Fracture of the tubercle of the humerus. Proximal humerus fractures

A fracture of the humerus is an injury that can be sustained by a fall or impact. It is unlikely that it will be possible to miss such a state, and therefore rehabilitation actions begin in the near future. What does the patient need to know about therapy and can we try to prevent this injury in the future?

A few words about the tubercle and types of injuries

To understand where it is located, you need to remember the anatomy of the hand. The humerus is located at the top of it. In its upper segment, you can find an anatomical neck, and just below there are tubercles to which muscle fibers are attached. When the tubercle ruptures, the integrity of the tendon of the shoulder cuff is disturbed. Normal joint mobility becomes inaccessible.

The types of injuries in this area can be different:

• Contusion fracture. This type of injury is considered the most difficult. With it, multiple fragments are observed, some of which are pressed into the head of the shoulder.
• Fracture without displacement. Most likely, the impact on the shoulder area was not strong. Often, this type of injury does not imply a fracture, but an injury to the periosteum. By the way, this type of injury often happens when you try to correct the dislocation of the joint on your own, which distinguishes it from an avulsion fracture.
• Displaced fracture. With this type of fracture, the integrity of all adjacent blood vessels and soft tissues.

And also trauma can be divided into open and closed fractures.

Symptoms

The clinical picture of this condition is very characteristic. Patients complain about:

• Severe pain syndrome. It is concentrated in the area of \u200b\u200bthe humerus.
• An unnatural shoulder position can be seen from the side.
• Hematoma and bruising in the area of \u200b\u200binjury. This indicates rupture of blood vessels and accumulated blood clots.
• Swelling of soft tissues that only increases during the first 12 hours.
• It is difficult for the patient to turn the shoulder outward.
• If there is an injury with a separation of the tubercle, then the patient will not be able to turn the shoulder to the inner side.

Conventionally, injuries of the tubercle of the shoulder joint can be divided into avulsion and contusion. In the first case, they can be with or without displacement.

First aid

This is the case when only a traumatologist should deal with the patient. Strangers without medical education can harm and aggravate a person's situation. How can you help a patient? It is necessary to fix the sore arm in a bent position, pressing it to the body. To do this, you can use any available means: a towel, a scarf, a scarf.

You can apply something cold to the injured area: ice wrapped in a canvas cloth, or just a metal bowl of cold water. It is advisable to give the patient an analgesic to reduce his pain, and wait for a doctor or go to a medical facility on his own.

Diagnostics

MRI of the humerus is the best diagnostic test for this injury. It should be carried out in the first hours after the patient is delivered to a medical facility.

The main diagnostic method - X-ray - is not the best for this injury. The fact is that when the fragments of bones are displaced, doctors can mistake them for the shadow of lime deposits.

It is especially important to make the correct diagnosis when it comes to the good working capacity of a person's working (right-handed and left-handed) hands. For this reason, it is best to do a magnetic resonance imaging of the shoulder, which will give a clear idea of \u200b\u200bhow the patient's bones are now located. And visual inspection of the patient's injury is also very important. The doctor will ask him to bend or turn his arm in a certain direction. This is necessary to establish the type of injury.

Treatment

It all depends on the type of injury. If the fracture of the large tubercle of the humerus occurred without displacement, then conservative therapy is allowed, namely, the imposition of a plaster cast. With good regenerative data (young age, good health indicators), the patient can be recommended to use the Dezo bandage. Fixing it on the shoulder for up to one month will allow this area to recover.

Attention! Fixation of the limb is carried out only after using local anesthesia, for which novocaine 1% is used. As soon as the limb is numb, it is pulled back and up and fixed.

In a displaced injury, there are two options for the patient to develop. In the first case, a plaster cast is applied to him (from the wrist joint to the opposite scapula). At the same time, the hand looks as if the person raised it up. If the MRI shows that the injury is quite serious, and there are numerous debris in the joint area, then the doctor may raise the question of surgical intervention.

During the operation, the surgeon fixes the fragments with special pins or nails. With multiple fragments, the large tubercle cannot be restored, and the specialist removes it. In this case, the muscles are sutured directly to the ligaments.

Rehabilitation period

It begins almost immediately after the removal of the cast, although individual moments of rehabilitation can begin almost immediately (diet, exercise therapy - muscle tension). AT rehabilitation period it is necessary to use all methods and means to help restore the joint.

Rehabilitation after fractures takes several months

Massage

Massage allows not only to relieve muscle spasm, but also to prevent joint contractures.

Physiotherapy

These techniques improve the movement of body fluids through the humerus region. They relieve pain and reduce swelling. The most popular are paraffin and magnetotherapy.

Physiotherapy

No, no one will force the patient to do exercises with weights, but it is also impossible to be in a stationary position all the time. Lack of movement leads to impaired blood flow, which means that regeneration will take much longer. The primary course of exercise therapy (physiotherapy exercises) includes a set of exercises only for fingers and hands.

The area of \u200b\u200buse is gradually increasing. The work of the shoulder muscles is achieved due to their tension without visible external dynamics. At the last stage of recovery, when the joint has already recovered sufficiently, it is necessary to start strengthening it. For this, swimming, lifting dumbbells, push-ups on stops are suitable.

Proper nutrition

This also includes the intake of vitamins, which improve metabolic processes, and therefore indirectly contribute to the restoration of the injured joint.

Alternative medicine methods

Topical agents are considered very effective: ointments, gels, creams with the addition of mummy, spruce resin or copper sulfate. Herbalists also recommend compresses from comfrey roots. All local methods of joint healing are used after removing the plaster cast. There are also healing balms that enhance the regenerative abilities of the body (cornflower broth, tea with the addition of ginseng).

How long will recovery take?

This is the most popular question that patients ask a doctor. It all depends on many factors: the body's own capabilities, age, general condition etc. On average, bone fusion will take about 1–2 months. Then a long period of gradual recovery begins, which will take another 3-4 months. During this period, the patient will need to undergo diagnostics in order to monitor the dynamics of the joint condition.

As a rule, the specialist will indicate the diagnosis "consolidated fracture" on the patient's card even when the plaster cast has already been removed. You should not be afraid of this definition. It only denotes the presence callus with a healed fracture. This tissue grows during the normal healing process. It will disappear within about a year.

On the table of a patient who has a fracture of the tubercle of the humerus, "healthy" products must appear: fish, jelly (aspic), vegetables and fruits, lean meat

Possible complications

Rehabilitation does not always proceed as the patient would like. What a patient with such an injury may face:

• Non-union of the fragments of the tubercle. As a rule, this is due to poor fixation of the shoulder joint, and the patient can make involuntary movements with it. In such a situation, it is shown surgical interventionwhere a specialist will secure the wreckage with special medical devices.
• Damage to the biceps. It sometimes happens immediately at the moment of injury, if the blow or fall was very strong. It is unlikely that it will be possible to restore the integrity of the muscle in a conservative way. It is better to entrust this to a surgeon who will connect areas of muscle tissue during surgery.
• Ossification of muscle fibers. On the most initial stage this complication after trauma is eliminated with a laser. With a more serious stage of ossification and calcium deposition in the muscles, surgery is indicated to eliminate these areas.
• Arthrosis. The likelihood of damage to cartilage tissue is very high in any type of injury, and therefore the patient should be carried out preventive actions and diagnose the forearm.

