Humeral head fractures

thumb|250px|right|Diagram of fracture lines of the humerus: 1. Break-off of the greater tubercle 2. Break-off of the lesser tubercle 3. Anatomical neck 4. Surgical neck

Fracture of the head of the humerus occurs most often in older patients (in young people, the shoulder joint is more likely to luxate, in children it is more likely to be the thumb|250px|right

AO classification
A – extra-articular two-fragmented

B – extra-articular three-fragmented

C – intra-articular

Classification according to Neer
thumb|250px|right|Neerova klasifikace

They correspond to 4 anatomical source
 * According to number of fragments:


 * head
 * Greater tubercle
 * Lesser tubercle
 * diaphysis

i.e. displacement over 1 cm or deflection over 45°
 * According to their dislocation:


 * I – No dislocation (any number of fragments)
 * II – two-fragment with dislocation
 * III – three-fragment with dislocation
 * IV – four-fragment with dislocation

Classification according to Zeman

 * anatomical neck fracture


 * surgical neck fracture


 * fracture of the greater tubercle


 * fracture of the lesser tubercle


 * anterior luxation fractures


 * posterior luxation fractures


 * According to the dislocq6ion :


 * According to the dislocation of the fragment


 * Discloated fragments:


 * Rupture of the greater tubercle – pull of the supraspinatus tendon (rotator cuff)


 * Rupture of the lesser tubercle – pulls of the subscapularis tendon medially


 * Fracture of the surgical neck – pull of the distal fragment medially ( pectoralis major)

If both cusps are broken off with a neck fracture, the head is at risk of avascular necrosis (in general, the head is at risk in intra-articular fractures, which have a worse prognosis than extra-articular)

Clinical picture and diagnosis

 * changes in configuration of the shoulder, swelling, antalgic posture, limited movement, crepitation of fragments, runaway hematomas, in case of luxation fractures, an empty socket of the shoulder joint


 * Diagnostics:
 * it is necessary to examine the innervation (injury of the axillaris nerve during neck fractures) and the pulse on the radial artery
 * x-ray in two projections

Conservative (mainly in type A)

 * not dislocated, dislocated stable after reduction


 * immobilization in abduction for 3-4 weeks (Desault bandage with axilla padding, abduction splint - 30° forearm flexion and 60° abduction, hanging plaster, scarf sling)


 * early rehabilitation

Surgery (type B and C)

 * closed irreplaceable or redeployable nonretinable, open and luxation fractures, fractures complicated by injury to blood vessels and nerves:
 * closed reduction and MIO (e.g. intramedullary osteosynthesis according to Hacketal)
 * open reduction and plate osteosynthesis (T-plate, PHILOS – proximal humeral internal locking system)
 * secured nail (PHN – proximal humeral nail)
 * screws, K-wires, traction cerclage in multifragmentary fractures
 * CKP in comminuted fractures with risk of avascular necrosis of the head

Specific treatment solutions

 * tuberosity fractures - non-dislocated: rest in a sling for 7 days, dislocated: screws or traction cerclage
 * neck fractures - non-dislocated immobilization in Desault for 3-4 weeks (in the young, where there is no such risk of shoulder stiffness), hanging cast for 4-6 weeks in the elderly (allows early swinging movements in the shoulder), plate osteosynthesis (PHILOS) during surgical treatment or PHN
 * multifragment head fractures – surgical treatment with osteosynthesis (screws, K-wires), possibly CCP

Related articles

 * Bones of upper upper limb
 * Fractures of the humerus

Source


Categories:Surgery Categories:Traumatology Categories:Orthopedics