Displaced fracture of the lateral condyle of the humerus. Fractures of the humeral condyle

A transcondylar (extensor and flexion) fracture is an intra-articular fracture. It occurs when falling on an elbow bent at an acute angle. The fracture plane has a transverse direction and passes directly above the epiphysis humerus or through it. If the fracture line passes through the epiphyseal line, it is in the nature of epiphysiolysis. The lower epiphysis is displaced and rotated anteriorly along the epiphyseal line. The degree of displacement can be different, most often small. This fracture occurs almost exclusively in childhood and adolescence(G. M. Ter-Egiazarov, 1975).

Symptoms and recognition. In area elbow joint there is swelling, and there is hemorrhage inside and around the joint. Active movements in the elbow joint are limited and painful, passive movements are painful, extension is limited. The symptoms are uncharacteristic, so a transcondylar fracture of the shoulder can easily be confused with a sprain of the ligamentous apparatus. In most cases, a transcondylar fracture is recognized only by radiographs, but even here difficulties arise when there is a slight displacement of the lower epiphysis. It should be taken into account that in children the lower epiphysis of the humerus is normally tilted slightly (10-20°) forward relative to the longitudinal axis of the humerus diaphysis. The forward tilt angle is individual, but never reaches 25°. To clarify the diagnosis, it is necessary to compare radiographs in the lateral projection of the injured arm and the healthy one. They must be made in identical and strict projections. Detection of displacement of the lower epiphysiolysis is of great importance practical significance, since fusion in a displaced position leads to limitation of flexion, which is directly dependent on the degree of increase in the angle of inclination of the epiphysis.

Treatment . Reduction in children is performed under anesthesia. The surgeon places one palm on the extensor surface of the lower shoulder, and the other applies pressure back on the lower epiphysis of the shoulder from its flexor surface. The forearm should be in an extended position. After reduction, the child’s arm, extended at the elbow joint, is fixed with a plaster splint for 8-10 days. Then begin gradual movements in the elbow joint. Treatment can also be carried out with constant skeletal traction on the upper part ulna within 5-10 days. Then the traction is removed and a splint is applied with the forearm bent at a right angle at the elbow joint for 5-7 days (N. G. Damier, 1960).

In adults, transcondylar fractures are treated in the same way as supracondylar fractures.

Intercondylar fractures of the humerus

This type of humerus fracture is intra-articular. T- and Y-shaped fractures occur under direct influence of great force on the elbow, for example, when falling on the elbow from a great height, etc. With this mechanism olecranon splits the block from below and is inserted between the condyles of the shoulder. At the same time, a supracondylar flexion fracture occurs. The lower end of the humeral diaphysis also inserts itself between the split condyles, moves them apart and so-called T- and Y-shaped fractures of the humeral condyles occur. With this mechanism, sometimes the condyles of the shoulder and often the olecranon are crushed, or a fracture of the condyles is combined with a dislocation and fracture of the forearm. These fractures can be like

flexion and extension types. T- and Y-shaped fractures are less common in children than in adults. A fracture of both humeral condyles may be accompanied by damage to blood vessels, nerves and skin.

Symptoms and recognition. When both condyles are fractured, there is significant swelling and hemorrhage both around and inside the joint. The lower part of the shoulder is sharply increased in volume, especially in the transverse direction. Feeling the elbow joint in the area of the bony protrusions is very painful. Active movements in the joint are impossible; with passive ones, severe pain, bone crunching and abnormal mobility in the anteroposterior and lateral directions are observed. Without radiographs taken in two projections, it is impossible to have an accurate idea of the nature of the fracture. It is important to diagnose damage to blood vessels and nerves in a timely manner.

Treatment. For non-displaced fractures in adults, a plaster cast is applied from the upper third of the shoulder to the base of the fingers. The elbow joint is fixed at an angle of 90-100°, and the forearm is fixed in an average position between pronation and supination. A plaster cast is applied for 2-3 weeks. Treatment can be carried out using knitting needles with thrust pads enclosed in an arc, or a Volkov-Oganesyan articulated apparatus. In children, the arm is fixed in the same position with a plaster splint and suspended on a scarf. The splint is removed after 6-10 days. From the first days, active movements in the shoulder joint and fingers are prescribed. After removing the splint, the function of the elbow joint is well restored; in adults, there is sometimes a slight restriction of movement for 5-8 weeks. The patients' ability to work is restored after 4-6 weeks.

For the outcome of treatment of T- and Y-shaped fractures of the humeral condyles with displacement of fragments, it is extremely important has good reposition of fragments. In adults, it is achieved by skeletal traction of the olecranon, which is carried out on an abduction splint or using a Balkan frame while the patient is in bed. Having eliminated the displacement of the fragments along the length, on the same day or the next, the diverged condyles of the humerus are brought together by compressing them between the palms and applying a U-shaped plaster splint along the outer and internal surfaces shoulder Based on the radiograph, you should ensure that the fragments are in the correct position. The traction is stopped on the 18-21st day and they begin dosed movements in the elbow joint, gradually increasing in volume, using a removable splint at first. Treatment can also be carried out using the Volkov-Oganesyan articulated compression-distraction apparatus. In this case, it is possible to begin movements in the elbow joint early.

In children, a single-stage reduction is usually performed under anesthesia, followed by fixation with a plaster splint. The hand is suspended on a scarf. The elbow joint is immobilized at an angle of 100°. Movement in the elbow joint begins in children with displaced fractures after 10 days.

If reposition is unsuccessful, skeletal traction is indicated for the upper part of the ulnar spine with compression of the condyles for 2-3 weeks in adults and 7-10 days in children. In some cases, if the fragments have been reduced, closed transosseous fixation with wires can be performed; then the traction is removed and a plaster splint is applied.

Massage, as well as violent and forced movements in the elbow joint are contraindicated, as they contribute to the formation of myositis ossificans and excess callus. Even with good alignment of the fragments, in cases of intra-articular fractures, restriction of movements in the elbow joint is often observed, especially in adults.