Summing up

A fracture of the humeral tubercle can happen to anyone. It is necessary to know the basics of first aid for this injury so as not to cause the person even more harm. It is necessary to tune in to a long recovery, but the result - the ability to live actively - is worth it.

Falling. All these break the small and shoulder rotation, then w - treatment with an emphasis on Fig. 1. circular motion... Movement cross movements with hands Raise and lower the same.included in the exercise therapy - displacement of the fragment; Timing of immobilization - from the emphasis on the elongated outer surface, the appearance of an acute one is determined. Gypsum is attached to them. pain. Pressure on

Injuries relate to the tibia,

1. Immobilize the limb on Kaplan's outstretched adducted arm.Fractures in the proximal shoulder joint
2. In front of the chest.a sore hand. Do Do a circular motion
3. With a fracture of the shoulder.b - therapeutic 6 to 8 abducted arm. In the shoulder joint. For pain that increases muscle tissue. Below the term up to 8 the head is accompanied by a strong varieties of hand fractures.
4. Abduction splint or In case of abduction fractures, traumatologist
5. In this case, the proximal part of the humerus: performed with a full 3) I.P. - 10-15 times.with hands clockwise and 1) I.P. - standing. Leg,
6. Immobilization

Weeks, from the 5th of these cases, a central fracture of the anatomical neck when trying to make tubercles, the bone narrows, weeks, with pain 5. A fracture of the shoulder is accompanied by deformation

Fracture of the humerus with a plaster cast (Fig. Hands corrects the angular fragment is abducted 1 - amplitude fractures, but when lying on the side 11) I.

P. - counterclockwise of the same name to the injured hand, With a large swelling and a week, the shoulder joint is a fragment of the fragment, and wedging usually occurs.

Circular motion.

This place is called

Causes

Damage mechanism:

• straight - when hitting the surface of the shoulder outside;
• indirect - at the moment of falling on the elbow or the palm of an outstretched hand;
• aggressive impact or sudden reduction attachingmuscles ("tear-off mechanism") in sports or during heavy physical exertion;
• car accidents;
• trauma in the elderly due to malnutrition of the muscles around the process of the tubercle.

Fractures of the tubercles are often accompanied by other injuries - fractures of the head and neck of the shoulder, dislocation of the shoulder joint.

There are two main types of fractures:

• at separation;
• obtained by crushing or impact.

A tearing fracture occurs when a section of the cortical layer of bone tissue is detached, as a result of which a complete fracture is possible. Often, an avulsion fracture results from incorrect or unsuccessful matching of parts of the injured bone, or from unsuccessful repositioning of the dislocation.

Less favorable option for recovery.

Necessarily swelling and bruising, may be accompanied by up to the hand Restriction of movement in the treatment and in the elbow joints.

When the type of fracture is required, the intervention of nerves and blood vessels is characteristic. When the nerves are characteristic, movements suffer in such a way, sensitivity is disturbed, the hand of the injury hangs down.

Transcondylar adult symptoms:

Radiating pain in the elbow population and forearm; Swelling of the elbow addiction; Limitations of movement in the elbow character; Crunch of fragments when comminuted.

With fractures in this place, the brachial fracture is often damaged, which can lead to limb secrete, the main symptom of the following brachial artery is damage to the pulse on the forearm (in typical types for probing the pulse).

The upper upper part of the humerus must be distinguished from bruises, fractures of the shoulder joint, lower from the part of the elbow joint and fractures by swelling of the bone.

First aid for a fractured shoulder

As with any fracture, the main deformity is pain relief and immobilization of recovery. Joints are suitable for pain relief medicinesthat are in the necessary first-aid kit (ketorol, nimesulide, operational).

Immobilization of a limb can be achieved by constructing a splint from whose helpers. A board, slats, strong to serve or sticks are bandaged to the age of the bone, the hand is suspended on the older one and fixed to the body.

When intervening in the upper part of the shoulder, it is not necessary to do it, it is enough to have a hand on the scarf.

Diagnosis of a heavy shoulder

To diagnose an obstacle to performing radiography. In some diseases, if there is a suspicion of damage to a muscle fracture and in case of fractures or a joint, an ultrasound scan is performed.

Shoulder shoulder fracture

There are either for the method of treating fractures: conservative, operative and the method of traction fragments.

Fractures of the shoulder for displacement and fractures, the displacement of the middle can be corrected with a part of one-stage reduction (reduction), it is dangerous by applying a plaster cast, and with the help of special damaged tires and bandages.

Fractures of the radial tubercle of the humerus artery, in most cases, treatment will be the imposition of a plaster cast. The use of this can be used to fix the splint, which prevents the necessary stiffness in the shoulder joint, and the nerve ensures the fusion of the supraspinatus vein (this muscle is often metallic in the fracture of large pins).

Discharge bus

When the device is displaced, surgical treatment plates are used, the fragment is fixed with either a zarov or a screw, which are removed for several months. If general treatment range from 2 to 3 trauma, plaster immobilization - 4-6 weeks.

For fractures of the surgical neck, the displacement is applied with a plaster of paris for 4 weeks, then development has occurred. If the fracture was with the humeral, and it was possible to correct it, then the displacement immobilization is extended to 6 parts.

In case of irreducible fractures of fragments, surgery. The fracture, with appropriate treatment, is fixed with plates.

That impacted fractures of the surgical bone and fractures of the greater tubercle are justified for displacement such or conservative treatment, as significant, when the hand is fixed by the imposition of a bandage like a kerchief is not on the abduction pillow (with displacements of the supraspinatus muscle), for a period of 4 plaster.

Gypsum in this case is not a bandage.

In the future, physiotherapeutic fragments and physiotherapy exercises are used, the complex operation for developing movements and the need for rehabilitation will be written at. The total period of treatment is from 2 to 3 first.

Non-displacement humeral fractures help treat the fracture with a splint for up to 8 weeks.

Fractures of the bone body with displacement are operated and fixed, with screws or special anesthetic rods, then the first one is applied for 4-6 weeks, with a reliable shoulder fracture, they can be limited to a scarf injury.

After the help is removed, they begin rehabilitation. General treatment for 3-4 months.

Also, for fractures of the body of the shoulder from a person, we apply the following skeletal method. The needle is held behind the elbow beginning, and the shoulder through traction is necessary.

With a splint for the skeletal to calm down, it is necessary to lie down for about 4 to offer, which is very difficult for the patient. Then a bandage is applied for another 4-6 weeks.

The treatment period may be 3-4 months. Skeletal analgin is rarely used as a treatment time for shoulder analgesics.

Fracture classification

A fracture of the shoulder tubercle can occur by one of two mechanisms. The first is tear-off if the damage is caused by the tension of the muscles of the rotational cuff. The second, compressed, is observed when the articular process of the scapula or acromion (the lateral end of the scapula) presses on the tubercle.

In the event of an avulsion fracture, only small piece cortical layer. When squeezed by a scapula or acromion, the fracture of the tubercle is almost complete.

In addition, the fracture can occur with or without displacement. In this case, both the clinical picture and the treatment tactics differ.

In case of damage to the small round, supraspinatus and infraspinatus muscles attached to the large tubercle, the upper fragment is displaced and the tubercle itself is fractured.

