11/13/2020 The humerus, which has a tubular shape, is located between the shoulder girdle and the elbow. The place most susceptible to injury is under the neck of the shoulder, under the tubercles to which the tendons are attached. The most common violation of this structure in older people is indirect injury to the shoulder region as a result of a fall on the hand, elbow, or straight arms. Also, a fracture of the humeral neck occurs due to direct physical impacts - pushes on the shoulder from the front/back.
Elderly women constitute the main group of humeral neck defects. This is due to specific transformations of the body during aging, such as:
- degeneration of the humeral metaphysis - due to insufficiency of bone protein;
- osteoporosis;
- other defects of the skeletal system caused by menopausal changes in the female body.
Humeral neck fractures are also provoked by other factors, for example: tumor pathologies, metastases, bone tuberculosis, osteomyelitis. These diseases increase the risk of injury even with low loads on the shoulder area.
Types of humeral neck fractures in the elderly
Experts identify the following types of shoulder neck injuries:
- Adduction. They usually occur when you fall on your arms with your elbows bent. An angle is formed between the central and distal fragments, which opens inward. Sharp fragments often damage the axial nerve or deltoid muscle.
- Hammered. A closed fracture with a transverse fracture and the entry of a peripheral piece into the articular humeral head. Rarely seen.
- Abduction. Possible when falling on outstretched arms. The distal fragment is located in the abduction position, the central one in adduction. External corner.
Exercise therapy in the first period of a shoulder fracture
The following types of humerus fractures are distinguished:
- anatomical neck of the shoulder (intra-articular fracture);
- surgical neck of the shoulder (extra-articular fracture);
- diaphysis (main part) of the humerus;
- distal section, located closer to the elbow.
Fractures of the surgical neck of the humerus are especially dangerous. They can lead to damage to the neurovascular bundle and limb paresis. At the initial stage of treatment, the choice of exercise therapy methods after a fracture of the surgical neck of the shoulder depends on the type and severity of the injury, and on the method of immobilization chosen. The largest range of movements when applying a Y-shaped bandage, and the minimum number of exercises, which will mainly consist of static muscle tension and mental sending of impulses, is used with a thoracobrachial bandage. In case of strictly transverse diaphyseal fractures of the shoulder, which are combined using an internal pin, as well as in case of a displaced fracture of the humerus, in which an extraosseous type of combination of fragments was used, exercise therapy instructors do not include emphasis on the broken arm in the set of exercise therapy exercises.
After immobilization is lifted and until complete rehabilitation, exercise therapy exercises for shoulder fractures and fractures of the surgical neck of the humerus are almost the same. Only specialists can understand the nuances of the difference. During the first rehabilitation period, the patient's arm may be secured with a bandage. A tilt is performed towards the injured limb. Then the affected arm is released from the bandage using the healthy one, after which the arm is moved to the side.
Immediately after fixing a shoulder fracture, you can perform the following exercises:
- make pendulum-like movements with your hands (swing forward and backward);
- clench your fingers into a fist and unclench again;
- bend the arm at the elbow joint;
- abduct the elbow;
- bend forward while raising your shoulder;
- make circular movements with your hands.
Therapeutic exercise helps improve lymph outflow, prevents the development of restrictions on the passive actions of the joint, improves blood circulation and maintains muscle tone. Breathing exercises help saturate the blood with oxygen and improve metabolic processes. Active movements (rotation, flexion and extension, pronation and supination) in the elbow and wrist joints stimulate blood circulation in the arm, reduce swelling and reduce the risk of blood clots.
Upon discharge from the rehabilitation clinic, the patient receives a list of exercise therapy exercises. They must be performed at home, otherwise it will be impossible to completely restore the mobility of the arm.
Symptoms and diagnosis of fracture
The most severe manifestations are characteristic of displacement injuries, when a compressive effect occurs on the blood vessels and muscles surrounding the edge of the bone. Manifestations: paralysis, soft tissue neurosis, swelling of the extremities, aneurysm. With an impacted disorder, on the contrary, the pain syndrome is not expressed. Often a person does not even suspect a serious violation for several days.
In other types of injury, people immediately feel severe pain in the area of the neck fracture, which does not subside when using commonly available painkillers. Swelling of the shoulder joint appears, turning into a hematoma - it descends along the chest wall or goes to the forearm and shoulder. The functions of the hand in the injured area are impaired.
If you suspect a fracture, you should immediately contact a traumatologist. He will conduct an examination and, if necessary, prescribe special examinations to clarify the diagnosis:
- Ultrasound (for intra-articular injuries);
- X-ray examination of the shoulder girdle;
- CT scan if radiography does not provide accurate information.
Time and place of surgery
The operation is performed in a hospital under general anesthesia. The shoulder is operated on if treatment with traction or plaster is not possible. When performing surgery, the fragments are fixed with screws and plates for a fracture of the humeral neck .
The most fragile part of the shoulder (the part of the arm located above the elbow) is the surgical neck, the part located in front of the shoulder joint. It can easily be damaged if it falls, gets pinched by a door, or hits something hard. A fracture can occur in one of three areas of the humerus:
- upper;
- lower;
- in the body of the humerus.
The decision on the advisability of the operation and the need to install a reconstruction plate is made by a traumatologist. He may consult with the patient's family, especially if the operation is required for an elderly person.
First aid
The main goals in providing first aid for a shoulder injury are to stop bleeding, immobilize the injured limb, and reduce pain. Any available painkillers are suitable for this. Aspirin should be avoided as it increases bleeding. With an open type of injury, stopping the bleeding is possible using tampons. If necessary, a tourniquet is applied. It is important to disinfect the wound. You can fix the injured limb by hanging it on any piece of fabric, as well as by applying a splint to the forearm with wooden planks on the sides. Dry, cold bandages will help reduce swelling around the injured area.
