Tibial and fibular shaft fractures
Introduction
Introduction to humeral shaft fracture The humeral shaft fracture accounts for 9.45% of the total body fractures. Children under 10 years old are particularly common. Among them, the double fracture of the humerus is the most, accounting for 5.1% of the total fracture, followed by the tibia, accounting for 3.85% of the total fracture. The humeral shaft fracture accounts for at least 0.59% of the total body fracture. Although the treatment is easier and there are no obvious dysfunctions, if it is not handled properly, there may be complications such as infection, slow healing or non-healing, and even serious consequences of amputation. Therefore, the fracture of the humerus should be carefully treated. basic knowledge The proportion of illness: 0.025% Susceptible people: children under 10 are especially common Mode of infection: non-infectious Complications: nonunion, chronic osteomyelitis, venous thrombosis
Cause
Causes of humeral shaft fracture
(1) Direct violence
The fracture of the humerus is often hit by heavy objects, kicks, impact injuries or wheel rolling injuries. The violence is mostly from the outer front side of the calf. The fracture line is mostly transverse or short oblique, and there is a lot of violence or traffic accidents. For comminuted fractures, because the front of the humerus is located under the skin, the fracture end may wear the skin very much, and the muscles are more likely to be contused.
(2) Indirect violence
The fracture caused by falling from a height, rotating violent sprain or slipping, is characterized by a skewed or spiral shape of the fracture line; the fracture line of the tibia is higher than the fracture line of the tibia, and the external force of the fracture of the tibia is generally small. Coupled with the greater toughness of the children's cortical bone, it can be a fracture of the green branch.
Prevention
Prevention of humeral shaft fracture
The disease is mainly caused by traumatic factors, so paying attention to production and life safety is the key to prevent this disease. In addition, because the complications of this disease are more common, it is more important for patients to prevent complications, such as blood loss. Sexual shock, nonunion, joint stiffness, etc., also need to pay attention to the early functional exercise of the affected limb, promote fracture healing and functional recovery.
Complication
Complications of humeral shaft fracture Complications, non-continuous osteomyelitis, venous thrombosis
The complications of this disease are mainly early and long-term:
First, early complications:
Early complications are mainly hemorrhagic shock and neurovascular injury.
Second, long-term complications:
1. Delayed fracture healing and nonunion
In the fractures of the iliac crest, especially in the middle and lower segment, the bone marrow cavity and the inner and outer membranes of the bone are severely damaged and damaged due to the destruction of the nourishing blood vessels of the bone. Because the surgery uses subperiosteal peeling, the bone nourishment vessels are destroyed a lot. At the same time, it increases the chance of infection and affects fracture healing. Therefore, strict selection of surgical indications and minimal peeling of periosteum are the main measures for prevention.
2, joint stiffness
In patients with nonunion of delayed fracture healing, adhesion of the joint capsule and surrounding soft tissue occurs due to prolonged external fixation. For patients with delayed bone healing, some scholars believe that in the case of fracture with strong internal fixation, it is gradually carried out. Joint function exercise, but weight-bearing exercise must be strictly controlled, no internal fixation or internal fixation is unreliable, careful exercise of joint function after removal of external fixation.
3. Chronic osteomyelitis
Mainly due to severe damage to soft tissue during trauma, residual necrotic tissue and foreign body, skin necrotic bone exposure, too late treatment time and long operation time, etc., to completely remove the necrotic tissue and foreign body in the wound during debridement, Suspected necrotic tissue should be resolutely removed, and try not to use a tourniquet. Try to use a simple fixation method to shorten the operation time. If there is a sign of infection, adequate early drainage should be performed. The internal fixation emphasizes that the effective fixation of the original wound should be minimized without In pursuit of strong internal fixation, wound closure should be closed according to the specific situation, but the wound must be sutured without tension. If the tension is large, all the mouth can be made after the sputum, and then the anterior incision is sutured.