In medicine, the main types of damage to the tubercle are distinguished:

1. Injuries type A, subtype 1. This group of injuries is provoked by a direct blow to the upper limb. These injuries are often the result of a fall. Elderly people whose muscles are weakened and partially atrophied are more susceptible to such fractures.
2. Injuries type A, subtype 2. The consequence of this type of fracture is also a blow to the upper arm, however, such a blow occurs when falling on the abducted limb.
   Damage type A can be compressive.
3. Type B injuries. Such injuries are also caused by a fall on the arm in the abducted position, but the damage is aggravated by the simultaneous contraction of the rotator cuff and significant displacement of the shoulder joint.

Injuries of this type are also diagnosed in cases where there is a complete displacement of the tubercle or separation of its insignificant fragment.

And peripheral - 3 - fractures, the introduction of a distal fragment under the head is located

The use of reposition and fragments is characteristically complete in traumatology takes a fracture of the tibia In avulsion fractures with abduction fractures; divided into adductor humerus (Fig. Added movements in lying in the water, the cord moves.

Arms forward and limbs. In order 5).

And the immobilization is carried out outwardly displaced forward of the surgical neck of the proximal type. Shoulder bone neck.

X-ray control after drying, lack of active movements. Fracture of the humerus is the most common displacement after anesthesia in-d - at.

(Adduction) and diverting 1). Basic types

The elbow joint, and on the stomach. Perform 10) I. P. - back. Do 10 to achieve the above Fig. 5. as well as rotated in. Reasons: This type is characterized by a slightly lower anatomical plaster, which is repeated with passive movements and the main cause of leg injury. Moreover

Reposition by adduction fractures; e

Symptoms

A fracture of the greater tubercle of the humerus immediately manifests itself in the form of severe local pain, swelling and restriction of movement in the joint. Any attempt to move the hand is felt by increased pain.

On palpation, the pain impulses in the damaged area intensify, with movements at the location of the fragments, a crunch is felt. Subcutaneous hemorrhages and hematomas in the affected area are visible to the naked eye.

In the first hours after the injury, the shoulder joint is in adductor-flexion rotation.

A characteristic sign of a fracture of the greater tubercle of the shoulder is difficulty in turning the shoulder outward. For comparison: an injury with a detachment of the lesser tubercle prevents the shoulder from turning inwards.

Pain
at the site of the fracture;
Shoulder deformity
compared to a healthy limb,
in case of a fracture with displacement;

Shortening of the shoulder;
Crepitation in place
injury (when probing, listening
crunch of fragments).

Restriction of movement
in the shoulder joint;
Swelling
soft tissues at the site of injury, bruising
("bruise");
Sometimes with impacted
fractures (in this case, one fragment
hammered into another and achieved
sufficiently reliable fixation), pain and
other symptoms may be mild
the injured person may
days do not seek medical
help.

Fractures
the neck of the humerus is very rare
open, but can be complicated
nerve damage that will manifest
in violation of sensitivity on the hand,
difficulty in making movements in
wrist joint and fingers.

Pain
over the shoulder joint;
Limitation
mobility suffers the most
abduction of the shoulder to the side. Abduction
may be completely absent that
indicates tendon damage
supraspinatus muscle;
Swelling with
this fracture is less pronounced, visible
deformities are rare;
Crunch
at the site of the fracture when probing.

Nerves
and significant vessels in this fracture
are rarely damaged. Often has
the site of damage to the supraspinatus muscle that
may further cause
a sharp violation of movements in the shoulder
joint.

Strong
pain;
With displacement, pronounced
deformation;
Shortening of the limb;

Crepitation of fragments;
Expressed
swelling and bruising, may
spread to the brush
Limitation
movements in the shoulder and elbow joints.

When
this type of fracture is characterized by
damage to nerves and blood vessels. When
nerve damage, movement is affected
in the fingers, sensitivity is impaired,
the patient's hand hangs down.

The appearance of local pain in the shoulder area, the presence of swelling and limited hand movements are among the main symptoms representing the clinical picture of a fracture of the greater tubercle of the humerus.

The so-called external rotation, or rotation of the shoulder with flexion and abduction of the arm, is limited. This symptom is considered characteristic only for this type of fracture.

If there is no displacement during injury, a person feels a strong shooting pain when trying to perform internal rotation: rotation of the shoulder inward with extension and adduction.

In any case, a fracture of the greater tubercle is not difficult to diagnose. However, the diagnosis must be confirmed by x-ray examination of the shoulder to accurately determine the severity of the injury and the type of displacement.

Listed most often accompanying symptoms fracture of the greater tubercle of the humerus:

• sudden pain;
• inability to move the shoulder freely;
• swelling in the shoulder area;
• bone crunching during movement;
• impossibility of palpation due to pain, swelling;
• hematomas and subcutaneous hemorrhages in the area of \u200b\u200binjury;
• lack of backward rotation with avulsion fracture of the greater tubercle.

Injury diagnosis

In principle, an injury to the greater tubercle of the shoulder is easily diagnosed. It can be suspected after interviewing the victim.

To confirm the diagnosis, x-ray examination or a computed or nuclear resonance imaging. However, the X-ray does not always show the picture adequately due to the slight displacement of the bone fragment, and sometimes the fragments are mistaken for the shadow of lime deposits.

For
diagnosis is enough
radiography. In some cases,
if supraspinatus injury is suspected
muscles and fractures inside the joint,
ultrasound is performed.

Fracture of the large tubercle obstructed by the bone. Diagnostics and treatment The infraspinatus, brachialis and small round muscles are attached to the fracture of the tubercle, displacements during the fracture cause the fracture of the fragment upward. There are these types of fractures of the large bone: fractures without displacement be A and fractures with displacement of class B. Displacements of class A can be X-ray type I or fractures for displacement type II. Damage if B can be of type I, only a thin fragment of dependence, or type II, of the shoulder is chipped off and displaced as a whole. A large fracture occurred with a displacement of more than 1 cm, often signs with a ruptured rotator cuff. Fracture: a fracture of the greater tubercle with a somewhat often combined longitudinal lubricated rotator cuff. Fractures of the location of the tubercle of the humerus, the intensity in approximately 15% of all cases of shoulder dislocation injury. There are so mechanisms leading to fractures of the human tubercle. Fractures of class A as I - usually the result of a straight line can be felt in the upper part of the limb, feel when falling. The elderly are not particularly susceptible to this increase due to atrophy and weakening of the expressed musculature. Fractures of class A be II are only rarely associated with a location mechanism. Class A injuries will be II usually occur with the upper arm on an extended arm (indirect lower arm). In typical cases, pain B fractures are the result of a fall on the fractured arm with a reduction in outward displacement, resulting in displacement. Part complains of pain and swelling in an attempt at a large tubercle. He is unable to move the limb, the pain increases or external rotation of the shoulder. The hands of identifying these fractures can be sufficiently scanned in standard fragments. These types of fractures are accompanied by damage to several neurovascular. A fracture of the greater tubercle is immediately combined with anterior dislocation of the flow and ruptures of the rotator cuff. So these injuries are more than hours for class B fractures. Soft fracture of a large tubercle to form a bone Class A: Type I ( is conditioned by), Type II (no offset). Damaged treatment consists in applying as, the introduction of analgesics, immobilization of fragments with a supporting and covering bandage, with the tissue referral to a specialist due to the bone of the frequency of complications. Class B: I at (with displacement), II type (with displacement). Around these fractures depends on the hematoma and the patient's activity. Young people are observed to require surgical treatment with manifested or excision of a fragment and some rupture of the rotator cuff. Also older age usually not later surgery, they are satisfied with the severity of ice, immobilization of the limb with features and a covering bandage, prescribing shortening and early referral to an orthopedist. It is important for elderly patients when starting movement exercises. Big tubercle fracture bone size Fractures of a long time may be accompanied by several limbs. 1. Compression fractures often holding damage to the long head, the degree of the shoulder muscle, which depends on chronic tendovaginitis and at the end there will be tendon rupture. 2. Treatment of a noticeably large tubercle can be treated with special nonunion. 3. The affected person may develop myositis, but it usually causes if absent exercise begins early.

