Double fracture of radial and ulna
Introduction
Introduction to the double fracture of the radius and ulna The ulna and the tibia are the two long bones of the forearm. The ulna is located on the inner side of the forearm and is a longer bone that can be divided into two ends. Located on the side of the little finger, it is more likely to fracture. The lateral fracture, overlap, rotation and angular deformity of the ulnar and radial fractures can be complicated. Different types of violent fractures have different types of fractures, and spiral fractures of the ulnar and radial bones occur. The direction of the fracture line is the same, and there are many ulnar bones that are inclined to the lower part of the humerus. basic knowledge The proportion of illness: 3% Susceptible people: no specific people Mode of infection: non-infectious Complications: ulnar shaft fracture
Cause
Causes of the double fracture of the radius and ulna
The disease is caused by arm trauma, and different violent factors can cause different types of fractures:
Indirect violence (30%):
When the person falls, the palm of the hand touches the ground, and the violent upload causes the middle or upper third of the humerus to fracture. The residual violence is transmitted obliquely down to the ulna through the interosseous membrane, causing the ulnar fracture. Therefore, the ulnar fracture line is lower than the tibia fracture line, and the humeral fracture is mostly horizontal. Or jagged, the ulna is mostly short and oblique.
Reversing violence (15%):
When the body falls, the body leans to one side, and the forearm is simultaneously subjected to longitudinal conduction and rotational torsion. The spiral fracture of the ulnar and radial bone occurs, and the fracture line has the same direction, and the ulna is obliquely inclined to the lower part of the humerus.
Direct violence (35%):
More common in combat or mechanical injury, the fracture is transverse or comminuted, and the fracture line is in the same plane.
Prevention
Prevention of double fracture of radius and ulna
The disease is mainly caused by traumatic factors. In addition to preventing trauma, the key point is to prevent complications of the disease. The following preventive measures are available:
(1) The reset request is accurate and the anatomical reduction is achieved as much as possible.
(2) Debridement is timely and thorough, emphasizing preoperative and intraoperative antibiotics.
(3) Grasp the indications for surgery.
(4) According to the principle of fracture fixation, the internal fixation material should be selected. The length of the selected steel plate should be greater than 5 times the diameter of the backbone, and the length of the intramedullary needle should be 8 to 10 cm beyond the fracture end to achieve a relatively firm fixation.
(5) When bone defects are present, try to plant autologous cancellous bone.
(6) The external fixation position is fixed at 20 degrees after the forearm is rotated. At this time, the interosseous membrane is tight to prevent contracture, the fixation is also the most stable, and the function of the joint rotation is also optimal.
(7) Intraoperative operation is gentle, and periosteal peeling is as small as possible.
(8) Properly raise the affected limb after surgery and use dehydrating agent to reduce swelling. Use antibiotics to prevent infection.
Complication
Complications of the ulnar and radial fractures Complications ulnar fracture
The common complications and possible causes of this disease are as follows:
(1) Fracture non-healing: The anatomical relationship of the ulnar and ulna is complex. The lower third of the radius and ulna is mainly surrounded by tendons. The surrounding soft tissue has poor blood supply, and the upper and lower ends of the ulna and humerus form joints. The two ends are oscillated with the ulna as the axis, and they are not subjected to the rotational force, and the broken ends of the ulna can be twisted to each other, affecting the healing of the fracture; the comminuted fracture bone defect, the surrounding soft tissue injury is serious; the periosteal microvascular embolism, resulting in Periosteal necrosis affects osteogenesis; all methods and materials for internal fixation are inadequate.
(2) Infection: It is mainly related to the long exposure time of wounds after injury, incomplete debridement and severe soft tissue injury.
(3) Forearm muscle compartment syndrome: Most of the soft tissue injury is severe, the technique is improper when the maneuver is reset, the operation is rough, the operation is rough and the various swelling and hemostasis measures are not actively performed in time, and the pressure in the muscle interval is continuously increased, and When the outer plate is fixed, the plaster is fixed too tightly.
(4) Forearm rotation function is limited: it is often caused by closed and reconstructed patients. The fracture end does not reach anatomical reduction, cross healing or bridge connection between the two bones, interosseous membrane contracture, soft tissue scar adhesion and upper and lower joint capsule contraction are also important reasons. .
(5) Pressure sores: mostly caused by gypsum shaping or bone pad extrusion after closure of the complex fracture, local edema, skin blood supply is also an important reason.
Symptom
Symptoms of ulnar and radial fractures Common symptoms Forearm supination function limited forearm rotation pain
The main symptoms of this disease are local swelling, deformity and tenderness, bone rubbing and abnormal activities, restricted forearm activity, children often with green branch fractures, angular deformities, no bone displacement, sometimes with median nerve Or ulnar nerve, radial nerve injury, should pay attention to check.
Examine
Examination of the double fracture of the radius and ulna
The disease can be initially diagnosed according to the history and clinical manifestations of the trauma, but some auxiliary examination methods should be used to help further diagnosis. X-ray films can identify the type of fracture and displacement. The photos should include elbow and wrist joints to understand whether there is any Rotational displacement and dislocation of the upper and lower ankle joints.
Diagnosis
Diagnosis and diagnosis of double fracture of radius and ulna
Pain after forearm trauma, mobility disorder, X-ray film can determine the type of fracture and displacement, the photo should include elbow, wrist joints to understand the presence or absence of rotational displacement and upper and lower ankle joint dislocation.
The disease is caused by traumatic factors. The fracture damage here can often be combined with the bone damage of other joints. Therefore, it is necessary to identify the possible fracture injuries:
1. Ulnar fractures;
2, fracture of the tibia.
A differential diagnosis can usually be made using X-ray examination.
