Introduction
Brief Overview of Disease
Susponic fracture of the humeral is mainly a fracture at the junction of the strong bone and the distal cancellous bone of the humeral shaft and the weak part of the anatomy within 2cm above and below the medial and lateral condyles of the humeral bone, accounting for 60% to 70% of the elbow fractures, and mostly occur in children aged 3 to 12. The fracture line often passes through the ulnar eagle fossa, and most of them are extracapsular fractures. Improper handling can easily cause Volk-mann ischemic muscle contracture or elbow varus deformity .
technology brief overview
Zhang's bone injury bone correction technology has a history of more than 170 years. Through the inheritance and development of the fourth-generation successor, Mr. Zhang Shaofu , the fifth-generation successor represented by Chief Physician Zhang Yuzhu, the current development of the Zhang's bone injury in Fuyang has gradually improved the theoretical system, academic connotation is continuously enriched, and the treatment effect is unique, and it has occupied an important position in the field of traditional Chinese medicine bone injury in China. The use of manual revision, external fixation of fir bark, and protrusion fixation of forearm to treat supracondylar fracture of the humerus is one of the main features of Zhang's bone injury bone correction technology. In recent decades, more than 10,000 cases of this disease have been cured, and its complications such as elbow varus are low, and the efficacy is satisfactory.
's main features are: ① Through the unique revision technique of pronounced flexion of elbow, extension and traction, end lift and press, and extreme elbow flexion, the fracture can be achieved or basically achieved anatomical reduction. ② The external fixation of homemade fir bark ply can maintain the fracture alignment after restoration and reduce the occurrence of displacement. Compared with the external fixation of gypsum, the external fixation of fir bark is light and there is a gap between the splints, which does not hinder the blood circulation of the entire limb, so the local blood circulation is good, the lumps are reduced, and the pain in the forearm disappears quickly. ③ External fixation of the forearm protrusion can effectively maintain the fracture alignment, generate compression force on the radial side of the fracture end, and tension on the ulnar side, thereby reducing the occurrence of elbow valgus. ④ Can exercise the contraction function of upper limb muscles earlier, so as to achieve a combination of "movement and stillness", thereby promoting fracture healing, shortening the course of the disease, and reducing complications.
Operator Qualification Requirements
Specialist
Diagnostic Standards
This disease type is diagnosed in accordance with the "Traditional Medicine Industry Standards of the People's Republic of China - Diagnostic and Efficacy Standards of Orthopedic Diseases of Traditional Chinese Medicine".
(1) Diagnostic basis:
① has a history of trauma.
② mostly occurs in children.
③The elbow has swelling, pain, deformity, tenderness, dysfunction, and even tension blisters, and the back elbow triangle relationship is normal.
④ Pay attention to any nerve and blood vessel damage.
⑤ x-ray examination can determine the fracture condition and type.
(2) Syndrome classification: According to the different injury mechanism, it can be divided into two types: straightening and flexion; according to the difference between lateral displacement, it can be further divided into ulnar-shaped and radial-shaped. However, it is still common to have a straight ruler tilt in clinical practice.
① Straight-type fracture: the injured limb elbow swollen or boot-like deformity, the tenderness at the top of the condyle is sharp, causing flexion and extension dysfunction, the distal end of the fracture is shifted backward, and the fracture line is mostly obliquely from the anterior to the bottom to the posterior to the upper posterior. It may be accompanied by distal radial or ulnar displacement, or at the same time with rotational displacement. Can be combined with blood vessel and nerve damage.
② flexural fracture: the injured limbs are swollen, tenderness is felt at the supracondyle, function is limited, the distal end of the fracture is shifted forward and upper, and the fracture line is obliquely from the posterior to the upper front from the bottom. It can be accompanied by distal radial side , ulnar side displacement or combined rotation displacement. Can be combined with blood vessel and nerve damage.
Indications
(1) Age 2-14 years old, gender is not limited.
(2) Fresh supracondylar fracture of the humeral about 1 week.
(3) X-ray shows obvious or no dislocation of the fracture.
contraindication
(1) open fracture .
(2) Pathological fracture.
(3) People with vascular nerve damage caused by trauma and severe damage to the soft tissue of the elbow skin.
(4) Deformity and other special diseases.
(5) stale fracture .
Technical operation method
1. Equipment
(1) The fir bark ply is made of large pieces of fir bark removed after Qingming Festival. Press it flat and dry it for later use. 4 small fir bark plywood: the three plywoods with the outer, back and inner lengths are equal, up to the armpits and down to the tip of the elbow. The front side plate is 1 cm above the armpit and 0.5~lcm above the horizontal lines of the elbow.The width of the splint is about 1/4 of the circumference of the limb minus 0.5 to 1.0 cm (adjusting with the thickness of the affected limb), and the thickness is 0.2 to 0.3 cm. The upper part of the ply plate is narrow and wide, and the lower ends of the three ply plates are trimmed into an arc shape, so that the appearance is consistent with the corresponding appearance after the elbow is flexed. When repairing the plywood, the thick skin should be peeled off, the four edges of the plywood should be smooth and shaped. See Figures 1 and 2 for details on the appearance.
(2) 1 ordinary medical strap (small); 1.0cm×l00cm4 strips of rubber tape; a little degreased cotton ; 1 piece of breathable and soft peach blossom paper backing paper.
(3) triangle scarf 1 pieces.