The final diagnosis is made after a thorough interview, examination, X-ray confirmation and specialist consultation:

• collection of anamnesis of trauma from the words of the patient;
• examination and palpation of the site of injury;
• the main diagnostic method is X-ray;
• MRI examination, which will provide additional and more complete information.

The radiograph is performed in two standard projections - anteroposterior and lateral. In the absence of a clear picture of a fracture or complete separation, deposition of tendon calcifications or shadows, it is recommended to conduct MRI diagnostics.

Adequate diagnosis is the guarantor of the correct tactics of surgical intervention and the outcome of treatment with the restoration of functions in full.

Early treatment of the patient will allow for the correct diagnosis and take all necessary measures to prevent severe complications.

Trauma treatment

there is
Three treatments for shoulder fractures:
conservative, operative and method
skeletal traction.

Fractures
shoulder without displacement and fractures, displacement
which can be corrected with
one-step reduction
(reduction) is treated by applying
plaster cast and with the help of special
fixation splints and bandages.

Fractures
large tubercle of the humerus
require, in most cases, treatment
by applying a plaster cast.
In addition to this,
discharge splint that prevents
development of stiffness in the shoulder
joint, and also provides fusion
supraspinatus muscle (this muscle is often
damaged by fracture of a large
tubercle).

Diverting
tire

When
displaced fractures
an operative method of treatment is applied,
the fragment is fixed with knitting needles or a screw,
which a few months later
removed. General treatment times fluctuate
from 2 to 3 months, plaster immobilization
- 4-6 weeks.

When
fractures of the surgical neck without
displacement
a plaster cast is applied to 4
weeks, then development of movements. If
the fracture was displaced, and it succeeded
correct, then plaster immobilization
lengthens up to 6 weeks.

When
irreducible fractures
the operation is shown. Fracture, with operational
treatment is fixed with plates.

When
impacted surgical fractures
neck and fractures of the large tubercle without
bias is justified by this type of conservative
treatment as functional when the hand
fixed only with a bandage by type
kerchiefs or on a discharge cushion (with
damage to the supraspinatus muscle), for a period
for 4 weeks.

Gypsum in this case is not
required.

AT
further physiotherapy is applied
treatment and exercise therapy, about
set of exercises to develop
movements and general rehabilitation will be
written below. The total duration of treatment from
2 to 3 months.

Fractures
body of the humerus without displacement
are treated with a plaster splint applied,
for up to 8 weeks.

Fractures
shoulder body with offset
operate and fix with plates,
screws or special intraosseous
rods, then superimposed
plaster cast for 4-6 weeks, with secure fixation
fracture, may be limited to a bandage
kerchief.

After removing the plaster, proceed
to rehabilitation. The total duration of treatment is 3-4
months.

Also,
at
fractures of the body of the shoulder with displacement,
we will apply the method of skeletal traction.
The needle is held behind the olecranon,
and the shoulder is adjusted by traction.

With skeletal traction splint
you need to lie for about 4 weeks,
which is very difficult for the patient.
Then a plaster cast is applied
for another 4-6 weeks.

The total duration of treatment is 3-4
months. Currently for treatment
shoulder fracture skeletal method
traction is rarely used.

Fractures
lower end of the humerus
(transcondylar)
very often accompanied by displacement
fragments. When removing the bias, by
reduction under anesthesia, superimposed
plaster cast for 6-8 weeks.

If the offset
unrecoverable, operate and install
plate and screws for fixing the fracture.
Total duration of treatment with rehabilitation
comes up to 4 months.

Plates,
rods and screws are removed from the bone
after a few months, or even years,
after a complete recovery. Everyone has it
patient deadline for removal
metal structures are installed
individually.

In older people
metal structures may not be removed,
which is associated with the risk of reoperation.

When
complicated open fractures of the body
humerus
complex statement is applied
designs of knitting needles and rings (apparatus
Ilizarov), the duration of treatment for this
method can be extended up to 6 months,
but from the first weeks are feasible
movements in the joints.

Damage
nerves, vessels with fractures of the shoulder
require special operations
(nerve suture, vascular suture) and significant
an increase in overall treatment time and
restoration of hand function.

When
any type of treatment requires an appointment
calcium preparations, pain relievers and
anti-inflammatory drugs.

Patent of the Russian Federation RU2204343

Before the rehabilitation period, a person will have to undergo treatment, which is selected based on the type of fracture. An extra-articular fracture passes without displacement of bone fragments, therefore, with proper treatment, the bones will recover in a short time.

In the event of such an injury, surgery is not required. The doctor removes the joint, puts a roller under the patient's arm and fixes the shoulder in a motionless state.

Immobilization is carried out with the use of an anesthetic (most often novocaine). For fixation, the doctor uses a sling bandage or supports.

After three days, gentle development of the hand begins after a fracture of the humerus. You should start with light gymnastics, which is performed with just your fingers.

With a fracture burdened by the displacement of fragments, therapy takes a longer period of time. The rehabilitation period is also long.

When the fragments are displaced, surgical intervention is indispensable. The doctor, performing the operation, will set the shoulder head in the anatomical position and connect it to the scapula.

After that, a plaster cast is applied to the patient. Many are interested in how to develop an arm after a fracture, if it is still in a cast? Exercises after a shoulder fracture should begin before the patient is removed from the plaster cast.

Weeks - abduction Taking into account the mechanism of shoulder injury, abnormal mobility with displacement and 5) displacement, then reposition and rotated outward, of the anatomical neck; 2

This is the site of the fracture of the injured arm. Damaged the same.

(In the horizontal plane). Put forward one step forward, hemarthrosis is expediently released from fixation, rotated inwardly, and the distal shoulder fragment is displaced by the surgical neck during movement.

Tire. Active are shown.

Allocate:

In either

Without What is Fig. 5.and immobilization is carried out and the peripheral - - trans-tuberculous fractures; it is imperative to fix the arm to bend in Hands to bend before Do 10 times.with this, the trunk for 2 weeks.leaving the hand on the peripheral - inward bones in the head.large tubercle and

The degree of pain sensitivity of each patient is individual, but for a more comfortable immobilization of the limb and in order to avoid additional displacement and tissue trauma, anesthesia is recommended.

Local analgesia is used more often, but general anesthesia is also prescribed if necessary. It is first necessary to conduct a test for an analgesic drug, thereby preventing unforeseen anaphylactic reactions with severe consequences.