Features of osteosynthesis of the humerus
Fixation of the humerus can be external or internal. For temporary use, the best option is an external device. It is quickly installed and adjusted if necessary. Does not require a special room for installation.
Indications for the use of external fixation devices:
- in the presence of serious injuries, multiple injuries to the bones of the extremities;
- for severe injuries of the humerus complicated by extensive soft tissue damage.
For other cases, it is better to use internal fixing devices. It is better to use nails to fix acute and pathological fractures.
If the fracture is characterized by multiple fragments, a metal plate is used to align them in a fracture of the humeral neck. A noticeable displacement of the proximal part indicates the need to achieve the most accurate anatomical reduction. This is especially important for older patients, who have a significantly higher risk of bone failure. To avoid loss of limb functionality, the plate after a humeral neck fracture must be of the required length and provide sufficient fixation points in the proximal humerus (humeral head).
For fractures that are characterized by compression of bone fragments, it is necessary to install a shoulder plate with compression lining.
Depending on the origin of the fracture, it may be necessary to achieve stable anchorage with tension screws reinforced with a neutralizing plate. An alternative option is to avoid intervention in the fractured area and install a bridge plate.
Treatment of injuries in the elderly
When treating such defects in pensioners, surgical intervention is performed only in particularly difficult cases. This is associated with long-term rehabilitation and an increased risk of developing infections. Thus, the occurrence of thromboembolism in an elderly person can cause the death of the latter. Most often, for a humeral neck defect in an elderly person, conservative treatment is sufficient. In case of an abduction fracture, before immobilizing the limb, traction is performed.
There are limitations in reducing pain in older people. To avoid side effects, the dose should be minimal. Treatment is carried out with the use of additional drugs - for example, containing calcium, to improve blood circulation and accelerate the process of bone tissue fusion. The duration of rehabilitation depends on the person’s feelings, his activity, and the presence of other diseases (diabetes, etc.).
Rehabilitation after treatment of injury
After a course of treatment, you should not think that everything has healed and return to your previous lifestyle. The body must recover and strengthen. To the question: is it possible to fully recover from such an injury in old age? There is no clear answer. It all depends on the health status of the particular person. But in any case, this is possible: with proper rehabilitation and especially with good health of the patient.
An important point during rehabilitation is the restoration of motor activity of the damaged joint and limb. In this case, physical exercises are good (be sure to start with the lungs, gradually increasing their activity), shoulder massage, ultrasound and laser procedures.
You should also monitor your diet: calcium and vitamins, protein and fiber. Rice removes toxins from the body well, which will allow it to recover faster from injury.
Possible consequences of injury
In practice, after damage to the integrity of the humeral neck, an elderly person often develops complications and consequences for the following reasons:
- improper fusion of bone tissue as a result of poor quality treatment;
- violation of nerve endings, ligaments, tendons - upon delivery to the hospital, at the time of injury;
- late seeking medical help.
To minimize the development of complications, it is important to visit a doctor in a timely manner to receive first aid, prescribe treatment and organize the rehabilitation process.
Removing pins
The pins are removed from the humerus after 8–9 months. The removal time is determined by the doctor based on radiographic studies. It is not recommended to skip this period, because osteosynthesis devices of the humerus may become overgrown with bone tissue. Leaving the structure inside is fraught with complications. A pin removed in time will not cause any trouble, leaving no scars or holes in the bone. Removing the pin after the recommended period may result in a serious operation.
Modern materials for osteosynthesis are biodegradable. They do not need to be removed; they dissolve inside the bone.
Which doctor should I contact?
The victim is hospitalized in the trauma department. The doctor examines the shoulder and performs testing. When the neck of the humerus is fractured, there is no characteristic springy resistance to movement, as with dislocations.
The shoulder is anesthetized, closed reduction is performed, and fixed with a splint or thoracobrachial bandage. Be sure to monitor the position of the bones using x-rays when the plaster dries and after 7 days.
Trochanteric femur fractures
These are fractures of the part of the femur closest to the pelvis. At the slightest movement, the legs are accompanied by sharp pain, after some time swelling and bruising appear. The hip bones heal very slowly, so the optimal solution in this situation is osteosynthesis surgery.
Conservative treatment, as in cases of hip injury, is used only in the presence of serious contraindications and can lead to serious complications. For example, the formation of blood clots and blood clots in blood vessels, which threatens the death of the patient. Therefore, massage and rubbing are mandatory, with the exception of the damaged area of the body.
The recovery period after surgery takes 6 months or more. At this time, an elderly person requires full care and assistance in the simplest daily procedures.
Recovery time
After surgical repair, the shoulder is fixed with a splint. In any case, from the third day after reposition and fixation of the shoulder, the patient is forced to move his fingers, bend and straighten the wrist and elbow joints. Surgical sutures are usually removed after a week. Movements in the shoulder are allowed from the 20th day . Metal elements during osteosynthesis are removed after three months.
With a conservative approach, immobilization lasts from 6 to 8 weeks, but after a month the plaster is removed and the arm is fixed on an abduction splint. The average rehabilitation period is 3–4 weeks, and full working capacity is restored after six months. The patient is forced to raise his arm on the splint to avoid pain.
In older people, recovery times are much longer and are usually associated with poor blood supply. Therefore, in old age, daily exercise and physiotherapeutic methods of regeneration are necessary.