Distal humerus total epiphysis separation
Introduction
Introduction to the separation of the distal humerus The distal end of the tibia of the newborn baby is composed of cartilage, and then the center of the bone gradually appears with the increase of age, and the cartilage plate is between the metaphysis and the structure is weak, so the child is caused by trauma due to trauma. . Its clinical features are similar to supracondylar fractures of the humerus. It is a special type of supracondylar fracture that occurs in early childhood development and is not common. basic knowledge The proportion of illness: 0.005% Susceptible people: good for infants and young children Mode of infection: non-infectious Complications: elbow varus deformity
Cause
The cause of total iliac crest separation
Indirect external force (50%):
The separation of the whole iliac crest is usually caused by the indirect external force, which is caused by the indirect external force. When the body falls, the affected arm stretches to support the ground. At the same time, the trunk rotates to the affected side, the elbow joint is overextended, and the center of gravity falls on the affected arm. The elbow is subjected to a strong internal rotation (actually the external rotation of the upper arm), inversion and overextension stress, and the strength of the child's tarsal plate is weaker than that of the joint capsule ligament, so it is easy to cause full iliac separation, rather than elbow dislocation.
The direction of the seesaw changes (30%):
The buckling type full iliac separation is relatively rare. The external force of the flexion elbow impacts the eagle mouth and then transmits to the ankle. This type of injury occurs mostly in older children and may be related to the change of the sacral direction (increased inclination).
Prevention
Distal iliac crest separation prevention
The disease is caused by traumatic factors, so special attention should be paid to the safety of children's life and avoiding trauma. If you fall, you should always pay attention to whether the child has abnormal performance, and actively seek medical treatment. For children diagnosed with this disease, they should actively carry out the disease. Treatment, so as not to leave serious sequelae.
Complication
Complications of distal iliac crest Complications elbow varus deformity
Severe cases can cause varus varus deformity or elbow joint dysfunction, one of the reasons is due to the displacement of the fracture itself, especially the ulnar deviation, rotational displacement, followed by the development of osteophyte injury and blood supply disorders Discontinuity, which is the cause of joint deformity in the clinically occurring anatomical alignment.
Symptom
Symptoms of total iliac separation at the distal radius. Common symptoms Elbow joint deformity elbow joint can not flex the localized pain of the sacral stem
The typical manifestation of the disease is that the distal end of the tibia and the ulnar humerus are displaced backwards and medially, while the lateral humerus and the proximal humerus maintain a good alignment. If the humerus is not ossified, it is easy to elbow. The dislocation of the joint is confused. If the displacement is mild, the X-ray film should be compared. The X-ray image of the humerus is the basis of diagnosis. The X-ray features are as follows:
(1) The ankle joint is normal, and the anterior and lateral slices of the elbow joint show the longitudinal axis of the humerus through the humeral head.
(2) The relationship between the ruler and the ruler is unchanged, that is, the upper ruler has a normal relationship.
(3) The humerus and ulnar humerus are arranged abnormally, often with a metaphyseal fracture of the ulna and the metatarsal or the lateral iliac crest of the humerus.
Examine
Examination of the separation of the distal humerus
The most common examination method for this disease is X-ray examination, which is also the basis for the diagnosis of this disease. Its X-ray characteristics are as follows:
(1) The ankle joint is normal, and the anterior and lateral slices of the elbow joint show the longitudinal axis of the humerus through the humeral head.
(2) The relationship between the ruler and the ruler is unchanged, that is, the upper ruler has a normal relationship.
(3) The humerus and ulnar humerus are arranged abnormally, often with a metaphyseal fracture of the ulna and the metatarsal or the lateral iliac crest of the humerus.
Diagnosis
Diagnosis and differentiation of distal humerus
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
1. Dislocation of the elbow joint: Before the appearance of the sacral skull degeneration center, the strength of the tarsal plate in this age group is weaker than that of the joint capsule and ligament, and the dislocation probability is very small. At the same time, the elastic fixation of the joint and the triangular relationship of the elbow are abnormal when the elbow dislocation is lacking. Clinical manifestations, after the appearance of the sacral small skull center, if the longitudinal axis of the tibia extends through the ossification center, the elbow dislocation can be ruled out.
2, internal or external iliac fractures: at this time, most of the fractures are lateral or / and rotational displacement, the proximal and distal ulna and the humerus are not separated, the elbow posterior triangle is abnormal, and the tenderness is limited to the lateral side of the joint, sometimes it can be touched. Abnormal activity of the external malleolus, X-ray film, the relationship between the humeral shaft and the ulna and the iliac bone was normal, and the lateral humerus was displaced to the outside.
3, elbow dislocation with humeral external malleolus or humeral condyle fracture: at this time the fracture block is usually displaced to the posterior or posterior, easy to reset, the fracture line is clear after the reduction, the elbow posterior triangle relationship is abnormal.
4, humeral intercondylar fracture: at this time the internal and external iliac crest separation and displacement, the proximal end of the ulna and the humerus distance becomes shorter.
5. If the external iliac crest is not ossified, the X-ray findings are difficult to distinguish from the sputum. The age of onset and the direction of displacement can be used as reference. The elbow joint is usually the lateral dislocation. The distal segment of the iliac crest is often moved inward, according to the whole process. The "feel" in the middle helps to differentiate the diagnosis. After the iliac bone has been ossified, the X-ray image can be used as a diagnostic basis.
6, external malleolus fracture combined with elbow dislocation, very rare, occasionally seen in school-age children, clinical manifestations of external malleolus fracture and elbow dislocation characteristics, such as the iliac crest and the proximal tibia, mostly for the sacral Separation.
