humeral shaft fracture
Introduction
Introduction to humeral shaft fracture The fracture of the fracture of the humerus (fractureofhumeralshaft) refers to the fracture of the humerus from 1 to 2 cm below the neck to 2 cm above the humerus, accounting for 1.31% of the total fracture. It occurs mostly in the middle of the backbone, followed by the lower part and the lower part. The lower third of the fracture is easy to have radial nerve injury, and the lower third of the fracture is prone to nonunion. basic knowledge Sickness ratio: 0.1% Susceptible people: no specific population Mode of infection: non-infectious Complications: radial nerve injury vascular injury tibiofibular nodule fracture
Cause
Causes of humeral shaft fracture
Direct violence (35%):
Such as blows, crush injuries or firearm injuries, etc., mostly occur in the middle third, mostly transverse fractures, comminuted fractures or open fractures, sometimes multiple fractures can occur.
Conducted violence (28%):
If the hand or elbow is on the ground when the fall, the ground counterattacks the violent upward conduction. When the fall is under the weight of the violent intersection, the oblique fracture or spiral fracture occurs in the humeral shaft. It is more common in the lower third of the humerus. The tip is easily inserted into the muscles, affecting the manual reset.
Rotational violence (10%):
For example, when throwing a grenade, a javelin or a wrist-wound to reverse the forearm, it may cause a fracture of the middle and lower third of the humerus, and the fracture of the tibia is mostly a typical spiral fracture.
After the humeral shaft fracture, due to the different points of muscle attachment at the fracture site, the relationship between the direction of violence and the position of the upper limbs, the fracture of the humerus can have different displacements, such as fractures above the deltoid point, and proximal fractures. The traction of the large muscle, the great round muscle and the latissimus dorsi muscle is displaced to the medial side; the distal fracture end is displaced upward due to the pulling action of the deltoid muscle, such as the proximal fracture end of the fracture below the deltoid muscle Due to the pulling action of the deltoid muscle and the diaphragm, it is outwardly displaced forward; the distal fracture end is pulled by the biceps and triceps, and the upward overlapping shift occurs (Fig. 2), such as The fracture is in the lower third part. Because the injured person often suspends the forearm in front of the chest, the internal rotation of the distal fracture end is displaced, and attention should be paid to correct the manipulation.
Prevention
Prevention of humeral shaft fracture
The disease is mainly caused by traumatic factors, so it is necessary to pay attention to safety, and the main point of prevention of this disease is to prevent the occurrence of complications. The middle and lower fractures of the humeral shaft are easy to be combined with radial nerve injury, and should be examined in detail before operation. Avoid injury, different plane fractures, different displacement directions, must be reset according to X-ray film, excessive fracture of the fracture end is prone to bone non-joining to form a pseudo-articular joint, early fracture of the upper arm muscle active contraction activity, and injury After 2 to 3 weeks, shoulder and elbow joint activities to prevent joint dysfunction.
Complication
Complications of humeral shaft fracture Complications, sacral nerve injury, vascular injury, tibial tuberosity
The disease can have some complications as follows:
1. Nerve injury The most common sacral nerve injury is the lower third of the humerus fracture. It is easy to cause incomplete radial nerve injury caused by the compression or contusion of the fracture end. Generally, it is 2 to 3 months, if there is no nerve function recovery performance. Surgery is performed again. During the observation period, the wrist joint is placed in the functional position, and the movable bracket that can be pulled by the straight finger is used to move the joints of the injured finger to prevent deformity or stiffness.
2. Vascular injury It is not uncommon in the complications of humeral shaft fractures. Generally, radial artery injury does not cause limb necrosis but can also cause insufficient blood supply. Therefore, blood vessels should still be repaired.
3. Fractures are not connected . The lower third of the humerus fractures are often seen. There are many reasons for the non-union of the fracture, which are related to the injury violence, the anatomical location of the fracture and the treatment method. The reduction causes severe damage to the periosteum and surrounding soft tissue at the fracture site, and the blood vessels in the soft tissue at the fracture end are seriously damaged, which causes the nutrient supply required for fracture repair to be interrupted, thereby affecting the healing of the fracture. The anatomical position of the fracture also affects the healing of the fracture. The line is below the deltoid end point. These types of fractures are only suspended by small splints or plaster casts and neck straps. They are easy to shorten in long oblique and spiral fractures, and easy to separate in transverse and short oblique fractures. This is an important reason for the need for multiple reductions. It is also one of the causes of non-union of the fracture. The external fixation is removed prematurely, the blood supply is damaged during the operation, the indications are improperly selected, and the soft tissue is embedded in the fracture end. Multi-segment fractures have not been properly treated. Generally, bone grafting plus internal fixation is used. Postoperative infection also causes bone disconnection, especially internal fixation is not correct. The main reason for the failure of open reduction cases is that the healing of the fracture is a continuous process. There should be no disturbance of the residual stress during the whole process, especially the shear and rotational stress. Therefore, the fracture end must be properly fixed. In the normal fracture healing process, intramembranous ossification and cartilage ossification are simultaneously performed. Under the interference of repeated stresses at the fracture end, the formation of new blood vessels from the marrow cavity, periosteum and surrounding soft tissue and mutual The docking process is affected, and intramembranous ossification and cartilage ossification will become slow or even terminate, delaying or non-healing fracture healing.