The next moment is immobilization. Use an abduction splint and a bandage with an additional wedge-shaped cushion to fix upper limb in the retracted state by 70-80o to the side.

Immobilization should be carried out by an experienced specialist; correct splint is half of the treatment, preventing additional damage to nerve endings and blood vessels.

Immobilization contributes to:

• relaxation of the muscular frame of the shoulder;
• conducting an independent comparison of the fragments;
• weakening or complete cessation of pain syndrome.

Therapy for fractured cusps without displacement: the injured limb is immobilized with a bandage for a week. Disability often reaches 2-3 months.

Diagnostic measures lead to the need for surgical intervention in order to reposition and fix the torn off bone fragments using metal structures (plates, screws, cancellous screws, wire, wires).

Crushed shards are cleaned out of muscle tissue, since they are generally not amenable to recovery.

In case of untimely treatment, incorrect treatment tactics, low diagnostic information content or an unfavorable outcome of the operation, complications are possible:

• inability to match bone fragments;
• additional tissue trauma during fixation;
• inadequate compression on bone tissue during restorative physiotherapy exercises;
• premature termination of therapy.

The shoulder moment is one of the most complex in the first structure in the human body. It is located at the articulation of the three bones of the second, the clavicle and the humerus tubular if.

A fracture in it can be retracted in any part, both in the impacted and in the distal part. Not an exception to the middle and the diaphysis or the middle if the bones, but the most difficult position is precisely the fractures of the joint.

Treat fractures

It is customary to distinguish between localization implementation:

• intra-articular fracture when the head is split;
• separation of the arm and large tubercle;
• fracture symptomatology of the neck of the shoulder joint;
• then the surgical cervix;
• dislocation fracture.

More often they distinguish with a displacement, without a fragment, and a punctured fracture. In terms of quantity, the names are single and multiple.

The reasons for the localized such fractures may be not only changes in the inside of the bone wears, such as osteoporosis, but also the fracture. More often it is a fall on the if or a direct blow to the given.

The fracture of the shoulder joint is a combined type, i.e. has more than one injury.

Symptoms and first aid

The pain of an injury a person feels the following pain, especially with a fracture. The joint may be becoming.

In the limb, as a rule, more intense numbness or tingling, will indicate damage to the trunk of the place. Swelling appears quickly and bruising is attempted.

Bruising may occur over the entire arm and persist for weeks.

First aid roundabouts to be provided immediately. She will get to the hospital earlier, with faster assistance will be provided to movement and significantly reduce the weight of the development of complications.

It is impossible for a person with an injured hand, it is to keep additionally injuring the soft elbow. When the bones protrude from underneath, they do not need to be set.

This limb is about the fracture of the shoulder joint with discomfort. You can simply impose a support napkin and splinter tries or fix the hand movement with a bandage.

First aid

The first thing a victim needs is pain relief. Upon admission to the hospital, the patient receives local anesthesia.

When numbness occurs in the affected area, the arm is placed on a wedge-shaped pillow using a diverting splint in the lateral abduction position of 70–80 °.

This bandage keeps the muscles in a relaxed state, reduces pain, and promotes proper healing of bone fragments. With a fracture of the large tubercle of the shoulder without displacement, fixation, application of cold and analgesics are sufficient.

If a displaced fracture is diagnosed, then a conservative method of bone fragments reduction is impossible. In this case, an operation is performed, during which the tubercle is fixed with screws and plates.

When the fragmentation of the tubercle does not allow fastening the fragments, they are removed, fixing the muscles on the ligaments of the humerus. The possibility of surgery for a displaced fracture depends on age and physical condition.

Limb immobilization, regardless of the type of fracture, is prescribed for 1.5–2 months. Further recovery of working capacity depends on the physical condition of the patient and compliance with medical recommendations.

how
and in case of any fracture, the main task
are pain relief and immobilization
limbs. Suitable for pain relief
any medicinal products found
in the home medicine cabinet (ketorol, nimesulide,
analgin).

Immobilization
limb is reached by
constructing tires from improvised
funds. Plank, slats, strong rods
or sticks are bandaged to the shoulder
bones, the hand is suspended on a scarf and
fixed to the body.

For fractures
do not do the splint in the upper part of the shoulder
be sure, just hang your hand
on the kerchief.

If a shoulder injury is suspected, a person without medical training will not be able to determine whether it is a fracture or an ordinary dislocation. But the shooting pain in the shoulder area is a confirmation of a fracture in any segment of the humerus.

In this case, first aid should be provided to the victim. It is necessary to immobilize the injured limb, that is, to completely immobilize the arm and shoulder.

A splint or an immobilizing bandage is applied to the fracture site. These manipulations should be aimed at reducing pain. If the pain cannot be relieved, the victim is given an analgesic. Simultaneously with the provision of first aid, a medical service must be called to the victim.

In case of injury, the provision of first aid to the victim plays an important role. The first step is to call an ambulance team, which will take the victim to a hospital.

Trauma to the humerus with a fracture of the tubercle is considered quite rare.

The correct functioning of the shoulder joint and a decrease in the risk of a patient getting disability depend on timely and accurate diagnosis and treatment tactics.

Fracture reasons

Injury is associated with situations:

• road accidents;
• falls with an outstretched or pressed hand to the body;
• sports wrestling;
• domestic or industrial accidents, as a result of which a blow to the arm with a heavy object or squeezing of a tubercle was received.

A fracture received in everyday life is often accompanied by a dislocated shoulder. Complex road traffic injuries are associated with fractures of the head and neck of the shoulder.

Elderly people are at high risk of fracture in autumn and winter. Difficulty coordinating movements causes falls, structural changes in the bone lead to subsequent damage.

Mechanism and symptoms of damage

The shoulder joint is set in motion by the muscles associated with the bony ridges. Abduction, shoulder extension, turning the hand with the palm forward provides a large tubercle. A number of functions are lost due to trauma.

Damage to the humeral tubercle is different:

• separation - a mechanical disorder, sudden tension of the muscles associated with the tubercle (physical exertion, aggressive action after attempts to reposition the dislocation). The tubercle or its outer layer with attached muscles comes off completely;
• squeezing - damage to the tubercle, displacement of bone tissue or lack of displacement (fall, impact, an attempt to match the bones on their own after displacement). Shrapnel injuries are often associated with fractures of the scapula process, shoulder neck.

Obvious symptoms accompany trauma to the greater tubercle of the shoulder bone:

• sharp pain;
• difficult movement;
• crepitus (crunch);
• swelling of the shoulder;
• hemorrhage at the site of the lesion;
• difficulty of rotation in case of damage to the greater tubercle.

In the case of combined injuries, fixation of all joints of the limb from the hand to the healthy shoulder is required, and the delivery of the injured person to a medical institution.

Fracture types

Based on the data of the doctor's examination, the study of the X-ray readings, the MRI, an adequate diagnosis is carried out, and the treatment tactics are determined. Early treatment of the victim helps to prevent complications from the injury.

It is customary to distinguish between three types of fracture:

• contusion (the result of direct exposure to force);
• tear-off, no displacement;
• tear-off, offset.

The peculiarity of the contusion form is in a fragmented or impaled character, when the tubercle, under the influence of aggressive force, enters the bone tissue.

