[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"disease-index":3,"disease-21":121,"navigation-categories":905,"navigation-categories-en":1022},{"data":4,"meta":117},[5,11,17,23,28,34,40,46,52,58,64,70,76,82,88,94,100,106,111],{"id":6,"attributes":7},4,{"title":8,"title_en":9,"slug_en":10},"Hernie discale lombaire","Lumbar Disc Herniation","lumbar-disc-herniation",{"id":12,"attributes":13},5,{"title":14,"title_en":15,"slug_en":16},"Prothèse totale de hanche ","Total Hip Replacement","total-hip-replacement",{"id":18,"attributes":19},7,{"title":20,"title_en":21,"slug_en":22},"ménisque","Meniscus","meniscus",{"id":24,"attributes":25},8,{"title":26,"title_en":26,"slug_en":27},"Hallux Valgus","hallux-valgus",{"id":29,"attributes":30},16,{"title":31,"title_en":32,"slug_en":33},"Pathologie dégénérative cheville","Degenerative Ankle Disease","degenerative-ankle-disease",{"id":35,"attributes":36},20,{"title":37,"title_en":38,"slug_en":39},"Prothèse épaule","Shoulder Replacement","shoulder-replacement",{"id":41,"attributes":42},19,{"title":43,"title_en":44,"slug_en":45},"Pathologies de la coiffe des rotateurs ","Rotator Cuff Disorders","rotator-cuff-disorders",{"id":47,"attributes":48},18,{"title":49,"title_en":50,"slug_en":51},"Rupture du tendon d'Achille","Achilles Tendon Rupture","achilles-tendon-rupture",{"id":53,"attributes":54},9,{"title":55,"title_en":56,"slug_en":57},"Le névrome de Morton ","Morton's neuroma","morton-s-neuroma",{"id":59,"attributes":60},22,{"title":61,"title_en":62,"slug_en":63},"L’instabilité d’épaule","Shoulder Instability","shoulder-instability",{"id":65,"attributes":66},23,{"title":67,"title_en":68,"slug_en":69},"Capsulite rétractile","Adhesive Capsulitis (Frozen Shoulder)","adhesive-capsulitis-frozen-shoulder",{"id":71,"attributes":72},11,{"title":73,"title_en":74,"slug_en":75},"La Pathologie Ligamentaire","Ligament Pathology","ligament-pathology",{"id":77,"attributes":78},17,{"title":79,"title_en":80,"slug_en":81},"La prothèse totale de genou ","Total Knee Replacement","total-knee-replacement",{"id":83,"attributes":84},24,{"title":85,"title_en":86,"slug_en":87},"Principes de rééducations ","Principles of rehabilitation","principles-of-rehabilitation",{"id":89,"attributes":90},14,{"title":91,"title_en":92,"slug_en":93},"Pathologie de la Rotule","Patellar Disorders","patellar-disorders",{"id":95,"attributes":96},21,{"title":97,"title_en":98,"slug_en":99},"Fracture épaule","Shoulder Fracture","shoulder-fracture",{"id":101,"attributes":102},15,{"title":103,"title_en":104,"slug_en":105},"Pathologie ligamentaire cheville","Ankle Ligament Pathology","ankle-ligament-pathology",{"id":107,"attributes":108},6,{"title":109,"title_en":110,"slug_en":110},"coxarthrose ","coxarthrosis",{"id":112,"attributes":113},10,{"title":114,"title_en":115,"slug_en":116},"Griffes d’orteils et métatarsalgies ","Toe claws and metatarsalgia","toe-claws-and-metatarsalgia",{"pagination":118},{"page":119,"pageSize":120,"pageCount":119,"total":41},1,100,{"data":122,"meta":904},{"id":95,"attributes":123},{"title":97,"content":124,"createdAt":549,"updatedAt":550,"publishedAt":551,"summary":180,"seoTitle":180,"seoDescription":180,"author":180,"reviewedBy":180,"medicalReviewer":180,"medicalReviewedAt":180,"associatedAnatomy":180,"title_en":98,"slug_en":99,"summary_en":180,"seoTitle_en":180,"seoDescription_en":180,"content_en":552,"associatedAnatomy_en":180,"ogImage":890,"pathologie_par_articulation":891,"sources":899,"relatedSurgeries":900,"possibleTreatments":902,"signsOrSymptoms":903},[125,131,135,138,142,145,149,152,156,159,163,169,195,199,203,206,210,214,217,221,225,229,232,236,240,243,246,250,254,258,262,281,285,289,293,296,300,304,322,340,358,361,365,368,372,376,380,384,387,390,394,398,416,420,424,428,432,435,439,443,447,451,454,458,461,465,469,472,475,479,482,486,489,493,496,500,504,507,511,514,517,520,523,526,529,532,535,538,542,546],{"type":126,"children":127},"paragraph",[128],{"text":129,"type":130},"","text",{"type":126,"children":132},[133],{"text":134,"type":130},"Pourquoi fait on une fracture à l’épaule ?",{"type":126,"children":136},[137],{"text":129,"type":130},{"type":126,"children":139},[140],{"text":141,"type":130},"Les fractures d’épaule, notamment les fractures de l’extrémité supérieure de l’humérus, sont des fractures fréquentes, en particulier chez la femme après 50 ans.",{"type":126,"children":143},[144],{"text":129,"type":130},{"type":126,"children":146},[147],{"text":148,"type":130},"Elles sont en effet liées à un phénomène d’appauvrissement de l’os appelé l’ostéoporose. L’ostéoporose est souvent responsable d’autres fractures (poignet, col du fémur, cheville, tassement vertébral) et touche