humeral condyle fracture
Introduction
Introduction to the fracture of the humerus Fractures of the internal humerus, which occur well in children, are rare. The scope of the attack includes most of the upper iliac crest and the trochlear. The damage mechanism, type and treatment method are very similar to the humeral external malleolus fracture, so the two form symmetric symmetry "image" damage. basic knowledge The proportion of illness: 0.001% Susceptible people: good for children Mode of infection: non-infectious Complications: olecranon olecranon fracture elbow valgus traumatic arthritis ischemic necrosis
Cause
Causes of humeral internal malleolus fracture
(1) Causes of the disease
Mostly caused by indirect violence.
(two) pathogenesis
The indirect external force is the majority of the injured person. After the fall, the palm is supported by the palm. The external force is transmitted to the elbow along the forearm. The joint surface of the olecranon and the trochlear impact can cause the fracture. It can also be the flexion of the elbow and the lower end of the humerus. The stress of turning causes the olecranon to collide with the trochlear and cause fracture. In addition, the fracture of the humerus may be avulsion fracture, and the fracture of the internal malleolus is similar. The specific way of colliding with the olecranon and the trochle may be due to The rotation of the ulna, the ulnar olecranon half-moon notch hits the inside of the humerus horizontally.
Prevention
Prevention of humeral fracture
This disease is a disease caused by traumatic factors, so pay attention to production and life safety, avoiding trauma is the key to prevent this disease.
For patients undergoing treatment, it is necessary to pay attention to functional exercise. You can use the joint function exerciser for postoperative recovery exercise (CPM), which can flexibly flex and extend the elbow joint, eliminate the resistance of pain-relieving muscle contracture, and gradually achieve better results. For children with joint fractures, special emphasis should be placed on passive functional exercise, especially in small age groups, where active activities are secondary.
Complication
Complications of the humeral condyle fracture Complications Ulnar olecranon fracture elbow valgus traumatic arthritis ischemic necrosis
Can be associated with subluxation of the elbow joint, the disease can also be combined with other injuries, such as the humeral head, neck, olecranon fracture, etc. In addition, because the internal humeral fracture is both an intra-articular fracture and an epiphyseal injury, so when the dissatisfaction is not satisfied It hinders the recovery of joint function, and may cause growth and development disorders, followed by limb malformation (such as elbow valgus) and traumatic arthritis. In some serious cases, the fracture block may be completely free, leading to ischemic fracture. Necrosis.
Symptom
Symptoms of internal humeral fractures Common symptoms Joint swelling, weakness, elbow dislocation, soft tissue swelling, hematoma, simple fracture
Children with this disease are more common than adults. After injury, the soft tissue around the medial and medial epicondyles is swollen, or there is a large hematoma formation. The isosceles triangle relationship of the elbow joint is clinically examined. The patient presents with pain, especially local swelling of the medial elbow. , tenderness, the contour of the normal internal palate disappears, the elbow joint activity is limited, the forearm pronation, the wrist, the flexion, the elbow joint dislocation, the shape of the elbow joint is obviously changed, the dysfunction is more obvious, often combined with the ruler Symptoms of nerve damage.
The type of injury is similar to that of the external iliac crest, which divides the fracture into three degrees.
I° fracture: the fracture is not displaced, and the fracture line is slanted outward from the upper upper iliac crest to the trochlear joint.
II° fracture: The fracture line is similar to I°. The fracture block has lateral or slight upward displacement but no rotation.
III° fracture: The bone has a significant rotational displacement, the most common is the rotation on the coronal plane, sometimes up to 180 degrees, causing the fracture surface to be completely opposite to the medial side, or to rotate in the sagittal plane, resulting in fracture surface After that, the joint of the pulley is forward, and sometimes the ulna can be displaced inward with the fracture block, resulting in subluxation of the elbow joint.
Examine
Examination of the fracture of the humerus
There is no relevant laboratory examination, and the auxiliary examination method for this disease is mainly X-ray examination:
In addition to detailed investigation of trauma history, clinical manifestations and some physical examinations, patients with clinical suspects should be photographed with contralateral elbow joint X-ray films, and sometimes the affected side can be seen with positive "fat pad" for ossification. Before the appearance of the center, patients with obvious swelling of the inner side of the elbow joint should be highly vigilant, and carefully check the range of tenderness and the presence or absence of abnormal activity in the internal iliac crest. If necessary, surgical exploration can be performed to confirm the diagnosis, but it is necessary to pay attention to the upper iliac crest. The diagnosis of the fracture of the humerus before the occurrence of the epiphyseal ossification center is difficult because the epiphysis has not been ossified, and the cartilage is not developed on the X-ray film. The fracture line through the cartilage portion cannot be directly displayed. This type of injury is on the X-ray film. Does not show any positive signs (no fractures or dislocation images), therefore, it must be examined in detail to prevent leakage and misdiagnosis. For cases where the diagnosis is difficult, the X-ray film at the same position on the healthy side can be identified. A CT or MRI examination is available to confirm the diagnosis.
The orthotopic X-ray film can show the direction of the fracture line, the size of the fracture block and the degree of displacement; the lateral X-ray film can indicate the forward and backward displacement of the fracture block, and must pay attention to the X-ray diagnosis. Before the ossification center does not appear, the fracture should be judged according to other anatomical landmarks, such as the position of the humerus in the humerus and the small skull of the humerus. If necessary, the contralateral elbow joint should be taken under the same conditions. Lateral X-ray films for comparison.
Diagnosis
Diagnosis and diagnosis of internal humeral fracture
diagnosis
The elbow joint is swollen, painful, stretched and flexed, and the inner part of the joint is tender. Sometimes the local can touch the bone friction. The X-ray film of the elbow joint can confirm the diagnosis, especially the positive position.
Differential diagnosis
1. Fracture of the external humerus;
2, the upper jaw fracture of the humerus.
For the above diseases, it can be identified according to X-ray examination. For some cases that are difficult to diagnose, CT and MRI examinations can be used to help differential diagnosis.
