Effective methods for the treatment of brachial tuberculk vehicle: Tips for a traumatologist. Treatment of Large Big Bugger Shoulder Bone Fracture Budrock Shoulder Bone Heads

Fractures, which lead to damage to the large tuberca bone, are quite rare and specific injuries. They differ from the other types of damage, first of all, by the fact that they are almost always accompanied by the removal of the shoulder. Such a trauma can cause contractures of the joint and significant violations in the functionality of the hand. Treatment and rehabilitation occupy a long time, require attention to the proper procedure execution, so treatment is carried out in the hospital under the supervision of doctors.

Shoulder bone - the second, after the femoral, largest in the body. It acts as an axis and is part shoulder Sustav - one of the most rolling part in the human body. The movements of this joint are made possible by the work of the muscles, which are attached to the big and small tubercles (special bone protrusions). The big tubercle is near the joint on the outer surface of the shoulder. His role is to hold the muscles (accumulative, small round, satellite), which allow you to perform extension and discrepancing shoulder movements, as well as supination (rotation on the outdoor side) hands.

With a fracture of the shoulder tubercle, all these functions are lost.

The fracture of the humerus of the shoulder bone can occur for two reasons:

• straight blow to the shoulder area;
• an indirect blow due to the thrust of the muscles (for example, with a sharp bending of the shoulder, falling on hand, etc.).

The fracture of the left or right shoulder burger, which occurred due to a direct strike leads to severe trauma with fragments, which may be accompanied by damage to the blade of the blade and neck of the shoulder bone.

If the cause of the occurrence is an indirect blow, most often, we are talking about a tearing fracture. In such cases, the tubercle can break away completely, or only its outer layer will suffer. He is also often accompanied by the removal of the shoulder.

Such a fracture can be a consequence of an accident:

• with an accident;
• in production;
• in sports;
• at home.

Symptoms of fracture

Symptoms of the brachial tuberca fracture clearly indicate the type of injury:

• strong pain in the joint (occurs immediately at the time of damage and does not pass with time, when palpation becomes stronger);
• swelling in the shoulder area (arises due to damage to the surrounding tissues, hematoma may also appear if the vessels are affected);
• deformation of the joint and the forced position of the hand (turned inside and culbble);
• capital (audible crunch);
• restriction in motion (when trying pain becomes stronger, a person cannot turn the shoulder inside).

Classification

Depending on how injury was obtained, and the degree of damage, the three main types differ:

• contusion;
• tearless without offset;
• disruptive with displacement.

The contusion fracture arises due to direct strike. It can be a fragmented or fragmentation. Also distinguish closed and open types of this injury. Such a fracture is rare. It is dangerous with the possibility of enhancing infection and the development of osteomyelitis (purulent inflammation of the bone). The tearless fractures accompanies a strong abbreviation of the muscles, which causes the bumps offset. Sometimes they arise if a person is wrong to push the wrapped shoulder.

The fracture of a large tubercle of the shoulder bone, occurring without a displacement, is characterized by the fact that only the cortical layer is damaged, and the tuber is not shifted. The fracture of the shoulder bone with displacement is also injured soft fabrics And vessels located around her. It is interesting to read -.

Treatment of fracture

Therapeutic activities begin with first aid. It is necessary to weaken the pain and prevent displacement in the future.

A person who broke the large tuber of the shoulder should be fixed the limb, tieding it to the body in the position in which it is located and bent in the elbow. To do this, you can use any segment of the fabric, bandage, scarf, etc. In the most painful place you can make a cold or give a person a painkiller and help get to the nearest medical institution.

The fracture of the large tubercle shoulder is a dangerous difficult injury, so you should not try to fix your hand or change its position yourself - it can aggravate the situation.

Treatment can be carried out by different methods, depending on the type of damage: conservative (immobilization of the "Dezo" bandage, plaster, with the help of a tire and dr.) Or surgical.

