Joint treatment

Fracture of the humerus in a child: fracture of the supracondylar bone, fractures of the head of the condyle of the humerus. Fracture of the humerus What is the external condyle of the humerus

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Forearm injuries

Fractures of the humerus in the distal segment

Causes. Supracondylar (extra-articular) fractures are divided into extensor, occurring when falling on an outstretched arm, and flexion, when falling on a sharply bent elbow. Intra-articular fractures include transcondylar fractures, T- and V-shaped fractures of the condyles, a fracture of the head of the condyle of the humerus (Fig. 46).

Signs: deformity 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 backwards and upwards, there is a retraction of the skin above it. A solid protrusion is palpated in front above the elbow bend (upper end of the peripheral or lower end of the central fragment of the humerus). Movement in the elbow joint is painful. A symptom of V.O. Marx is positive (violation of the perpendicularity of the intersection of the axis of the shoulder with the line connecting the epicondyles of the shoulder - Fig. 47). With intra-articular fractures, in addition to deformation, pathological mobility and crepitus of fragments are determined. These fractures should be differentiated from dislocations of the forearm. Mandatory control over the integrity of the brachial artery and peripheral nerves! The final nature of the damage is determined by radiographs.

46. Options fractures distal metaepiphysis brachialis 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; eight - transcondylar fracture.

47. sign V.O. Marx. a-c norm ; b-at supradiadylic fracture brachial bones.

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

Treatment. First aid - transport immobilization of the limb with a splint or scarf, the introduction of analgesics. Reposition of fragments in supracondylar fractures is performed after anesthesia by strong traction along the axis of the shoulder (for 5-6 minutes) and additional pressure on the distal fragment: with extensor fractures anteriorly and medially, with flexion fractures, posteriorly and medially (the forearm should be in position pronation). 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 extensor fractures) or up to 110° (for flexion fractures - Fig. 48).

The hand is placed on the outlet tire. If the reposition failed (X-ray control!), Then impose skeletal traction behind the olecranon. The period of immobilization with a plaster splint is 4-5 weeks. Rehabilitation - 4-6 weeks. Ability to work is restored after 2/2-3 months. With these fractures, there is a risk of damage to the brachial artery with subsequent malnutrition of the muscles, which leads to the development of Volkmann's ischemic contracture.

The use of external fixation devices significantly increased the possibilities of closed reposition of fragments and rehabilitation of the victims (Fig. 49). Strong fixation is provided by bone osteosynthesis (Fig. 50).

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

When the fragments are displaced, skeletal traction is used for the olecranon on the outlet splint. After elimination of the displacement along the length, the fragments are squeezed and a U-shaped splint is applied along the outer and inner surfaces of the shoulder through the elbow joint without removing the traction. The latter is stopped after 4-5 weeks, immobilization - 8-10 weeks, rehabilitation - 5-7 weeks. Ability to work is restored after 21/2-3 months. The use of external fixation devices reduces the recovery time by 1-1*/2 months (Fig. 51).

Open reduction of fragments is indicated in violation of blood circulation in the limb and its innervation. For fixation of fragments, rods, knitting needles, screws, bolts, external fixation devices are used. The limb is fixed with a posterior plaster splint for 4-6 weeks. Rehabilitation - 3-4 weeks. Ability to work 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 with intra-articular fractures brachial bones.

FRACTURES OF THE CONDYLE OF THE HUMERUS 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 edema in the area of the elbow joint, its movements and palpation are painful. Guther's triangle broken. The diagnosis is clarified by X-ray examination.

Treatment. In the absence of displacement of 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 inwards. The traumatologist puts pressure on the fragment to set it. When repositioning the medial fragment, the forearm is deflected outwards. In a plaster splint, a control radiograph is made. If closed reduction failed, then they resort to surgical treatment with fixation of fragments with a pin 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 when using external fixation devices.

FRACTURES OF THE MEDIAL EPCONDYLE.

Causes: a fall on an outstretched arm with an outward deviation of the forearm, a dislocation of the forearm (a torn epicondyle can be pinched in the joint during the reduction of the dislocation).

Signs: local swelling, pain on palpation, limitation of joint function, violation of the isosceles triangle of Guther, x-ray helps to clarify the diagnosis.

Treatment the same as with a fracture of the condyle.

FRACTURE OF THE HEAD OF THE CONDYLE OF THE HUMERUS.

Causes: a fall on an outstretched arm, while the head of the radius moves upward and injures the condyle of the shoulder.

Signs: swelling, hematoma in the area of the external epicondyle, restriction of movements. A large fragment can be felt in the region of the cubital fossa. In the diagnosis of decisive importance are x-rays in two projections.

Treatment. Produce hyperextension and traction of the elbow joint with varus adduction of the forearm. The traumatologist sets the fragment, pressing on it with two thumbs downwards and backwards. Then the forearm is flexed to 90°, and the limb is immobilized with a posterior plaster splint for 4-6 weeks. Control radiography is required. Rehabilitation - 4-6 weeks. Ability to work is restored after 3-4 months.

Surgical treatment is indicated for unresolved displacement, with a detachment of small fragments blocking the joint.

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

During the recovery period 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, electrophoresis of sodium chloride or thiosulfate, underwater massage are shown.

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Fractures of the diaphysis of the humerusForearm injuries

Fractures of the condyles of the shoulder occur when falling on an outstretched and abducted arm. In this case, the acting force is transmitted most often through the head of the radius, then the external condyle is damaged, in rare cases - through the olecranon, then the internal condyle of the humerus is damaged. These fractures are intra-articular. The displacement of the condyles occurs predominantly upward and outwards, although in some cases rotational displacement is also noted and the condyle turns outwards by the fracture plane.

Symptoms. Non-displaced fractures are difficult to diagnose. In the area of the elbow joint, swelling, soreness are determined, corresponding to the damaged condyle, some limitation of movements in the elbow joint due to pain. With the displacement of the condyle, especially the external one, in the first hours one can clearly see a violation of the configuration of the joint, and on palpation, a mobile displaced condyle is sometimes determined. For specification of the diagnosis the X-ray analysis in two projections is obligatory.