2. Operation steps
1. Straightened supracondylar fracture of humeral
(1) revision. Repair method (taking the right side as an example): The patient takes a seat and faces the surgeon, and the assistant fixes the patient's torso and shoulders; or the parents hold it on his knee and face the doctor for surgery. The surgeon holds the middle and lower section of the forearm of the affected limb with his right hand, and the thumb on his left hand presses the proximal end of the upper elbow fossa of the anterior elbow, and the tiger's mouth presses the proximal end of the lateral fracture. The other four fingers obliquely embrace the distal end of the posterior and medial fractures.
Protrusion and flexion of the elbow: The surgeon pronounces the forearm of the affected limb very much, and then slowly bends the elbow to 45° with a slight traction.
Extraction and traction: The surgeon stretches and traction in the longitudinal axis of the humerus with his right hand, presses down the edge of the little finger of the right hand, slowly bends the elbow at the top of the tiger's mouth, and holds the elbow with his left hand and stretches slightly outward and downward along the longitudinal axis of the upper arm to correct the overlapping displacement of the fracture.
end lift and press: Under the continuous traction of the hand holding the patient's forearm, the operator's left hand squeezes the outer side of the proximal end of the fracture with force, and lifts the inner side of the distal end of the four fingers to correct the deviation of the fracture.
Extreme elbow: The right hand flexes the forearm of the affected limb in the pronounced position by 130°~140°, and at the same time, the left thumb pushes the proximal end of the fracture backward, and the four fingers push the distal end forward to correct the anterior and posterior displacement of the fracture. The above are the decomposition actions during the revision process. During actual operation, the above actions are completed in one go.
(2) Fixation method: After the revision, the surgeon keeps the affected limb in the pronounced position and bent elbow at 120°, the assistant stands on the outside of the affected limb, applies wound ointment to the affected area, and wraps 2 to 3 layers with peach blossom paper. Then place the plywood in the order inside, outside, back and front, then use tape to spiral from top to bottom and then fasten vertically from inside to outside. After fixing the elbow joint , then wrap it in a spiral shape with a small bandage and tape, and tighten it longitudinally with two tapes. Then use a triangle scarf to cover the elbow and palm of the affected limb, hang the affected limb in front of the chest, and keep it at a position of 120° of the forearm protruding and flexing the elbow.
2. Flexible humeral supracondylar fracture
(1) Repair of the technique: The patient is sitting on a bench, and the assistant presses the patient's shoulders to make an anti-fix. The doctor operates on the opposite side of the patient, holding the proximal end of the fracture with one hand and pronating the forearm with the other hand, then flexing the affected limb elbow extremely, and then returning the affected elbow to a 90° position. The four fingers of the hand held at the proximal end of the fracture were pressed backwards. The thumb pushed the distal end of the fracture forward, and the hand holding the forearm was pulled down to restore.
(2) Bandage and fixation: The fixation and bandage method is the same as the straightened supramic fracture of the humeral. After fixing, the forearm is protruded and bent to elbow and suspended the triangle scarf at a position of 90° near the elbow.
Key technical links
(1) Repair technique: A unique repair technique of protruding elbow bend, stretching and pulling, end lifting and pressing, and extreme elbow bend is completed in one go, so that the fracture area can reach or basically achieve anatomical reduction.
(2) Making and placement of fir bark plywood: 4 small fir bark plywood, the outer, back and inner 3 plywood are equal in length, up to the armpit and down to the tip of the elbow. The front side plate is 1cm above the armpit and 0.5-1cm above the horizontal lines of the elbow. The width of the splint is about 1/4 of the limb circumference minus 0.5 to 1.0 cm, and the thickness is 0.2 to 0.3 cm. The upper part of the ply plate is narrow and wide, and the lower ends of the three ply plates are trimmed into an arc shape, so that the appearance is consistent with the corresponding shape after the elbow is flexed and shaped.
(3) Fixed position: ① Straightened supracondylar fracture of humeral: protruding forearm, 120° flexion of elbow. ② Flexed humeral supracondylar fracture: protruding forearm, near 90° elbow flexion.
Treatment time and course of treatment
According to the swelling condition, the re-examination will be adjusted once every 3 to 7 days. After the course of the disease, the straps will be replaced every 7 days. Depending on age, the external fixation time is generally 3 to 4 weeks.
X-ray observation: ①After the fracture is restored, the film is taken to check the reduction status; ②Review the fracture alignment within 1 week, and adjust it in time if there is any displacement. ③Please take a film once a week to observe the alignment line, the growth of callus, etc. until the fracture heals.
Precautions (especially safety guarantee measures)
Pay attention to prevent vascular nerve damage, ischemic muscle contracture early manifestations or symptoms of "5P" symptoms, adjust the tightness of the splint in time or remove external fixation, and treat the symptomatically.
Possible unexpected situations and treatment plans
(1) If severe pressure ulcers, eczema , itching causes skin ulcers and cannot continue external fixation, stop treatment.
(2) causes vascular and nerve damage, and presents early manifestations of ischemic muscle contracture or symptoms of "5P" symptoms, remove external fixation immediately, and provide drug for dilating blood vessels and removing vasospasm for treatment and observation, and if necessary, surgical investigation.
Adverse reactions/events
Common complications are skin allergies, rashes, itching, skin blisters, skin pressure ulcers, etc. If the damage is severe and causes severe swelling of the elbow, tension blisters or mild skin pressure ulcers will often appear. The skin will be disinfected and removed, and the dressing will be changed regularly to prevent secondary infections. This treatment can be continued.
operation video