Immobilization with a fracture

The immobilization method is admissible if there is no displacement, or it can facilitate the normalization of the position of fragments. To immobilize your hand, it is flexed in the elbow at an angle of 90 degrees and put the shoulder in the position, a bit allotted from the body (up to 70 degrees). Under the shoulder put a special wedge-shaped pillow. Fixing bandage must be worn at least 3-4 weeks. After removing the bandage, a person must undergo a rehabilitation course.

Surgery

It is carried out if the fragments were formed during the fracture, or it is impossible to compare the debris closed correctly. Also, this method is necessary if the injury is accompanied by a cervical fracture of the neck of the shoulder bone and damage to the joint capsule.

The operation includes a comparison of bone fragments in the open form and applying metalosynthesis (fixation with screws, brackets, or metal plates). It is removed no later than half a year after overlay.

In the event of a fragmentation of the tubercle and the impossibility of its recovery, all of its parts are removed and the muscle tendons is fixed to the nearest portion of the shoulder bone. Immobilization should continue at least one and a half months.

Rehabilitation

A person with such an injury must complete a full course of rehabilitation. It is necessary for full recovery The functionality of the hand. Prolonged immobilization leads to the weakening of muscles and ligaments, stress phenomena and tissue dystrophy. This may entail unwanted consequences, so it is necessary to adhere to the recommendations of the recovery rehabilitologist.

Most effective methods Recovery after the brachial bone fracture:

• Physiotherapeutic procedures;
• Medical physical culture (LFC);
• Massage;
• Special bandage;
• Proper nutrition.

The duration of the course depends on the degree of injury, its character, as well as on the general condition of the body. The first period of rehabilitation begins on the 2nd week after the fracture. Special exercises Designed so that bone fragments gradually become in their place, and the shoulder restored their functions in full.

Therapeutic massage is one of the most pleasant rehabilitation procedures. It normalizes the metabolism and increases blood circulation, and also helps to remove contractures and swelling. Massage starts after removing the immobilizing bandage, if the shoulder skin is not damaged. It is important to remember the difference between therapeutic and ordinary mascas. Therapeutic massage should conduct a specialist, since it is high like a re-damage to the shoulder.

Physiotherapy

Physiotherapy helps restore metabolic processes in tissues, contributes to the speedy recovery. The patient is prescribed UHF, infrared irradiation, ionophoresis, ultrasound, electromagnetic therapy, etc. Good effect provide mineral dirt, bath, thalassotherapy.

First stage

At the first stage, the tasks of therapeutic physical education are to restore blood circulation in the limbs, stimulate the outflow of lymphs, remove the muscle spasm, normalize metabolic processes in the tissues. A person must perform an exercise on the brush, rays-up and elbow joints, as well as damaged shoulder joint (lead and bending).

The first stage lasts two weeks.

Second phase

At the second stage, the purpose of rehabilitation is the restoration of the functions of the limb, an increase in muscle tone and their performance. Exercise volume increases, they become more difficult and more intense, movements with a ball and a gymnastic stick are added. Each exercise must be performed at least 6 times a day for 2-3 weeks.

Third stage

During this period, the hand almost completely restores its functions, but the shoulder can not fulfill the full volume of movements. The goal is to bring it to a normal state. It is necessary to carry out the exercises at home and visit the Halls of the LFC, working with dumbbells and other gymnastic shells. Good effect gives swimming, volleyball games, badminton.

Effects

The consequences of the lap of a large tubercle of the shoulder bone can be partial limitations in the movements of the hand or its complete immobility. The most common are complications such as biceps injury, incoming tuberca, the formation of a besifier myositis, the development of contractures of joint or arthrosis.

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Distinguish fractures of the head, anatomical neck (intra-art); Ensure fractures and fractures of surgical cervical (embracing); Outflows of a large tubercle shoulder bone (Fig. 1). The main types of fractures are given in AO / ASIF UKP.

Fig. one.Fractures in the proximal part of the shoulder bone: 1 - fractures of anatomical neck; 2 - Eurelm fractures; 3 - fractures of surgical cervical

Fractures of the head and anatomical neck of the shoulder bone

The reasons:fall on the elbow or straight blow along the outer surface of the shoulder joint. With a fracture of an anatomical neck, a distal fragment of the shoulder bone is inserted into the head.