In case of fractures of the condyles without displacement, treatment is carried out by immobilizing the arm with a posterior plaster splint or a circular plaster cast with the elbow bent at a right angle and the forearm set in the middle position between pronation and supination. A bandage or tire is applied from the heads of the metacarpal bones to the upper third of the shoulder. The fixation period is 2-3 weeks in children, 4 weeks in adults.

When the condyles are displaced, but without turning them around their axis, it is necessary to reduce, local anesthesia in adults (15-20 ml of 1% novocaine solution), in children - anesthesia. With a fracture of the lateral condyle, the arm is extended at the elbow joint. The assistant fixes the hand with one hand, and rests against the inner surface of the elbow joint with the other. By traction along the axis of the forearm and adduction of the forearm along the outer surface of the elbow joint, some diastasis is created, which allows the surgeon to press the thumbs of both hands on the displaced condyle downwards and inwardly set the fragment into place.

After that, the arm is given a flexion position to an angle of 90-100 °. An x-ray control is performed and, if the condyle is in a favorable position, the limb is fixed with a posterior plaster splint or a circular plaster cast for a period of 2-3 weeks for children and 4 weeks for adults.

When reducing the internal condyle, the same technique is followed, but instead of adducting the forearm, abduction is performed. In cases where the closed reduction was unsuccessful, as well as in fractures of the condyle with rotation of the fragment around the axis, when the closed reposition is ineffective, as well as in stale fractures (over 5 days), an open reposition of the condyle is indicated. The essence of the operation is to reduce and hold the condyle, which is fixed to the maternal bed with catgut or silk in children and screws, bone pins or metal needles in adults (Fig. 38). Postoperative fixation with a plaster cast or posterior plaster splint for 3-4 weeks.

With all methods of treatment, from the first days, movements begin in the fingers of the hand, in the shoulder joint, and after the termination of immobilization, in the elbow joint. Massage the muscles of the shoulder and forearm. Ability to work is restored within 8 weeks.

Rice. 38. Fixation of the external condyle of the humerus.

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

Symptoms and recognition. There is swelling in the area of the elbow joint, and hemorrhage inside and near 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 be easily confused with a sprain of the ligamentous apparatus. In most cases, a transcondylar fracture is recognized only by radiography, but even here difficulties arise when there is a slight displacement of the lower epiphysis. It should be noted that in children, the lower epiphysis of the humerus is normally inclined somewhat (by 10-20 °) forward with respect to the longitudinal axis of the shaft of the shoulder. The angle of inclination forward 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 the same and strict projections. Identification of the displacement of the lower epiphysiolysis is of great practical importance, since fusion in a displaced position leads to a restriction 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 puts one palm on the extensor surface of the lower shoulder, and the other produces 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 proceed to gradual movements in the elbow joint. Treatment can also be carried out with constant skeletal traction on the upper part of the ulna for 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 fracture of the humerus refers to intra-articular. T- and Y-shaped fractures occur under direct impact on the elbow of great force, for example, when falling onto the elbow from a great height, etc. With this mechanism, the olecranon splits the block from below and is introduced between the condyles of the shoulder. At the same time, a supracondylar flexion fracture occurs. The lower end of the diaphysis of the shoulder also penetrates between the split condyles, pushes them apart and the so-called T- and Y-shaped fractures of the condyles of the shoulder occur. With this mechanism, fragmentation of the condyles of the shoulder sometimes occurs and often the olecranon or a fracture of the condyles is combined with a dislocation and fracture of the forearm. These fractures can be

flexion and extensor types. In children, T- and Y-shaped fractures are less common than in adults. Fracture of both condyles of the shoulder 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 within the joint. The lower part of the shoulder is sharply enlarged in volume, especially in the transverse direction. The palpation of 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 crunch and abnormal mobility in the anteroposterior and lateral directions are observed. Without radiographs made 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 fractures without displacement 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 in the middle position between pronation and supination. A plaster bandage is applied for 2-3 weeks. Treatment can be carried out with the help of spokes with persistent platforms enclosed in an arc, or VolkovOganesyan's articulated apparatus. In children, the hand is fixed in the same position with a plaster splint and hung on a scarf. Longueta 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; adults sometimes have a slight restriction of movement for 5-8 weeks. The working capacity of patients is restored after 4-6 weeks.

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

In children, usually under anesthesia, a one-stage reposition is performed, followed by fixation with a plaster splint. The hand is hung on a scarf. Immobilization of the elbow joint is performed at an angle of 100°. Movements in the elbow joint begin in children with fractures with displacement after 10 days.

If the reposition fails, skeletal traction is shown 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 are reduced, it is possible to make a closed transosseous fixation of them with knitting needles; 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 ossifying myositis and excessive callus. Even with a good standing of fragments in cases of intra-articular fractures, there is often a limitation of movements in the elbow joint, especially in adults.

Operative treatment. It is proven if the reduction of fragments according to the described method fails or there are symptoms of disorders of the innervation and blood circulation of the limb. The operation is performed under anesthesia. The incision is made longitudinal

the middle of the extensor surface of the shoulder in the lower third. In order to avoid damage to the ulnar nerve, it is better to preliminarily isolate it and take it on a holder from a thin rubber strip. The condyles should not be separated from the muscles and ligaments attached to them, otherwise their blood supply will be disturbed and necrosis of the condyle will occur. To connect fragments, it is better to use thin needles with ends brought out 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 the appropriate length or bone pins. In children, in those rare cases when it is necessary to operate, fragments are well held by thick catgut threads passed through holes drilled or made with an awl in the bone. On the shoulder and forearm, bent at an angle of 100 °, a plaster splint is applied along the extensor surface and the arm is suspended on a scarf. The pins are removed after 3 weeks. Movements in the elbow joint in adults begin after 3 weeks, in children - after 10 days.

