Open reduction and internal fixation for fractures of the lower one-third of the radial shaft combined with dislocation of the lower radioulnar joint

Ulnar fractures are common. Due to the cause of violence and the posture of the injured limb and the state of muscle contraction, a double fracture or a single fracture of the radius and ulna can occur. Among them, it can occur in different planes. Upper 1/3 of the ulnar shaft fracture combined with humeral head dislocation (Montaggia fracture). The lower third of the humerus fracture combined with the lower ankle joint dislocation (Galeazzi fracture). Among them, the double fracture of the ulnar and radial bone accounted for 5.41% of the total fracture, which was the third. The fracture of the tibia was 4.23%, which was the fifth. The ulnar fracture accounted for 1.05% and was the 17th. The Monteggia fracture accounted for 0.63% and was the 38th. Gai's fracture accounted for 0.35% and was the 50th. Due to the rotational function of the forearm, in the event of a fracture, there is a severe rotational shift in addition to overlap and lateral displacement. Therefore, the requirements for resetting are higher. If the manual reset is not satisfactory, it is difficult to achieve the recovery of the expected function, that is, the indication of surgical reduction. Treatment of diseases: Gai's fracture Indication The lower third of the humeral shaft fracture combined with the lower ankle joint dislocation open reduction and internal fixation is applicable to: 1. There is a significant displacement of the Gai's fracture with a manual reduction failure. 2. It has been 1 to 2 weeks of Gai's fracture and there is a significant displacement. Preoperative preparation Internal fixation equipment should be prepared before surgery. For the lower third of the humerus fracture, a triangular intramedullary needle can be used, or a bone plate can be used. It should be selected and prepared according to the specific situation. Surgical procedure 1. The operation is performed under the balloon tourniquet. The lower part of the tibia incision line was about 4 to 5 cm long. After the deep fascia was dissected, the ankle extensor muscle was separated from the finger extensor muscle. The total extensor muscle is guided to the ulnar side, the radial extensor muscle of the ankle, the long abductor muscle and the short extensor muscle of the thumb are pulled to the temporal side, and the fracture end is exposed, and the subperiosteal peeling is not performed. Remove the blood at the fracture end, make a small incision about 2cm long between the long extensor tendon and the extensor tendon of the ankle at the styloid process of the humerus. Cut the skin and avoid the superficial vein and the superficial branch of the radial nerve. The periosteum was cut in the dorsal side of the styloid process and slightly peeled off. Use a 2mm × 2.5mm drill bit to tilt the hole up 30° to reach the medullary cavity. The distal end of the humerus is then inserted with a selected triangular intramedullary or Kirschner wire. When the needle tip reaches the distal end of the fracture, the fracture is repositioned and the needle is inserted into the proximal medullary cavity. Cut the short tail to bend under the skin or outside the skin. 2. After the reduction of the Gai's fracture, the lower ankle joint can be reset by itself. If the fracture is fresh, the torn or dorsal ligament is fixed by cast, and the wound can be healed. If the old fracture is dislocated, if the ulnar small head is still displaced to the dorsal side after the reduction, the dorsal ligament should be repaired. The method is: a 4~5cm incision is made on the dorsal side of the lower ankle joint. After the deep fascia is cut, the ulnar wrist extensor tendon is separated from the total extensor tendon and retracted to both sides. See the fractured dorsal ligament and joint capsule. The assistant pressed the ulnar head down and the surgeon repaired the dorsal ligament and joint capsule with intermittent suture. The incision is then sutured in turn, and the thick dressing is pressure wrapped. complication In the lower part of the humeral shaft, the medullary cavity is larger and the upper part is thinner. Only the thin triangular needle or the round needle can be selected by intramedullary nail fixation. If the intramedullary nail is too short, it may cause poor fracture of the fracture end, and the fixation is not strong, which will affect the healing of the fracture and even the nonunion. To this end, the intramedullary needle should be of sufficient length to reach the lower humeral neck or the trochanteric plane.