Surgical treatment. It is proven if the reduction of fragments using the described method fails or there are symptoms of a disorder of the innervation and blood circulation of the limb. The operation is performed under anesthesia. The incision is made longitudinally along

the middle of the extensor surface of the shoulder in the lower third. To avoid damage to the ulnar nerve, it is better to first isolate it and place it on a holder made of a thin rubber strip. The condyles should not be separated from the muscles and ligaments attached to them, otherwise their blood supply will be disrupted and necrosis of the condyle will occur. To connect fragments, it is better to use thin knitting needles with the ends brought above the skin (so that they can be easily removed) or left under the skin (Fig. 59). You can also use 12 thin nails or screws of appropriate length or bone pins. In children, in those rare cases when it is necessary to operate, the fragments are well held by thick catgut threads passed through holes drilled or made with an awl in the bone. A plaster splint is placed on the shoulder and forearm, bent at an angle of 100°, along the extensor surface and the arm is suspended on a scarf. The needles are removed after 3 weeks. Movement in the elbow joint in adults begins after 3 weeks, in children – after 10 days.

In case of improperly healed fractures, severe limitation of movements, ankylosis of the elbow joint, especially in a functionally disadvantageous position, arthroplasty is performed in adults. In children, resection of the elbow joint and arthroplasty are not indicated due to possible growth arrest of the limb. The operation should be postponed until after mature age. In the elderly and old age for intra-articular fractures, they are limited to placing the limb in a functionally advantageous position and functional treatment.

Fracture of the lateral condyle of the humerus

Fracture of the external condyle is not uncommon, especially common in children under 15 years of age. A fracture occurs as a result of a fall on the elbow or hand of an extended and abducted limb. The head of the radius, resting against the capitate eminence of the humerus, breaks off the entire external condyle, epiphysis and a small piece of the adjacent part of the block. The articulating surface of the capitate eminence remains intact. The fracture plane has a direction from below and inwards, outwards and upwards and always penetrates into the joint.

Along with fractures without displacement, fractures with a slight shift of the condyle outward and upward are observed. A more severe form is a fracture, in which the broken condyle moves outward and upward, slips out of the joint and rotates in the horizontal and vertical planes (90-180°) with the inner surface outward. Slight lateral displacement without rotation of the fragment does not interfere with fusion and preservation full function. When the fragment rotates, fibrous fusion occurs. Cubitus valgus is often observed with subsequent involvement of the ulnar nerve.

Symptoms and recognition. A nondisplaced fracture of the lateral condyle of the humerus is difficult to recognize. There is hemorrhage and swelling in the area of the elbow joint. When the condyle is displaced upward, the external epicondyle stands higher than the internal one. The distance between the external epicondyle and the olecranon process is greater than between it and the internal epicondyle (normally it is the same). Pressure on the lateral condyle causes pain. Sometimes it is possible to palpate the displaced fragment and determine the bone crunch. Flexion and extension of the elbow joint are preserved, but rotation of the forearm is sharply painful. When the lateral condyle is fractured with displacement, the physiological valgus position of the elbow, especially pronounced in children and women (10-12°), increases. The forearm is in an abducted position and can be forcefully adducted. To recognize a fracture great importance have radiographs taken in two projections; it's hard to install without them accurate diagnosis. Sometimes difficulties arise when interpreting radiographs in children. Cause

The point is that although the ossification nucleus of the external condyle can be seen in the 2nd year of life, the fracture line goes through the cartilaginous section, which is not visible on the image.

Treatment . Fractures of the lateral condyle without displacement are treated with a plaster cast, and in children with a splint, which is applied to the shoulder, forearm and hand. The elbow joint is fixed at an angle of 90-100°.

Rice. 59. Transcondylar comminuted fracture with large displacement of fragments before and after osteosynthesis with wires.

If there is an outward displacement of the fragment with a slight rotation of the broken condyle, reduction is performed under local or general anesthesia. Assistant

Humeral condyle fractures belong to the category of intra-articular fractures. Most patients of the Central Clinical Hospital of the Russian Academy of Sciences who are diagnosed this pathology– children and adolescents; damage to the humeral condyle occurs less frequently in adults.

Possible causes of fracture

Fall on a straight arm;
Falling on an arm bent at the elbow;
A strong direct blow to the area of the humeral condyle.

Symptoms of a fracture of the condyles of the humerus

Pain when pressing on the condyle;
Soreness in the elbow area;
Hemorrhage in the shoulder joint;
Violation of the “isosceles” of the Huter triangle;
Limited hand movement.

Diagnostics

Diagnosis is complicated by the similarity of symptoms of a fracture of the humeral condyles with a sprain.

Clarification of the circumstances that led to the traumatic action
Inspection, checking pulse and sensitivity in the damaged area
If necessary, a consultation with a specialist – a neurosurgeon, angiosurgeon – can be carried out.

Treatment

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Forearm injuries

Distal humerus fractures

Causes. Supracondylar (extra-articular) fractures are divided into extension ones, which occur when falling on an outstretched arm, and flexion ones, which occur when falling on a sharply bent elbow. Intra-articular fractures include transcondylar fractures, T- and V-shaped condylar fractures, and a fracture of the head of the humeral condyle (Fig. 46).

Signs: deformation of the elbow joint and the lower third of the shoulder, the forearm is bent, the anteroposterior size of the lower third of the shoulder is increased, the olecranon is displaced posteriorly and upward, and there is retraction of the skin above it. A hard protrusion (the upper end of the peripheral or lower end of the central fragment of the humerus) is palpated in front above the elbow bend. Movement in the elbow joint is painful. V.O. Marx’s symptom is positive (violation of the perpendicularity of the intersection of the shoulder axis with the line connecting the epicondyles of the shoulder - Fig. 47). In intra-articular fractures, in addition to deformation, pathological mobility and crepitus of fragments are determined. These fractures should be differentiated from forearm dislocations. Monitoring the integrity of the brachial artery and peripheral nerves is mandatory! The final nature of the damage is determined by radiographs.