With incorrectly fused fractures, a sharp 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 the possible stunting of the limb. Surgery should be delayed until adulthood. In the elderly and senile age with intra-articular fractures, they are limited to establishing a limb in a functionally advantageous position and functional treatment.

Fracture of the lateral condyle of the humerus

Fracture of the lateral condyle is not uncommon, especially 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 shoulder, breaks off the entire external condyle, the epiphysis and a small piece of the adjacent part of the block. The articulating surface of the capitate eminence remains intact. The plane of the fracture has a direction from below and inside outwards and upwards and always penetrates into the joint.

Along with fractures without displacement, fractures with a slight shift of the condyle outwards and upwards are observed. A more severe form is a fracture, in which the detached condyle shifts outward and upward, slips out of the joint and turns in the horizontal and vertical planes (by 90-180 °) with the inner surface outward. Slight lateral displacement without rotation of the fragment does not prevent fusion and preservation of full function. When the fragment is rotated, fibrous fusion occurs. Often there is cubitus valgus followed by involvement of the ulnar nerve.

Symptoms and recognition. A fracture of the lateral condyle of the shoulder without displacement is difficult to recognize. There is hemorrhage and swelling in the area of the elbow joint. The outer epicondyle, when the condyle is displaced upward, is higher than the inner one. The distance between the external epicondyle and the olecranon 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 feel the displaced fragment and determine the bone crunch. Flexion and extension in the elbow joint is preserved, but the rotation of the forearm is sharply painful. With a fracture of the external condyle 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 forcibly adducted. For the recognition of a fracture, radiographs taken in two projections are of great importance; without them, it is difficult to make an accurate diagnosis. Sometimes there are difficulties in deciphering radiographs in children. Cause

lies in the fact that although the nucleus of ossification of the external condyle can be seen in the 2nd year of life, but the fracture line goes through the cartilaginous section, which is not detected in the picture.

Treatment . Fractures of the external 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 multicomminuted fracture with a large displacement of fragments before and after osteosynthesis with pins.

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

A fracture of the humerus is an injury that occurs as a result of a blow that the bone tissue is not able to withstand. This injury is widespread. Fracture of the capitate of the humerus and other departments in young people is much less common than in older people, treatment and symptoms depend on the location and complexity of the injury.

Anatomy

The long tubular bone of the upper limb is the humerus, which performs a motor function, plays the role of a lever.

The humerus is divided into three parts:

Proximal epiphysis - located in the upper part of the body and is a rounded and adjacent part of the bone.
The diaphysis is the middle part or body.
The distal epiphysis is the lower part of the humerus, which is removed from the body.

proximal epiphysis

The proximal epiphysis most often suffers from trauma to the large tubercle and neck. It consists of:

Head and articular cavity of the scapula.
The anatomical neck, which serves as a dividing groove between the head and the rest of the parts.
Small and large tubercle, located behind the neck.
Intertubercular furrow, which is the point of passage of the veins with the length of the head.
The surgical neck is considered the thinnest part of the humerus and is one of the leaders in damage.

diaphysis

The longest part of the humerus is called the diaphysis. The length of the body exceeds all other departments. Injury to this area is called a fracture of the diaphysis of the humerus. The diaphysis is:

The upper part of the body is similar to a cylinder, and in section, the distal epiphysis resembles a three-angled figure.
Along the perimeter of the diaphysis there is a spiral hollow, inside which there is a radial nerve, which provides a link between the limb and the center of the entire nervous system.

Distal epiphysis

The distal or condylar region is the connector of the lower ulnar region with the forearm area. As a result of injuries, a transcondylar fracture of the humerus can occur, which refers to intra-articular fractures. Even in this segment, supracondylar injuries can occur with a careless fall or impact - a fracture of the epicondyle of the humerus. Description of the distal site:

The lower part of the shoulder section is much wider and flatter than the diaphysis.
The elbow joint includes two articular planes connecting the humerus with the ulna and radius.
The block of the humerus has the shape of a cylinder and articulates with the bone sections of the ulna.
On the outer plane of the shoulder is the head, which connects to the radius.
The internal and external epicondyles, which hold the hand and separately the fingers, are attached to the side of the epiphysis.
The extensor muscles are attached to the lateral condyle.
The flexor muscles are attached to the medial condyle.

Humerus fractures can occur in any part of it. Sometimes injuries can affect two adjacent areas of the humerus. Shoulder injury is often combined with pathologies around the bone - nerve endings, brachial vein, part of the vascular system, skin. A person who falls unsuccessfully on the upper part of the shoulder with an emphasis can receive a transcondylar fracture of the shoulder or a fracture of the condyle of the humerus.

Damage factors

The causes of a fracture of the humerus are as follows:

Fall on elbow or outstretched arm.
A fall on a hyperextended outstretched arm results in an extensor fracture.
A fall on the elbow, with a strongly bent forearm, causes a flexion fracture.
A blow to the upper shoulder area.
Detachment of the tubercles can occur due to dislocation of the shoulder joint. This happens due to a sharp and strong contraction of the muscles attached to it.

Types of fracture

Different classifications of humerus fractures are used to describe the clinical picture of injuries.

Main types:

Traumatic - due to the strongest mechanical load at an angle or perpendicular to a part of the skeletal system relative to the bone axis.
Pathological - appears against the background of chronic pathologies that reduce the strength of bone tissue up to destruction at the slightest load.

According to the type and direction of destruction, shoulder fractures are divided into:

Transverse - due to damage to the bone tissue perpendicular to the axis of the bone.
Longitudinal - damage to the bone extends along the perimeter of the tissue.
Oblique - a fracture of the bone at an acute angle relative to the axis.
A helical fracture occurs due to a circular injury. The wreckage is displaced in a circle.
A comminuted fracture of the humerus is characterized by the fact that with it the fracture line is completely lubricated, and the bone tissue turns into fragmental fragments.
Wedge-shaped occurs during the indentation of one bone into another and this type of damage is typical for vertebral fractures.
Impacted fracture of the humerus - one bone is wedged inside the other.
A depressed or impression fracture of the head of the humerus occurs when pressed into the bone tissue.

