subluxation of radial head
Introduction
Brief introduction of humeral head subluxation First described by Fournier in 1671, it is one of the common elbow injuries in infants and young children. The age of onset is 1-4 years old, of which 2-3 years old has the highest incidence rate, accounting for 62.5% of boys more than girls, and the left side is more than the right side. When the elbow joint is straightened, the forearm pronation position is suddenly caused by longitudinal traction, which may cause the humeral head to subluxate. It is common for an adult to appear when pulling the arm when the child is on the steps. basic knowledge The proportion of sickness: 0.01%-0.05% Susceptible people: good for infants and young children Mode of infection: non-infectious Complications: muscle atrophy
Cause
Causes of humeral head subluxation
The articular surface of the humeral head and the longitudinal axis of the humerus have a certain inclination, and its size is related to the rotation of the forearm. The change of the inclination affects the up and down movement of the annular ligament, and the inclination of the forearm. The variability undoubtedly makes it easy to dislocate. When the elbow joint is straight and the wrist or forearm is suddenly pulled by the longitudinal movement of the rotating motion, the lower part of the annular ligament will have a horizontal tear, a slight downward movement, the ankle joint gap becomes larger, and the joint capsule And the upper part of the annular ligament due to the negative pressure of the joint cavity, only a part of the articular surface of the distal end of the humerus can be incarcerated in the joint space of the humerus, thereby preventing the reduction of the humeral head and causing the subluxation of the humeral head.
Prevention
Radial head subluxation prevention
Prevention of humeral head subluxation in children:
1 When pulling the hand of the child at ordinary times, the sleeve should be pulled at the same time.
2 prevent falling servants.
3 adults and children should pay attention to the method when they are noisy, can not single (hand).
4 If the above performance occurs, parents can reset themselves. If they are not successful, they should go to the hospital.
5 Avoid repeated dislocations and form habits.
6 When wearing clothes, you should avoid pulling the hand in front of the hand and pull it at the same time as the sleeve.
Complication
Complications of humeral head subluxation Complications muscle atrophy
Although the humeral head subluxation injury is not heavy, it also affects the elbow joint function. Most patients need to be reset to get healing, but generally the effect is good after treatment, no complications occur, and some patients are not timely. It may take a little longer to recover, but it also has no complications.
Symptom
Symptoms of humeral head subluxation Common symptoms Elbow joint can not flex elbow pain elbow sprain
Pain in the elbow, pain in the child, half flexion in the elbow, moderate pronation in the forearm, no need to spin and elbow, refuse to lift and move the affected limb, tenderness of the humeral head, negative X-ray .
Examine
Examination of the humeral head subluxation
The X-ray examination of this disease is negative, generally can be diagnosed according to clinical manifestations and medical history, no need for auxiliary examination, the main points of diagnosis are as follows:
1, the disease is mostly caused by indirect violence, such as: using both hands to pull the child's wrist to fall while walking; wearing clothes when the wrist is pulled by the cuff; when rolling on the bed, the body will press the upper limb under the body, forcing the elbow Caused by external forces such as excessive joints.
2, after the injury, do not want to lift the affected limb, the forearm can not be rotated.
3, the elbow joint is stretched, the forearm pre-rotation position.
4, elbow joints are not swollen, deformed, but there is obvious tenderness at the small head of the humerus.
5. There is no abnormality in the line.
Diagnosis
Diagnosis and diagnosis of humeral head subluxation
diagnosis
1, the disease is mostly caused by indirect violence, such as: using both hands to pull the child's wrist to fall while walking; wearing clothes when the wrist is pulled by the cuff; when rolling on the bed, the body will press the upper limb under the body, forcing the elbow Caused by external forces such as excessive joints.
2, after the injury, do not want to lift the affected limb, the forearm can not be rotated.
3, the elbow joint is stretched, the forearm pre-rotation position.
4, elbow joints are not swollen, deformed, but there is obvious tenderness at the small head of the humerus.
5. There is no abnormality in the line.
Differential diagnosis
In the differential diagnosis, the dislocation of the humeral head and the subluxation of the humerus are distinguished. The main points are as follows:
(1) The humeral head subluxation is common in children aged 2-4 years. Because the humeral head is not fully developed, the annular ligament is loose. When it is pulled strongly, it is prone to dislocation, and the humeral head is pulled to the far end of the funnel ring ligament. On the side, sometimes part of the ligament is embedded between the ankle joints.
(2) There is often a history of injury to the child's arm up the stairs or walking.
(3) The child was crying during the subluxation, elbow pain, half flexion of the elbow, moderate forefront of the forearm, no fear of twisting and elbow flexion, refused to lift and move the affected limb, tenderness of the humeral head, X The line check is negative.
(4) Do not use anesthesia during resetting, first rotate the forearm, stretch the elbow and pull it slightly, press the elbow to the elbow and bend the elbow joint, and if necessary, rotate the forearm back and forth to feel the sound of the reset, the elbow after resetting. The forearm can move freely.
(5) After resetting, use a triangle towel to suspend for one week.
(6) If the pain or recurrence during the activity, it is best to use plaster to fix the elbow at 90 degrees for 2 weeks. Care should be taken not to lift the child's arm to prevent recurrence.
(7) When the humeral head grows up around 5 years old, it is not easy to get out.
(8) Note that the dislocation of the humeral head is mostly congenital, rarely seen, no history of trauma in children, elbow can be paralyzed and dislocated, and the X-ray film shows dislocation of the humeral head, which can confirm the diagnosis.
(9) In infants and young children, the dislocation of the radial head can be attempted to close and reset. The posterior tibial position of the humeral head is dislocated and the elbow joint is fixed in the straight position. The anterior tibial dislocation of the humerus is fixed in the elbow joint and the cast is fixed after the reduction. 4-6 weeks, the effect is poor.
(10) The treatment of humeral head dislocation surgery should be performed after the age of 3 years. The humeral head is used for open reduction and reduction, and the osteotomy of the anterior humerus at the attachment point of the humerus is shortened and the ligament reconstruction is performed. Temporarily fix the humeral head and the humeral head, and remove the Kirschner wire after 6 weeks of plaster fixation.
(11) Larger children with humeral head dislocation because of the inability to reset, can be considered adolescent period of humeral head resection.
In addition, clinically, the subluxation of the humeral head needs to be differentiated from the soft tissue injury of the elbow joint, the external humerus fracture, and the radial head fracture.