préférentiellement les femmes après la ménopause.",{"type":126,"children":150},[151],{"text":129,"type":130},{"type":126,"children":153},[154],{"text":155,"type":130},"Le phénomène, associé à une chute sur l’épaule le plus souvent, rarement sur la main, peut être à l’origine d’une fracture de l’extrémité supérieure de l’humérus.",{"type":126,"children":157},[158],{"text":129,"type":130},{"type":126,"children":160},[161],{"text":162,"type":130},"Plus rarement, les fractures surviennent dans un contexte de traumatisme violent (accident de sport, accident de la voie publique), elles touchent alors plus souvent l’homme jeune..",{"type":164,"level":165,"children":166},"heading",3,[167],{"text":168,"type":130},"Signes cliniques",{"type":170,"image":171,"children":193},"image",{"ext":172,"url":173,"hash":174,"mime":175,"name":176,"size":177,"width":178,"height":179,"caption":180,"formats":181,"provider":190,"createdAt":191,"updatedAt":192,"previewUrl":180,"alternativeText":176,"provider_metadata":180},".jpg","https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Ff_e_1_971907181c.jpg","f_e_1_971907181c","image\u002Fjpeg","f e 1.jpg",23.18,400,213,null,{"thumbnail":182},{"ext":172,"url":183,"hash":184,"mime":175,"name":185,"path":180,"size":186,"width":187,"height":188,"sizeInBytes":189},"\u002Fuploads\u002Fthumbnail_f_e_1_971907181c.jpg","thumbnail_f_e_1_971907181c","thumbnail_f e 1.jpg",11.66,245,130,11656,"local","2024-10-13T12:20:19.012Z","2024-10-18T23:05:22.335Z",[194],{"text":129,"type":130},{"type":126,"children":196},[197],{"text":198,"type":130},"La douleur est intense, il est impossible de lever le bras ou même de l’écarter du corps.",{"type":126,"children":200},[201],{"text":202,"type":130},"Un hématome peut parfois apparaître secondairement devant l’épaule et diffuser jusqu’au bras et même jusqu’au thorax. Il n’a pas de caractère de gravité quand il apparaît en 12 à 24 heures et qu’il diffuse lentement sans autre signe clinique : il ne fait que traduire le saignement lié à la fracture osseuse.",{"type":126,"children":204},[205],{"text":129,"type":130},{"type":126,"children":207},[208],{"text":209,"type":130},"Très rarement, mais votre chirurgien le recherchera toujours, la fracture peut comprimer un nerf du membre supérieur ou une artère et entraîner une paralysie ou un défaut d’apport sanguin au membre supérieur : l’hospitalisation et le traitement en urgence sont alors nécessaires.",{"type":126,"children":211},[212],{"text":213,"type":130},"Quel traitement ?",{"type":126,"children":215},[216],{"text":129,"type":130},{"type":126,"children":218},[219],{"text":220,"type":130},"FRACTURES SIMPLES",{"type":126,"children":222},[223],{"text":224,"type":130},"Ces fractures sont souvent simples (2 fragments), peu déplacées et traitées par un grand bandage coude au corps appelé bandage de Dujarier, que l’on garde de 3 à 5 semaines, en fonction de l’âge et de l’importance de la fracture.",{"type":126,"children":226},[227],{"text":228,"type":130},"Des radiographies avec consultation de votre chirurgien sont nécessaires à intervalles réguliers afin de dépister un déplacement de la fracture qui pourrait alors nécessiter un autre type de traitement.",{"type":126,"children":230},[231],{"text":129,"type":130},{"type":126,"children":233},[234],{"text":235,"type":130},"Une fois l’immobilisation terminée, la rééducation est indispensable et doit être prolongée, souvent de 3 à 6 mois, avant de pouvoir récupérer une épaule fonctionnelle et indolore.",{"type":126,"children":237},[238],{"text":239,"type":130},"Dans les fractures simples, il n’y a souvent aucune séquelle et la fonction est récupérée sans difficultés.",{"type":126,"children":241},[242],{"text":129,"type":130},{"type":126,"children":244},[245],{"text":129,"type":130},{"type":126,"children":247},[248],{"text":249,"type":130},"FRACTURES COMPLEXES",{"type":126,"children":251},[252],{"text":253,"type":130},"Parfois, les fractures sont plus complexes (3 fragments et plus) et\u002Fou sont très déplacées et peuvent alors nécessiter un traitement chirurgical.",{"type":126,"children":255},[256],{"text":257,"type":130},"Ce traitement varie d’une fracture à l’autre et dépend beaucoup d’une part de la complexité et du déplacement de la fracture, d’autre part de l’âge du patient.",{"type":126,"children":259},[260],{"text":261,"type":130},"Plus la fracture est complexe, plus il est difficile de l’analyser sur des radiographies simples. Votre chirurgien vous prescrira alors un scanner qui lui permettra de mieux analyser le nombre de fragments et le déplacement de chacun des fragments afin de choisir le meilleur traitement pour chaque type de