46. Options fractures distal metaepiphysis humerus bones.

1, 4 - lateral And medial fractures condyle ;

2 -fracture heads condyle; 3, 5-V- And T-shaped fractures ;

6, 7 - extensor And flexion supracondylar fractures; 8 -transcondylar fracture

47. Sign V.O. Marx. a-c normal ; b-pri supradisylar fracture brachial bones.

48.Reposition fragments at supracondylar fractures brachial bones. a-pri flexion fractures ; b-pri extensor fractures.

Treatment. First aid - transport immobilization limbs with a splint or scarf, administration of analgesics. Reposition of fragments in supracondylar fractures is carried out after anesthesia by strong traction along the axis of the shoulder (for 5-6 minutes) and additional pressure on the distal fragment: for extension fractures anteriorly and inwardly, for flexion fractures - posteriorly and inwardly (the forearm should be in a pronated position). After reposition, the limb is fixed with a posterior plaster splint (from the metacarpophalangeal joints to the upper third of the shoulder), the forearm is bent to 70° (for extension fractures) or up to 110° (for flexion fractures - Fig. 48).

The hand is placed on the abductor splint. If the reposition is unsuccessful (x-ray control!), then skeletal traction is applied to the olecranon process. The period of immobilization with a plaster splint is 4-5 weeks. Rehabilitation - 4-6 weeks. Working capacity is restored after 2/2-3 months. With these fractures, there is a risk of damage to the brachial artery with subsequent disruption of muscle nutrition, which leads to the development of ischemic Volkmann contracture.

The use of external fixation devices has significantly increased the possibilities of closed reduction of fragments and rehabilitation of victims (Fig. 49). Provides strong fixation extramedullary osteosynthesis(Fig. 50).

In case of an intra-articular fracture without displacement of the fragments, a plaster splint is applied to the posterior surface of the limb in a position of flexion at the elbow joint at an angle of 90-100°. The forearm is in an average physiological position. The period of immobilization is 3-4 weeks, then - functional treatment(4-6 weeks). Working capacity is restored after 2-2*/2 months.

When fragments are displaced, skeletal traction is applied to the olecranon process on an abduction splint. After eliminating the displacement along the length, the fragments are compressed and a U-shaped splint is applied along the outer and inner surfaces of the shoulder through the elbow joint, without removing traction. The latter is stopped after 4-5 weeks, immobilization - 8-10 weeks, rehabilitation - 5-7 weeks. Working capacity is restored after 21/2-3 months. The use of external fixation devices reduces the time required to restore working capacity by 1-1*/2 months (Fig. 51).

Open reduction of fragments is indicated when there is a violation of blood circulation in the limb and its innervation. To fix fragments, rods, knitting needles, screws, bolts, and external fixation devices are used. The limb is fixed with a posterior plaster splint for 4-6 weeks. Rehabilitation - 3-4 weeks. Working capacity is restored after 21/2-3 months.

49. Outer osteosynthesis at fractures condyles brachial bones.

50. Interior osteosynthesis at fractures condyles brachial bones.

51. Outer osteosynthesis intra-articular fractures brachial bones.

FRACTURES OF THE HUMERAL CONDYLE IN ADOLESCENTS observed when falling on the hand of the abducted hand. The lateral part of the condyle is most often damaged.

Signs: hemorrhages and swelling in the elbow joint; movement and palpation are painful. Huther's triangle is broken. The diagnosis is confirmed by X-ray examination.

Treatment. If there is no displacement of the fragments, the limb is immobilized with a splint for 3-4 weeks in the position of flexion of the forearm to 90°. Rehabilitation - 2-4 weeks. When the lateral fragment of the condyle is displaced, after anesthesia, traction is performed along the axis of the shoulder and the forearm is deflected inward. The traumatologist sets it by applying pressure to the fragment. When repositioning the medial fragment, the forearm is deviated outward. A control radiograph is taken in a plaster splint. If closed reduction fails, then resort to surgical treatment with fixation of fragments with a knitting needle or screw. The limb is fixed with a posterior plaster splint for 2-3 weeks, then exercise therapy. The metal retainer is removed after 5-6 weeks. Rehabilitation is accelerated with the use of external fixation devices.

FRACTURES OF THE MEDIAL EPICONYLE.

Causes: falling onto an outstretched arm with outward deviation of the forearm, dislocation of the forearm (the torn epicondyle can become pinched in the joint during reduction of the dislocation).

Signs: local swelling, pain on palpation, limited joint function, violation of the isosceles of Huter's triangle, radiography helps to clarify the diagnosis.

Treatment the same as for a condyle fracture.

FRACTURE OF THE HEAD OF THE HUMERAL CONDYLE.

Causes: falling on an outstretched arm, while the head of the radial bone moves upward and injures the condyle of the shoulder.

Signs: swelling, hematoma in the area of the external epicondyle, limitation of movements. A large fragment can be felt in the area of the ulnar fossa. Radiographs in two projections are of decisive importance in diagnosis.

Treatment. The elbow joint is hyperextended and stretched with varus adduction of the forearm. The traumatologist sets the fragment by pressing on it with two thumbs downwards and backwards. The forearm is then flexed to 90° and the limb is immobilized in a posterior plaster cast for 4 to 6 weeks. Control radiography is required. Rehabilitation - 4-6 weeks. Working capacity is restored after 3-4 months.

Surgical treatment is indicated for unresolved displacement, when small fragments blocking the joint are torn off.

A large fragment is fixed with a knitting needle for 4-6 weeks. Loose small fragments are removed.

During the period of restoration of the function of the elbow joint, local thermal procedures and active massage are contraindicated (they contribute to the formation of calcifications that limit mobility). Gymnastics, mechanotherapy, sodium chloride or thiosulfate electrophoresis, and underwater massage are indicated.

