radial head fracture
Introduction
Brief introduction of humeral head fracture A small head fracture of the humerus is a common elbow injury, accounting for 0.8% of the total body fracture. About one third of the patients have joint damage to other parts of the joint. A small head fracture of the humerus is an intra-articular fracture. If there is a displacement, it should be cut open and internal fixation to restore the anatomical position and early activity to restore the elbow flexion and forearm rotation. The incidence of humeral head fractures is high, and clinical examinations are easily overlooked. If timely treatment is not available, it will cause rotatory forearm dysfunction or traumatic arthritis. basic knowledge The proportion of sickness: 0.007% Susceptible people: no specific population Mode of infection: non-infectious Complications: joint dislocation ossifying myositis ischemic necrosis
Cause
Causes of humeral head fracture
Caused by trauma (90%)
The fracture caused by direct external force is rare. It is common for the elbow joint to fall straight and the palm of the hand to land. The external force causes the humeral head to collide with the humeral head to cause a fracture, often involving the humeral head injury and the medial side. The collateral ligament injury is more common in adults and is easily missed. If early treatment is not available, some patients have limited forearm rotation and have to remove the humeral head. According to the fracture morphology, the following types are classified.
Pathogenesis
Crack-type fractures: there is no displacement of linear fractures, and the fracture line is mostly from the lateral to the posterior aspect of the articular surface. The annular ligament has no damage and stabilizes the fracture, so it is not easy to shift.
Crushing fracture: no displacement still maintains the shape of the humeral head, there is still a complete articular surface, the annular ligament is intact, there are displaced, and the annular ligament is more damaged. Radial head fracture
Collapse fracture: the articular surface of the humeral head is compressed and collapsed.
Prevention
Prevention of humeral head fracture
This disease is mostly caused by traumatic factors, so pay attention to production and life safety, avoid trauma, ensure personal safety is the key to prevent this disease, but also should pay attention to patients with dislocation or fracture of elbow joint due to traumatic factors, should be X Line examination to rule out the presence of this disease, so as not to delay treatment.
Complication
Complications of humeral head fracture Complications, joint dislocation, ossifying myositis, ischemic necrosis
Local pain after the injury, swelling, deformity posture, often combined with joint dislocation, if delayed surgery, prone to ossifying myositis, elbow function recovery is also poor, there may be avascular necrosis of the humeral head, Inadequate attention during surgery may also damage the deep branch of the radial nerve, resulting in complications of nerve injury. In the case of comminuted fracture of the humeral head, the operation area and the elbow joint cavity should be washed more during the operation to avoid residual bone fragments. After affecting the function of the elbow joint, it is best to perform artificial humeral head replacement at the same time, especially for young and middle-aged patients, because of a series of complications in the long-term after humeral head resection, for young adults and physical strength Laborers have a certain influence.
Symptom
Symptoms of humeral head fracture Common symptoms Forearm and wrist pain Forearm supination function limited Forearm Rotation pain Forearm has pronation deformity
Local pain, mild swelling of the lateral elbow, obvious tenderness around the humeral head, limited forearm rotation, pain during passive movement, especially during the supination, elbow flexion and extension activities are not limited, but pain during activity, clinical There are three types that can be divided into:
First, the straight fracture
Local pain and swelling after injury can lead to a new typical deformity posture, that is, a "silver fork" deformity on the side, and a "gun-like" deformity on the front side. The local tenderness is obvious, the wrist joint is in motion, and the X-ray film shows the distal end of the fracture. The iliac crest, the dorsal side, and the proximal volar shift, thus exhibiting typical malformation signs, can be associated with dislocation of the lower ankle joint.
Second, flexion fracture
After the injury, the wrist is drooping, local swelling, subcutaneous ecchymosis on the back of the wrist, restricted wrist activity, and obvious tenderness in the examination. X-ray film can be found as a typical displacement, near the torso to the back side, and far to the end Lateral, temporal displacement, opposite to the direction of displacement of the straight fracture, becoming an anti-Colles fracture or a Smith fracture.
Third, distal radius fracture of the articular surface with dislocation of the wrist
Clinically, it is similar to the "Silver Fork" deformity and corresponding signs of Colles fracture. X-ray film can be found as a typical displacement. When falling, the wrist flexion is injured on the back of the hand, and the lower tibia of the humerus opposite to the surgery can occur. Articular surface fractures and carpal bone displacement to the volar side, these fractures are rare, clinically long leakage or misdiagnosis of wrist dislocation, as long as careful reading of X-ray film diagnosis is not difficult.
Examine
Examination of humeral head fracture
According to the patient's history of trauma, the disease can generally make a preliminary diagnosis. At this time, it is necessary to increase the auxiliary examination method. The patients with small head fractures of the humerus are mainly X-ray examination, including the X-ray before and after the reduction of elbow dislocation. Avoid missed diagnosis and determine the degree of injury of the radial head fracture, which has a direct impact on the treatment and prognosis.
Diagnosis
Diagnosis and diagnosis of humeral head fracture
The disease needs to be differentiated from traumatic humeral head dislocation.
Common Monteggia fractures, humeral neck fractures, traction of elbows and other parts of the injury cause traumatic humeral head dislocation, ulnar bending is not a proprietary feature of congenital humeral head dislocation, can occur in unreset traumatic humeral head dislocation The congenital humeral head dislocation has a small development of the humeral head, the humeral head is oval, and the soft tissue around the humeral head has ossification suggesting that the unreported traumatic humeral head dislocation.
