supracondylar fracture of humerus
Introduction
Introduction to supracondylar fracture of the humerus The supracondylar fracture of the humerus refers to the fracture above the medial and lateral iliac crest of the distal radius. It is most common in children, accounting for 3% to 7% of fractures in the limbs of children, 30% to 40% of elbow fractures, and about 90% of the extensions. . The multiple age is 5 to 12 years old. When the treatment of the supracondylar fracture of the humerus is easy to cause Volkmann ischemic contracture or cubitus varus deformity, although the various treatment methods have improved or improved, the Volkmann ischemic contracture has been significantly reduced, but still Occurrence of elbow varus deformity, the incidence is still high, must pay attention to treatment. basic knowledge The proportion of illness: 0.03% Susceptible people: children born in 5 to 12 years old Mode of infection: non-infectious Complications: supracondylar fracture of the humerus elbow varus deformity elbow valgus ulnar nerve injury median nerve injury ossifying myositis
Cause
Causes of supracondylar fracture of the humerus
Trauma factor (90%)
The supracondylar fracture of the humerus is caused by indirect violence. Supracondylar fractures of the humerus occur mostly in sports injuries, life injuries and traffic accidents. The fracture is usually divided into a straight type and a flexion type. According to the displacement of the fracture, the straight type is divided into a straight-line type and a straight-line type.
Pathogenesis
1. Stretching type: When falling, the elbow joint is semi-flexed to the ground, and the reaction force of the ground is transmitted to the lower end of the humerus through the forearm; in the upper part of the humerus, the proximal end of the fracture is displaced forward, and the distal end is moved backward. Position, the direction of the fracture line is obliquely from the posterior to the anterior and inferior. If the displacement is severe, the proximal end of the fracture often damages the tibialis anterior muscle and causes damage to the radial artery. The nerve injury caused by the proximal end of the fracture is mostly the median nerve and the radial nerve. .
2. Extensional ulnar deviation: external force from the anterior lateral aspect of the humeral condyle, the humeral condyle is subjected to force, so that the distal end of the supracondylar fracture of the humerus is displaced to the ulnar side and the posterior side, and the medial bone may be partially compressed, the lateral periosteum There is fashion integrity, the tendency of internal displacement and varus of such fractures is large, and the fracture must be adjusted to avoid the elbow varus deformity.
3. Stretching partial type: external force from the anterior medial aspect of the humerus, after the fracture, the distal fracture end is displaced to the temporal and posterior side; this fracture is not prone to elbow varus deformity.
4. Flexion type: multiple flexion of elbow joint, landing behind elbow, external force from bottom to top, olecranon directly impacts the humeral humerus, causing upper fracture of the iliac crest, distal displacement of the fracture, proximal segmental bone The end is displaced backwards, and the fracture line is inclined obliquely from the front to the back.
Prevention
Prevention of supracondylar fracture of the humerus
The disease is caused by traumatic factors, no effective preventive measures, attention to production and life safety on weekdays, and avoiding trauma is the key.
The most important aspect in prevention and treatment is to diagnose and treat as early as possible; after the reduction of the fracture, the swelling pain and peripheral circulation should be closely observed. If the distal blood supply disorder is found, early surgery; when the elbow swelling is obvious, the biceps aponeurosis is cut off. Decompression; supracondylar fractures are easy to use Kirschner wire cross fixation to reduce surgical trauma.
Complication
Complications of supracondylar fracture Complications humeral supracondylar fracture elbow varus deformity elbow valgus ulnar nerve injury median nerve injury ossifying myositis
1. Volkmann ischemic muscle contracture: a common and serious complication of supracondylar fracture of the humerus. The early symptoms are severe pain, the brachial artery pulsation disappears or weakens, the peripheral circulation is poor, the skin of the hand is pale and cool, and the passive flexion is straight. When the finger causes severe pain, etc., the elbow should be straightened immediately, and the fixation and dressing should be loosened. If the blood supply is not improved after a short period of observation, the radial artery should be explored in time. The artery of the iliac crest can be wetted with warm saline. If rucaine is closed and there is vascular injury, repair surgery should be performed. Forearm swelling should be aggravated. If the pressure of the interfascial compartment is high, the decompression of the compartment should be performed.
2. Elbow varus: It is a common late deformity of the supracondylar fracture, the incidence rate is up to 30%. There are many different explanations for the cause of cubitus varus. For example, the fracture of the humerus is not balanced during the fracture; The rotation of the segment is not corrected; or after the reduction, due to the natural pronation position of the forearm and the inward-facing angle with the upper arm, the rotation is displaced; the ulnar deviation fracture cannot be corrected, because the incidence of the ulnar deviation is high, so it is required The ulnar deviation fracture should be accurately reset or overcorrected, so that it is mildly paralyzed. One week after the reduction of the fracture, the X-ray positive position is taken. According to the distribution of the epiphysis in the fracture end, the occurrence of elbow varus is predicted. No, if it is predicted that cubitus varus occurs, under the full anesthesia, the palpebral flexion and bone correction are fixed in the extension position. The elbow varus deformity does not affect the flexion and extension of the elbow joint, but affects the appearance and patient psychology. The deformity exceeds 20 Above °, 1 to 2 years after the injury is stable, it is feasible to correct the upper and lower wedge osteotomy of the humerus.
