fractures of the shoulder

These are intra-articular fractures, which are characterized by simultaneous damage to the integrity of both condyles and the supracondylar region. Such damage usually occurs in accidents and falls from great heights. This is a fairly severe injury, which is accompanied by serious damage to nerves, muscles and blood vessels.

Other types of fractures

Violations of bone integrity are classified according to other criteria:

Characteristic symptoms of fractures of different locations

Proximal humerus

Damage to the upper epiphysis is characterized by:

• severe sharp pain;
• tissue swelling;
• limited or complete absence of mobility in the shoulder joint;
• bruises.

Body of humerus

When the diaphysis is fractured, the following are observed:

If the radial nerve is damaged, loss of sensation may occur, including complete paralysis of the limb.

Distal section

A fracture in the lower part is characterized by:

• severe pain at the site of injury and throughout the arm;
• hemorrhage and swelling;
• deformation and absence or difficulty in mobility of the elbow joint.

In some cases, such a fracture causes tears and serious damage to nerve fibers and blood vessels. This condition is characterized by numbness of the hand and forearm, their pallor and “marbling”, a sensation of “pins and needles” and tingling. In such cases, the victim must be immediately taken to a medical institution, since in the absence of treatment for a long time, complete loss of part of the arm is possible.

Features of a fracture of the humerus in a child

Children, due to their increased mobility, are quite often exposed to fractures and other injuries. In most cases, treatment tactics do not differ from adult patients. Fractures of the lower part of the humerus are especially dangerous in childhood, since this is where the growth points are located. If they are damaged, growth stops, which leads to deformation and disruption of the functioning of the elbow joint.

Shoulder fracture in old age

In old age, the risk of fractures increases significantly, since with age the nutrition of bone tissue is disrupted and it loses its strength. Treatment of such damage is particularly difficult, since regeneration and recovery processes slow down. In addition, most older people suffer from osteoporosis.

Diagnostics

To diagnose a fracture of the humerus, examination and radiography in 2 projections are usually sufficient.

In some cases, if surrounding tissues are damaged or intra-articular fractures, ultrasound, CT or MRI may be necessary.

First aid

First of all, after receiving an injury, the victim must be calmed down. If a person is very worried and panics, you can use sedatives, for example, tincture of valerian or motherwort, Novo-Passit, Sedavit.

Then you need to eliminate the pain. To do this, you can use almost any analgesic or NSAID: Analgin, Diclofenac, Ibuprofen, Ketanov, Nimid, etc.

It is important to immobilize the injured limb. To do this, you can use various available means: planks, sticks, strong rods. They are tied to the shoulder or forearm as carefully as possible so as not to provoke displacement of the fragments. Next, the hand is suspended on a scarf.

If the fracture is open, the site of the soft tissue rupture should be washed if contaminated and a bandage applied. This is where the first aid ends. The victim should be taken to a medical facility. Transported in a sitting position.

Treatment and recovery after a fracture

The choice of treatment tactics depends entirely on the characteristics of the fracture. In most cases, treatment is carried out on an outpatient basis, but sometimes a hospital stay is required.

Treatment of a minor fracture

For a closed fracture of the humerus that is not accompanied by displacement, fixation with a plaster or a special splint is necessary. The fixation period depends on the nature of the damage and can be 1-2 months. The plaster cast covers not only the damaged bone itself, but also the elbow and shoulder joints. If the diaphysis is damaged, then partial coverage of the chest with plaster is required. After wearing the cast, short-term use of a scarf may be recommended.

Treatment of a displaced fracture

A displaced fracture of the humerus has its own treatment characteristics. First of all, a comparison of the fragments is carried out. It must be carried out within the first hours after the injury, before the hand swells too much. The procedure is performed under general anesthesia. To prevent repeated displacement, skeletal traction is used, and then a special splint or orthosis is applied to the arm.

Surgery

A comminuted fracture of the humerus requires surgical intervention. Surgery is also necessary when the integrity of nerve fibers and blood vessels is damaged, in osteoporosis, when tissue is pinched between fragments, or when it is impossible to compare the bone using the closed method.

During surgery, the fragments are fixed using special metal plates, screws, knitting needles and other devices. This intervention is called osteosynthesis. If the head of the bone is split and the joint is seriously damaged, endoprosthetics is performed, which involves the use of an artificial prosthesis.

Complications and prognosis

A non-displaced humerus fracture usually heals without negative consequences. And complex injuries, accompanied by displacement, damage to the joint or the formation of a large number of fragments, can subsequently manifest themselves as various complications in the form of:

• partial or complete loss of sensation in the hand due to rupture of nerve fibers;
• arthrogenic contracture, manifested by limitation of joint movements;
• the formation of a false joint when it is impossible to fuse the fragments due to pinched tissues between them.

Rehabilitation

To restore the full functioning of the hand, rehabilitation measures are necessary. They include massages, physiotherapy, and therapeutic exercises.