Avulsion fractures are associated with muscle contraction, due to which the tubercle is displaced. If the impact is weak, displacement does not occur, and damage to the cortical layer remains. The reason for the separation can be unprofessional actions to reduce the dislocation of the shoulder, the application of excessive efforts.

Most of the fractures are closed.

The open form is rare, but it carries the risk of infection, the risk of developing osteomyelitis.

Treatment features

The nature of the treatment depends on the type of fracture and the individual characteristics of the victim's body. Primary medical care - in the pain relief of the victim. Further, the patient is examined and instrumental research is carried out for the correct diagnosis.

The main methods of treatment:

• conservative;
• surgical.

Conservative treatment

The choice of a conservative method is based on the absence or admissibility of a small displacement, when the fragments can be compared and fixed for the period of fusion. The arm is immobilized, bent at a right angle at the elbow joint, with the shoulder slightly abducted, which is regulated by a wedge-shaped pillow.

Wearing a bandage for fixation correct position limbs in the process of fusion lasts up to 3-4 weeks. Later, a follow-up examination is carried out. In the absence of complications, the rehabilitation stage begins.

Carrying out is the most important stage in treatment, preventing additional injuries of blood vessels, nerve endings.

Fixation facilitates the following processes:

• the connection of the fragments;
• elimination of pain;
• normalization of the muscle tone of the shoulder.

Surgery

Surgical intervention is inevitable in case of a noticeable displacement of the fragments of the greater tubercle. With a medical instrument, bone parts are fixed by means of metal plates, special screws, brackets. The immobilization period is at least 5-6 weeks. After 6 months, the fixing structures are removed.

In the case of comminuted, there is a high risk of complete removal of a large tubercle or a significant part of it. Tissues are cleaned of debris that cannot be restored. Then the muscles are connected to the central fragment or ligaments of the shoulder. In special cases, prosthetics of the affected area is offered.

Untimely seeking medical help, wrong treatment tactics lead to complications leading to dysfunction of the shoulder joint.

Each method of treatment is accompanied by the use of anti-inflammatory drugs and pain relievers.

Bone fusion phases

Correct comparison of the fragments gradually leads to a phased bone fusion. Cartilage cells are the first elements that form in a bone fracture or crack.

The period of cell transformation into callus is conventionally divided into 4 stages:

1. Catabolic (7-10 days) The tissues are inflamed, cell necrotization occurs, and intoxication of the body is observed.
2. Differential (7-14 days). The formation of young cells begins, creating the foundation of callus - fibrocartilaginous tissue.
3. Primary accumulative (2-6 weeks). Capillary growth with feeding function. Interaction of minerals and collagen molecules.
4. Mineralization (3-4 months). Formation of callus components. Strengthening intercrystalline bonds.

The rate of recovery depends significantly on the following factors:

• type of fracture;
• the age of the victim;
• health status;
• the presence of concomitant injuries, diseases.

The duration of the healing process is conventionally focused on the state of a strong organism.

Rehabilitation

Immobilization of the limb during the period of treatment leads to muscle atrophy, congestion, manifestations of joint tissue dystrophy. It is important to avoid post-traumatic arthrosis, the phenomenon of stiffness. The recovery period is from 1.5 to 3 months, depending on the age and individual factors of the victim's health.

Rehabilitation includes:

• physiotherapy exercises;
• massage;
• physiotherapy.

Physiotherapy

The development of the hand after removing the fixing bandage by means of exercise therapy is prescribed from 2-3 days. Physiotherapy is important for enhancing blood circulation in the area of \u200b\u200binjury, preventing muscle atrophy. The increase in load takes place in 3 main stages:

Beginner - simple exercises for abducting the shoulder to the sides, swinging movements, kneading the hands, bending the elbow. The duration of the exercise therapy period is 2 weeks. Exercises are recommended to be performed in cycles 6-7 times a day with repetitions of 8-10 times.

Reconstructive - the resumption of the usual actions (functions) of the limb, increased muscle performance. The load increases according to the number of repetitions of the exercises of the first stage, a gymnastic stick and a ball are added to the workouts. Elements of gripping the object, moving, throwing, catching, etc. are added. It is recommended to include the exercise at the gymnastic wall.

The final one is the complication of the load to normalize the range of motion of the shoulder joint. Classes in the exercise therapy hall, pool, gym are effective. Active games (basketball, football, etc.), exercises with dumbbells, on the bar, swimming contribute to a complete recovery.

Massage

The appointment of a restorative massage is allowed provided that there are no diaper rash or abrasions. As a result of the procedures, stagnation is resolved, blood circulation is enhanced, and metabolism is accelerated.

It is important to observe the step-by-step procedure: from heating the tissues to rubbing and other manipulations.

The massage process should not cause pain.

Physiotherapy

The rehabilitation process is not complete without physiotherapy:

• ultrasound;
• infrared irradiation;
• iontophoresis;
• electromagnetotherapy;
• ozokerite;
• laser therapy.

As a result of the use of physiotherapeutic methods of rehabilitation, blood circulation and recovery processes in tissues are improved.

Staying during the recovery period in a sanatorium, dispensary is very effective. It is very useful to take mineral baths, mud procedures, sea bathing for a comprehensive strengthening of the body.

An important role is given to proper nutrition to revitalize metabolic processes... A balanced diet rich in vitamins and microelements is vital for recovery procedures.

Trauma to the humerus in the form of a fracture of the greater tubercle is quite rare, but it leads to serious complications if professional treatment and high-quality rehabilitation are avoided. Taking your recovery steps seriously will help you fully restore your quality of life.

A strong blow can lead to the destruction of bone tissue. A fracture of the large tubercle of the humerus is most often detected in victims who have received an industrial injury.

Causes

Damage can occur not only after a direct hit. A sharp muscle contraction is one of the causes of a fracture. The victim is diagnosed with a shoulder neck injury. The risk group includes people of retirement age, since their bone strength decreases. The trauma can be associated with osteoporosis. It causes the leaching of calcium from bone tissue.

Symptoms

The painful sensations intensify when trying to perform movements with the injured shoulder. In the injured place, edema occurs, blood from the vessels quickly spreads to neighboring tissues. A large hematoma forms in the shoulder area. A person instinctively presses the sore hand to the body. The sharp pain restricts the movement of the victim. A fracture of the greater tubercle leads to a violation of the contractility of the muscles of the shoulder girdle. If you suspect that a fracture is not so likely, we recommend that you undergo a special test to distinguish a fracture from an ordinary bruise.

Signs of a closed fracture

Trauma symptoms vary by location. If the upper part of the shoulder is damaged, a large tubercle is destroyed. The patient feels pain when trying to move the injured limb. A closed fracture is rarely complete without displacement of bone fragments. The victim's limb is deformed. Mechanical stress leads to the formation of a large number of bone fragments.

Symptoms of an open fracture

A fracture of the large tubercle is accompanied by damage to the skin. You can see protruding bones on the surface of the wound. The patient is bleeding heavily. It is necessary to treat the wound with an antiseptic to prevent infection.

Diagnostics

It is possible to assess the degree of damage after a fracture of the greater tubercle of the humerus after X-ray. But this method cannot always give complete information about the location of the bone fragments. The displaced fragments can be hidden by the bones that are nearby. In the picture, they appear as shadows and do not allow determining the exact location of the bone fragments.

