avulsion fracture
Introduction
Introduction to avulsion fracture Muscle contractility is dependent on the contractile properties of the muscle itself and the starting and ending points of the muscle's cross-articular growth (some protrusions and trochanteric bones are tendon attachment points). A person can cause muscle contraction during strenuous activity, and the protrusion of the bone connected to the tendon and part or all of the bone of the trochanter are separated. X-ray films show avulsion fractures in a certain area. basic knowledge The proportion of sickness: 0.6% Susceptible people: no specific population Mode of infection: non-infectious Complications: shock, acne, arthritis
Cause
Avulsion fracture cause
Often caused by falling or throwing sports.
When the elbow joint falls straight, the hand supports the ground, the upper limb is in the outreach position, the valgus stress causes the elbow joint to valgus, and the forearm flexor muscle group suddenly contracts, the inner upper jaw is avulsed, and the upper upper jaw is a closed comparison. Late epiphyses, the squall line itself is a potential weakness before it is closed. Therefore, the osteophyte can be separated, pulled down and forwarded, and rotated. At the same time, the medial space of the elbow joint is temporarily pulled apart, or the posterior lateral dislocation of the elbow joint occurs. The avulsed internal epicondyle (bone callus) is clamped in the joint and can be divided into 4 degrees according to the severity of the injury.
I° injury: only fractures or osteophytes are separated and the displacement is minimal.
II° injury: The bone block is displaced downwards and is rotated forward to reach the joint level.
III° injury: The fracture block is clamped in the joint and has a subluxation of the elbow joint.
IV° injury: posterior dislocation of the elbow or posterolateral dislocation, the bone is clamped in the joint.
Prevention
Avulsion fracture prevention
In general, patients with injuries for 1 to 2 weeks need to be light, easy to absorb and digest. They should be given more vegetables, fruits, fish soup, eggs, soy products, etc., and should be steamed or stewed. Mainly, eat less spicy, greasy and fried foods. In particular, you can eat more honey and bananas, because most patients in bed will have symptoms such as constipation, these foods can help defecation.
Patients with fractures of 2 to 4 weeks of injury, their bodies are no longer so weak, their appetite and gastrointestinal functions are restored, and nutrition can be supplemented at that time, such as bone soup, fish, eggs and animal liver. Well, you should also eat more radishes, tomatoes, green peppers, etc. These foods can meet the needs of bone growth and promote wound healing.
In the days that follow, in addition to those foods that are obviously unhelpful, fracture patients do not have to avoid it. Some critically ill patients and patients with other complications caused by fractures cannot be generalized. Reasonable arrangements must be made according to the condition and medical advice.
After more than 5 weeks of fracture, patients can eat high-nutrition foods and foods containing trace elements such as calcium, manganese and iron. Animal liver, eggs, green vegetables and wheat contain more iron. Comparison of zinc content in seafood and soybeans More; oatmeal, egg yolk and other manganese-containing. At the same time, with chicken soup, fish soup, various bone soup, etc., you can optionally add red dates, medlar and so on.
Complication
Avulsion fracture complications Complications, acne, arthritis
1. Early complications:
(1) Shock: severe injury, caused by major bleeding or major organ damage.
(2) Fat embolism syndrome: occurs in adults, due to excessive tension in the hemorrhage of the sacral cavity in the fracture, fat drops into the ruptured sinus, can cause lung and brain fat embolism.
(3) Important internal organ damage: 1 liver and spleen rupture. 2 chest and lung injury. 2 bladder and urethral injury. Intestinal damage.
(4) Important surrounding tissue damage:
1 important vascular injury; common such as straight rib exploration fracture, proximal fracture end is easy to cause aortic injury, pre-cavity or posterior luminal artery injury, upper femoral fracture, distal fracture end can cause Take arterial injury.
2 peripheral nerve injury: especially in the area where the nerve is closely adjacent to the bone, such as the fracture at the middle and lower 1/3 of the rib, it is easy to damage the nerve that is close to the skin, and the fracture of the rib is easy to cause total nerve damage.
3 spinal cord injury; a serious complication of spinal fracture and dislocation, more common in the cervical spine and thoracolumbar segment, paraplegia can occur.
(5) Osteofascial compartment syndrome: a series of early syndromes caused by acute ischemia in the muscles and nerves of the fascia formed by bone, interosseous membrane, intramuscular septum and deep fascia. Most commonly found in the volar and calf of the forearm, often caused by hematoma and tissue edema of the fracture to increase the volume of the indoor contents or over-tightening, local pressure forced the volume of the compartment of the fascia to decrease, resulting in increased pressure in the compartment of the fascia .
2. Late complications:
(l) Fallen pneumonia: It occurs mostly in patients who have been bedridden for a long time due to fractures, especially those who are frail and have chronic diseases. Sometimes they can endanger the lives of patients, and encourage people to get out of bed early. .
(2) Hemorrhoids: After severe fracture, the patient is bedridden for a long time, the body bone is compressed, and local blood circulation disorder is easy to form hemorrhoids. Common parts include bone, broken, and heel.
(3) deep venous thrombosis of the lower extremity: more common in pelvic fractures or lower limb fractures, long-term braking of the lower limbs, slow venous return, combined with blood hypercoagulability caused by injury, prone to thrombosis. Activity should be strengthened to prevent it from happening.
(4) Infection: Open fractures, especially those with heavy pollution or severe soft tissue injury. If the debridement is not complete, the residual necrotic tissue or soft tissue coverage may be poor, and infection may occur. Improper handling can cause suppurative osteomyelitis.
