Fractura de Humerus
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![Page 1: Fractura de Humerus](https://reader030.fdocument.pub/reader030/viewer/2022033004/563dbb00550346aa9aa973f9/html5/thumbnails/1.jpg)
Fracturile extremitatii superioare a humerusului
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Anatomie
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Mecanismele fracturii
Traumatism direct Traumatism indirect
(cadere)
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Fracturi extra-articulare
Cu bratul in abductie sub 45° = fractura prin adductie
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Fracturi extra-articulare
Cu bratul in abductie peste 45° = fractura prin abductie
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Diagnostic
• Durere locala• Deformare vizibila (fractura prin abductie)• Echimoza intinsa (HENNEQIN)• Complicatii posibile:
– Vasculare (puls)
– Nervoase (plex brahial, circonflex radial)
– Cutanate (fractura deschisa)
– Musculare (deltoid, tendonul biceps, interpozitie)
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Radiografie
Fractura cu fragmente multiple
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Identificarea fragmentelor poate fi dificila pe radiografia simpla
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Scannerul poate identifica mai usor numarul si pozitia fragmentelor
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Clasificare
• Fracturi extra-articulare– Tuberozitate (trohiter, trohin)– Fracturei sub-tuberozitare (col
chirurgical) angrenat 70%
• Fracturi articulare
• Fracturi cefalo-metafizare
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Fracturi extra-articulare
Fr trochiter
Fr sub-tuberozitare
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Fracturi articulare
angrenate deplasate foarte deplasate fract-luxatie
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Fractura-luxatie
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Fractura de trohiter
Necesita reducere chirurgicala a fragmentelor deplasate
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1 Osteosinteza fracturii de trohiter
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Complicatii vasculare
Pulsatiile arteriale absente +++
Doppler sau arteriografie
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Cerc peritrohiterian
Art.circumflexa posterioara
Art. humerala profunda
Art. circumflexaanterioara
Art. scapulara inf Art. scapulara
sup
Art. acromio-toracica
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Fracturi fara deplasare :
Bandaj 30 zile
Dupa 15 zile: mobilizare blanda la 30 zile: reeducare
Tratamentul ortopedic
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Dupa 15 zile: mobilizare blanda la 30 zile: reeducare
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Fracturi deplasate: reducere sub A.G
Tractiune adductie reducere si relaxare
Tratament ortopedic
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(mobilizarea umarului dupa 3-4 saptamani)
Reducerea manuala este urmata de bandaj sau gips
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Pozitia imobilizarii in fracturile neangrenate
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Tratament ortopedicFracturi deplasate : reducere lenta
Aparat gipsat de atarnare
a)- incorect
b)-corect
a b
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Tratament ortopedic
Extensia blanda se continua si in timpul repausului la pat (orizontal)
Fracturi deplasate : reducere lenta
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Fracturile cu deplasari mari : tractiune continua de asteptare in vedera operatiei
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Tratamentul chirurgical al fracturilor proximale ale
humerusului
• Osteosinteza clasica – cu brose K– cu suruburi– cu placa insurubata
• Osteosinteza elastica
• Tija C.M. zavorata
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Pozitia pe masa de operatie pentru osteosinteza centromedulara a humerusului
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Photo J. chouteau
Osteosinteza cu brose K
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Osteosinteza cu brose K
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Osteosinteza cu focar inchis
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Osteosinteza cu suruburi
(risc de desurubare dupa mobilizarea precoce)
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Osteosinteza cu suruburi
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Osteosinteza cu placa insurubata
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Osteosinteza elastica(A.Firica)
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Fixare elasitca centromedulara
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Photo J. chouteau
Abord prin trohiter Introducerea cuiului dupa alezaj Insurubare
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Fixare centromedulara cu tija scurta « telegraf »
Este permisa reeducarea imediata
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Photo J. chouteau
Tija zavorata pentru fractura cominutiva metadiafizara
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Osteosinteza prin placa
Risc de pseudoartroza
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Fracturi deschise
Pierderi de substanta osoasa
Pseudartroza infectata
Fixator extern
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Complicatiile fracturii de humerus
• Deschiderea focarului (rara)• Leziuni vasculare (art.axilara)• Necroza capului humral (1 %)• Pseudartroza (rara)• Redoare • Calus vicios:
– Deficit functional in special in asocierile cu fracturile de trohiter
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Necroza de cap humeral dupa tratament ortopedic
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Calusul vicios al trohiterului Face abductia limitata si dureroasa
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Fractura de humerus la copil
Se confunda uneori cu cartilajul de crestere (necesitatea radiografiilor comparative)
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Dezvoltarea epifizei humerale superioare
1 an 3 ani 6 ani
10 ani 15 ani 18 ani
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Fractura in « bulgare de unt » Decolare Salter II
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Fractura de humerus la copilAsemanatoare in 80% din cazuri cu fractura la adulti
Se fixeaza cu un singur surub pentru a nu leza C de C
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Evolutie dupa 7 ani
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Fractura decolare epifizara:20%