fracture.",{"type":170,"image":263,"children":279},{"ext":172,"url":264,"hash":265,"mime":175,"name":266,"size":267,"width":178,"height":268,"caption":180,"formats":269,"provider":190,"createdAt":278,"updatedAt":278,"previewUrl":180,"alternativeText":266,"provider_metadata":180},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Ffe2_b5bd40255c.jpg","fe2_b5bd40255c","fe2.jpg",11.69,301,{"thumbnail":270},{"ext":172,"url":271,"hash":272,"mime":175,"name":273,"path":180,"size":274,"width":275,"height":276,"sizeInBytes":277},"\u002Fuploads\u002Fthumbnail_fe2_b5bd40255c.jpg","thumbnail_fe2_b5bd40255c","thumbnail_fe2.jpg",4.48,207,156,4484,"2024-10-13T12:20:18.995Z",[280],{"text":129,"type":130},{"type":126,"children":282},[283],{"text":284,"type":130},"Quels traitements chirurgicaux peut-on utiliser ?",{"type":126,"children":286},[287],{"text":288,"type":130},"1° LES BROCHES: Traitement simple et rapide, elles sont réservées aux fractures déplacées du patient jeune (moins de 50 ans en général). Elles imposent une immobilisation complémentaire, bien tolérée chez le patient jeune.",{"type":126,"children":290},[291],{"text":292,"type":130},"Une ablation de matériel est indispensable, 2 à 3 mois après, une fois la fracture consolidée et la fonction de l’épaule récupérée.",{"type":126,"children":294},[295],{"text":129,"type":130},{"type":126,"children":297},[298],{"text":299,"type":130},"2° LES BROCHES ET LES CERCLES: Les cercles peuvent être métalliques mais ils sont le plus souvent constitués de fils de gros diamètre invisibles à la radiographie.",{"type":126,"children":301},[302],{"text":303,"type":130},"Ce type de technique peut être utilisé dans des fractures déplacées du patient âgé, mais pas trop complexes car la tenue des fils et des broches chez le patient âgé dépend beaucoup de la qualité de l’os qui est parfois précaire à un âge avancé.",{"type":170,"image":305,"children":320},{"ext":172,"url":306,"hash":307,"mime":175,"name":308,"size":309,"width":178,"height":310,"caption":180,"formats":311,"provider":190,"createdAt":319,"updatedAt":319,"previewUrl":180,"alternativeText":308,"provider_metadata":180},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Ffe3_cc85f9d9f2.jpg","fe3_cc85f9d9f2","fe3.jpg",12.47,262,{"thumbnail":312},{"ext":172,"url":313,"hash":314,"mime":175,"name":315,"path":180,"size":316,"width":317,"height":276,"sizeInBytes":318},"\u002Fuploads\u002Fthumbnail_fe3_cc85f9d9f2.jpg","thumbnail_fe3_cc85f9d9f2","thumbnail_fe3.jpg",5.98,238,5979,"2024-10-13T12:20:18.994Z",[321],{"text":129,"type":130},{"type":170,"image":323,"children":338},{"ext":172,"url":324,"hash":325,"mime":175,"name":326,"size":327,"width":178,"height":328,"caption":180,"formats":329,"provider":190,"createdAt":337,"updatedAt":337,"previewUrl":180,"alternativeText":326,"provider_metadata":180},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Ffe4_2c87547876.jpg","fe4_2c87547876","fe4.jpg",9.5,309,{"thumbnail":330},{"ext":172,"url":331,"hash":332,"mime":175,"name":333,"path":180,"size":334,"width":335,"height":276,"sizeInBytes":336},"\u002Fuploads\u002Fthumbnail_fe4_2c87547876.jpg","thumbnail_fe4_2c87547876","thumbnail_fe4.jpg",3.88,202,3878,"2024-10-13T12:20:18.968Z",[339],{"text":129,"type":130},{"type":170,"image":341,"children":356},{"ext":172,"url":342,"hash":343,"mime":175,"name":344,"size":345,"width":178,"height":346,"caption":180,"formats":347,"provider":190,"createdAt":355,"updatedAt":355,"previewUrl":180,"alternativeText":344,"provider_metadata":180},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Ffe5_da9eb539dd.jpg","fe5_da9eb539dd","fe5.jpg",10.19,196,{"thumbnail":348},{"ext":172,"url":349,"hash":350,"mime":175,"name":351,"path":180,"size":352,"width":187,"height":353,"sizeInBytes":354},"\u002Fuploads\u002Fthumbnail_fe5_da9eb539dd.jpg","thumbnail_fe5_da9eb539dd","thumbnail_fe5.jpg",5.02,120,5021,"2024-10-13T12:20:18.964Z",[357],{"text":129,"type":130},{"type":126,"children":359},[360],{"text":129,"type":130},{"type":126,"children":362},[363],{"text":364,"type":130},"Elles sont surtout utilisées dans les fractures du patient jeune. Certains modèles récemment développés sont plus facilement utilisables chez les patients plus âgés, mais leur emploi doit être bien codifié. L’ablation du matériel est rarement nécessaire au-delà de 50 ans ; il est souhaitable avant cet âge.",{"type":126,"children":366},[367],{"text":129,"type":130},{"type":126,"children":369},[370],{"text":371,"type":130},"4° LES CLOUS",{"type":126,"children":373},[374],{"text":375,"type":130},"Ce sont des systèmes que l’on met à l’intérieur de l’os, en association avec des vis.",{"type":126,"children":377},[378],{"text":379,"type":130},"Ils sont très utiles chez les