34. Fracture of the surgical neck of the humerus

Essay 34- Fracture of the surgical neck of the humerus

Classification of humeral fractures

• Fractures of head
• Fractures of anatomical neck
• Pertubercular fractures of the humeral bone
• Fractures of the major and minor tubercle
• Fractures of the surgical neck
• Abduction fractures
• Adduction fractures

Etiology (mechanism)

• Indirect trauma- falling onto the arm or the elbow
• The diaphysis is pressed by the compression against the metaphysis and is flexed or rotated (torsion)
• Sometimes the distal fragment may be set into the central one
• Dislocated fractures have an angular dislocation

Symptoms

• Pain in upper part of shoulder bone
• Movements are with pain
• Healthy arm supports injured one
• Deformity is noticed
• Edema
• Hematoma
• Hemorrhage spreads to the brachium, skin turns blueish in colour
• On palpation- pain, pathological mobility, bone crepitations, disturbed axis

Diagnosis

• X-ray clarifies the diagnosis!

First aid

• Dislocated fractures- brachium is pulled along the length and the angular formation is straightened!
• The extremity is immobilized in a position of a flexed elbow under a right angle with a dorsal plaster splint
• A wire splint can also be used
• The arm is attached in the Mittela

Treatment

• The non-dislocated (or wedged fractures) are stable and are immobilized in a soft bandage for two weeks!
• In dislocated fractures, repositioning is performed together with immobilization in a thoraco-brachial plaster