2 English reference humeral supracondylar fracture [Chinese medicine terminology Committee. Terminology of Traditional Chinese Medicine (2004)]
Conclusion Supracondylar fracture of humerus [1] is the name of the disease [2]. It refers to the fracture with elbow joint pain, obvious swelling and even tension blisters, elbow joint deformity and dyskinesia, which occurs within 2cm above the medial and lateral epicondyle of the lower humerus [2][ 1].
Supracondylar fracture of humerus refers to the fracture above medial and lateral condyle of distal humerus. The supracondylar area of humerus is flat and wide, with a coronary fossa in front and an eagle fossa in the back. There is only a thin layer of bone between them, which is easy to fracture. Supracondylar fracture of humerus is the most common in children, accounting for about 3% ~ 7% of limb fractures and 30% ~ 40% of elbow fractures, of which straight fractures account for about 90%. The multiple age range is 5 ~ 65438 02 years old. Most fractures are caused by indirect violence. It can be divided into two types: extension type and flexion type. The former is more common, accounting for about 90%. Improper treatment in the early stage is prone to ischemic contracture, and cubitus varus and other deformities may occur in the later stage.
4 Name of disease Supracondylar fracture of humerus
5 English names supracondylar fracture of humerus
6 supracondylar fracture of humerus alias supracondylar fracture of humerus
7 classification orthopedics > limb injury > humeral shaft fracture and elbow joint trauma >: elbow joint fracture.
8 ICD number S42.4
The causes of supracondylar fracture of humerus are mostly caused by indirect violence.
10 Pathogenesis Supracondylar fracture of humerus mostly occurs in sports injury, life injury and traffic accidents. It was caused by indirect violence. The injury mechanism of various types of fractures is not consistent. Fractures are usually divided into extension type, extension-ulnar deviation type, extension-radial deviation type and flexion type.
10. 1 When stretching and falling, the elbow joint is semi-flexed, and the ground reaction force is transmitted to the lower end of the humerus through the forearm; Supracondylar fracture of humerus, with proximal fracture moving forward and distal fracture moving backward (Figure 1). The fracture line is inclined from the upper back to the front. If the displacement is serious, the proximal end of the fracture will often damage the anterior humeral muscle and cause damage to the brachial artery. Most of the nerve injuries caused by proximal fractures are median nerve and radial nerve.
10.2 The external force of straightening ulnar deviation acts from the anterolateral side of humeral condyle, which makes the distal end of supracondylar fracture of humerus shift to ulnar side and posterior side. The medial bone may be partially compressed and the lateral periosteum is intact (Figure 2). This kind of fracture tends to move inward and varus, so it must be reset when the fracture is displaced to avoid cubitus varus deformity.
10.3 the external force of radial deviation extends from the anteromedial side of humeral condyle, and the distal end of fracture shifts to the radial side and the posterior side after fracture; This kind of fracture is not prone to cubitus varus deformity (Figure 3).
10.4 flexion type multi-system elbow flexion position, elbow landing. The olecranon of the ulna directly hit the humeral condyle from bottom to top, resulting in the fracture of the epicondyle. The distal end of the fracture is displaced forward and the proximal end is displaced backward. The fracture line inclines from the front top to the back bottom (Figure 4).
Clinical manifestations of supracondylar fracture of humerus 1 1 Patients with supracondylar fracture of humerus are more common in children and have a history of external injury. After the injury, the elbow joint can not move locally, and the swelling is obvious. There is a bone triangle relationship at the elbow, which means there is no dislocation. The elbow joint is in a semi-flexion position, and the socket of the elbow joint is full. And can touch the proximal humerus at the cubital fossa. If careful examination is impossible due to swelling and pain, X-ray positive and lateral films should be taken quickly to determine the fracture and displacement.
Supracondylar fracture of humerus should be differentiated from complete epiphysis separation of distal humerus in children under 5 ~ 6 years old. Because the ossification center of humeral capitulum appears at about 1 year, and the ossification center of trochlea appears at about1year, the epiphysis on X-ray film is completely separated, and there is no fracture line. The relationship between the radial longitudinal axis and humeral capitulum remains unchanged, but the relationship with the lower end of humerus changes, and the elbow joint is swollen and tender around. Simple fracture of capitulum humeri can be diagnosed by X-ray film, and the longitudinal axis of radius does not need to pass through capitulum humeri (Figure 5). Attention should be paid to the pulse of radial artery and the role of median nerve in diagnosis.