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Humeral shaft fracturesForearm injuries

Which doctors should you contact if you have Humeral Condyle Fractures?

What are Humeral Condyle Fractures?

Damage to the following sections that make up the condyle of the humerus is possible: the medial and lateral epicondyles of the humerus, the head of the condyle of the humerus, the trochlea, the condyle itself in the form of linear T- and U-shaped fractures.

Such fractures belong to the category of extra-articular injuries and are more common in children and adolescents. The mechanism of injury is indirect - excessive deviation of the forearm inward or outward (avulsion fractures), but can also be direct - a blow to the elbow joint or a fall on it. The internal epicondyle of the humerus is most often affected.

These fractures as separate nosological forms of injury are very rare.

These are complex intra-articular injuries that can result in limitation or loss of function of the elbow joint.

Symptoms of Humeral Condyle Fractures

Fractures of the epicondyles of the humerus

The patient is bothered by pain at the site of injury, swelling and bruising are also noted here. Palpation reveals pain, sometimes a mobile bone fragment, and crepitus. The external landmarks of the joint are disturbed. Normally, the protruding points of the epicondyles and the olecranon form an isosceles triangle when the forearm is bent, and when the elbow is extended, the points diverge, forming a straight line - a triangle and Huther's line. Displacement of the epicondyle leads to deformation of these conventional figures. Movement in the elbow joint is moderately limited due to pain. For the same reason, but the limitation of rotational movements of the forearm, flexion of the hand in case of a fracture of the internal epicondyle, and extension of the hand in case of injury to the external epicondyle of the humerus are more pronounced.

Fractures are intra-articular, which determines their clinical picture: pain and limited function in the elbow joint, hemarthrosis and significant swelling, positive symptom axial load. An x-ray confirms the diagnosis.

Linear (marginal), T- and U-shaped fractures of the humeral condyle

They arise as a result of a direct or indirect mechanism of injury.

Clinical manifestations are characterized by pain, loss of function, significant swelling, and deformity of the elbow joint. The triangle and line of Huter, a sign of Marx, are violated, and in some cases are not determined.

Diagnosis of humeral condyle fractures

X-ray of the elbow joint in frontal and lateral projections confirms the diagnosis.

Treatment of Humeral Condyle Fractures

Fractures of the epicondyles of the humerus

For non-displaced fractures or if the fragment is located above the joint space, conservative treatment is used. After novocaine blockade of the fracture zone, the limb is immobilized with a plaster splint from the upper third of the shoulder to the heads of the metacarpal bones in the position of the forearm, average between supination and pronation. The elbow joint is bent at an angle of 90°, the wrist joint is extended at an angle of 150°. The period of immobilization is 3 weeks.

Subsequently, restorative treatment is carried out. If there is significant displacement of the fragment, closed manual reduction is performed. After anesthesia, the forearm is tilted towards the broken epicondyle and the fragment is pressed with your fingers. The forearm is bent to right angle. A circular plaster cast is applied from the upper third of the shoulder to the heads of the metacarpal bones for 3 weeks, then the bandage is transferred to a removable one for 1-2 weeks, and after this period, restorative treatment is carried out.

Sometimes for forearm dislocations the internal epicondyle is torn off and pinched in the joint cavity.

Clinical symptoms in such cases are determined by the fact that after repositioning the forearm, the function of the elbow joint is not restored ("block" of the joint) and remains pain syndrome. The radiograph shows a strangulated epicondyle of the humerus.

Urgent shown surgery. The elbow joint is opened from the inside, exposing the area of epicondyle separation. The joint space is opened by deviating the forearm outward. A pinched bone fragment with muscles attached to it is removed using a single-tooth hook. This manipulation should be carried out very carefully, as the ulnar nerve may be pinched. The torn bone fragment is fixed with a knitting needle or screw. The terms of immobilization and restoration of working capacity are the same as with conservative treatment.

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

For non-displaced fractures The elbow joint is punctured, the blood is evacuated and 10 ml of a 1% novocaine solution is injected. The limb is fixed with a plaster cast in a functionally advantageous position from the upper third of the shoulder to the metacarpophalangeal joints for 2-3 weeks. Then they begin to develop movements, and the immobilization is used as a removable one for another 4 weeks. Rehabilitation treatment continue after removal of the plaster.

In cases of displaced fractures perform closed manual reduction. After anesthesia, the arm is extended at the elbow joint, traction is created along the longitudinal axis of the forearm and it is hyperextended, trying to widen the gap of the elbow joint as much as possible. The torn fragment, usually located on the front surface, is set by pressure thumbs. The limb is bent to 90° with the forearm pronated and fixed with a plaster cast for 3-5 weeks. Get started therapeutic exercises active type, and immobilization is maintained for another month.

If closed comparison of fragments is impossible, open reduction and fixation of fragments with Kirschner wires is performed. It is necessary to insert at least 2 wires to exclude possible rotation of the fragment. The limb is immobilized with a plaster splint. The needles are removed after 3 weeks. From this time, the immobilization is converted into removable and maintained for another 4 weeks. In case of comminuted fractures, good functional results are obtained after resection of the crushed head of the humeral condyle.

Linear (marginal), T- and U-shaped fractures of the humeral condyle

For fractures without displacement of fragments treatment consists of eliminating hemarthrosis and anesthetizing the joint. The limb is fixed with a plaster splint from the upper third of the shoulder to the heads of the metacarpal bones. The forearm is bent to 90-100° - the middle position between supination and pronation. After 4-6 weeks, the immobilization is converted into removable for 2-3 weeks.