Sometimes the shoulder head is crushed and deformed. There is a separation of the head, while it unfolds the cartilage surface to a distal fragment.

Signs.Shoulder joint is increased in volume due to edema and hemorrhage. Active movements in the joint are limited or impossible due to pain. Palpation of the area of \u200b\u200bthe shoulder joint and the tendering on the elbow is painful. With passive rotary movements, the large tubercle moves along with the shoulder. With the concomitant dislocation of the head, the latter does not fit in its place. Clinical signs are less pronounced with a framed fracture: active movements are possible, with passive movements, the head follows the diaphysia. The diagnosis clarify X-ray, a snapshot in an axial projection is required. Mandatory monitoring of vascular and neurological disorders are required.

Treatment.Ambulators are hurried with knocked fractures of the head and anatomical neck of the shoulder. 20-30 ml of 1% of the nomocaine solution are administered to the joint cavity, the hand is immobilized with plaster Longets in I. Tourneur in the position of the title (using a roller, pillows) by 45-50 °, flexions in the shoulder joint to 30 °, in the elbow - up to 80-90 °. Analgesics, sedatives are prescribed, from the 3rd day begin magnetotherapy, UHF to the shoulder area, from the 7-10rd day - active movements in the rayscass and elbow and passive - in the shoulder joint (removable Longets!), Novocaine electrophoresis, calcium chloride , UFO, ultrasound, massage.

After 4 weeks Gypsum Longets are replaced by a tireless bandage, strengthen restorative treatment. Rehabilitation - up to 5 weeks.

Disability is restored after 2- 2 1/2 months.

Indications for surgery: the impossibility of reposition with unstable fractures with a significant displacement of fragments, interposition of soft tissues and fragments between the joint surfaces (type A3 and heavier).

Fractures of the surgical cervical bone

The reasons.Fractures without displacement of fragments, as a rule, framed or rigid. Fractures with displacement of fragments depending on their position are divided into leading (adduction) and discharge (abduction). Adduction fractures occur when falling with an emphasis on the elongated hand. In this case, the proximal fraction turns out to be allocated and the rotated dust, and the peripheral - shifts the dust, forward and rotated inside. Abduction fractures occur when falling with an emphasis on an elongated staged hand. In these cases, the central fragment is shown and rotated by Knutrice, and the peripheral - knutrice and the shock with the offset forward and up. There is an angle, open duck and the stop.

Signs.With pted fractures and fractures without displacement, local diseases are determined, increasing under the load on the axis of the limb and rotation of the shoulder, the function of the shoulder joint is possible, but is limited. With a passive allocation and rotation of the shoulder, the head follows the diaphysia. The angular displacement of fragments is determined on the radiograph. When fractures with displacement of fragments, the main signs are sharp pain, impairment of the shoulder joint function, pathological mobility at the level of fracture, shortening and violation of the axis of the shoulder. The character of the fracture and the degree of displacement of fragments specify radiographically.

Treatment.First aid includes the introduction of analgesics (Promedol), immobilization of a transport bus or a dressing of dezo (Fig. 2), hospitalization in a traumatological hospital, where a full examination is carried out, anesthesia of the fracture site, the reposition and immobilization of the limb to Longheta (with fallen fractures) or a bracking bandage with mandatory X-ray control after drying gypsum and after 7-10 days.

Fig. 2.Transport immobilization for brave bone fractures: A, B - Dzo's bandage (1-5 - Bandage Stroke); in - stair tire

Features of the reposition(Fig. 3): With adduction fractures, the assistant raises the hand of the patient ahead to 30-45 ° and takes 90 °, bends in the elbow to 90 °, rotates the shoulder of the duck 90 ° and gradually smoothly stretches along the shoulder axis. The traumatologist controls the reposition and spends corrective manipulations in the fracture area. The traction along the shoulder axis should be strong, sometimes for this assistant carries out the opposite foot in the area of \u200b\u200bthe axillary fifth. After that, the hand is fixed with a stormy bandage in the position of the shoulder leads to 90-100 °, flexions in the elbow joint up to 80-90 °, extension in the ray-exclusive joint to 160 °.

