navicular fracture
Introduction
Introduction to scaphoid fracture The scaphoid fracture (fractures of scaphoid) accounted for 71.2% of the carpal fracture, mostly in the scaphoid waist, accounting for 70% of the scaphoid fracture. The scaphoid nodule and the proximal scaphoid fracture accounted for 10% to 15% each. The line starts from the palm and the ulnar side, and then reaches the dorsolateral side. It is more common in young people and children are rare. When the scaphoid fracture has other carpal fractures and dislocations, the prognosis is poor. Most of the scaphoid is covered by articular cartilage. Only the scaphoid nodules and the dorsolateral part of the lumbar spine are exposed, and the nourishing blood vessels enter the bone and supply blood to the surrounding branches. The blood of 2/3~3/4 in the proximal side of the scaphoid comes from the blood vessels of the lumbar bone, and the blood vessels of the scaphoid nodules are nourished in the distal side by 1/4 to 1/3. Blood vessels that are supplied from the lumbar into the bone and retrograde to the proximal pole may be damaged by the fracture of the waist, resulting in ischemic necrosis in the proximal fracture segment. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: Traumatic arthritis Vascular injury
Cause
Cause of scaphoid fracture
Violence factor (95%)
The wrist scaphoid fracture is mostly due to the palm of the hand when the fall, so that the wrist joint suddenly stretches back to the squat, and the wrist scaphoid is fractured by the impact of the sacral stem. Violence directly affects the limb and occurs in the scaphoid fracture. The fracture site is often accompanied by varying degrees of soft tissue injury, including neurovascular damage.
Pathogenesis
Mainly for the palm of the hand when falling, the person leans forward and the forearm rotates internally, so that the stress directly hits the scaphoid bone and is blocked by the distal humerus articular surface, plus the compressive stress of the volar sacral ligament, if the external force is concentrated in the boat Bone, which causes fractures. In addition, if the scaphoid is subjected to direct violent impact, fractures may occur, but it is less common.
Prevention
Scapho fracture prevention
The disease is mainly caused by traumatic factors, and the fracture is caused by violence. Therefore, prevention work starts from life, and we must pay attention to safety. Prevent external damage.
In the early stage, you should eat some foods that promote blood circulation and dissipate, such as vegetables, soy products, fish soup, and eggs.
In the medium term, you can eat some foods that help and stop pain, phlegm and stasis, and bones, such as bone soup, Tianqi chicken, animal liver and so on.
In the later stage, you can eat more foods that supplement the liver and kidney, qi and nourish blood, and relax the muscles. It can help the formation of osteophytes, such as old hen soup, pork bone soup, and sheep bone soup.
Complication
Scaphoid fracture complications Complications, traumatic arthritis, vascular injury
There are many types, such as proximal fracture segment necrosis, fracture nonunion, delayed healing, back-angled malformation healing and traumatic wrist arthritis. These complications can occur alone or in combination, and the treatment is difficult and the residual symptoms are heavy. The joint function recovered poorly.
Necrosis of proximal fracture
The incidence rate is 30% to 40%, mostly due to the proximal 1/3 fracture, but sometimes also seen after surgery, the X-ray film shows that the density of the proximal fracture segment is significantly higher than the distal fracture segment and other carpal bones, if trauma has not occurred Arthritis, feasible open reduction, bone grafting (or free bone graft or musculoskeletal transplantation) and internal fixation, after this treatment, the necrotic bone segment is expected to re-establish blood circulation, and the distal fracture segment heal, traumatic Arthritis, feasible proximal carpal bone resection, joint fusion and other operations.
2. Fracture does not heal
There are many reasons, delays in diagnosis and treatment, fracture displacement, vascular injury inside and outside the bone can lead to non-union of the fracture, and the clinical findings are not healed. Most of them are caused by delays in diagnosis and treatment. It is difficult to accurately calculate the rate of fracture nonunion because many The patient's symptoms were mild and he did not go to the hospital for treatment and could not be counted.
Non-union of the fracture can cause pain in the wrist of the wrist, limited movement and decreased grip strength. X-ray examination shows widening of the fracture space, hardening of the fracture end, cystic deformation near the bone, angular displacement of the fracture and the back of the wrist. The extension is unstable, the fracture end can have pseudo-articular activity, and the far-end, proximal fracture segment can change with the joint movement at any time. Traumatic arthritis can occur in the advanced stage. It should be noted that the degree of joint damage is not parallel with the clinical manifestation. In severe cases, the symptoms may not be obvious; those with prominent symptoms may not be seriously injured, and the fractures are stable and there is no arthritis. Although there are sclerosis and cystic changes, there are often no or only mild clinical symptoms, not necessarily immediate treatment, but should be The patient stated that non-healing eventually leads to traumatic arthritis, which is related to the degree of joint use.
Symptom
Scaphoid fracture symptoms Common symptoms Wrist pain Joint pain Wrist swelling and tenderness
The scaphoid fracture is more common in young men, and the wrist is swollen, especially on the temporal side of the wrist, the nasopharyngeal fossa becomes shallow, the scaphoid nodule and the nasopharyngeal fossa have obvious tenderness, and the vertical push of the thumb can cause pain.
Examine
Scaphoid fracture examination
Suspected fractures should be taken in the right position, lateral position, scaphoid position, anterior and posterior oblique anterior oblique X-ray film, most fractures can be shown, incomplete fractures, the fracture line may show unclear or not displayed, easily lead to missed diagnosis For those with obvious local symptoms, the fracture should be treated first, fixed with cast for 2 weeks and then re-examined. It may be due to bone resorption at the fracture site, which can show the fracture line and early CT examination.
According to the location of the fracture line shown on the X-ray film, it is generally divided into the following three types.
1. Nodular fracture: The fracture line is located at the distal nodule of the scaphoid. There are many ligaments attached. It is basically a tear fracture. It is rare in clinical practice. Because of the rich blood supply, it heals faster.
2. Lumbar fractures: The most common, the blood supply is poor, the closer to the proximal end, the worse the healing time is more than 3 months, about one-third of the cases can form the consequences of nonunion.
3. Proximal fracture: Once the fracture occurs, the blood supply is almost completely interrupted. Here is the most difficult part to heal. The rate of nonunion and aseptic necrosis after fracture is as high as 60%.
The above classification is relatively simple, and some people have divided the lumbar fracture into a distal fracture and a middle fracture.
Diagnosis
Diagnosis and diagnosis of scaphoid fracture
Generally not confused with other diseases.
1. There is a history of wrist trauma and local swelling, pain, and obvious signs of tenderness of the nasopharynx.
2. X-ray filming can be selected according to clinical features, lateral position, scaphoid position, anterior-posterior and posterior oblique position. Sometimes the early fracture line is unclear and can be taken after two weeks to confirm the diagnosis. If necessary, CT examination can be performed first, and X-ray films can be diagnosed two weeks later.