Treatment of fractures with displaced fragments comes down to closed reposition. It can be either immediate manual or gradual using skeletal traction for the olecranon process or with an external fixation device. The main thing is that the restoration of the anatomical relationships of bone fragments should be as accurate as possible, since inaccurate comparison and redundant callus limit the function of the elbow joint. The reposition technique is non-standard, its stages are selected for each specific case. The principle of reposition is to stretch the forearm bent at a right angle in order to relax the muscles, tilt the forearm outward or inward to eliminate angular displacement and displacement in width. The forearm is placed in a mid-position between supination and pronation.

General anesthesia is better. Successful comparison of fragments (under x-ray control) is completed by applying a plaster splint from the shoulder joint to the heads of the metacarpal bones. Bend the elbow joint at an angle of 90-100°. A ball of loosely laid cotton wool is placed in the area of the elbow bend. Tight bandaging and constrictions in the articulation area should be avoided, otherwise increasing swelling will lead to compression and the development of ischemic contracture. The period of permanent immobilization is 5-6 weeks, removable immobilization is another 3-4 weeks.

Surgical treatment is used when conservative attempts at matching are unsuccessful. Open reduction is performed as gently as possible. It is impossible to separate the joint capsule and muscles from bone fragments, as this will lead to malnutrition and aseptic necrosis of bone areas. The juxtaposed fragments are fixed using one of the known methods.

After suturing the wound, the limb is fixed with a plaster splint for 3 weeks.

Intra-articular fractures are considered the most severe types of such injuries, which is explained by the complexity of treatment, as well as the prevention of their consequences. Even after effective assistance in such patients the high risk development of traumatic arthrosis associated with inadequate healing. A fracture does not go away without leaving a trace even in relation to bone tissue, but for the joint it causes damage many times greater.

The severity of the consequences is due to the complex mechanism of damage - at the same time, significant destruction of cartilage, membranes, and blood entering the joint cavity is observed. These tissues are extremely poorly restored, which creates conditions for the formation chronic inflammation. His undercurrent within a few years it becomes the cause sharp decline functional capabilities of the joint.

IN clinical practice Injuries of the elbow joint are of significant interest - its complex structure determines their diversity. Fractures of the bones that form it can occur in almost any area. At first glance they all seem the same, due to the similarity clinical symptoms. But when assessing specific manifestations, it is possible to identify signs inherent certain species fracture of the elbow joint.

Brachial bone

Injuries in this location are much less common than fractures in the upper third of the forearm. This is due to the significant thickness of the humerus in lower section, where it consists of three anatomical sections. The defeat of each of them directly or indirectly affects the functioning of the elbow joint:

Fractures in the lower third are often intra-articular for two reasons. Firstly, the articular capsule is large and is attached at a fairly large distance from the articular surface of the condyle and the head of the humerus. And secondly, such a fracture of the elbow joint is rarely transverse - its line usually has an oblique direction. All this leads to the fact that the defect line crosses the boundary of the joint shells.
The epicondyles are bony ridges located just above the inner and outer surfaces of the joint. They serve as the attachment point for most of the muscles of the forearm. Therefore, their fractures also immediately affect the work of the nearest connecting structure- elbow.
Finally, the most complete intra-articular fractures are injuries to the head and condyle of the humerus. They articulate directly with the bones of the forearm, and are covered with cartilage tissue. Therefore, their injury is considered the most unfavorable in terms of prognosis.

Carrying out differential diagnosis between fractures of the listed structures allows you to choose adequate tactics of assistance even at the stage of assessing symptoms.

Lower third

Depending on the mechanism of injury, there are two types of damage to the diaphysis of the humerus at the border with the ulnar joint. Moreover, the separation occurs, as with dislocations in this localization, which requires an initial separation of them from each other. To put it simply, one or another injury can develop from the same impact.

The limb in each case takes on a characteristic appearance associated with the displacement of the bones that form the elbow. Therefore, it is necessary to evaluate additional signs:

In the extension version, the upper limb is in the most straightened position. Visually, a thickening is noted above the joint on the side, while above the olecranon there is a small depression - a fossa. When palpated, a compaction with slight mobility can be identified in front above the joint - a fragment. Active or passive flexion is carried out to a small extent, or completely impossible.
The flexion variant is characterized by the exact opposite position of the arm - it is maximally bent at the elbow joint. Any attempts to straighten upper limb are ineffective and extremely painful for the victim. Immediately above the olecranon there is deformation and swelling, when palpated one can notice pathological mobility.
Both options also have common specific manifestations. Marx's sign is the loss of a right angle between the axis of the shoulder and the line connecting the epicondyles. Huther's sign is a change of equal sides into a triangle, the bases and apex of which are the epicondyles and the olecranon.

The fractured area of the humerus does not always cross the border of the joint, which is determined using radiography, and affects further treatment tactics.

Epicondyle

Although these formations are symmetrical and are located on the outer and inner sides of the articulation, signs of their fracture may not be considered separately. Manifestations have general character, and for their correct assessment, their localization is simply additionally assessed. Therefore, just listing them is enough, without applying them to a specific epicondyle:

The leading symptom of injury is pain. At rest, it can be localized, felt only in the area of the bony protrusions above the elbow. Any movement in the joint leads to its strengthening, after which it spreads to the surrounding areas.
Soon after the injury, limited swelling develops in the projection of the damaged epicondyle. Typically the areas of greatest tenderness and swelling coincide, indicating the approximate location of the fracture.
Since a complete fracture of the elbow joint does not occur, its function is only partially impaired. Mobility is limited only due to discomfort, but the patient is still able to bend or straighten the arm at the elbow.
Güter's sign can also be positive, since the epicondyles are an anatomical landmark for its assessment.

Most often, a fracture in such a localization is incomplete - only a crack forms in the bone tissue, which does not violate its functional integrity.