Fig. 3.Reposition and hold of fragments of shoulder bone: a, b - with abduction fractures; V-d - with adduction fractures; E is a thoracic bandage; Well - Treatment on Kaplan

With the abduction fractures, the traumatologist corrects his hands the angular displacement, then the reposition and immobilization are carried out in the same way as with adduction fractures.

The deadlines of immobilization - from 6 to 8 weeks, from the 5th week, the shoulder joint is released from fixation, leaving a hand on the discharge tire.

Rehabilitation time - 3-4 weeks.

Disability is restored after 2-2 1/2 months.

From the first day of immobilization, patients should actively move their fingers and brush. After converting the circular bandage, lone-honesty (after 4 weeks) allow passive movements in the elbow joint (with a healthy hand), and another week - active. At the same time, massage and mehanotherapy are prescribed (for dosage load on the muscles). LFC Patients are engaged daily under the guidance of the methodologist and independently every 2-3 hours to 20-30 minutes.

After the patient can repeatedly raise a hand over the tire by 30-45 ° and hold the limb in this position 20-30 s, the removal tire is removed and rehabilitated in full. If the closer reposition fails, then the operational treatment is shown (Fig. 4).

Fig. four.Osteosynthesis at a fracture of the surgical neck of the humeral bone Answered (A) and the IRABOD device (b)

After the open reposition, frank the fragments with t-shaped plates are fixed. If the bone is osteopranny, then apply the needles and tightening wire seams. The fourframed fractures of the head and neck of the shoulder bone (type C2) are an indication for endoprosthetics.

Fractures of hollow bones

The reasons.The fracture of a large tuberca often occurs when the shoulder dislocation. The separation of it with the displacement occurs as a result of the reflex reduction of the supervoloral, sirebo and small circular muscles. The isolated fracture of a large tubercle without a displacement is mainly associated with a straight blow to the shoulder.

Signs.Limited swelling, soreness and attitudes during palpation. The active leads and rotation of the shoulder of the shower are impossible, passive movements are sharply painful. The diagnosis clarify x-ray.

Treatment.When fractures of a large tubercle, without a displacement after the blockade, the novokain hand is placed on a discharge pillow and immobilized with a dressing of a dezo or a shell for 3-4 weeks.

Rehabilitation - 2-3 weeks.

Disability is restored after 5-6 weeks.

When disruptable fractures with displacement after anesthesia, they are repositioned by leading and outer rotation of the shoulder, then the limb on the removal tire or gypsum bandage is immobilized (Fig. 5).

Fig. five.Fracture of a large tubercle shoulder bone: A - displacement of a fragment; B - Medical Immobilization

With a large swelling and hemarthrosis, it is advisable for 2 weeks. Use your shoulder stretch. Hand heading on the tire stops as soon as the patient can lift and rotate the shoulder.

Rehabilitation - 2-4 weeks.

Disability is restored after 2-2 1/2 months.

Indications for surgery.Intra-articular swollen fractures with a significant displacement of fragments, a failed reposition with a fracture of the surgical neck of the shoulder, the infringement of a large tubercle in the custody of the joint. Osteosynthesis is performed by a screw or tightening wire loop (Fig. 6).

Fig. 6.Surgical treatment of the lap of a large tubercle of the shoulder bone: A - displacement of a fragment; B - fixation of the screw; in - fixation with wire

Complications are the same as when the shoulder dislocations.

Traumatology and orthopedics. N. V. Kornilov

There are several types of damage to the tubercle and muscles, which are attached to it:

• the first type of injuries include the resulting direct strikes on the top of the hand. This is possible when dropping. Often in the risk group are older people with weakened muscles;
• to the second type belongs to the same injuries from falling, but on an elongated arm;
• and if the first two refers to the class A, then the third appearance is already to class V. Here it is about falling on an elongated hand, but as a result, it is a fracture with displacement.

Let's learn the main causes of such fractures. These include:

• falling on a relaxed hand in an ordinary anatomical position;
• drop on the hand stretched forward;
• professional injuries in athletes;
• the result of the ears of the shoulder bone is a heavy item.