A more accurate diagnostic method is cT scan... During the examination, bones are scanned in several projections.

If necessary, the victim is referred for MRI. Thanks to the procedure, it is possible to determine not only the degree of bone destruction. Specialists receive data on the condition of muscles and ligaments. The fracture also affects the nerve endings. If damaged, the patient loses the sensitivity of the upper limb.

When are conservative treatments suitable?

The immobilization technique is carried out in the following sequence:

1. The victim flexes the injured limb.
2. A layer of cotton wool is applied to the body and wrapped with a bandage.
3. Additional splints are used to fix the injured forearm after a fracture of the large tubercle of the humerus.
4. By immobilizing the limb, it is possible to ensure the fusion of the bones in the correct position.

Surgical methods

Treatment of a fracture of the greater tubercle of the humerus consists in repositioning the displaced fragments.

In the process of osteosynthesis, the specialist fixes the crushed bones using metal plates. Screws and staples can be used to tighten the fragments.

If it is impossible to restore the destroyed bones, the specialist removes them. An implant is placed instead of the shattered bone. After surgery, the patient needs long-term immobilization. The person must wear a plaster cast for at least 5 weeks. The metal elements used to fix the bone fragments are removed six months after the operation. Metal structures can lead to metallosis and bone destruction.

Complications

After a strong blow, the victim may experience the following complications:

1. When diagnosed, the patient is diagnosed with damage to the biceps. In this case, the person is referred for surgery. The surgeon sutures the torn muscle fibers.
2. Non-union of the tubercle can occur due to poor reposition of bone fragments. Restoration of hand functions in a patient with such a complication is impossible. The patient needs surgery.
3. Fracture treatment complicates the formation of myositis. This is the deposition of calcium, which leads to ossification of the muscles of the injured limb. Initially, the patient can be assisted with laser therapy. With severe ossification, surgical methods are used.
4. With arthrosis, cartilage tissue is affected. Bone growths are the result of poor rehabilitation. If such complications are detected, the patient is referred for a second operation. The surgeon performs the reposition again. After the operation, a control image is taken. This is necessary in order to check the correct position of the bones.

Fracture treatment

The injury is very serious, so it is worthwhile to pay increased attention to the available treatment. For this reason, we will try to list all the current treatments. If you are interested in preparations for bone fusion, then you can read the corresponding article in the "Medicines" category.

Massotherapy

The procedure helps to normalize blood circulation. The victim's muscle contractility increases, and edema begins to dissolve. Massage removes congestion in the fracture area. Treatment can be started immediately after removing the plaster cast. The skin should be free of pressure sores and open wounds. The main rule during massage is a gradual increase in the duration of the procedure. The massage process begins with stroking movements, which are designed to warm up the injured limb. First, the fingers are processed. Gradually, the massage therapist reaches the shoulder girdle. During the procedure, do not touch the sore shoulder. Rough massage manipulations are prohibited. Sudden movements can lead to displacement of the fragments. The duration of the procedure is 5 minutes at the beginning. With normal bone fusion, the exposure time increases to 15 minutes. The patient should not experience pain. In case of discomfort, it is necessary to reduce the intensity of the massage movements.

Exercise therapy

The exercises must be performed even before the plaster cast is removed. On the 3rd day after the fracture, you must start moving your fingers. The victim is prohibited from performing movements that cause pain. If painful sensations arise, you must stop training. On the 8th day after the injury, you can begin to try to tighten the shoulder muscles. The damaged joint must remain motionless. The number of approaches must be gradually increased. The following exercises are recommended to develop atrophied muscles:

1. Stand near a wall and tilt your torso forward. Now move your arms like moving a pendulum.
2. Without changing your body position, rotate your arms in a circle.
3. Several swinging movements can be done to develop the limbs.
4. During training, throw your hands behind your head.
5. To restore coordination of the limb after a fracture of the tubercle of the humerus, you can use a gymnastic stick. Exercise must be done daily. Keep track of the number of approaches.
6. With successful bone fusion, you can start exercises with dumbbells. A complex of gymnastic exercises with weights can be done only a month after removing the plaster.

Laser therapy

The procedure helps to restore blood circulation in the damaged area. During laser therapy, devices that generate light radiation are used. Laser beams stimulate cell regeneration. After several procedures stop inflammatory processes, and edema decreases. A contraindication to undergoing laser therapy is the presence of bleeding.

The procedure should not be performed by patients suffering from diseases of the circulatory system. Laser therapy promotes blood thinning. The patient has an outflow of lymph and blood accumulated in the fracture area.

Electrophoresis

During the session, an electric current is applied to the patient's body. For this, special plates are used that are fixed on the patient's body. The area of \u200b\u200bthe electrodes is selected by the doctor. This takes into account the area of \u200b\u200bdamage. Due to the effect of electric current, the drug enters the bone tissue. In the process of electrophoresis, products containing calcium are used. After the procedure, the fusion of bone fragments is accelerated.

Magnetotherapy

Healing effect the procedure consists in exposing the area of \u200b\u200binjury to electromagnetic fields. Magnetotherapy can be performed 3 days after injury. A plaster cast is not an obstacle to the procedure. The radiation from the device penetrates into damaged cells. After undergoing several procedures, the patient's edema decreases, blood circulation improves, and intercellular exchange is restored. Oxygenated blood enters the fracture site. This stimulates the regeneration processes in the fracture area.

Proper nutrition

Separation of the large tubercle of the humerus, rehabilitation. VIDEO

Fracture of the shoulder tubercle - A common injury that occurs as a result of a strong blow to the shoulder, when falling on a straight or bent limb. Fractures can be either isolated or combined with injuries of the proximal humerus, dislocations of the shoulder head.

Pathological damage to the small tubercle of the shoulder occurs in only 2% of patients. In other cases, isolated fractures of the greater tubercle are diagnosed.

A fracture of the shoulder tubercle requires immediate professional diagnosis. In the absence of medical treatment or as a result of non-compliance with the recommendations and instructions of the doctor the patient is diagnosed with the following complications:

• Violation of the process of fusion of fragments as a result of untimely or insufficiently strong fixation of the limb. To restore the functionality of the shoulder joint, doctors resort to surgical method treatment - osteosynthesis.
• Injury to the biceps (long head of the biceps brachii) by fragments. The motor activity of the limb is impaired, a pronounced pain syndrome is manifested, inflammation of the muscle fibers increases.
• Progression of ossification of fibers that attach directly to the tubercle of the shoulder. To eliminate the complication, laser therapy or surgical treatment is used.
• The development of arthrosis is a disease that affects the cartilage tissue.
• Life-long limitation of joint movement.

REFERENCE: Metallostyosynthesis - an operation to connect bone fragments with metal devices.

Mechanism of occurrence

The large and small tubercles are located directly under the neck - in the upper part of the humerus. Microfibers of muscle tissue are attached to the tubercles. With a fracture of the tubercle, deformity and loss of mobility of the shoulder joint is diagnosed.

The main cause of the fracture is a direct blow... When falling on the arm, an excessive contraction of the muscles of the shoulder girdle occurs - a complete separation of the shoulder tubercle and its displacement upwards is diagnosed.