Shoulder fractures according to the severity of damage to the skin and muscle tissue:

Closed fracture of the humerus - without breaking the skin.
Open fracture - muscles and skin are injured, bone fragments are visible in the resulting wound.

Fractures according to the placement of fragments:

Fracture of the humerus without displacement.
Displaced fracture of the humerus - refers to complex fractures, before treatment it is necessary to combine all bone fragments.

Perhaps surgery to accurately align the fragments.

Fractures are also classified by location relative to the joints:

Extra-articular.
Intra-articular - affects the part of the bone that forms the joint and is covered by the articular capsule.

With all injuries of the humerus, a closed fracture of the shoulder predominates, and most often it happens with a displacement. It should be noted that several types of fractures can be combined at the same time, but within the same department.

Fracture of the head of the shoulder, anatomical, surgical neck most often occurs in the elderly. A fracture of the humerus in children occurs after an unsuccessful fall and most often these are intercondylar and transcondylar injuries. The body of the bone or the diaphysis is quite often subject to injury. Fractures occur with bruises of the shoulder, as well as from a fall on the elbow or a straightened arm.

Symptoms of damage

Due to the strong innervation of the shoulder girdle, a humeroscapular fracture brings changes in the general condition of the patient. Shoulder fracture symptoms may vary depending on the type of injury:

Upper shoulder fracture

Acute pain syndrome.
Swelling of tissues in the area of fracture of the upper end of the humerus.
Hemorrhage under the skin.
The restriction in joint mobility is partial or complete immobilization due to the fact that a fracture of the upper third or another department has occurred.

Fracture of the middle shoulder

Deformation of the arm due to the shift of bone fragments and reduction of the damaged shoulder relative to the healthy one.
Intense pain.
Violation of the work of the arm - volumetric movements in the joints of the elbow and shoulder are limited due to a violation of bone integrity.
Edema.
There is hemorrhage under the skin in the fracture zone.

Lower shoulder fracture

Supracondylar

Swelling in the area of the elbow joint.
Deformity - displacement and retraction of the elbow, a protrusion is visible on the front surface of the joint. These signs of a fracture appear only for the first time hours of injury, then the edema hides these pathologies.
Acute pain syndrome.
Restriction in joint mobility.
Subcutaneous hemorrhages.

transcondylar

Swelling in the elbow area.
Strong pain.
Hemorrhage in the joint.
Movement restriction.

First aid

First aid for a fracture of the humerus or shoulder joint with displacement should be provided to the victim in a timely and correct manner. The speed of action determines how long the injury will be treated, as well as the result of all therapeutic and surgical procedures, regardless of the age of the patient. Help should be provided correctly, by a person who knows the algorithm of actions.

The main help for a fracture of the shoulder to the victim is the following measures:

Pain relief with drugs and injections.
Immobilization of the injured limb with the help of improvised means - a board, a stick, a scarf will make the arm immobile, which will not allow the bone fragments to move.
During the transfer, it is important that the casualty is seated and not standing. If there is a need, then it can be supported from the side opposite from the injury - right or left.

Important! If a fracture occurs in a child, the people accompanying him must not panic, so as not to frighten the child and not strain the situation. In no case, when providing assistance, you can not independently palpate the fracture site. It is necessary to avoid any rough and abrupt movements, this will help to avoid displacement of fragments, damage to blood vessels and nerves.

First aid is the key to a quick recovery with minimal negative consequences.

Diagnostics

The victim should be taken to the emergency room as soon as possible, where he will be examined by a specialist. He will feel the area where the shoulder fracture occurred and the symptoms will reveal the specific symptoms of the injury:

When tapping or pressing in the elbow area, the pain increases significantly.
During the palpation of the joint, a characteristic sound appears, resembling bursting bubbles - these are the sharp edges of the fragments touching each other.
The doctor performs various manipulations with the victim's shoulder, while he tries to feel with his fingers which bones are displaced and which remain in place.
If a dislocation is present simultaneously with a bone fracture, then when palpating the shoulder joint, the traumatologist does not find the head of the shoulder in its anatomical location.
In the area of the elbow joint - protrusions and depressions are felt in front and behind. They are located in the direction of displacement of fragments.
Shoulder deformity - the epicondyles deviate from their normal position.

Only a specialist doctor should check all these indicators. Inept actions can cause damage to blood vessels and nerves, and as a result, serious complications.

The final diagnosis is made only after an X-ray examination. The picture will show at what level the humerus is broken, in which direction the displacement occurred.

What therapeutic measures will be prescribed by the doctor, and how long the treatment lasts.

Treatment

Treatment of a fracture of the humerus consists of three methods: surgical therapy, conservative treatment, and the traction method. If the fracture of the shoulder joint does not have displacements or it can be corrected by performing a one-stage reposition, then it will be enough to apply a plaster or other fixative.

Conservative therapy

It is based on the complete immobilization of the injured hand with fixation with special pads and is used for injuries:

A large tubercle, where, in addition to the fixing tape, a special splint is used to prevent immobilization of the joint and ensure splicing of the supraspinatus muscle. In the case when the fragment of the tubercle has moved from its place, then it is necessary to fix it in the correct position with knitting needles or screws. After 1.5 months, the structure should be removed.
A fracture of the shoulder joint without displacement is treated with a splint, which is applied to the injury for a period of two months. If there is a displacement, then resort to the help of skeletal traction. The victim will have to spend a month in an immobilized position. After that, plaster will be applied for the same period. Recently, the therapeutic technique of skeletal traction has been replaced by osteosynthesis, which does not confine the patient to bed for such a long time.
Treatment of the surgical neck without displacement is carried out using a plaster fixative. They put it on for a month. If the reduction was carried out, and it was carried out successfully, then the plaster is worn for two weeks more. When it is not possible to set the bone fragments, then a surgical intervention is prescribed, where fixation is carried out inside the bone with the help of plates. If an impacted fracture occurs, then it will be correct to use wicking pillows or special scarves. How long does this therapy last? The treatment period for a fracture of the shoulder joint can be extended by three months until the bones are completely fused.
Transcondylar injuries are always accompanied by displacement of debris. Their comparison is carried out under anesthesia, followed by the imposition of plaster for up to two months.

