medial epicondyle fracture of humerus
Introduction
Introduction to the fracture of the humerus The internal humeral fracture is the most common type of elbow injury, accounting for about 10% of the elbow fracture, second only to the supracondylar fracture of the humerus and the external humerus fracture, accounting for the third place in the elbow injury. Fractures occur mostly in teenagers and children. In this age group, the upper iliac crest is a callus, which has not been fused with the lower end of the humerus, so it is easy to avulse, which is called avulsion fracture of the upper humerus. basic knowledge The proportion of sickness: 0.01% Susceptible people: mostly in teenagers and children Mode of infection: non-infectious Complications: olecranon fractures, joint dislocation
Cause
Causes of humeral epicondylar 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. In the late epiphysis, the sacral line itself is a potential weakness before it is closed. Therefore, the epiphysis can be separated, pulled down and forward, and rotated, and the medial space of the elbow is temporarily pulled open, or the elbow joint occurs. The lateral dislocation, the avulsed internal epicondyle (bone callus), is trapped in the joint and can be divided into 4 degrees depending on 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.
Pathogenesis:
The fracture of the humerus is usually caused by sports injuries such as falling or throwing on the flat. When the forearm is stretched and abducted during the fall, and the forearm flexor is violently contracted, the upper jaw of the humerus is pulled by the flexor muscles to cause avulsion fracture and tear. The fractured part of the fracture is displaced forward and downward and may rotate. Because the elbow joint is placed in the valgus position, the avulsion fracture of the internal malleolus often coincides with dislocation of the elbow joint.
Prevention
Prevention of fracture of the medial epicondyle
The disease is a traumatic disease, pay attention to the safety of daily life, there is no other effective preventive measures, and it is especially important to note that this disease is easy to be complicated with cubital varus. Therefore, in addition to active treatment, patients with this disease should also pay attention to prevention. The occurrence of elbow varus, the focus of prevention has the following three points:
1. Good fracture reduction;
2. Reasonable fixation;
3. Correct X-ray valuation.
Complication
Complications of the internal humerus fracture Complications, ulnar olecranon fracture, joint dislocation
The disease is caused by traumatic factors, and it is easy to combine other injuries, including humeral head, neck, olecranon fracture, etc., and the most common complication of this disease is cubitus varus, sometimes accompanied by elbow dislocation, pay attention to the ulnar nerve no damage.
Mechanisms about the occurrence of cubitus varus Many scholars have different views. The general view is that the cubitus varus is the compression collapse of the medial cortical bone at the distal end of the distal end, the reduction or maintenance of the poor reduction and the gravity of the medial displacement of the scale, and the callus Irrespective of the growth rate, the distal end of the rotation displacement causes the elbow to varus, because the rotating fulcrum is mostly in the wider lateral iliac crest, the medial condyle loses support, and the gravity of the limb and the force of the muscle pulling cause the inner side to tilt.
Symptom
Symptoms of internal humerus fractures Common symptoms Soft tissue swelling Elbow joint dislocation Avulsion fracture Hematoma formation
Children are more common than adults. After injury, the soft tissue around the medial and medial epicondyles is swollen, or there is a large hematoma formation. The clinical examination of the elbow joint has an isosceles triangular relationship, pain, especially local swelling of the elbow, tenderness, normal The contour of the upper jaw disappeared, the elbow joint activity was limited, the forearm pronation, flexion wrist, flexion and weakness, combined with elbow dislocation, the elbow joint shape changed significantly, dysfunction was more obvious, often combined with ulnar nerve injury symptoms.
In the case of avulsion fracture of the upper iliac crest, the medial tissues of the elbow joint, such as the collateral ligament, joint capsule, internal iliac crest and ulnar nerve, can be injured, the inner side of the elbow joint is swollen, pain, local subcutaneous visible congestion, tenderness is limited On the inside of the elbow, sometimes the bone friction is felt, and the elbow joint extension and flexion are limited.