patients âgés, car ils ont une meilleure tenue que les broches et les cercles simples et ne nécessitent pas un abord chirurgical trop extensif , contrairement aux plaques par exemple , qui nécessitent d’exposer toute la fracture pour en effectuer la fixation. Cet avantage permet de diminuer les lésions du tissu autour de l’os (le périoste) crée par un abord direct, lésions qui peuvent être défavorables à la consolidation.",{"type":126,"children":381},[382],{"text":383,"type":130},"Ils sont particulièrement utiles dans les fractures à 2 fragments déplacées du patient âgé.",{"type":126,"children":385},[386],{"text":129,"type":130},{"type":126,"children":388},[389],{"text":129,"type":130},{"type":126,"children":391},[392],{"text":393,"type":130},"5° LES SYSTEMES D’OSTEOSYNTHESE CENTROMEDULLAIRE DIFFERENTS DES CLOUS",{"type":126,"children":395},[396],{"text":397,"type":130},"Certains systèmes permettent une stabilisation interne des fragments fracturaires et augurent de la possibilité d’une meilleure consolidation osseuse, en essayant de garder le maximum d’os possible (implant Bilboquet).",{"type":170,"image":399,"children":414},{"ext":172,"url":400,"hash":401,"mime":175,"name":402,"size":403,"width":178,"height":404,"caption":180,"formats":405,"provider":190,"createdAt":413,"updatedAt":413,"previewUrl":180,"alternativeText":402,"provider_metadata":180},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Ffe6_5b602a41be.jpg","fe6_5b602a41be","fe6.jpg",11.46,365,{"thumbnail":406},{"ext":172,"url":407,"hash":408,"mime":175,"name":409,"path":180,"size":410,"width":411,"height":276,"sizeInBytes":412},"\u002Fuploads\u002Fthumbnail_fe6_5b602a41be.jpg","thumbnail_fe6_5b602a41be","thumbnail_fe6.jpg",3.39,171,3385,"2024-10-13T12:20:18.991Z",[415],{"text":129,"type":130},{"type":126,"children":417},[418],{"text":419,"type":130},"6° LA PROTHESE D’EPAULE POUR FRACTURE dite aussi « PROTHESE HUMERALE SIMPLE »",{"type":126,"children":421},[422],{"text":423,"type":130},"Elle reste très utilisée, en particulier dans les fractures les plus complexes",{"type":126,"children":425},[426],{"text":427,"type":130},"Ces fractures,comme les fractures de l’extrémité supérieure du fémur (fracture du « col » du fémur), sont fragiles lorsqu’on essaye de garder tout l’os avec un système d’ostéosynthèse. Pour ces fractures, il existe un risque de déplacement secondaire et de nécrose osseuse par disparition de l’apport vasculaire après la mise en place d’une ostéosynthèse.",{"type":126,"children":429},[430],{"text":431,"type":130},"Contrairement aux systèmes d’ostéosynthèse, la prothèse humérale ne conserve pas l’os de l’extrémité supérieure de l’humérus, mais en remplace une grande partie par un élément métallique (la prothèse), qui est cimentée dans l’humérus.",{"type":126,"children":433},[434],{"text":129,"type":130},{"type":126,"children":436},[437],{"text":438,"type":130},"Il y a quelques années les résultats des prothèses d’épaule pour fracture, bons sur la douleur, étaient insuffisants sur la mobilité et la force. L’apparition de nouvelles prothèses mieux adaptées à la morphologie de l’humérus et non pas calquées sur les prothèses de l’extrémité supérieure du fémur, permettent à l’heure actuelle d’espérer de meilleurs résultats sur la mobilité et la force.",{"type":126,"children":440},[441],{"text":442,"type":130},"Toutefois, quel que soit le modèle utilisé, l’immobilisation est variable de quelques jous à 3 semaines, en fonction de la stabilité du montage chirurgical et la rééducation est longue (6 mois, parfois plus).",{"type":126,"children":444},[445],{"text":446,"type":130},"Le résultat dépend beaucoup de la qualité de l’os mais surtout de la qualité du chirurgien , qui doit être habitué à ce type de fracture (on ne peut y être habitué si on en opère moins de 10 par an), afin de régler au mieux la position de la prothèse par rapport à l’os,position qui conditionne le bon résultat final.",{"type":164,"level":165,"children":448},[449],{"text":450,"type":130},"Peut on retrouver une fonction normale ?",{"type":126,"children":452},[453],{"text":129,"type":130},{"type":126,"children":455},[456],{"text":457,"type":130},"C’est le but de tout traitement !!",{"type":126,"children":459},[460],{"text":129,"type":130},{"type":126,"children":462},[463],{"text":464,"type":130},"Néanmoins, tout dépend de plusieurs facteurs :",{"type":126,"children":466},[467],{"text":468,"type":130},"– La complexité de la fracture",{"type":126,"children":470},[471],{"text":129,"type":130},{"type":126,"children":473},[474],{"text":129,"type":130},{"type":126,"children":476},[477],{"text":478,"type":130},"– L’âge du