A fracture of the shoulder joint can lead to injury to blood vessels or nerves. In this case, an operation is required, which consists of suturing. This increases the duration of therapy.

Important! It is not always possible to fully restore the functions of the damaged limb with this damage.

Of the medications, in the treatment of a fracture, prescribe drugs containing calcium, analgesics and antibiotics.

Surgical intervention

If there are prerequisites for operations, then they are carried out using modern techniques and are prescribed when conventional therapy does not give a positive result in case of a fracture:

Displaced shoulder fracture - the fragments are fixed with special rods, and after a while, until the fracture heals, they are removed from the bone.
If there is damage that cannot be reduced in the usual way, then plate fixation without plaster is used, followed by removal.
Fracture of the body with a displacement - during the operation, intraosseous rods are inserted into the bones for a period of a paltar of a month. During rehabilitation, the treatment of a fracture of the humerus is extended by the same period.
The trauma of the transcondylar ends, accompanied by the displacement of fragments, is reduced under anesthesia with the imposition of plaster for two months. If the displacement could not be eliminated, then an operation is performed during which screws and plates are used. Put them on for a few years
Fracture of complex, open injuries of the body is treated using the Ilizarov construction, which allows you to move your arm from the very beginning of therapy. This design is kept on the limb for about six months.
If an injury to the humerus caused damage to the nerve endings and veins, then an urgent surgical intervention is prescribed.

The term and treatment of fusion in case of a fracture of the humerus with displacement directly depends on the severity of the injury. Gypsum is applied for 2-3 months.

Skeletal traction

It is used if there is a fracture of the humerus with displacement. During this method, a special pin is inserted into the elbow to help set the bones. With an exhaust structure, the patient lies for about a month. This type of therapy is rarely used.

Rehabilitation

After the bones grow together and the bandage is removed, one should proceed to rehabilitation measures aimed at developing the injured arm.

Rehabilitation includes:

Physiotherapy treatment of a fracture of the shoulder joint - it is necessary to undergo several courses, consisting of 10 procedures. Electrophoresis with novocaine, calcium chloride can be prescribed. Ultrasound treatment gives good results.
Massage. If it is not possible to visit a specialist in the office, then it can be performed independently. To speed up the healing period and stimulate blood circulation, it is recommended to use special ointments and oils.
A set of therapeutic exercises.

Important! The development of the shoulder joint after a fracture is an integral part of bone restoration and plays no less important role than adequate therapy.

Complications

Upper shoulder fracture

Disruption of the deltoid muscle occurs as a result of nerve damage. Paresis or partial movement disorder, complete paralysis may appear. It is difficult for the victim not to take his shoulder to the side, to raise his arm high.

Arthrogenic contracture is a violation of movements in the shoulder joint due to a pathological change in it. This happens due to the destruction of articular cartilage, the growth of scar tissue. The joint capsule and ligaments become very dense, their elasticity is lost.

Habitual dislocation of the shoulder a consequence that develops after fracture-dislocation. This is when a shoulder joint fracture and dislocation occurs. If the therapy is carried out incorrectly or untimely, then in the future it is easy to re-dislocate from any effort.

Fracture of the middle part of the humerus

This nerve runs along a spiral groove located on the humerus and innervates the muscles of the shoulder, forearm, hand, which leads to paresis or complete paralysis.

The neurologist deals with the treatment of complications. The damaged nerve is restored with the help of medicines, vitamins, physiotherapy.

False joint. If a piece of muscle or other soft tissue is pinched between the fragments, then they cannot grow together. Abnormal mobility remains, as if a new joint has appeared. Requires surgery.

Fracture of the lower part

Volkmann's contracture is a decrease in mobility in the elbow joint due to circulatory disorders. Vessels can be damaged by bone fragments or squeezed when wearing an incorrectly applied fixator for a long time. Nerves and muscles stop receiving oxygen, resulting in a violation of movement and sensitivity.

Arthrogenic contracture in the elbow joint develop after pathological changes in the joint itself, as in the case of arthrogenic contracture of the shoulder joint with fractures of the shoulder in the upper part.

Dysfunction of the muscles of the forearm is due to damage to the radial and other nerves.

Conclusion

Treatment of any fracture requires compliance with all prescriptions of specialists. Immobilization and complete rest of the injured surface is replaced by a certain load over time. Courses of physiotherapy, exercise therapy, massage can be prescribed repeatedly with interruptions until full recovery of all functions. It is also important to follow all recommendations for recovery at home.

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Fractures of the medial epicondyle of the humerus are avulsion in nature and account for 35% of all fractures of the distal part of this bone. They are the result of an indirect mechanism of injury and occur during a fall with an emphasis on the hand of an extended arm with a deviation of the forearm outward. Muscles attached to the medial epicondyle tear it off.

In this case, a significant rupture of the capsule of the elbow joint occurs. The mechanism of occurrence of a fracture of the medial epicondyle corresponds to the mechanism of dislocation of the bones of the forearm. Quite often at dislocation of a forearm there is an infringement of this epicondyle in an elbow joint. According to our statistics, 62% of dislocations of both bones of the forearm were accompanied by detachment of the medial epicondyle.

There are the following types of fractures of the medial epicondyle of the humerus:

fractures without displacement;

fractures with displacement in width;

fractures with rotation;

fractures with infringement in the elbow joint;

fractures with nerve damage;

fractures in combination with dislocation of the forearm;

repeated breaks.

