Open reduction and internal fixation of supracondylar humerus fractures

The supracondylar fracture of the humerus is the most common fracture in children. The vast majority of fresh fractures are treated with manual splint reduction and the results are satisfactory. Some patients have severe swelling, which is not suitable for manual reduction. It can also be solved with olecranon olecranon traction. In addition, children (especially under 9 years old) have a strong ability to shape, and even if the manipulation is not satisfactory, the deformity heals, there is no need to rush to surgery. Any deformity consistent with the direction of the elbow joint can be corrected gradually during the growth and development process; and the deformity perpendicular to the elbow joint activity, such as the elbow and the valgus, can cause permanent deformity, and can also be used for later osteotomy. . Therefore, fresh humeral fractures of the humerus require minimal open reduction. Treatment of diseases: supracondylar fracture of the humerus Indication 1. A supracondylar fracture of the humerus with a radial or median nerve injury. 2. The humeral supracondylar fracture failed to reset, especially in the distal fold. 3. The supracondylar fracture of the humerus has been 2 weeks, and there is an elbow varus deformity. It cannot be reset by hand or the olecranon is removed. Contraindications 1. The general situation of the wounded is not good, or the concomitant shock, must first rescue, until the shock is stable, the general situation can be improved before surgery. 2. If there is a life-threatening head, chest or abdominal cavity and other important organ damage, it must be treated first. The treatment of the fracture should be relegated to the secondary position. Temporary external fixation can be performed first, and the fracture should be treated after the condition is stable, or non-surgical treatment can be used. Try to get a better reset as much as possible. 3. There are more than 8 to 12 hours of open wounds in the fracture. Preoperative preparation 1. The fracture is caused by severe trauma. The patient has severe pain and blood loss. Analgesic and blood matching should be given before surgery. For patients with poor general condition or existing shock, anti-shock treatment such as infusion and blood transfusion should be given, and the operation should be performed after the condition is stable. 2. Preoperative fracture site should be taken with positive lateral x-ray film to determine the location, shape and displacement of the fracture, which is convenient for determining the surgical procedure and internal fixation. For those who need to take x-rays during surgery, they should inform the radiology department and the operating room in advance to prepare. 3. The surgeon should propose the special equipment to be used and check whether the preparation of the equipment is complete, so as to avoid temporary preparation and prolong the operation time. 4. Open fractures should be treated with antibiotics and tetanus antitoxins; or if the original open fractures were delayed for more than 2 weeks, antibiotics and repeated injections of tetanus antitoxin should be used. 5. After the reduction and reduction, the internal fixation or bone graft should be used. The antibiotic should be intravenously administered immediately after anesthesia, and once every 6 hours, share 4 times. 6. The fracture site should have sufficient range of cleaning and disinfection preparations. The surgeon should avoid contact with the suppurative wound on the same day, and strictly follow the hand washing procedure to prevent the wound infection. 7. Patients who need to delay surgery for the first time should be towed first, can be reset, temporarily fixed, and can overcome soft tissue contracture, reducing the difficulty of resetting during surgery. 8. Need to simultaneously bone fractures, such as delayed bone fractures, slow healing fractures, etc., should be prepared for the bone area after surgery. Surgical procedure 1. Position: Fresh fractures combined with vascular injury, because of the anterior incision, so the supine position, the injured upper limb abduction, forearm supination, placed on the small table next to the operating table. For avascular injury, only those with varus deformity, or those with fractured fibrous healing, should take the posterior incision. The patient should be placed in the supine position and the elbow should be placed on the chest. 2. Incision: S-shaped anterior incision, starting from the medial side of the elbow 8 cm, along the biceps and triceps gaps, to the elbow transverse stripes across the elbow joint, and then 4 cm along the inner edge of the diaphragm. 3. Exposing the agitation and vein: open the skin, open the flap to the sides, ligation, cut off the median vein that affects the exposure, and carefully cut the deep fascia of the elbow along the inner edge of the biceps muscle. Do not damage the underlying spurs, veins, remove the deep fascia hematoma, and separate the iliac, veins and median nerves descending from the medial nerve. At the center of the elbow, there is a biceps aponeurosis covering the front of the artery. By cutting off the diaphragm, the agitation, veins, and exploration can be fully revealed. Pulling the biceps and its ankles to the outside reveals the diaphragm behind it. When the humerus fractures, the diaphragm has more fractures, and the fracture end can protrude outside the muscle. 4. Treatment of blood vessels: If the blood vessels are stressed or damaged, priority should be given to restore the forearm blood supply as soon as possible. The humerus is folded upwards, and the biceps tendon is tight due to the proximal fold end, which often causes the swaying and veins between the two to be compressed. In general, the aponeurosis of the biceps muscle can be cut off. Sometimes the spurs and veins are directly pressed by the proximal end of the fracture. The direct traction should be carried out under direct vision to separate the fracture ends and separate the movements and veins to relieve the compression. If there is vasospasm, heat with warm saline gauze, brachial plexus anesthesia, tolazoline 25mg intramuscular or warm 2% procaine solution warming, etc., often can be lifted. If a blood vessel ruptures, it should be repaired. 5. Fracture reduction: longitudinal separation of the diaphragm, pulled open to both sides, you can see the supracondylar fracture of the humerus. The assistant grasped the forearm traction to overcome the overlap displacement; the surgeon used the periosteal stripper to open the fracture end, reset the maneuver, and used the periosteal stripper to push the proximal end of the fracture back and temporarily reset. Be careful not to pinch the soft tissue between the fracture ends. 6. Internal fixation: The supracondylar fracture of the humerus is often fixed with two Kirschner wires. The medial incision was first opened to expose the medial malleolus of the humerus. The Kirschner wire was inserted into the humerus at an angle of 45° to the diaphysis, and the contralateral cortical bone was directly passed through the fracture surface. Then make another small incision in the outer sill, also nailed into another steel needle, and cross-fixed with the opposite side steel needle. If the fracture is well matched, the broken diaphragm can be sutured. Cut off the excess Kirschner wire so that the exposed needle tail is about 0.5 cm long and bend it into a hook shape. Finally, the skin incision and the small incision of the external malleolus are sutured, only the skin is sutured, and the deep fascia is not sewn complication Infection: If you do not pay attention to hygiene or anti-infection, it is easy to cause wound infection. If it happens, you should seek medical advice immediately.