Such fractures are also offset, and without offset. But if a fracture with the displacement, then the elbow of the tip of the bone of the bone has the type of plate.

What distinguishing features has a fracture of a large tubercle shoulder bone

In order to understand what trauma you got, it is advisable to know her symptoms:

• pain in the shoulder area, which are enhanced during the movements in the joint;
• swelling and hemorrhage at the injury;
• restriction of shoulder mobility;
• any touch in the area of \u200b\u200bthe tuberca enhances pain.

What to do in this case? Definitely, the victim needs first aid. In this situation, this is the introduction of painkillers and the imposition of a special tire for the transportation of the patient. If there is no tire, then you just need to bind your hand to the body.

Doctor in order to make a diagnosis, you will need the following:

• fix the fact of injury;
• conduct a shoulder inspection;
• to make an X-ray;
• to confirm the diagnosis, can assign computer tomography.

X-ray at a fracture of the tuberca sometimes does not show a fracture. This is due to the displacement of the bone fragment. There are cases when a fracture with displacement, and fragments of the bone consider shadow from lime deposits. If we are talking about right hand, playing the main role in the life of most people, then the correct diagnosis and correct treatment have even greater importance for disability.

There is a diagnosis - prescribe treatment

For each case - its own treatment strategy. For example, a fracture without displacement is treated with a conservative way. If the patient it is enough young, then you can use a special dressing dezo. It fixes the sore shoulder for up to one month. In a more mature age, the gypsum bandage is applied to immobilization, placing the patient's hand on a wedge-shaped pillow or a tire.

If the fracture of a large tubercle with a displacement, then there are two options. The first: Conduct immobilization of the gypsum tire, overlapping it from the edge of the opposite blade to the ray-taking joint. The second is used if it is impossible to fold fragments without surgical intervention. In this case, operate.

If the fracture is multi-circle, then the big tubercle has to be removed, and the muscles that are attached to it are laid to the ligaments.

In case the fragments do not fire, operate again. All fragments are connected with the help of spokes or plates and gently sew soft tissues. When a small element of a tuberca does not grow, it is simply removed, and the muscles are sewn from it to the shoulder bones. After that, fixation of the limb using plaster tires.

Without rehabilitation

Recovery requires an integrated approach and consists of several events:

• hand massage;
• physiotherapy;
• balanced diet;
• wearing a bandage;
• sanatorium treatment.

It is important to know that therapeutic gymnastics is already needed on the second day after injury. There are special techniques to restore all temporarily lost functions. upper limb. Alternate active and passive movements with hand. The passive part of the exercises is carried out with the help of a doctor or special devices.

Physiotherapy includes such recovery methods:

• paraffin applications;
• dirt treatment;
• water treatment;
• balnesese.

Massage tasks:

• strengthening of lymphotock and blood circulation in the damaged shoulder;
• strengthening bias of the shoulder joint;
• prevent possible changes in tissues as a result of a fracture;
• improving muscle regeneration processes;
• strengthening muscle tone.

Experts also recommend visiting the pool. But you need to remember that physical exercise Only moderate are allowed. They should include specially selected exercises. And the usual training will be able to resume only after treatment and rehabilitation, but not earlier than in three months.

Finally, let's make a conclusion that you need to be very vigilant and careful in ordinary life.

The fracture of a large tubercle shoulder bone can occur for various reasons. Most often, household injury happens, falling on elongated or bent hands, in this case such a fracture can be supplemented by removal of the shoulder. Damage to the joint is a consequence of a similar injury requiring serious qualified treatment and subsequent rehabilitation.

Sport or production injuries should also occur quite often, but the most severe consequences of road traffic accidents remain. In this case, there are common fractures with muscle damage.

The measure of measures allows you to preserve the functions of the limbs in full and avoid disability, which is quite possible, if treatment and recovery measures are not treated with full seriousness. Rehabilitation after a fracture of a humerus of the shoulder bone is a set of actions that allow you to fully recover after the injury gained.