Clinical and radiological diagnostics

Limited tissue swelling along the anteromedial surface of the elbow joint, extensive bruising, and local pain are expressed. On palpation, a mobile epicondyle can be determined. This resembles the symptoms of a transcondylar fracture with displacement of the distal fragment to the lateral side. However, with the latter, the swelling extends to the entire elbow joint, and the sharp edge of the central fragment is determined on the medial side of the elbow joint. When the medial epicondyle is torn off, extension in the elbow joint with the deviation of the extended fingers to the back causes pain in the projection of this epicondyle, fluid is determined in the cavity of the elbow joint, and signs of nerve damage are revealed. With a dislocation of the bones of the forearm, deformation of the elbow joint is observed. The nature of the deformation is determined by the type of dislocation. With repeated detachments of the medial epicondyle, which occur with fibrous fusion of the false joints, the symptoms are “blurred”, the swelling is small and limited, there is no bruising, on the anteromedial surface of the elbow joint, soft tissue compaction associated with the humerus is palpated.

Difficulties in X-ray diagnosis arise mainly in children under 6 years of age, in whom the ossification nucleus has not yet appeared, and in the absence of displacement of the epicondyle.

The combination of separation of the medial epicondyle and dislocation of both bones of the forearm is characteristic, therefore, when studying radiographs, it is necessary to pay attention to the area of the medial epicondyle. Sometimes it is difficult to distinguish a repeated fracture from a primary one. Only the presence of ossification indicates re-injury.

In children, avulsion of the medial epicondyle occurs as apophyseolysis or osteoapophyseolisis. There are detachments of only part of the apophysis. Sometimes it is a cartilage plate that is not radiopaque. Separations of a muscular leg with a periosteum are observed. The muscle leg is sometimes infringed in the elbow joint, dragging the ulnar nerve with it, and signs of damage to it are determined. The latter cases are rare and difficult to recognize, but should always be kept in mind. There are detachments at the same time and the lateral epicondyle of the humerus. Separation of the medial epicondyle is often combined with other fractures in the elbow joint.

The fragment under the influence of muscle traction is displaced downward and to the radial side. Infringement of the epicondyle in the elbow joint is of two types:

when it is all in the joint cavity;

when only its edge is infringed.

The joint space is expanded from the medial side. With a cartilaginous epicondyle, this x-ray sign becomes especially valuable. Be sure to pay attention to the degree of rotation of the fragment, the shape and size of the ossification nucleus. In children 6-7 years old, the ossification nucleus has a rounded shape and at first its shadow appears in the form of a dot.

Treatment

If there is no displacement of the bone fragment, then treatment is limited to immobilization of the posterior plaster splint for 15-20 days. With a displacement of more than 5 mm, rotational displacement, infringement of the epicondyle, surgical treatment is indicated. In case of dislocation of the bones of the forearm, the dislocation is first reduced and only then the question of surgical treatment is decided. The operation is technically simple and, if performed correctly, leads to a complete recovery.

Open reduction is sought to be performed as soon as possible after injury. In the first 1-3 days, the operation is performed with minimal soft tissue trauma, and it is not associated with any difficulties. The skin incision is made along the anteromedial surface of the elbow joint. Stupidly separate the soft tissues and approach the fracture site. This removes blood clots. The wound surface of the humerus is freed from the soft tissues covering it, which are retracted medially along with the ulnar nerve. Determine the position of the epicondyle, the degree of damage to the capsule and joint. If a fragment is infringed in the joint cavity, it is removed. Be sure to evacuate blood clots from the joint cavity. To compare the fragment, it must be shifted upwards and slightly backwards. In the center of the epicondyle, a needle with a thrust platform or an awl with a removable handle is injected so that it runs perpendicular to the plane of the fracture. The end of the needle is brought out above the wound surface by 0.5-1 cm. With the help of a needle, the epicondyle is pulled up. Then the end of the spoke is placed in the center of the facet on the humerus and, acting on the principle of a lever, reposition is achieved. The needle is introduced into the condyle of the humerus, pressing the epicondyle against it with a persistent platform. This technique greatly facilitates reduction, especially with stale fractures. Visually check the accuracy of the reduction. The wound is sewn up tightly. Be sure to produce x-ray control, bearing in mind that when the epicondyle is torn off, there is a tendency to dislocation of the forearm. Impose a back plaster bandage from the bases of the fingers to the upper third of the shoulder. The elbow joint is immobilized at an angle of 140°. Practice shows that from this position of the joint, its function is restored faster. In order to avoid the formation of conflicts, the edges of the splint are bent. In the postoperative period, a UHF field is prescribed. Immobilization is continued for at least 3 weeks. The fixing needle is removed and exercise therapy is prescribed. Movements in the elbow joint are carried out within the amplitude that does not cause pain. Forced restoration of function, violent movements lead to a reflex closure of the elbow joint, the formation of ossifications and, ultimately, to a prolongation of the restoration of the function of the elbow joint. Massage of the elbow joint area, warming it up also have a negative effect.

During the first week, the first signs of recovery of movements are already noted. During this period, the child and his parents master the basic principles of exercise therapy quite well and, after discharge from the hospital, carry it out at home under the supervision of an exercise therapy methodologist.

The most common complication is the formation of a false joint. With non-surgical treatment, this complication is observed in 40% of cases, which is mainly associated with soft tissue interposition. In surgical treatment, it is rare and is associated with errors in the surgical technique, as well as in the treatment of stale fractures.

Avulsion fractures of the lateral epicondyle of the humerus are very rare. Usually, only its outer plate is torn off, to which the radial collateral ligament of the elbow joint and muscle is attached. The displacement is usually insignificant and easily eliminated. Fixation of the lateral epicondyle is carried out with a thin needle. Outcomes are favorable. Indications for surgical treatment are very rare.

Fractures of the head of the condyle of the humerus

Among all fractures of the bones that make up the elbow joint, fractures of the head of the condyle of the humerus occupy the first place in terms of the frequency of adverse outcomes. This is a violation of the function of the elbow joint, delayed consolidation, the formation of pseudarthrosis and other complications. These fractures account for 8.2% of all fractures in the elbow joint. They arise from an indirect mechanism of injury, when falling on an outstretched, slightly bent arm; more often occur in children aged 5-7 years.