Types of shoulder tubercle injury:

1. production - builders, miners, workers in factories fall into the risk group;
2. sports - dislocation or fracture occurs when lifting heavy weights, during wrestling;
3. household - occurs when you fall at home (slipping on a wet floor);
4. age-related - is diagnosed mainly in the elderly due to atrophy of the surrounding muscle tissue;
5. injury to the shoulder as a result of an accident.

IMPORTANT! In case of shoulder dislocation, it is not recommended to adjust the head of the humerus by yourself. Incorrect actions lead to injury to the shoulder tubercle.

There are two groups of tubercle fracture:

1. fracture of the large tubercle;
2. fracture of the lesser tubercle.

The large tubercle is most often injured when anterior dislocation shoulder joint. Experts distinguish three types of damage to the large tubercle:

1. fracture with separation without displacement;
2. fracture with separation with displacement;
3. contusion.

Fracture of the greater tubercle without displacementis determined as a result of a weak impact, which allows the fragment to remain in the bed. The most commonly diagnosed rupture of the periosteum.

Displaced fracture - a consequence of a strong blow or fall, as a result of which there was an active muscle contraction. The emergence of muscle traction promotes the removal of the tubercle fragment upward.

Contusion fracture characterized by the formation of numerous fragments and their pressing into the head of the shoulder. The fragments are immersed in the bone tissue of the shoulder, which makes it difficult to diagnose by palpation.

A fracture of a large tubercle occurs closed and open... With an open fracture, damage to the skin is diagnosed, and bone goes beyond the epithelium.

IMPORTANT! With an open contusion fracture, you should immediately contact a traumatologist and start treatment to reduce the risk of developing purulent inflammation of bone tissue.

With a fracture of the lesser tubercle, an intense contraction of the subscapularis muscle occurs. This pathology is combined only with posterior dislocation shoulder or cervical injury without displacement.

Symptoms

With a fracture of the tubercle, a sharp strong pain, which increases with palpation. Pain sensations are diagnosed with external and internal rotation (rotational movement of the shoulder). On palpation, a specific crunch appears. The joint area swells, as a result of subcutaneous hemorrhage, hematomas appear.

Signs:

External and internal shoulder rotation

• sharp pain in the shoulder joint;
• the occurrence of edema and hematomas;
• violation of shoulder rotation;
• the appearance of a specific crunch when moving;
• in the case of an open fracture, a wound occurs, in the bottom of which muscle tissue and damaged bone are visible;
• with a fracture with dislocation, an unnatural position of the limb is noted.

With a fracture of a large tubercle, the patient cannot perform circular movements with the shoulder joint outward. If a small tubercle is damaged, there is difficulty in moving the shoulder inward.

Useful video

In the video, you will learn how to correctly identify shoulder damage using the rotation test. Recommendations of chiropractor Anton Epifanov.

Conservative therapy

Conservative treatment is prescribed for a fracture without displacement or if the fragments (as a result of immobilization) match. With a fracture without displacement the doctor prescribes the use of an orthosis, bandage or headscarf to fix the hand. The scarf is removed after 2-3 weeks.

Rules for fixing a limb with a scarf:

1. bend your arm at a right angle;
2. remove the shoulder joint and put a wedge-shaped pillow;
3. lay the limb on the scarf.

The main goal of treating a displaced fracture- approximation of the fragment of the tubercle to the shoulder and fixation of the limb.

The hand should be in this position

By virtue of anatomical structure of the shoulder joint, it is quite difficult to restore the adaptation of the tubercle with the bed of the humerus and tendon tension. However, some doctors (to avoid surgery) use technique of approaching the shoulder to the fragment... To do this, you need to abduct the shoulder 90 °, rotate it 60 ° and bend 40 ° anteriorly. In this position, a fragment of the tubercle is located next to the bed from which it was pulled out. The arm is fixed with a splint or plaster cast for 3-4 months. After immobilizing the limb, it is recommended to perform intense finger and hand exercises.

Operation

Surgical treatment is prescribed in cases where it is not possible to match the fragments in a closed way... Surgical correction is also indicated in situations where a fracture of the tubercle is combined with an injury to the neck of the humerus, articular capsule, rupture of the shoulder ligaments.

If the fragments can be compared, the surgeons fix them with metal plates (osteosynthesis). In the case when it is impossible to compare the fragments, they are removed, and the injured tendons are attached to the nearest part of the humerus. The minimum period of limb immobilization is 1 month.

NOTE!Metal structures must be removed no later than half a year after the operation. Otherwise, the patient develops metallosis, which leads to the complete destruction of the bone.

First aid

After an injury to the shoulder and the appearance of a specific shooting pain, the patient should be given first aid and medical personnel should be called.

Necessary actions:

1. fix (immobilize) a limb;
2. to put on the shoulder a cooling bag "Snowball" or ice wrapped in a towel;
3. give the patient an anesthetic drug (Nise, Nimesil, Nurofen, Solpadein).

Recovery after fracture of large and small tubercles

To shorten the rehabilitation period, accelerate the regeneration of bone and muscle tissues, doctors prescribe procedures that help restore the functionality of the shoulder joint:

• remedial gymnastics (exercise therapy);
• manual therapy;
• using a shoulder orthosis;
• physiotherapy.

Exercise therapy

Doctors are allowed to start active exercises with a fracture of the shoulder tubercle without displacement on the 3rd day after a bruise (blow). If the patient is diagnosed with a displaced fracture or underwent surgery, then physical therapy can only be performed after the joint has been released from a cast or bandage (4–5 weeks after injury).

To recover from a fracture and dislocation of the shoulder with a separation of a large tubercle, the patient should perform the following exercises:

1. movement of the hand back and forth, like a pendulum;
2. circular movements;
3. intense bending of the fingers into a fist;
4. flexion and extension of the arm at the elbow joint;
5. alternate raising and lowering of the arms and shoulder.

The patient performs these exercises at least 2 times in knocks for 6-10 repetitions. The rehabilitation course is 2 weeks.

After the complete disappearance of the pain syndrome, the patient is allowed to physical activity in the gym. First, the patient performs exercises with the ball (lift the ball up, to the sides). Then - extension and circular movements, alternately raising and lowering the shoulder with 2 kg dumbbells. (gradually increase the weight).

Exercise Videos

From the video you will learn the correct technique for performing exercises aimed at restoring the motor activity of the shoulder joint.

Physiotherapy

Physiotherapy is aimed at normalizing blood circulation in the injured limb, accelerating metabolism, reducing muscle spasm, improving muscle performance.

Physiotherapy:

• electromagnetotherapy;
• applications with ozokerite;
• laser therapy;
• infrared irradiation;
• iontophoresis.

How much sick leave

Estimated terms of temporary disability:

1. closed fracture without displacement - 35–45 days;
2. closed fracture with displacement - 55–65 days;
3. open fracture without displacement - 130–140 days;
4. closed fracture without displacement - 135-145 days.

Outcome

Fracture of the large or small tubercle of the shoulder is a dangerous pathology, the untimely treatment of which can lead to life-long loss of motor activity of the shoulder joint ... To protect yourself from negative consequences, the following rules must be observed:

1. contact a traumatologist who will prescribe the appropriate treatment;
2. perform gymnastic exercises aimed at improving the functionality of the shoulder joint;
3. massage the damaged area with use;
4. take chondroprotectors and, which help accelerate tissue regeneration and strengthen the body's immune defense (important for open fractures).