Complications of supracondylar fracture of humerus 12. 1 Volkmann ischemic muscle contracture is easy to cause Volkmann ischemic muscle contracture or cubitus varus deformity if the supracondylar fracture of humerus is not handled properly. Although all kinds of treatment methods have been improved or improved, the severe Volkmann ischemic muscle contracture has been obviously alleviated, cubitus varus deformity still occurs, and the incidence rate is still high, which must be paid attention to in the treatment process.
Volkmann ischemic muscle contracture is a common and serious complication of supracondylar fracture of humerus. Its early symptoms are severe pain, disappearance or weakening of radial artery pulsation, poor peripheral circulation, pale and cold hand skin, and severe pain caused by passive extension and flexion of fingers. The elbow joint should be straightened immediately, and the fixation and dressing should be relaxed. If the blood supply does not improve after short-term observation, the brachial artery should be explored in time. Spastic arteries can be wet compressed with warm saline, and arteries can be blocked with procaine. Those that do have vascular damage should be repaired. If the swelling of the forearm is aggravated and the pressure in the osteofascial compartment is high, the osteofascial compartment should be cut open for decompression.
12.2 cubitus varus cubitus varus is a common late deformity of supracondylar fracture, with an incidence of 30%. There are many different explanations for cubitus varus: for example, the medial epiphyseal line of humerus develops unevenly during fracture; The rotation of the distal fracture segment has not been corrected; Or after reduction, due to the natural pronation position of the forearm and the inward angle with the upper arm, it leads to rotational displacement; Skew fracture of ulna cannot be corrected. Due to the high incidence of ulnar deviation, it is required that the ulnar deviation fracture should be accurately reduced or overcorrected to make it slightly radial deviation. X-ray was taken every week after fracture reduction, and cubitus varus was predicted according to the distribution of callus inside and outside the fracture end. If cubitus varus is predicted, under sufficient anesthesia, the fractured bone is gently rubbed and fixed in a straight position. Elbow varus deformity does not affect the extension and flexion of elbow joint, but affects the appearance and patient's psychology. If the deformity is greater than 20 degrees and the deformity is stable after injury 1 ~ 2 years, the supracondylar wedge osteotomy of humerus can be used for correction.
12.3 cubitus valgus rarely occurs, which can be seen in cases of poor reduction of lateral condyle fracture of humerus. Severe cases should cause ulnar neuritis, and nerve advancement or osteotomy should be carried out as soon as possible.
Nerve injury is common in 12.4, while radial nerve and ulnar nerve injury are rare, mainly due to local compression, involvement or contusion, and fracture is rare. With the reduction of fractures, most of them can recover spontaneously within a few weeks after injury. If it still does not recover after 8 weeks, surgical exploration can be considered and appropriate treatment can be carried out.
12.5 Osteomyositis of elbow joint In the functional recovery period, the intense passive flexion and extension of elbow joint can lead to a large number of ossified blocks around the joint, which makes the joint swell again and the active flexion and extension activities gradually decrease. In this case, the passive traction joint should be stopped immediately and braked for several weeks, and then the flexion and extension activities of the active joint should be resumed. Hyperplastic bone tissue in children hardly needs surgical resection.
13 x-ray film of elbow joint can show fracture and displacement.
14 the diagnosis of supracondylar fracture of humerus is mainly based on the following contents:
1. Trauma history? Life and sports accidents are the most common, especially in preschool children.
2. Clinical manifestations? The main symptoms are elbow swelling (obvious), severe pain and limited activity, so we should pay special attention to whether there is blood vessel injury.
3. Imaging examination? Conventional positive and lateral X-ray films can make diagnosis and classification.
155 differential diagnosis of children under 6 years old, supracondylar fracture of humerus should be differentiated from total epiphysis separation of distal humerus. Because the ossification center of humeral capitulum appears at about 1 year, and the ossification center of trochlea appears at about1year, the epiphysis on X-ray film is completely separated, and there is no fracture line. The relationship between the radial longitudinal axis and humeral capitulum remains unchanged, but the relationship with the lower end of humerus changes, and the elbow joint is swollen and tender around.