3. Elbow valgus: elbow valgus rarely occurs, can be seen in the case of poor reduction of the external humerus fracture, severe temperament neuritis, early nerve advancement or osteotomy.
4. Nerve injury: median nerve injury is more common, sacral nerve and ulnar nerve injury are rare, mainly due to local compression, involvement or contusion, fracture is rare, and most of the fracture recovery can be self-recovery within a few weeks after injury. If there is no recovery after 8 weeks of injury, surgical exploration may be considered and appropriate treatment.
5. Elbow joint ossifying myositis: In the functional recovery period, strong passive flexion and extension of the elbow joint can lead to a large number of ossified masses around the joint, causing the joint to swell again, and the active flexion and extension activities are gradually reduced. In this case, it should be immediately Stop passively pulling the joint, and should be braked for several weeks, and then restart the active exercise of joint flexion and extension activities. In children, there is little need for surgical removal of hyperplastic bone tissue.
Symptom
Symptoms of supracondylar fracture of the humerus Common symptoms Acute pain in the elbow joint deformity of the forearm and hand muscles... Forearm shortening elbow joint can not flex the ischemic contracture elbow valgus angle increase
The patient is more common in children, has a history of trauma, the elbow joint can not move after injury, the swelling is obvious, the elbow bone triangle relationship exists, indicating that there is no dislocation, the elbow is in a semi-flexion, the elbow is full, and the tibia can be touched in the elbow fossa. Near the end of the fold, such as swelling, pain can not be carefully examined, you should quickly take X-ray positive, lateral slices to determine the fracture and displacement.
In children under 5-6 years of age, the supracondylar fracture of the humerus should be distinguished from the distal iliac crest, because the ossification center of the humeral head appears around 1 year old, and the ossification center of the trochle is only about 10 years old. Appeared, so the complete separation of the epiphysis in the X-ray film without fracture line, the longitudinal axis of the humerus and the humeral head does not change, but the relationship with the lower end of the humerus, elbow swelling, circumferential tenderness, simple humeral head fracture, on the X-ray On the film, the longitudinal axis of the humerus can be diagnosed without passing through the humeral head. In the diagnosis, the function of the radial artery pulsation and the median nerve should be noted.
The characteristics of the supracondylar fracture of the humerus are: the fracture line is at or above the level of the olecranon in the lower part of the humerus. The direction of the fracture is from the front to the back. The fracture is angled forward and the distal end is displaced backward. The fracture line of the supracondylar fracture of the humerus can be transverse, the fracture is angled backward, and the distal end is displaced forward or without significant displacement.
Examine
Examination of supracondylar fracture of the humerus
The auxiliary examination method for this disease is mainly X-ray examination: when X-ray examination is used for the patient, in addition to the positive and lateral X-ray film, the special body phase should be taken according to the injury, such as the opening position (upper cervical vertebra injury). Dynamic lateral position (cervical vertebrae), axial position (scaphoid, calcaneus, etc.) and tangential position (tibia), complex pelvic fractures or suspected intraspinal fractures, should be considered as a slice or CT examination .
Diagnosis
Diagnosis and diagnosis of supracondylar fracture of humerus
diagnosis:
Mainly based on the following:
1. The history of trauma is more frequent in life and sports accidents, and more common in preschool children.
2. The clinical manifestations are mainly swelling of the elbow (more obvious), severe pain and limited activity, and special attention should be paid to the presence or absence of vascular injury.
3. The upper arm of the fracture is shortened, the normal upper arm of the forearm is normal, and the forearm is shortened.
4. Imaging examination is regular, and the lateral X-ray film can be diagnosed and typed.
Differential diagnosis
The supracondylar fracture of the humerus mainly needs to be distinguished from the dislocation of the elbow joint. The main points are as follows:
1. Supracondylar fracture of the humerus (shoulder type): The elbow joint can be partially moved, the triangle of the elbow does not change, the upper arm is shortened, and the forearm is normal.
2. Dislocation of the elbow joint: the elbow joint is elastically fixed, the triangle of the elbow is changed, the upper arm is normal, and the forearm is shortened.
3. In children under 5-6 years of age, the supracondylar fracture of the humerus should be distinguished from the distal iliac crest separation, because the ossification center of the humeral head appears around 1 year old, and the ossification center of the trochlear is 10 years old. The left and right appeared, so the osteophytes were completely separated in the X-ray film without fracture line. The relationship between the longitudinal axis of the humerus and the humeral head was not changed, but the relationship with the lower end of the humerus was changed, the elbow was swollen, and the circumference was tender.