Head and condyle

The most severe type of injury is direct damage to the structures of the humerus that are directly part of the articulation - the condyle and the head. Typically, the fracture is axial in nature, and the traumatic effect is often carried out by the head of the radius, which transmits the blow. If the strength of the condyle is not enough, then it fractures, accompanied by the following symptoms:

The first symptom is sharp pain, which can spread along the back of the forearm. Any movement of a limb (even passive) leads to its strengthening, so victims often hold it with their healthy hand, pressing it to the body.
In the area of the external epicondyle, swelling forms quite quickly, and a little later - hemorrhage. Then the hematoma gradually spreads to the back surface of the elbow.
The limitation of movements increases over time - immediately after the injury, the patient can still bend or straighten the arm to a limited extent. Due to the increase in edema and hemorrhage in the joint, the range of mobility is quickly minimized.
When palpated in the area of the ulnar fossa, one can identify a protruding bone fragment, characterized by pathological displacement under pressure.

To confirm an intra-articular fracture, specific diagnostics are required - in addition to standard radiography, a puncture of the joint cavity is performed.

Bones of the forearm

Dislocation and fracture of the elbow joint always have common reasons, as a result of which the weakest link in the joint is determined. If the bone tissue cannot withstand dynamic stress, then the pathological effect ends with its destruction in the weakest areas. In the bones of the forearm, these are usually the structures in the area of the connection with the shoulder:

The most vulnerable, from an anatomical point of view, is the coronoid process - during an axial impact, it occupies an almost perpendicular position. Therefore, the force of the impact can cause it to tear off, after which a fracture of the ulna develops with its displacement back.
Damage to the olecranon process is less common - usually its fractures are observed as a result of direct blows. In an awkward fall, a person lands directly on his elbow, which does not always end well.
Damage to the radius is extremely rare - its functionally advantageous position affects it. Typically, its fractures are combined with a simultaneous dislocation of the elbow joint.

The danger of this type of injury is explained by its primary instability - constantly loaded processes can rarely be fixed in a conservative way.

Olecranon

Since the cause of a fracture is usually a direct blow, its signs appear instantly. And due to the characteristic deformation of the limb, it is often confused with the anterior type of dislocation:

If the fracture is incomplete, or there is no displacement of the fragments, then mobility in the joint is partially preserved. Otherwise, active extension of the limb at the elbow becomes impossible.
The pain is localized, determined mainly along the posterior surface of the joint. When pressing or tapping on the olecranon process, it will be significantly strengthened.
Swelling and external deformation of the joint develop, which is especially noticeable when viewed from the side or behind. After some time, the swelling increases, becomes tense, the skin darkens - hemarthrosis (bleeding into the joint) forms.
When palpating the olecranon process, you can notice a retraction in its lower part, as well as pathological displacement and mobility of the fragment.

An elbow fracture in this location is best treated conservatively - manual reduction is performed, after which the arm is fixed with a plaster splint.

Coronoid process

A fracture of this formation is extremely rarely formed in isolation - the mechanism of injury leads to the fact that it is complicated by dislocation. The coronoid process, located perpendicular to the axis of the limb, is also the anatomical support for the entire joint. Therefore, its damage immediately disrupts its stability, which is accompanied by the following symptoms:

Movements in the joint are maintained, but become sharply painful. Noted characteristic feature– inability to rely on an extended arm, which causes a sharp increase in discomfort.
Severe swelling is not typical - usually only a slight swelling appears in the area of the cubital fossa. When viewed from the rear and side, the shape of the joint remains virtually unchanged.
After some time, mobility decreases, which is associated with the development of hemarthrosis. The skin in the area of the ulnar fossa darkens due to hemorrhage.
When palpated, it is rarely possible to detect a protruding fragment or any deformation - only local pain along the anterior surface of the joint.

The listed manifestations are indicated for a non-displaced fracture. If there is a complete separation of the coronoid process, then a posterior dislocation develops, the symptoms of which are noticeable even with a simple examination.

Radial head

Damage to this anatomical formation is observed only when a fall occurs on a straightened arm turned to the side. In this case, the maximum pressure is not on the olecranon process, but on the adjacent head of the radius. If it cannot withstand the blow, then signs of its fracture appear:

A characteristic soreness immediately appears - it is localized along the outer edge of the elbow joint. Unlike pain with a fracture of the lateral epicondyle, at rest it is felt mainly in the upper third of the forearm.
Another characteristic manifestation is a violation of rotational mobility, with relatively full preservation of flexion and extension. The victim cannot turn due to pain water tap, or open the lock with a key.
When palpated, an increase in pain impulses is noted when pressing in the projection of the head of the radial bone. This point is located exactly in the middle of the fossa on the lateral surface of the elbow joint. Also, with pressure in this location, pathological displacement of the fragment can be determined.

Further tactics for such a fracture depend on the position of the bone fragments, assessed using an x-ray. If they are stable, a plaster cast is immediately applied in a functionally advantageous position. If there is displacement, then reposition is performed, after which plaster is also applied.

Symptoms and treatment of fractures of the neck and shoulder bones

A shoulder fracture is a fairly rare occurrence, occurring in 7% of cases.

The rarity of the disease presented is based on high density bones, as well as “fitting” to the body.

Most shoulder bone fractures occur in car accidents—people often throw their arms forward in a collision.

Depending on the location and shape of the fracture, it depends further treatment and necessity surgical intervention.

Anatomical certificate

The humerus consists of three main sections:

The head of the humerus and surgical neck- the upper part of the humerus, consisting of an anatomical neck, greater and lesser tubercle. Often a person breaks the anatomical neck and greater tubercle.
The body of the humerus is the middle and long part of the upper arm bone. In some medical sources you can find a second name for this department - the diaphysis of the shoulder.
The distal part or condylar region is the lower part of the described bone, connects to the forearm at the ulna. A fracture of the condylar region is called a transcondylar fracture.

Fractures of the condylar region and the head of the humerus in medical terminology are classified as intra-articular injuries.

The complexity of fractures is due to damage and ruptures of ligaments and tendons. Particularly difficult cases of fractures involve damage or tears to the shoulder muscles.