Physiotherapy

Physiotherapy usually begins immediately after removal of the immobilizing splint or cast. It is aimed at restoring and improving blood circulation and tissue nutrition, accelerating regeneration, eliminating pain, and reducing swelling. May be prescribed: electrophoresis, ultrasound, ultraviolet irradiation.

Massage

Massage is also prescribed immediately after the cast is removed. Its action is aimed at improving microcirculation and tissue trophism, restoring muscle strength and joint mobility.

How to develop an arm after a humerus fracture

To restore the functionality of the hand to full extent, physical therapy is prescribed. A set of exercises is selected individually, with gradual complication. Within a few days after applying the plaster, you should try to move your fingers. After a week, you can begin to strain the shoulder muscles, and after removing the plaster cast, begin active movements in the elbow and shoulder joints.

Prevention

Prevention of forearm fractures is avoidance of traumatic situations. In addition, it is recommended to lead a healthy lifestyle, eat well, and, if necessary, take vitamin and mineral complexes to strengthen bone tissue.

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This fracture is more common in children. In most cases, the medial epicondyle is damaged laterally.

In humans, at the age of five to seven years, an ossification center of the medial epicondyle appears, and only by the age of twenty does it merge with the distal part of the humerus.

Fractures of the epicondyles of the humerus occur mainly in childhood and adolescence as a result of a fall on an outstretched arm (hand) with a sudden deviation of the forearm outward (less often inward).

At this moment, excessive tension occurs in the internal collateral ligament, which tears off the epicondyle, i.e. the mechanism of injury is indirect.

Fractures of the epicondyles from direct traumatic force occur much less frequently. More often, epicondyle fractures are combined with traumatic posterolateral dislocations of the forearm.

Symptoms

Acute pain, swelling, and hemorrhage occur along the inner surface of the elbow joint, which leads to an asymmetrical defiguration of the elbow joint.

The victim fixes his arm half-bent at the elbow joint, active and passive movements are limited, painful, intensified when trying to clench his fingers into a fist or when impulsively contracting the flexor muscles of the hand and fingers.

On palpation, pain is localized in the area of ​​​​the projection of the epicondyle. Sometimes crepitus of the fragments is felt, Huter's triangle, and Marx's sign are violated.

The forward and downward displacement of the epicondyle is caused by contraction of the flexors of the hand and fingers. Sometimes the epicondyle rotates around the sagittal axis at 90°. Wedging of the epicondyle between the articular surfaces occurs, which causes a block of the elbow joint.

Urgent Care

If a fracture of the internal epicondyle of the humerus is suspected, the victim must be given pain relief and the elbow joint should be secured with any available means.

To do this, you can use planks, rods, cardboard, bandages, fabric, and hang them on a scarf over your head. Then urgently seek help from qualified specialists.

Treatment

No offset

They are treated conservatively. Immobilization with a posterior plaster splint from the upper third of the shoulder to the heads of the metacarpal bones for a period of 3-4 weeks.

With offset

Subject to surgical intervention. A semi-oval or bayonet-shaped Ollier approach, 5-6 cm long, is used along the inner surface of the elbow joint, the center of which corresponds to the projection of the epicondyle. The skin, subcutaneous tissue, and fascia are dissected and hemostasis is performed.

The wound is opened with hooks, blood clots are removed, and the displaced epicondyle is isolated. If a small section of the epicondyle is torn off or the fracture is a fragment, the epicondyle is removed.

The muscles that originate from the epicondyle are sutured with a U-shaped silk (nylon) suture, the forearm is bent to an angle of 120-110° and the muscles are transosseously sutured to the condyle.

In cases where the epicondyle is torn off and rotated, with the forearm half-bent, it is pulled proximally, rotation is eliminated, the fracture plane is cleared of blood clots, compared and fixed with metal screws.

In children, the epicondyle is fixed with catgut or nylon sutures. After synthesis, the soft tissue is carefully sutured over the fracture and the wound is sutured tightly in layers.

Immobilization is carried out with a posterior plaster splint for a period of 3-4 weeks. During surgery and suturing of soft tissues, it is necessary to prevent damage to the ulnar nerve.

If there is a block of the elbow joint

An arcuate incision 6-7 cm long above the apex of the medial condyle of the humerus is used to dissect the skin, subcutaneous tissue, and fascia.

Hemostasis is performed and the wound is widened with hooks, the fracture plane on the condyle is identified, and blood clots are removed.

Then, in the distal part of the wound, bundles of muscles of the flexors of the hand and fingers are found, the proximal end of which is immersed from the epicondyle into the joint cavity.

The assistant tilts the forearms outward, the joint space on the medial side widens, the surgeon at this time identifies the herniation of the epicondyle and brings it into the wound. An assistant bends the forearm to an angle of 120-110°, the fragments are compared and fixed with metal or bone nails or a screw.

Soft tissues are carefully sutured over the fracture site, and the wound is sutured tightly. Immobilization is carried out with a posterior plaster splint from the upper third of the shoulder to the heads of the metacarpal bones for a period of 3-4 weeks.