Fractures of a shoulder make about 7% of total number of changes. Depending on localization fractures of a shoulder are subdivided on: changes of the top departments of a humeral bone; diafizarny fractures of a shoulder (changes of a middle part of a shoulder); changes of the lower departments of a humeral bone. Fractures of a shoulder are followed by pain and hypostasis, deformation and a krepitation in the field of a change, restriction the movement of a hand. At intra articulate fractures of a shoulder it is possible . The main method of diagnosis of a fracture of humeral bone are a X-ray analysis, ultrasonography, joint KT or MPT, a diagnostic puncture in addition can be carried out. Treatment includes a repozition of otlomk, their keeping by means of spokes, plates or screws, imposing of a plaster bandage, rehabilitation of a hand after plaster removal (massage, LFK, physiotherapy).
Fracture of a humeral bone
Fractures of a shoulder make about 7% of total number of changes.
The top end of a humeral bone has the form of a hemisphere and connects to the articulate surface of a shovel, participating in formation of a shoulder joint. The part of a humeral bone located at once under a head carries the name of an anatomic neck of a shoulder. There are points of an attachment of muscles slightly below – small and big hillocks. The capsule of a shoulder joint covers an anatomic neck of a shoulder and comes to an end over hillocks. Under hillocks the bone is a little narrowed and forms a surgical neck of a shoulder. The lower part of a humeral bone comes to an end with the roundish head of a condyle which is jointed with a beam bone and the block of a humeral bone connecting to an elbow bone.
Depending on localization traumatologists subdivide shoulder fractures on:
- changes of the top departments of a humeral bone;
- diafizarny fractures of a shoulder (changes of a middle part of a shoulder);
- changes of the lower departments of a humeral bone.
The shoulder fracture in its top departments can be intra articulate (podbugorkovy) and extra articulate (podbugorkovy).
The head change, separation of a small or big hillock, fracture of an anatomic and surgical neck of a shoulder is possible. Fractures of a surgical neck are most widespread, and an overwhelming part of victims is made by people of advanced age. Falling on an elbow, a shoulder or the taken-away hand becomes the change reason usually.
The patient shows complaints to pains in a shoulder joint. The driven changes are followed by unsharp hypostasis, morbidity in attempt of active movements. The passive movements are limited slightly. At a change with shift a clinical picture brighter. The victim is disturbed by the expressed pains. Moderate hypostasis, deformation of area of a joint and shortening of an extremity comes to light. The krepitation (a crunch of bone fragments) is defined. The diagnosis is specified by results of a X-ray analysis. At an intra articulate change ultrasonography of a shoulder joint can be carried out.
At the driven changes the hand is fixed a special bandage. At fractures of a surgical neck with shift in office of traumatology carry out a repozition under local anesthesia. In the subsequent fixing by a bandage on Turnera or on the taking-away tire, leykoplastyrny or skeletal extension is possible. LFK is appointed, since 7-10 treatments. The term of an immobilization makes 6 weeks. Operation is shown at unstable and splintered changes. A contraindication to operation is the senile age and serious chronic illnesses.
Shoulder fractures on average department (diafizarny fractures of a shoulder) result from falling on a hand or blow in a shoulder, can be slanting, cross, spiral and splintered. Diafizarny fractures of a shoulder are quite often combined with injury of a beam nerve. Injury of humeral arteries and veins is possible.
Clinical symptoms of a fracture of shoulder are pains, puffiness, deformation, a krepitation of bone fragments and pathological mobility of a humeral bone. At shoulder fractures with injury of a beam nerve the patient cannot independently unbend fingers and a brush. For specification of the diagnosis and the choice of tactics of treatment carry out a radiographic research.
Shoulder fractures without shift fix the plaster tire. At shoulder fractures with shift impose skeletal or leykoplastyrny extension which after emergence of radiological signs of a bone callosity is replaced plaster longety. Total period of an immobilization at diafizarny fractures of a shoulder makes 3-3,5 months.
At well compared fractures of a shoulder which are combined with injury of a beam nerve conservative therapy (an adequate immobilization of a fracture of shoulder, medicinal stimulation of restoration of a nerve, LFK, physiotreatment) is carried out. If within 2-3 months there are no signs of regeneration of a nerve, carry out operation. Surgical treatment is shown at multisplintered fractures of a shoulder, impossibility of the closed repozition, interposition of soft fabrics and damage of vessels. Fixing of otlomk is carried out by means of plates, metal pins or Ilizarov's device.
Intra articulate and intra articulate fractures of a shoulder in the lower departments are possible. To extra articulate changes of the lower departments of a shoulder nadmyshchelkovy changes, belong to intra articulate changes – changes of the block, a golovchaty eminence of a humeral bone and intercondyloid changes.
Taking into account the trauma mechanism nadmyshchelkovy fractures of a shoulder are subdivided on razgibatelny and sgibatelny. Sgibatelny nadmyshchelkovy changes meet more often, arise when falling on the bent hand. Falling on the reunbent hand becomes the reason of a razgibatelny change.
The area of a shoulder over an elbow joint is edematous, sharply painful. Sgibatelny changes are followed by visual lengthening of a forearm, at razgibatelny changes the forearm looks shortened. Nadmyshchelkovy fractures of a shoulder can be combined with dislocation of bones of a forearm. The diagnosis is established after a X-ray analysis.
At uncomplicated changes the field of damage is fixed plaster longety for 3-4 weeks. At the big shift of otlomk and impossibility of a repozition carry out operation.
Changes of condyles
The change of an external condyle arises when falling with a support on the unbent hand, a change of an internal condyle – when falling on an elbow. The direct trauma is possible (blow to the area of a condyle). The elbow joint is edematous, is sharp . As a rule, changes of condyles are followed by development of a gemartroz (a blood congestion in an elbow joint) at which pains and hypostasis become more expressed. The diagnosis is established after a X-ray analysis.
At changes without shift carry out an immobilization plaster longety. At changes with shift carry out a repozition under local anesthesia. If fragments cannot be compared, surgical treatment is carried out (fixing of otlomk spokes, plates or screws). Physiotherapeutic procedures at this type of fractures of shoulder are contraindicated. To patients appoint LFK and mechanotherapy.
Usually occur at children. Arise when falling on an elbow. Are followed by pain, hypostasis, restriction of movements in a joint. Treatment as at changes of condyles.