patient",{"type":126,"children":480},[481],{"text":129,"type":130},{"type":126,"children":483},[484],{"text":485,"type":130},"– La capacité du patient à se prendre en main et à assumer une rééducation post-opératoire longue et parfois fastidieuse, mais totalement indispensable.",{"type":126,"children":487},[488],{"text":129,"type":130},{"type":126,"children":490},[491],{"text":492,"type":130},"– La dextérité du chirurgien qui doit être habitué à ce type de fracture.",{"type":126,"children":494},[495],{"text":129,"type":130},{"type":126,"children":497},[498],{"text":499,"type":130},"La réunion de tous ces facteurs favorables peut permettre de retrouver une épaule normale, c’est à dire sans douleur, de mobilité comparable à l’épaule saine et avec une force permettant les gestes de la vie quotidienne, du travail et des loisirs.",{"type":126,"children":501},[502],{"text":503,"type":130},"Si un seul de ces facteurs est gravement déficient (fracture très complexe, patient très âgé,incapacité à comprendre et à suivre la rééducation post-opératoire, chirurgien « insuffisamment entraîné »), l’épaule sera peut être indolore, mais sera rarement normale en terme de mobilité et de force.",{"type":126,"children":505},[506],{"text":129,"type":130},{"type":126,"children":508},[509],{"text":510,"type":130},"– La capacité du patient à se prendre en main et à assumer une rééducation post-opératoire longue et parfois fastidieuse, mais totalement indispensable. – La dextérité du chirurgien qui doit être habitué à ce type de fracture.",{"type":126,"children":512},[513],{"text":129,"type":130},{"type":126,"children":515},[516],{"text":499,"type":130},{"type":126,"children":518},[519],{"text":503,"type":130},{"type":126,"children":521},[522],{"text":129,"type":130},{"type":126,"children":524},[525],{"text":510,"type":130},{"type":126,"children":527},[528],{"text":129,"type":130},{"type":126,"children":530},[531],{"text":499,"type":130},{"type":126,"children":533},[534],{"text":503,"type":130},{"type":126,"children":536},[537],{"text":129,"type":130},{"type":126,"children":539},[540],{"text":541,"type":130},"En conclusion, ces fractures sont complexes et l’on peut tout y rencontrer, depuis la fracture très simple qui consolidera en 3 semaines d’immobilisation, jusqu’aux fractures les plus complexes qui nécessitent la mise en place d’une prothèse et une longue rééducation.",{"type":126,"children":543},[544],{"text":545,"type":130},"Seul votre médecin saura apprécier la gravité de la fracture et vous orienter vers l’une ou l’autre des diverses thérapeutiques.",{"type":126,"children":547},[548],{"text":129,"type":130},"2024-10-13T12:22:09.710Z","2024-10-18T23:09:12.537Z","2024-10-13T12:22:12.938Z",[553,556,560,563,567,570,574,577,581,584,588,592,598,602,606,609,613,617,620,624,628,632,635,639,643,646,649,653,657,661,665,671,675,679,683,686,690,694,700,706,712,715,719,722,726,730,734,738,741,744,748,752,758,761,765,769,773,776,780,784,788,792,795,799,802,806,810,813,816,820,823,827,830,834,837,841,845,848,852,855,858,861,864,867,870,873,876,879,883,887],{"type":126,"children":554},[555],{"text":129,"type":130},{"type":126,"children":557},[558],{"text":559,"type":130},"Why do we fracture our shoulders?",{"type":126,"children":561},[562],{"text":129,"type":130},{"type":126,"children":564},[565],{"text":566,"type":130},"Shoulder fractures, particularly fractures of the upper end of the humerus, are common fractures, particularly in women over the age of 50.",{"type":126,"children":568},[569],{"text":129,"type":130},{"type":126,"children":571},[572],{"text":573,"type":130},"They are in fact linked to a phenomenon of bone impoverishment called osteoporosis. Osteoporosis is often responsible for other fractures (wrist, femoral neck, ankle, vertebral compression) and preferentially affects women after menopause.",{"type":126,"children":575},[576],{"text":129,"type":130},{"type":126,"children":578},[579],{"text":580,"type":130},"The phenomenon, associated with a fall on the shoulder most often, rarely on the hand, can be the cause of a fracture of the upper end of the humerus.",{"type":126,"children":582},[583],{"text":129,"type":130},{"type":126,"children":585},[586],{"text":587,"type":130},"More rarely, fractures occur in the context of violent trauma (sports accident, public road accident), so they more often affect young men.",{"type":164,"level":165,"children":589},[590],{"text":591,"type":130},"Clinical signs",{"type":170,"image":593,"children":596},{"ext":172,"url":173,"hash":174,"mime":175,"name":176,"size":177,"width":178,"height":179,"caption":180,"formats":594,"provider":190,"createdAt":191,"updatedAt":192,"previewUrl":180,"alternativeText":176,"provider_metadata":180},{"thumbnail":595},{"ext":172,"url":183,"hash":184,"mime":175,"name":185,"path":180,"size":186,"width":187,"height":188,"sizeInBytes":189},[597],{"text":129,"type":130},{"type":126,"children":599},[600],{"text":601,"type":130},"The