Classification of fractures

In medicine, there is its own classification of a humerus fracture. There are several subsections here, which depend on the factors and forms of damage received by a person.

Fracture shape depending on location:

fracture of the upper part - corresponding damage to the head, anatomical neck of the shoulder and tubercles is diagnosed;
fracture of the body of the humerus;
fracture of the lower part - characteristic damage to the trochlea, head and epicondyles is diagnosed.

Type of injury depending on the location of the fracture line in relation to the joint:

intra-articular injury - the injury was caused by damaging the bone, which due to its anatomical structure participates in the formation of the joint;
extra-articular injury.

A fracture of the humerus differs in the location of the separated parts:

with displacement - involves restoration of the original anatomical location of the fractured bone, since individual parts of the described section were somewhat displaced;
without displacement – entails fixation of the damaged area and does not require long-term recovery.

Type of damage according to wound formation:

closed – the skin remains in its original state;
open - the injury resulted in a rupture of the wound, where protrusion of fragments may be observed.

The type of injury received affects further move treatment and time allotted for recovery.

The victim may also suffer painful a certain form injuries, for example, a closed fracture does not cause as much pain to a person as an open one. At open form large blood loss is possible.

Causes of injuries received

Experts conditionally divide the causes of fractures of the shoulder joint into direct mechanical impact and indirect.

Direct mechanical impact is characterized by a blow to outer surface shoulder Car mechanics and other workers whose work involves suspended large objects often suffer such injuries (they simply fall into people’s hands).

Indirect mechanical impact is based on a fall on the elbow. Often such falls occur in children who play carelessly and inattentively on playgrounds.

Symptoms of fractures depending on location

Depending on the part of the shoulder bone that is damaged, the symptoms may be completely different.

Upper part of the humerus

A fracture of the upper part of the shoulder sometimes occurs with hemorrhage, which leads to a characteristic increase in the damaged area and hemorrhage, which quite quickly leads to the appearance of a blood network on the skin.

Pain occurs every time it is palpated. When a displacement is detected, a deviation from the original position of the limb axis can be observed.

If the diagnosis has confirmed the fragmentation of the upper part of the bone, the patient experiences immobility of the limb, and any strain to raise the arm causes a sharp attack of pain.

The doctor diagnoses suspected damage to the tubercle of the external part if the patient complains of painful sensations while turning the arm inward.

Body of humerus

A diaphysis fracture is easy to see with the naked eye if there is bone displacement. Damage that does not result in displacement causes severe attacks pain when moving your hand. Next, swelling occurs and in some cases hemorrhage occurs.

It is also noted characteristic disorder hand functionality.

Sometimes a fracture of the humeral body results in damage to the radial nerve. In this case, the patient’s fingers cannot unclench.

Distal section

Since the distal part forms the elbow joint, the fracture is divided into extra-articular and intra-articular. In both

In cases, the patient complains of pain when trying to make movements with his hand, which is practically impossible. Pain is accompanied characteristic swelling with possible hemorrhage.

Often a distal fracture occurs with a dislocation of the elbow joint. Such cases are diagnosed when a person falls on their elbow.

In this case, the patient exhibits swelling, hemorrhage, immobility of the hand, and possible inability to straighten the hand or fingers.

First aid

A bone fracture is always accompanied by severe pain, so first aid for a person involves taking a painkiller.

It is desirable that such measures be provided to the victim immediately and intramuscularly. Otherwise, try to get the injured person to the hospital as quickly as possible.

In addition to taking painkillers, it is necessary to ensure complete immobility of the hand. Use the first suitable tools. These can be boards or slats. Lower your arm down and bandage it to your body, first bending it at the elbow.

Diagnostics

Diagnosis of injury is based on x-ray examination. In some cases, when there is suspicion of damage to ligaments and muscles, an ultrasound scan is performed.

Treatment and recovery after a fracture

After diagnosis, a fracture of the shoulder bone is subject to mandatory fixation of the limb.

In some cases, surgical intervention is performed - an operation to connect the fragments and restore damaged ligaments or muscles.

Treatment of a minor fracture

If the shoulder fracture is not accompanied by displacement or damage to soft tissues, the limb is fixed using an abduction splint.

In cases of slight displacement, specialists use the installation of a removable splint.

Such minor fractures allow you to undergo physiotherapy sessions within 3-4 days for rapid “healing”.

A week after the fracture, the patient begins a course to restore the elbow joint with the help of massage and other physical therapy sessions. After 3 weeks or a month, the plaster and additional parts are removed.

Treatment of a displaced fracture

Restoration of damaged bone occurs in a hospital setting with regular intake painkillers and X-ray studies as an observation.

Of course, the sick person has the fragments restored to their original state using a local anesthetic or general anesthesia, followed by fixation.

From the first, a person must move his fingers to recover, and after 4 weeks he attends physical therapy sessions. The minimum stay in a cast is 6-7 weeks.

Surgery

If the injury causes the humerus to split into small pieces, conventional repair will not help. Here, reconstruction operations are performed using pins, screws or plates.

Sometimes an Ilizarov apparatus is used to hold the fragments until they are completely united. The damaged limb is also fixed until complete recovery, which lasts for several months.

Only after 3-4 weeks does a person begin to pass additional procedures physiotherapy. The entire course of treatment may take several months.

Complications and prognosis

A shoulder fracture is rarely accompanied by complications, since the slightest movements cause pain, which means that a person instinctively tries not to move his arm and immediately turns to a doctor for help.

As for forecasts, we should not talk about unfavorable outcomes. With timely and qualified assistance, a person recovers quickly and does not suffer unpleasant consequences. Exceptions may include medical errors, both in diagnosis and treatment.

Remember that with any assistance provided during an injury, the person should feel significant relief.

If this is not observed and even fixing the limb with a cast causes pain, contact another specialist for a re-examination and diagnosis.