(5) Injury ossification: also known as ossifying myositis. Due to joint sprain, dislocation or fracture near the joint, periosteal peeling forms a subperiosteal hematoma. Improper treatment makes the hematoma enlarge, mechanized and extensive ossification in the soft tissue near the joint, causing severe joint activity dysfunction. Especially seen in the elbow joint.
(6) Injurious arthritis: intra-articular fracture, joint surface is destroyed, and it can not be accurately reset. After the bone is healed, the joint surface is not flat. Long-term wear and tear can easily cause arthritis of the injured part, resulting in pain during joint movement.
(7) Joint stiffness: the limbs are fixed for a long time, the veins and lymphatic drainage are not smooth, the fibrous exudation of the serous tissue and fibrin deposition in the tissues around the joints. Fibrous adhesions occur, accompanied by joint changes and peripheral muscle contractures, resulting in joints. Activity barriers. This is the most common complication of fractures and joint injuries. Timely disassembly and active functional exercise are effective ways to prevent and treat joint stiffness.
(8) Acute bone atrophy: disease osteoporosis near the joint caused by injury, also known as reflex sympathetic bone dystrophy c occurs after hand and foot fractures, typical symptoms are pain and vasomotor disorder.
(9) ischemic osteonecrosis: the fracture causes the blood supply to a fracture segment to be destroyed, and the ischemic necrosis of the fracture segment occurs. Common is arrhythmic necrosis of the proximal fracture after a scaphoid fracture.
(10) ischemic muscle contracture: mostly the serious consequences of improper treatment of compartment syndrome, is one of the most serious complications of fracture. It can be caused by fracture and soft tissue damage, and is often caused by improper treatment of the fracture, especially the external fixation is too tight. It is difficult to treat on a day, often causing severe disability. Typical malformations are claw-shaped and claw-shaped feet.
Symptom
Avulsion fracture symptoms Common symptoms Joint pain Joint swelling Joint stiffness
The symptoms of avulsion fractures are similar to those of fractures, with the main points of pain and limited joint activity, followed by local swelling and tenderness. Avulsion fracture of the humeral condyle is a special type of intra-articular fracture of 23, often avulsion fracture of the anterior cruciate ligament or posterior cruciate ligament at the attachment of the tibia. Improper treatment can lead to malformation and cause instability of the knee joint. The avulsion fracture of the humeral condyle was treated with traditional open reduction and internal fixation with wire. Although the internal fixation of the open reduction wire can effectively reduce and fix the fracture block, it has a long incision and a large trauma. The postoperative functional exercise is extremely painful and long, and the knee joint is prone to stiffness, and the operation of the intercondylar notch is inconvenient.
Examine
Avulsion fracture examination
Children are more common than adults. After the injury, the soft tissue around the medial and medial epicondyles of the elbow is swollen, or a large hematoma is formed. Clinical examination of the elbow joint isose triangle relationship exists. Pain, especially local swelling of the inside of the elbow, tenderness, and disappearance of the contour of the normal internal palate. Elbow joint activity is limited, forearm pronation, flexion, and weakness. In patients with dislocation of the elbow joint, the shape of the elbow joint was significantly changed, and the dysfunction was more obvious. The symptoms of ulnar nerve injury were often combined.
In the case of avulsion fracture of the medial malleolus of the humerus, the medial tissues of the elbow joint, such as the collateral ligament, joint capsule, internal iliac crest and ulnar nerve, can be damaged. The inside of the elbow joint is swollen and painful, and localized subcutaneous can be seen as congestion. The tenderness is limited to the inside of the elbow. Sometimes it can touch the feeling of bone friction. Elbow joint flexion and rotation are limited.
The medial epicondyle of the humerus was separated, displaced or rotated from the iliac crest of the lower end of the humerus, and the degree of displacement was judged according to the displacement of the fracture piece. Children with humeral fractures of the humerus are more likely to be confused with the medial malleolus of the humerus and the avulsion fracture of the humerus. Before the humerus of the humerus has not appeared (usually 6 years old), the signs of the ossification center cannot be on the X-ray. The film is shown, the osteophyte line is not closed, which increases the difficulty of differential diagnosis. If necessary, the contralateral elbow joint X-ray film is taken. Detailed physical examination, asking for injuries, combined with age characteristics. Only in this way can we accurately diagnose and select better surgical treatment methods.
Diagnosis
Diagnosis and diagnosis of avulsion fracture
X-ray diagnosis is very important and should be carefully observed.
I degree fractures may sometimes be missed, but there are cases where the presence of a fracture should be considered: 1 When there is a fat pad sign, that is, bleeding or exudate after the elbow will be crown and socket The fat pad in the socket is pushed open in an "eight" shape; 2 the epiphysis is not parallel with the metaphyseal end; 3 the edge of the epiphysis is unclear, especially the thin layer of metaphyseal fracture is found; 4 the inner and outer symmetry of the lower end of the humerus is due to The shape of the inner and outer protrusions of the lower end of the normal humerus is asymmetrical, and the inner upper jaw is more inwardly protruding.
III, IV degree fracture should pay attention to the presence of internal humeral condyle. If you have difficulty, you should emphasize the imaging of the lateral or oblique X-ray of the same position on both sides, and observe whether the bilateral joint space is equal width, bilateral internal iliac crest. Whether it is symmetrical. In children under 5 years of age, the ossification center of the upper jaw of the humerus has not yet appeared, so it is more difficult to distinguish it from the fracture of the humerus. In the case of severe injury, attention should be paid to the presence or absence of a humeral head, an olecranon, and an external humeral fracture.