There are several types of these fractures:

epimetaphyseal fracture of the outer part of the condyle;

osteoepiphyseolysis;

pure epiphysiolysis;

fracture of the nucleus of ossification of the head of the condyle;

subchondral fractures;

fracture or epiphysiolysis in combination with dislocation in the elbow joint.

Fractures of the head of the condyle of the humerus are sometimes combined with fractures of the medial epicondyle, olecranon, and neck of the radius. Fractures of the head of the condyle of the humerus in combination with dislocations in the elbow joint occur in 2% of cases. Anterior-medial dislocation predominates, posterior-medial dislocation is less common.

Clinical and radiological characterization

There is swelling of the lateral side of the elbow joint, sharp pain on palpation of the lateral surface of the distal part of the humerus. In the joint cavity fluid, hemarthrosis are determined. Sometimes the mobility of a broken bone fragment is determined. Difficulties in radiographic diagnosis may arise in the absence of displacement. Usually, a broken bone fragment is displaced laterally and downward, anteriorly or posteriorly, as well as at an angle open posteriorly or anteriorly. Quite often, rotation of the fragment is observed, due to the traction of the muscles attached to it. Typically, rotation occurs in more than one plane and is often quite significant. In such cases, the articular surface of the head of the condyle may be directed towards the wound surface of the humerus. It loses contact with the head of the radius and is in a position of subluxation or dislocation.

In osteoepiphysiolysis, a fragment of the metaphysis can be of various sizes and shapes. Its crescent shape is characteristic. It occurs at the time of injury with displacement laterally and posteriorly. In this case, only a compact plate breaks off from the lateral or posterior surface of the metaphysis of the humerus. On radiographs, it is defined as a sickle, which at one end approaches the lateral surface of the nucleus of ossification of the head of the condyle of the humerus.

By the nature of the fracture plane and the degree of displacement, the depth of the blood supply disturbance of the broken fragment is determined with a sufficient degree of certainty. To the greatest extent, it suffers from pure epiphysiolysis. The state of blood supply largely determines the choice of treatment tactics.

Treatment

The method of treatment is chosen on the basis of studying all the features of the fracture. In the absence of displacement, a posterior plaster splint is applied from the bases of the fingers to the upper part of the shoulder. If there is a slight displacement, then it is preferable to fix the fragment with knitting needles. This eliminates the possibility of slow consolidation.

When the fragment is displaced along the width, at an angle and slightly rotated, a closed reposition is used. It is carried out with very careful movements. At the same time, the direction of displacement and the localization of unbroken soft tissues that bind the fragments and give them a certain stabilization are taken into account. When the fragment is displaced laterally and downwards, the forearm is deflected medially and by pressing the fingers on the fragment from the outside up and inward, it is brought closer to the humerus, introducing it between the condyle of the humerus and the head of the radius. When displaced backwards, they press on the fragment from behind and bend the limb at the elbow joint. Then the fragment is percutaneously fixed with pins with thrust pads to the humerus. Produce x-ray control. The terms of immobilization are 4-5 weeks.

Fractures of the head of the condyle of the humerus in combination with dislocation in the shoulder joint

The study of such injuries showed that at the time of injury, the head of the condyle of the humerus is fractured, then dislocation occurs. As a result, the broken fragment retains its connection with a part of the epicondyle of the humerus through soft tissues. There is a displacement in one ligament of the forearm with the head of the condyle of the humerus. This explains the possibility of bloodless reduction in such injuries. In the course of surgical interventions, it was found that in children with similar fracture-dislocations, there was an infringement of soft tissues in the humeroulnar joint or there was a significant rupture of the articular capsule and other soft tissues. After elimination of the infringement of soft tissues in the joint cavity, free reduction of the bone fragment occurred.

Treatment options

Based on the clinical and radiological study of patients, as well as the analysis of surgical findings, a technique for bloodless reduction of fractures of the head of the condyle of the humerus in combination with dislocation in the glenohumeral joint was developed. Its principle is that the fracture and dislocation are reduced simultaneously. At the same time, all manipulations should be reasonable, purposeful and as sparing as possible in order to avoid additional rupture of soft tissues. Otherwise, the reduction becomes ineffective. The result of reduction is controlled by radiography, osteosynthesis is carried out with pins with thrust pads.

In children, as a rule, there are many cartilaginous elements in the elbow joint, so the correct assessment of the position of the broken fragment can be difficult. It is especially difficult to determine the degree of rotation. Therefore, in doubtful cases, open reposition is preferred.

Of fundamental importance is the question of the timing of immobilization for all fractures of the head of the condyle of the humerus. Experience convinces us that the reduction of terms even in the absence of displacement unacceptably showed that the complication was often in those in whom the displacement was either absent at all, or was insignificant. Guided by this, doctors stopped immobilization in patients of this category already 2 weeks after the injury, which was the reason for nonunion of the bone.

The period of immobilization depends on a number of factors and, especially, on the age of the patient, the degree of adaptation of the fragments and the violation of the blood supply to the broken fragment. With epiphysiolysis, in connection with this, the fixation time should be large. On average, rest of the fracture area should last at least 4-5 weeks. Of decisive importance in deciding whether to remove the plaster cast are the data of the control radiographs. The fear of the occurrence of post-immobilization contractures in children is not justified. With delayed consolidation, immobilization is extended until the fracture heals.

With a significant rotational displacement, an open reduction is resorted to without attempting a closed reduction. The operation is performed with gentle techniques. Fixation is carried out with spokes with thrust pads, which create a certain compression between the fragments.