Shoulder surgery: surgical treatment of the shoulder (arthroscopy)

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Sometimes it is possible to restore the patient’s ability to work, the ability to actively engage in sports and perform usual activities in case of articular pathologies or after an injury only through surgery on the shoulder joint.

Modern methods of surgical intervention allow it to be performed without complications and long-term rehabilitation.

The shoulder joint is different from all others in the human body; it is the most mobile. Its structure and functionality unique, it is able to withstand varied loads.

But it is for this reason that the shoulder joint is often injured. A dislocated or severely sprained ligament can only be corrected through surgery.

Types of surgery on the shoulder joint

Indications for surgery on the shoulder joint may include injuries varying degrees severity, dislocations, subluxations, fractures, ligament ruptures, arthrosis accompanied by deformation of the articular surfaces, necrosis of the head of the humerus, purulent inflammation and other pathologies.

Depending on the volume and nature of the lesions, one of the following surgical techniques is chosen:

Endoprosthetics;
Arthrotomy;
Arthroplasty;
Arthrodesis;
An operation to stitch and fix the joint ligaments in case of traumatic or habitual dislocation of the shoulder joint.

The operation is usually planned; before it is performed, the patient is comprehensively examined and prepared depending on the type of operation chosen. Contraindications may include chronic pathologies of any internal organ in severe form, trophic disorders - anything that could interfere with the administration of anesthesia or cause difficulties during the operation.

The operation is not started if contraindications are not eliminated. This is also included in preparatory activities before surgery. Very often it is necessary to perform surgery on the shoulder when it is habitually dislocated. If dislocation occurs twice a year or more often, then ligation and fixation of the ligament are necessary.

In case of traumatic dislocation, the bone is attached to the acromion process. In this case, a graft is taken from the patient’s own thigh tissue; this operation is complex and is always performed only under general anesthesia.

With a diagnosis such as purulent arthritis, arthrotomy is required. This type of operation consists of cutting the joint capsule and pumping out its purulent contents. The exudate is sent for research - this helps to identify the causative agent of the infection and establish the root cause of the disease for further treatment.

In case of fractures of the head of the humerus and other damage to the articular elements, in case of neoplasms in the tissues of the shoulder joint, partial dissection is carried out, also always under general anesthesia.

Sometimes excessive joint mobility causes the development of numerous complications and pathologies. In particular, the head of the humerus is injured. In this case, the only solution to the problem is full fixation joint forever. This operation (arthrodesis) is performed under general anesthesia.

Shoulder arthroplasty today is a very rare type of surgery on the shoulder joint. It is indicated for non-healing fractures and other serious injuries leading to severe limitation of joint functionality and mobility of the upper limb.

Shoulder arthroplasty

Shoulder replacement can be of two types:

Unipolar - when only some part of the joint is replaced, for example, the surface of the scapula or the head of the humerus.
Total – when all elements of the shoulder joint, including ligaments and cartilage, are completely replaced.

The design and type of prosthesis are selected individually, depending on the nature of the damage and individual characteristics patient.

The prosthetic operation consists of the following stages:

Preparing the patient - a comprehensive examination, biochemical blood tests, consultations with specialists if diseases are identified that may cause contraindications for surgery, examination and consultation with an anesthesiologist.
The operation is performed only under general anesthesia. Soft tissue dissection is performed to gain access to the joint. Then the destroyed elements are removed.
Implants made of a special alloy are installed in place of the removed articular fragments and fixed with medical cement. After this, the dissected tissues are combined, and sutures are placed on the wound.

This operation helps protect the remaining healthy tissue from destruction and restore joint mobility. In total, the installation of prostheses lasts no more than three hours. A fixing bandage is applied to the operated joint, and the patient is temporarily placed in the ward intensive care, a few hours later - to a private operating room.

Minor loads on the new joint can be placed within a day after surgery. Then the loads gradually increase. To speed up the physical adaptation of the prosthesis, exercises from physical therapy and breathing exercises.

Rehabilitation should take place only under the supervision of a doctor. You cannot increase the load prematurely on your own, as this can cause serious complications and lead to re-operation.

Today, this is the safest and most gentle method of surgical intervention, in which the periarticular tissues are practically not subjected to mechanical stress. Not long ago, arthroscopy was used only for diagnosis.

But thanks to the use of modern microdevices and microtools, it has become possible to perform operations inside the joint using this technique. Its main advantage is that, since the tissue is not cut, the recovery period after surgery is noticeably reduced, and no cosmetic defects remain on the skin.

What does shoulder arthroscopy involve? IN soft tissues One or two punctures are made around the affected joint, through this hole a special instrument with a camera on the tip is inserted into the joint cavity. In this way, the surgeon can clearly see everything that happens inside the joint, assess its condition and choose the optimal treatment and surgical tactics.

Then instruments are inserted through the same holes and all necessary manipulations are performed. The doctor does not act blindly - all images are displayed on the monitor. In this case, the operation is carried out under local anesthesia. Only in severe cases, when the operation may be delayed or for other indications, general anesthesia is used.

Before the operation, the diseased joint is completely examined: prescribed ultrasonography, radiography, computed tomography or magnetic resonance imaging. Naturally, arthroscopic diagnosis is carried out. Complications and side effects problems that may occur after arthroscopy:

Tissue swelling;
Accumulation of blood in the joint cavity;
Joint infection;
Temperature increase;
Blood clot formation.

Indications for arthroscopy include rheumatoid arthritis, osteoarthritis, ligament and tendon ruptures, and meniscal injuries. Arthroscopy is not performed in case of fusion of articular elements, purulent infectious inflammation of tissues, fresh injuries or any other inflammatory processes in the body.

Rehabilitation after shoulder surgery can last differently for everyone. Usually passive loads are given immediately, after a month they move on to gymnastics in water. Full performance and the ability to play sports return after six months, provided that the doctor’s recommendations are strictly followed.

Relieves pain and swelling in joints due to arthritis and arthrosis
Restores joints and tissues, effective for osteochondrosis

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