In suspected such injury, it is necessary to urgently apply to the medical institution. Only a specialist can make the correct diagnosis and avoid exacerbation of the situation. Urgently consult a traumatologist if:

• after the injury arose acute pain In the shoulder joint, which is enhanced with any movements, an attempt to take or raise a hand;
• turning the damaged area causes an increase in pain, the characteristic crunch of bone fragments is heard during the examination;
• perhaps the presence of a hematoma, swelling is noticeable;
• a person intuitively tries to protect the injured limb, the hand is bent and pressed against the body.

In this case, immobilization activities are made to immobilize the shoulder. The hand is fixed with a bandage or golk, as a tire you can use a healthy agent, often the hand is tied to the body. If a person has no allergies, you can give it an anesthetic.

Important:i urgently call an ambulance or help the victim to get to the medical institution, since only the doctor can determine the degree of damage.

The diagnosis is made on the basis of radiography, more accurate modern method It is a computer or magnetic resonance imaging (CT, MRI).

With the usual fracture, a gypsum bandage is superimposed, which ensures immobility of the shoulder joint and makes it possible to grow damaged bones and recover muscles. If the injury is obtained sustal fractureThe displacement or serious damage to the joint occurred, the operation is necessary to be able to completely restore the functions of the hand. Operations are not carried out by age patients, the cause is the reduced rehabilitation abilities of the body.

An ordinary fracture grows approximately 6 weeks. Splicing and subsequent rehabilitation after the bracket bone fracture can take longer. Usually from 1.5 to 3 months.

The absence of mobility and illiterate actions of the victim after a fracture can lead to sad consequences. The joint gets used to a fixed position, loses mobility and elasticity, as a result, various post-traumatic diseases are developing (contractures, arthrosis).

The contracture is called a decrease in the mobility of the joint, arthrosis is a change in the structure of the cartilage tissue.

To fully restore functions use:

1. Physiotherapeutic events.
2. Massotherapy.
3. Complexes of special exercise.

Exercises begin to do on 3 day after injury. Light movements of damaged hands improve the bloodstream, give a light gentle load on the injured limb. After a week, you can start straining the muscles of the shoulder, while maintenance of the brachial joint.

To begin with, it is necessary to practice these exercises with a healthy hand. The main complex of measures aimed at rehabilitation after the fracture of the humerus of the shoulder bone is carried out, of course, after removing the gypsum.

The prescribed physiotherapeutic procedures help to develop a limb after injury much faster and less painful, which is why it is worthwhile to manage the recommended courses of physioprocessed.

Massage is also aimed at accelerating the recovery process. It improves blood flow and helps to provide tissues with oxygen, restores the metabolism, removes muscle spasms, often occurring in the damaged limb.

Is it possible to do one or better under observation

After the splicing of damaged bones and removal of gypsum, the doctor necessarily constitutes individual recommendations for the development of a shoulder, elbow Sustava And the whole injured hand. Of course, you should not forget about the loads on a healthy limb. Massage is better to entrust a competent specialist. If you find this difficult, ask to master the necessary complex of someone from loved ones, in extreme case, Perform massage items yourself.

Of course, the last option is the most difficult, the main thing is to remember that the recovery and lack of problems in the future depends on the system of occupy and their correctness.

The same can be said about the complex of therapeutic physical education: of course, classes under the supervision of a competent specialist are preferable, but if necessary, they can be carried out independently, the main thing is that the load is fired optimally. Many after the fracture are unnecessarily gear damaged hand, others give an excessive load. Both makes a lot of harm.

Complex of exercises after a fracture of a hormone bone

To perform exercises, a stick may need, perfectly restored lost after fracture function using a wicked expenditress or a small rubber ball. In the first stages often have to help themselves healthy hand.

Important:in the first stages of recovery, it should not be afraid of pain if classes remain systemic, the pain will soon go; In case of reluctance, you can get much more problems in the injured hand.

Classes can be carried out in the pool. Exercises in water do easier and more interesting, and swimming is one of the best rehabilitation procedures in the rehabilitation complex after a larger of a large tubercle shoulder bone.