Differentiation between supracondylar fracture of humerus and dislocation of elbow joint;
Supracondylar fracture of humerus (straight type) can partially move elbow joint, the posterior triangle of elbow joint has no change, the upper arm is shortened and the forearm is normal.
Elbow dislocation elbow joint is fixed elastically, and the posterior triangle of elbow joint has changed.
Treatment of supracondylar fracture of humerus 16 split fracture, non-displaced fracture can be suspended by neck wrist band or fixed by plaster for 2 ~ 3 weeks.
Dislocated fractures should be closed and reduced as soon as possible. Reduction was performed under hematoma anesthesia. First, stretch the elbow to correct the lateral displacement and the rotation between the folded ends, and then correct the front and rear displacement. The elbow flexion position of straight type is fixed, and the elbow flexion position of elbow flexion type is fixed and in a semi-straight position. Usually, the long arm plaster is used for posterior support, and the small splint is simple and easy to fix, and the fixation is released after 3 weeks to move the joint.
In most cases, surgery is not needed, but closed reduction should try to correct varus and pronation deformity, restore Bowman angle (humeral angle) and avoid cubitus varus deformity. Even if there is a certain degree of anterior and posterior dislocation or angle, it can be gradually corrected during the growth process, and the long-term function will not be affected.
Some unstable fractures can be cross-fixed by percutaneous kirschner wire from medial and lateral condyles after reduction to maintain the reduction position.
Patients with vascular and nerve injuries should be treated with emergency exploration and fracture reduction at the same time, and fixed with Kirschner wire.
Displaced fractures, most of which have severe swelling or tension blisters, should not be reset immediately. Deng Lupu traction is feasible. Raise the affected limb first, and then reduce the swelling. Traction treatment is suitable for fractures with more than 24 ~ 48h hours, severe swelling of soft tissue, blister formation, inability to be manually reduced or unstable after reduction.
There are many complications of supracondylar fracture of humerus in children. The early serious complication is ischemic contracture of forearm, which will cause lifelong disability once it occurs. Therefore, in the process of diagnosis and treatment, we should always be vigilant, pay attention to observe and judge the blood supply situation, and deal with it in time to prevent adverse consequences. The late complication is mainly cubitus varus deformity, and the incidence of cubitus varus deformity is the highest in patients with distal extension fracture adduction. Therefore, the humeral angle should be restored as much as possible during reduction; Forearm pronation should be used for plaster fixation, which has been confirmed by Abrahan's experiment (1982) and Arnold's clinical report.
The fracture mechanism of adult condyle is similar, but the fracture line is slightly lower, the distal fracture end is more common, and the metaphyseal end can be shattered. This kind of fracture can be closed for reduction, and the long arm can be fixed with plaster support for 3 ~ 4 weeks after reduction. Perform functional exercise after gypsum removal.
17 Prognosis During the treatment of supracondylar fracture of humerus, there are many complications of blood vessels, nerves and ilium, so the treatment scheme should be adjusted at any time. Once complications occur or form, immediate or late surgical treatment is needed, especially late surgical treatment, and the effect is very unsatisfactory.
18 fracture (fracture [1]) is the name of the disease [3]. It refers to diseases caused by the destruction of the integrity or continuity of bone, which are characterized by pain, swelling, bruising, dysfunction, deformity and bone friction [1]. See "Secret Stories from Outside Taiwan", Volume 29. Fractures are also called broken bones, broken wounds, broken wounds and ulceration [3].
18. 1 Etiology and pathogenesis are caused by external force, muscle tension or osteopathy [3].
The symptoms of 18.2 are generally truncated, broken or inclined [3]. The injured part may have blood stasis, swelling and pain, dislocation, deformity, bone sound, axial percussion pain, abnormal activity and dysfunction [3]. If the bone itself suffers from tuberculosis, osteomyelitis and osteoma, then every time it encounters a slight external force collision, it is called pathological fracture [3].
18.3 treatment
1, material: potato
2. Accessories: Zanthoxylum bungeanum and sesame.
3. Seasoning: salt, sesame oil, soy sauce, balsamic vinegar and sugar.
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