pain is intense, it is impossible to raise the arm or even move it away from the body.",{"type":126,"children":603},[604],{"text":605,"type":130},"A hematoma can sometimes appear secondarily in front of the shoulder and spread to the arm and even to the thorax. It is not serious when it appears within 12 to 24 hours and spreads slowly without any other clinical sign: it only reflects the bleeding linked to the bone fracture.",{"type":126,"children":607},[608],{"text":129,"type":130},{"type":126,"children":610},[611],{"text":612,"type":130},"Very rarely, but your surgeon will always look for it, the fracture can compress a nerve of the upper limb or an artery and lead to paralysis or a lack of blood supply to the upper limb: hospitalization and emergency treatment are then necessary.",{"type":126,"children":614},[615],{"text":616,"type":130},"What treatment?",{"type":126,"children":618},[619],{"text":129,"type":130},{"type":126,"children":621},[622],{"text":623,"type":130},"SIMPLE FRACTURES",{"type":126,"children":625},[626],{"text":627,"type":130},"These fractures are often simple (2 fragments), barely displaced and treated with a large elbow-to-body bandage called Dujarier bandage, which is kept on for 3 to 5 weeks, depending on the age and severity of the fracture.",{"type":126,"children":629},[630],{"text":631,"type":130},"X-rays with consultation from your surgeon are necessary at regular intervals in order to detect a displacement of the fracture which could then require another type of treatment.",{"type":126,"children":633},[634],{"text":129,"type":130},{"type":126,"children":636},[637],{"text":638,"type":130},"Once immobilization is complete, rehabilitation is essential and must be prolonged, often 3 to 6 months, before being able to recover a functional and pain-free shoulder.",{"type":126,"children":640},[641],{"text":642,"type":130},"In simple fractures, there are often no after-effects and function is recovered without difficulty.",{"type":126,"children":644},[645],{"text":129,"type":130},{"type":126,"children":647},[648],{"text":129,"type":130},{"type":126,"children":650},[651],{"text":652,"type":130},"COMPLEX FRACTURES",{"type":126,"children":654},[655],{"text":656,"type":130},"Sometimes, the fractures are more complex (3 fragments or more) and\u002For are very displaced and may then require surgical treatment.",{"type":126,"children":658},[659],{"text":660,"type":130},"This treatment varies from one fracture to another and depends greatly on the complexity and displacement of the fracture and the age of the patient.",{"type":126,"children":662},[663],{"text":664,"type":130},"The more complex the fracture, the more difficult it is to analyze it on simple x-rays. Your surgeon will then prescribe a CT scan which will allow him to better analyze the number of fragments and the movement of each fragment in order to choose the best treatment for each type of fracture.",{"type":170,"image":666,"children":669},{"ext":172,"url":264,"hash":265,"mime":175,"name":266,"size":267,"width":178,"height":268,"caption":180,"formats":667,"provider":190,"createdAt":278,"updatedAt":278,"previewUrl":180,"alternativeText":266,"provider_metadata":180},{"thumbnail":668},{"ext":172,"url":271,"hash":272,"mime":175,"name":273,"path":180,"size":274,"width":275,"height":276,"sizeInBytes":277},[670],{"text":129,"type":130},{"type":126,"children":672},[673],{"text":674,"type":130},"What surgical treatments can be used?",{"type":126,"children":676},[677],{"text":678,"type":130},"1° BROKES: Simple and quick treatment, they are reserved for displaced fractures in young patients (generally under 50 years old). They require additional immobilization, which is well tolerated in young patients.",{"type":126,"children":680},[681],{"text":682,"type":130},"Removal of material is essential, 2 to 3 months later, once the fracture has consolidated and shoulder function has recovered.",{"type":126,"children":684},[685],{"text":129,"type":130},{"type":126,"children":687},[688],{"text":689,"type":130},"2° PINS AND CIRCLES: The circles can be metallic but they are most often made up of large diameter wires invisible on x-rays.",{"type":126,"children":691},[692],{"text":693,"type":130},"This type of technique can be used in displaced fractures in the elderly patient, but not too complex because the holding of the wires and pins in the elderly patient depends a lot on the quality of the bone which is sometimes precarious at