Exercise number 1

Performing standing or sitting. Hands need to pull out the palms up in front of them. Then they slowly bend in the elbows, while you need to touch the shoulders.

Exercise number 2.

Hands slowly rise above their heads through the sides, come into contact with palms and fall.

Exercise number 3.

Hands can be put on the belt or simply press to the torso slightly bent in the elbows. Perform slow rotation shoulders back and forth.

Exercise number 4.

Hands stretch forward, then discharge back.

Exercise number 5.

Circular movements with hands. In childhood, this exercise was called a mill.

Each exercise must be performed at least 5 times. Gradually, when the sick hand will move better, increase the quantity - first up to 7, after - up to 10 times. The complex does not take much time and is performed three times a day. Do not do exercises immediately before bedtime.

Conclusion

Of course, any fracture is an injury for the body, but fortunately, we are so arranged that high-quality health care And the active subsequent rehabilitation allows you to forget about the injuries and return to the usual way of life.

The main thing is not to forget that, avoiding reasonable loads, a person is not able to recover, but he loses his health in this case he is very rapidly pace.

In relation to the fractures of the Big Budrock of the shoulder bone, it is worth recognizing that they do not always attract the attention that deserve. This leads to an infallible and improper treatment, as a result of which a person can become disabled. In the process of fracturing, the humerus of the shoulder bone takes place of the torque cuff, that is, the main engine of the shoulder joint. This fact should encourage carefully to treat injury.

Classification of damage

Multiple muscles are attached to the tubercle: small round, supervoloral and share. In case of injuries, they lead to a displacement of a fragment from above. Two main mechanism lead to damage to the tubercle:

• Damage to class A. Type 1. Injuries included in this group are formed as a result of direct strike on the top of the hand. This often happens when falling. Such fractures often occur in the elderly, as they have a weakening of the surrounding muscles.
• Damage to class A. Type 2. They can also be associated with the aforementioned mechanism, but are mainly formed when the hand is falling in the extended position.
• Class B. Damage is injuries that occurred due to falling on an elongated hand, but at the same time there is a reduction in the outer rotor, therefore the displacement is observed.

Class A injuries can be compression belonging to the first type. It can also be fractures without a second type offset. Class B injuries can belong to the first type if the cortical thin fragment is shifted. The second type includes damage when the big tubercle is entirely shifted and pluck.

Symptoms

The clinical picture is represented by such symptoms as local pain, swelling and restriction of movements in the joint. In addition, there is a limited outdoor rotation of the shoulder due to the retraction, which is attached to the small tubercle of the shoulder bone. This is a pathognomonic symptom. If the injury does not combine with the displacement, there is a sharp pain, especially if a person is trying to make the inner rotation of the shoulder.

In fact, it is not difficult to determine the injury of a large tubercle. In any case, the diagnosis must be confirmed by X-ray. It is important to determine the type of displacement and the severity of the fracture.

First aid and treatment

If you can see that a man broke his shoulder, a person who does not have medical education is difficult to determine in what kind of place there was a fracture. However, this should not prevent first aid. With any fractures, it is important to immobilize the place of the fracture, in this case, shoulder and hand. This is called immobilization. It is performed using a tire or immobilizing dressing. It is important that this does not cause an additional pain to a person, but, on the contrary, reduced it. You can give a victim an anesthetic.

Fractures of a large tubercle shoulder bone are treated depending on the presence of a displacement.

• Treatment of fractures without displacement is based on the applying of ice, the use of analgesics and immobilization of the limb. Thanks to these measures, it is possible to prevent complications. In the hospital, further treatment is appointed depending on the diagnosis. A discharge gypsum bandage is often used, as it allows you to relax muscles that are attached to a large tubercle.
• Treatment of fractures with displacement depends on physical condition Patient and his age. For the treatment of young, operational methods based on fixation, excision of the fragment and the break of the gap of the rotational cuffs are used. In old age, the operation does not make. In this case, immobilization and analgesics are used. Elderly patients should try to carry out rotational movements as early as possible.

Damage to a large tubercle may lead to the following complications.