4. Malformation healing Because of the wide range of motion of the shoulder joint, although the humeral fracture has some angles, rotation or shortening deformity, it does not affect the active function of the injured limb, but the displacement of the humerus fracture is particularly serious, and the fracture function is not restored. The requirements severely destroy the biomechanical relationship of the upper limbs, which will bring damaging arthritis to the shoulder or elbow joints, and will also bring pain to the wounded. Therefore, for young adults and young casualties, when conditionally treated, Osteotomy should be performed to correct malunion.
For the humeral shaft fracture, the angular deformity is obvious, and the osteotomy should be performed. The osteotomy of the humerus neck is better. Otherwise, the osteotomy can be produced in the humeral shaft fracture; for example, when the humerus neck Patients with severe fractures should be treated with osteotomy at the neck of the humerus.
5. Shoulder and elbow joint dysfunction are more common in elderly patients. Therefore, it is not only impossible to use a wide range of long-term fixation for elderly patients, but also to strengthen the muscles and joint function as soon as possible. If shoulder or elbow joint dysfunction has occurred, it is necessary. Strengthen the exercise of its functional activities, supplemented by physical therapy and physical therapy, so as to restore joint function as soon as possible.
6. Shoulder and elbow joint function is limited : the most common is the effect of antegrade nail on shoulder joint function, the reason:
(1) The end of the intramedullary nail is not completely buried under the bone surface, thus occupying the subacromial gap, causing shoulder joint impact during activity, which is one of the main causes of shoulder joint pain and dysfunction.
(2) Injury and scar formation of the supraspinatus tendon and synovial sac are the main reasons for shoulder abduction limitation and pain without intramedullary nail tail. Intraoperative attention to repair of the rotator cuff can reduce this complication.
(3) The time and scope of postoperative shoulder exercise will also affect the recovery of function.
(4) Older age is another cause of poor recovery of shoulder function.
7. iatrogenic fractures: large tibial tuberosity fractures, surgical neck fractures, fractures of the fractures at the fracture end, and the fractures at the entry point are often related to improper operation. Carefully determine the entry point, the opening is large enough, and the reaming is appropriate. Gently insert the intramedullary nail to avoid forced hammering into the nail to prevent iatrogenic fractures.
8. Locking nail fracture : If the patient has multiple injuries, when the lower limbs are unable to move freely, the bed activity is mainly supported by the upper limbs, the fracture is not healed, and excessive weight can cause the proximal locking nail to break.
9. The lower third of the fracture is easy to be associated with radial nerve injury, and the lower third of the fracture is prone to nonunion.
Symptom
Symptoms of humeral shaft fracture Common symptoms Traumatic scapular scapula and upper extremity pain simple fracture upper limb semi-flexion
1. Pain manifested as local pain, ring tenderness and conduction pain, etc., generally more obvious.
2. Swelling and complete fracture, especially the comminuted type of local bleeding can be as much as 200ml or more, combined with traumatic reaction, so local swelling is obvious.
3. Deformity After the trauma, the patient first found that the upper arm appeared angulated and shortened deformity, except for incomplete fractures, generally more obvious.
4. Abnormal activity also occurs immediately after injury. The patient's nerve trunk is close to the bone surface and is easily crushed or stabbed. The surrounding blood vessels may also be damaged. Therefore, it is necessary to be at the distal end of the limb during clinical examination and diagnosis. Feeling, exercise, and brachial artery pulsation are examined and compared with the contralateral side. Any indication of this comorbidity should be noted at the time of diagnosis.
Examine
Examination of humeral shaft fracture
There is no relevant laboratory inspection. In the inspection, there are mainly the following aspects:
1, physical examination can be found in pseudo-articular activity, bone friction, bone conduction sounds weakened or disappeared;
2, X-ray film can determine the type of fracture, displacement direction.
3. Electromyography can be performed on patients suspected of having nerve damage.
Diagnosis
Diagnosis and diagnosis of humeral shaft fracture
diagnosis
History of trauma, local swelling, pain, annular tenderness and conduction pain, abnormal activity and angulation, shortening deformity, positive lateral X-ray can confirm fracture and fracture displacement.
Differential diagnosis
1. The X-ray positive lateral position of the upper arm can identify the location, type and displacement of the fracture, and help to identify whether it is a pathological fracture caused by bone cyst.
2, the humeral shaft fracture caused by rotation violence should be differentiated from the upper arm sprain, the latter has traction pain, tenderness is limited to the injury site, but no ring tenderness, longitudinal snoring pain and abnormal activity.
3, if there is sacral nerve injury, it is necessary to distinguish whether it is preoperative injury or intraoperative injury. By asking about medical history, onset time and onset of disease, clinical manifestations, combined with EMG examination is not difficult to diagnose, if there is no sacral nerve injury before surgery Performance and immediate postoperative findings are considered to be caused by traction and rough operation. If the progressive sacral nerve injury appears after surgery, it should be considered as osteophyte or scar adhesion.