an advanced age.",{"type":170,"image":695,"children":698},{"ext":172,"url":306,"hash":307,"mime":175,"name":308,"size":309,"width":178,"height":310,"caption":180,"formats":696,"provider":190,"createdAt":319,"updatedAt":319,"previewUrl":180,"alternativeText":308,"provider_metadata":180},{"thumbnail":697},{"ext":172,"url":313,"hash":314,"mime":175,"name":315,"path":180,"size":316,"width":317,"height":276,"sizeInBytes":318},[699],{"text":129,"type":130},{"type":170,"image":701,"children":704},{"ext":172,"url":324,"hash":325,"mime":175,"name":326,"size":327,"width":178,"height":328,"caption":180,"formats":702,"provider":190,"createdAt":337,"updatedAt":337,"previewUrl":180,"alternativeText":326,"provider_metadata":180},{"thumbnail":703},{"ext":172,"url":331,"hash":332,"mime":175,"name":333,"path":180,"size":334,"width":335,"height":276,"sizeInBytes":336},[705],{"text":129,"type":130},{"type":170,"image":707,"children":710},{"ext":172,"url":342,"hash":343,"mime":175,"name":344,"size":345,"width":178,"height":346,"caption":180,"formats":708,"provider":190,"createdAt":355,"updatedAt":355,"previewUrl":180,"alternativeText":344,"provider_metadata":180},{"thumbnail":709},{"ext":172,"url":349,"hash":350,"mime":175,"name":351,"path":180,"size":352,"width":187,"height":353,"sizeInBytes":354},[711],{"text":129,"type":130},{"type":126,"children":713},[714],{"text":129,"type":130},{"type":126,"children":716},[717],{"text":718,"type":130},"They are mainly used in fractures in young patients. Some recently developed models are more easily used in older patients, but their use must be well codified. Removal of the material is rarely necessary beyond the age of 50; it is desirable before this age.",{"type":126,"children":720},[721],{"text":129,"type":130},{"type":126,"children":723},[724],{"text":725,"type":130},"4° NAILS",{"type":126,"children":727},[728],{"text":729,"type":130},"These are systems that are placed inside the bone, in association with screws.",{"type":126,"children":731},[732],{"text":733,"type":130},"They are very useful in elderly patients, because they have better hold than pins and simple circles and do not require an overly extensive surgical approach, unlike plates for example, which require exposing the entire fracture to perform fixation. This advantage makes it possible to reduce damage to the tissue around the bone (the periosteum) created by a direct approach, lesions which can be unfavorable for consolidation.",{"type":126,"children":735},[736],{"text":737,"type":130},"They are particularly useful in displaced 2-part fractures in elderly patients.",{"type":126,"children":739},[740],{"text":129,"type":130},{"type":126,"children":742},[743],{"text":129,"type":130},{"type":126,"children":745},[746],{"text":747,"type":130},"5° CENTROMEDULLARY OSTEOSYNTHESIS SYSTEMS DIFFERENT FROM NAILS",{"type":126,"children":749},[750],{"text":751,"type":130},"Certain systems allow internal stabilization of fracture fragments and promise the possibility of better bone consolidation, while trying to keep as much bone as possible (Bilboquet implant).",{"type":170,"image":753,"children":756},{"ext":172,"url":400,"hash":401,"mime":175,"name":402,"size":403,"width":178,"height":404,"caption":180,"formats":754,"provider":190,"createdAt":413,"updatedAt":413,"previewUrl":180,"alternativeText":402,"provider_metadata":180},{"thumbnail":755},{"ext":172,"url":407,"hash":408,"mime":175,"name":409,"path":180,"size":410,"width":411,"height":276,"sizeInBytes":412},[757],{"text":129,"type":130},{"type":126,"children":759},[760],{"text":419,"type":130},{"type":126,"children":762},[763],{"text":764,"type":130},"It remains widely used, particularly in the most complex fractures.",{"type":126,"children":766},[767],{"text":768,"type":130},"These fractures, like fractures of the upper end of the femur (fracture of the “neck” of the femur), are fragile when trying to keep the entire bone with an osteosynthesis system. For these fractures, there is a risk of secondary displacement and bone necrosis due to disappearance of the vascular supply after the installation of osteosynthesis.",{"type":126,"children":770},[771],{"text":772,"type":130},"Unlike osteosynthesis systems, the humeral prosthesis does not preserve the bone of the upper end of the humerus, but replaces a large part of it with a metal element (the prosthesis), which is cemented into the humerus.",{"type":126,"children":774},[775],{"text":129,"type":130},{"type":126,"children":777},[778],{"text":779,"type":130},"A few years ago, the results of shoulder prostheses for fractures, good in terms of pain, were insufficient in terms of mobility and strength. The appearance of new prostheses