The medial epicondyle of the humerus is separated from the medial condyle of the lower end of the humerus, displaced or rotated, and the degree of displacement is judged according to the displacement of the fracture piece. The fracture of the humerus in the child is easier to be with the humerus and the humeral head. The avulsion fracture is confused with the displaced person. Before the humeral condyle of the child has not appeared (usually 6 years old), the signs of the ossification center cannot be shown on the X-ray film, and the epiphyseal line is not closed, which increases the difficulty of differential diagnosis. When taking the contralateral elbow joint X-ray film, detailed physical examination, and asking about the injury, combined with the age characteristics, the only way to accurately diagnose and choose a better surgical treatment.
X-ray diagnosis is very important and should be carefully observed.
I degree fractures may sometimes be missed, but the following conditions should be considered:
1 When there is a fat pad sign, that is, bleeding or exudate after the elbow injury pushes the fat pad in the coronal socket and the olecranon to an "eight" shape;
2 The epiphysis is not parallel to the metaphysis;
3 The edge of the epiphysis is unclear, especially the thin layer of metaphyseal fractures are found;
4 The inner and outer protrusions of the lower end of the humerus are symmetrical. Because the shape of the inner and outer protrusions of the lower end of the normal humerus is asymmetrical, the inner upper jaw is more inwardly protruding.
III, IV degree fracture should pay attention to the presence of the upper iliac crest. If there is difficulty, it 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, children under 5 years old, because the ossification center of the upper jaw of the humerus has not appeared, it is difficult to distinguish from the fracture of the humerus. In severe injury, attention should be paid to the presence or absence of the humeral head, the olecranon, and the external iliac crest. The fracture exists.
The ulnar nerve travels in the ulnar nerve groove behind the iliac crest. When the fracture occurs, the ulnar nerve may be pulled, collapsed, and even inserted into the joint space together with the fracture block, causing ulnar nerve injury.
Type of injury: According to the displacement of the avulsed fracture piece and the change of the elbow joint, it can be divided into four degrees.
I degree of humeral fracture of the upper tibia, mild separation or rotational displacement.
In the second degree of upper ankle fracture piece, the traction displacement is obvious, reaching the level of the elbow joint, and there may be a rotational shift, which is difficult to reset.
At the moment of avulsion of the III degree fracture piece, the valgus violent is large, and the inside of the joint is opened. The fracture piece is embedded in the joint space. The fracture piece is stuck with the joint capsule, such as a button-like joint, which is difficult to rectify. .
IV degree of humeral epicondyle avulsion fracture with elbow dislocation, the most serious injury of internal iliac crest fracture, a small number of ulnar nerve injury.
Examine
Examination of the fracture of the humerus
There is no relevant laboratory examination. The examination of this disease mainly involves physical examination and X-ray examination:
1, comprehensive physical examination:
Pay attention to whether there is shock, soft tissue injury, bleeding, check the size, shape, depth and pollution of the wound, whether there is bone end exposure, whether there are nerves, blood vessels, craniocerebral, visceral injuries and other parts of the fracture, which must be carried out quickly for serious wounded .
2, X-ray inspection:
In addition to positive, lateral X-ray film, should also be based on the injury to shoot a special body phase, such as the opening position (upper cervical spine injury), dynamic lateral position (cervical vertebra), axial position (scaphoid, calcane, etc.) and For tangential position (tibia), complex pelvic fractures or suspected intraspinal fractures, orthodontic or CT examination should be performed as appropriate.
Diagnosis
Diagnosis and diagnosis of humerus fracture
diagnosis
Traumatic history, swelling of the elbow joint, pain, subcutaneous congestion and localized tenderness, sometimes touching the fracture piece, X-ray examination can confirm the diagnosis, and should pay attention to whether there are other injuries, such as the humeral head, neck, olecranon fracture, etc. .
Differential diagnosis
According to the history of trauma, clinical manifestations and X-ray examination, the disease can generally make a diagnosis, but for some special cases, it still needs careful identification, especially to distinguish the upper humerus from the humerus. The epiphysis appears at about 6 to 10 years old and is closed around 18 years old, but sometimes there may be people who are not closed. It should be distinguished from the fracture.