Due to the peculiarities of the blood supply to the distal end of the humerus in its fractures, especially the lateral part, often there is a delayed consolidation, a false joint of the head of the condyle, the phenomena of its avascular necrosis. These complications are facilitated by ineffective and short-term immobilization. Delayed consolidation and false joints often occur with non-displaced fractures. In such cases, doctors erroneously shorten the immobilization period, which is the cause of the noted complications. For their treatment, closed fixation of fragments is used using a specially designed screw that allows it to be inserted using a removable handle. If the fragment is displaced simultaneously with the movements of the forearm, then the latter is set in the position in which the head of the condyle of the shoulder is set in the correct position. Fragments are fixed with a needle. Then, with a scalpel, an incision is made up to 5 mm in the direction of the head of the condyle of the humerus. A canal is made through the incision with an awl through the head of the condyle into another fragment. A screw is passed through the channel using a removable handle. The screw creates compression between fragments. Apply a plaster cast. After healing the fracture with a removable handle, the screw is removed on an outpatient basis.

Subchondral fractures of the head of the condyle of the humerus.

A special group of fractures of the head of the condyle are subchondral fractures. We are talking about the separation of articular cartilage with areas of bone substance. They are not so rare, but, as a rule, are not diagnosed. They are usually referred to the group of epiphyseolysis. Subchondral fractures are observed only in children 12-14 years old. Displacement only anteriorly is characteristic. They are unfamiliar to practitioners, since the mention of them is very rare. Meanwhile, they require a special approach in the diagnosis and choice of treatment.

Clinical and radiological signs

The clinical manifestations of subchondral fractures depend on the time elapsed since the injury and the degree of displacement. In recent cases, marked pain in the elbow joint, aggravated by movement. The contours of the joint are smoothed, local pain is detected with pressure on the head of the condyle. In the cavity of the elbow joint in fresh and stale cases, fluid is determined.

X-ray examination is of decisive diagnostic value. The radiological picture of the damage depends on the size of the broken articular cartilage and bone plates, as well as on the steppes and its displacement. In most cases, the fracture extends only to the head of the condyle, but it often passes to the lateral surface of the shaft of the block. In one patient, articular cartilage was removed from the entire distal epiphysis of the shoulder.

Since plates of bone substance of various sizes break off with articular cartilage, the contours of the separated fragment are quite clearly visible on radiographs.

It should be noted that in a number of patients, the cortical plate and bone substance break off from the outer surface of the head of the condyle of the humerus. Further, the fracture plane goes inward, separating only the articular cartilage. Therefore, on the lateral radiograph, when the fragment is displaced anteriorly, a picture of the displacement of the entire epiphysis of the humerus in the form of a hemisphere is revealed.

In practice, it is advisable to distinguish 5 groups of subchondral fractures:

fractures without displacement and with slight displacement; they are visible only on the lateral radiograph; at the same time doubling of a contour of a head of a condyle comes to light; treatment consists in immobilization of the elbow joint for 3-4 weeks;

fractures with displacement, but only at an angle open anteriorly; reposition consists in pressure on the head of the condyle from front to back and full extension in the elbow joint; in this position, a plaster splint is applied; as a rule, reposition leads to the desired result;

fractures with displacement not only at an angle, but also in width anteriorly; at the same time, the wound surfaces of the fragments from behind are still in contact; reposition is also carried out by the same methods as for fractures of the previous group;

complete displacement of the fragment anteriorly; while its wound surface is adjacent to the anterior surface of the distal part of the humerus; closed reduction fails, surgical treatment is indicated;

displacement of the fragment into the anterior torsion of the elbow joint; in such cases, movements in the elbow joint are restored completely without eliminating the displacement; with uncorrected displacements of the 3rd and 4th groups, the function of the elbow joint is sharply disturbed, primarily extension suffers.

With stale fractures without displacement, clinical symptoms are not very pronounced. Patients complain of moderate pain in the elbow joint, extension in it is limited. There is fluid in the joint cavity.

Palpation is not painful. On the lateral radiograph, fragmentation of one of the contours of the head of the condyle of the humerus is sometimes revealed. Treatment begins with immobilization of the joint. Then use exercise therapy, FTL.

Humeral block fractures

Fractures of the block of the humerus in children are very rare and arise from an indirect mechanism of injury, when falling on an adducted and slightly bent arm at the elbow joint. They are typical for children of the older age group. There are metaepiphyseal fractures of the medial part of the condyle of the humerus, vertical fractures of the medial edge of the block with the medial epicondyle, and epiphysiolysis.

Clinical and radiological picture

A fracture of the block of the humerus is characterized by swelling of the elbow joint, sometimes significant, but more localized on its medial side. With full extension of the fingers and in the wrist joint, pain also appears on the medial side of the joint.

On palpation, a sharp pain is detected here, sometimes the mobility of a bone fragment. In the joint cavity, fluid is determined, which is regarded as hemarthrosis.

On radiographs, a block fracture of a different nature is revealed. Difficulties in interpreting radiographs may arise in children in whom the block is represented by several ossification nuclei. The fragment is displaced inwards and downwards. Quite often, rotation of the fragment is observed, sometimes it is significant, due to the traction of the muscles attached to the medial epicondyle.

Treatment

Treatment of block fractures without displacement is limited to immobilization of the posterior plaster splint for 3 weeks.

Displacement of fractures of the block of the humerus leads to restriction of movements in the elbow joint, so they must be eliminated. When offset in width, an accurate comparison is usually possible in a closed way by direct pressure with fingers on the fragment. In order to avoid secondary displacement, osteosynthesis with wires is used. Fragment rotation, as a rule, cannot be eliminated closed, therefore an open reduction is used.

Apply medial access to the fracture site. The ulnar nerve is isolated and retracted medially. Under the control of the eye, an accurate comparison of the fragments is achieved. They are fixed with knitting needles with persistent platforms. After layer-by-layer suturing of the wound, the arm is fixed with a posterior plaster splint for 4 weeks. The spokes are removed and the movement in the elbow joint is restored according to the principles outlined earlier. Proper use of exercise therapy guarantees complete restoration of the functions of the elbow joint.