better adapted to the morphology of the humerus and not modeled on prostheses of the upper end of the femur, currently allows us to hope for better results in terms of mobility and strength.",{"type":126,"children":781},[782],{"text":783,"type":130},"However, whatever the model used, immobilization varies from a few days to 3 weeks, depending on the stability of the surgical setup and rehabilitation is long (6 months, sometimes more).",{"type":126,"children":785},[786],{"text":787,"type":130},"The result depends a lot on the quality of the bone but above all on the quality of the surgeon, who must be used to this type of fracture (you cannot be used to it if you operate less than 10 per year), in order to best adjust the position of the prosthesis in relation to the bone, a position which determines the good final result.",{"type":164,"level":165,"children":789},[790],{"text":791,"type":130},"Can we regain normal function?",{"type":126,"children":793},[794],{"text":129,"type":130},{"type":126,"children":796},[797],{"text":798,"type":130},"This is the goal of all treatment!!",{"type":126,"children":800},[801],{"text":129,"type":130},{"type":126,"children":803},[804],{"text":805,"type":130},"However, it all depends on several factors:",{"type":126,"children":807},[808],{"text":809,"type":130},"– The complexity of the fracture",{"type":126,"children":811},[812],{"text":129,"type":130},{"type":126,"children":814},[815],{"text":129,"type":130},{"type":126,"children":817},[818],{"text":819,"type":130},"– The age of the patient",{"type":126,"children":821},[822],{"text":129,"type":130},{"type":126,"children":824},[825],{"text":826,"type":130},"– The patient's ability to take charge of themselves and to cope with long and sometimes tedious, but totally essential, post-operative rehabilitation.",{"type":126,"children":828},[829],{"text":129,"type":130},{"type":126,"children":831},[832],{"text":833,"type":130},"– The dexterity of the surgeon who must be used to this type of fracture.",{"type":126,"children":835},[836],{"text":129,"type":130},{"type":126,"children":838},[839],{"text":840,"type":130},"The combination of all these favorable factors can make it possible to regain a normal shoulder, that is to say without pain, with mobility comparable to the healthy shoulder and with strength allowing the gestures of daily life, work and leisure.",{"type":126,"children":842},[843],{"text":844,"type":130},"If only one of these factors is seriously deficient (very complex fracture, very old patient, inability to understand and follow post-operative rehabilitation, “insufficiently trained” surgeon), the shoulder may be painless, but will rarely be normal in terms of mobility and strength.",{"type":126,"children":846},[847],{"text":129,"type":130},{"type":126,"children":849},[850],{"text":851,"type":130},"– The patient's ability to take charge of themselves and to cope with long and sometimes tedious, but totally essential, post-operative rehabilitation. – The dexterity of the surgeon who must be used to this type of fracture.",{"type":126,"children":853},[854],{"text":129,"type":130},{"type":126,"children":856},[857],{"text":840,"type":130},{"type":126,"children":859},[860],{"text":844,"type":130},{"type":126,"children":862},[863],{"text":129,"type":130},{"type":126,"children":865},[866],{"text":851,"type":130},{"type":126,"children":868},[869],{"text":129,"type":130},{"type":126,"children":871},[872],{"text":840,"type":130},{"type":126,"children":874},[875],{"text":844,"type":130},{"type":126,"children":877},[878],{"text":129,"type":130},{"type":126,"children":880},[881],{"text":882,"type":130},"In conclusion, these fractures are complex and we can encounter everything, from the very simple fracture which will consolidate in 3 weeks of immobilization, to the most complex fractures which require the installation of a prosthesis and long rehabilitation.",{"type":126,"children":884},[885],{"text":886,"type":130},"Only your doctor will be able to assess the seriousness of the fracture and direct you towards one or other of the various therapies.",{"type":126,"children":888},[889],{"text":129,"type":130},{"data":180},{"data":892},{"id":893,"attributes":894},29,{"createdAt":895,"updatedAt":896,"publishedAt":897,"name":898},"2024-10-13T12:17:46.400Z","2024-10-13T12:22:51.507Z","2024-10-13T12:22:51.505Z","  Fracture épaule",[],{"data":901},[],[],[],{},[906,924,943,956,977,1008],{"id":112,"name":907,"pathologie_par_articulation":908,"texte_articles_pathologie":-1},"Ankle",[909,914,918],{"id":59,"name":910,"texte_articles_pathologie":911},"Pathologie dégénérative de cheville 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