ASPECTS OF PREDICTION OF VASCULAR DISORDERS IN HUMERUS FRACTURES

Abstract

Vascular damage in skeletal bone fractures occurs in 1.5% of cases. The cause of the disorders can be both direct and indirect factors affecting the bone fragments on the vascular component. This leads to hemodynamic disorders and the occurrence of arterial and venous thrombotic complications. A prognostic assessment of the occurrence of damage to the brachial arteries and veins requires in-depth knowledge of their anatomical and topographic features in normal conditions and alterations. Magnetic resonance imaging greatly facilitates the study of individual anatomical features of a large number of patients. When predicting the risk of developing hemodynamic disorders in patients with humeral diaphysis fractures, the biomechanical effect of the muscle component is practically not taken into account. Methods of transport immobilization of the injured extremity play a significant role in the prevention of vascular damage. Purpose. Study of the alternative topographical and anatomical features of the location of humeral vessels with subsequent planning of prognostic and diagnostic measures to prevent their damage depending on the type of displacement of bone fragments in humerus fractures. Object and Methods. 32 MRI scans, performed in patients aged 18 to 68 years for reasons not related to the presence of pathological disorders of the vascular, muscular and osseous components of the humeral segment, have been studied. The clinical group included 36 patients aged 23 to 85 years with closed fractures of the humeral diaphysis. The data was processed by the methods of non-parametric statistics. Results. The findings of the study of the anatomotopographical group revealed individual and gender features of the location of the brachial artery, as well as brachial and basilar veins. Their spatial positional relationship with the groups of muscles of the proximal humerus have been differentiated. During the study of the clinical group, differentiation of the applied methods of transport immobilization at the pre-hospital stage has been made, and the analysis of the vector and nature of the displacement of bone fragments in humeral diaphysis fractures has been carried out. The age-related relationship between the level of the fracture and the type of displacement was revealed. The risk of damage to the vessels of the proximal part of the humerus is high in the adduction type of fracture of the humeral diaphysis. In-depth knowledge of clinical anatomy and the interrelationships of various types of soft tissue structures of the humeral diaphysis will prevent the possibility of direct or indirect damage to the brachial vessels, shorten the period of patients’ incapacity and reduce the degree of disability.

Keywords

• humerus fractures,brachial vessels,stepped therapy,humeral diaphysis