4, deep vein thrombosis
Lower extremity venous return mainly relies on the pressure generated by muscle contraction, and the lower extremity fracture stays in bed for a long time, the venous return is slow, platelet clotting, resulting in deep vein thrombosis, and early muscle contraction after fracture can minimize the occurrence of deep vein thrombosis. rate.
Symptom
Symptoms of humeral shaft fracture Common symptoms Gastrocnemius tonic contraction... Local thigh swelling and deformation of the tibia and bones without tibia tenderness and humeral pain
After the fracture of the tibia, the calf is swollen and painful, and there may be deformities and abnormal movements.
Like the femur, the humerus is an important bone for weight bearing. It is located under the skin. The humerus in front is an important sign of manual reduction after fracture. The transverse section of the humerus is triangular, and the quadrilateral is at the junction of the middle and lower 1/3. The junction of the Mitsubishi and the quadrilateral is the predilection site of the fracture. Since the entire humerus is located under the skin, the fracture end easily penetrates the skin and becomes an open fracture. The upper end of the humerus and the articular surface of the lower end are parallel to each other. The joint surface is lost parallel, the force surface of the joint is changed, and traumatic arthritis is easy to occur. The upper and lower ends of the humerus and the tibia constitute the supraorbital joint and the infraorbital joint, which are micro-movement joints, and the humerus and tibia are not produced separately. Exercise, but can withstand 1/6 of the weight, there is an interosseous membrane connection between the tibia, the force that is sustained in the ankle joint is transmitted along the humeral shaft, and is also transmitted from the tibia through the interosseous membrane. After the artery, the hair is moved down through the soleus muscle, where the blood vessel is fixed, and the upper third of the humerus is fractured, which can cause arterial injury after the dissection, causing severe blood circulation disorder and even ischemic necrosis of the lower limb. The muscle fascia of the leg and the tibia, together with the intersacral membrane of the tibia constitute four fascia chambers, which can cause high pressure in the compartment of the compartment due to bleeding of the bone marrow cavity after the fracture, or bleeding from muscle damage, or bleeding due to vascular injury. Muscle ischemic necrosis, late fibrosis, will seriously affect the function of the lower limbs. The nutrient vessels of the tibia are from the humeral shaft, and the middle third of the junction enters the bone. In the middle and lower third, the fracture causes the nutritional artery to be damaged. The blood circulation of the lower third of the tibia is significantly reduced, while the lower third of the tibia has almost no muscle attachment. The blood circulation obtained from the distal end of the humerus is very small, so the fracture of the lower third of the fracture heals slowly, prone to delayed healing or Non-healing, in the humeral neck of the common peroneal nerve from the armpit, the lateral obliquely downward to the outside, through the humerus section into the humerus long, short muscles and the anterior muscles of the lower back, the fracture of the humeral neck can cause total sputum Nerve damage .
Examine
Examination of humeral shaft fracture
The diagnosis of this disease is not difficult, but some auxiliary examination methods are needed to help better diagnosis. The auxiliary examination method is mainly for X-ray examination. X-ray examination is helpful for the diagnosis of fractures and fracture types. Note that when a radial or oblique fracture of the humerus is found in the clinic, even if the fracture is a mid-lower segment fracture, a full-length X-ray of the calf should be taken to check for the presence or absence of the upper humeral fracture.
Diagnosis
Diagnosis and diagnosis of humeral shaft fracture
Mainly based on the history of trauma and clinical manifestations.
After the fracture of the tibia, the calf is swollen and painful, and there may be malformations and abnormal motility; X-ray examination is helpful for the diagnosis of fractures and fracture types; this fracture should pay attention to the extent and extent of tissue damage, and whether there is nerve or vascular injury. The upper humerus fracture and the tibial neck fracture should pay attention to the possibility of radial artery and common peroneal nerve injury.
The diagnosis of this disease is not difficult. Because it is mostly caused by traumatic factors, and most of them are open wounds, the diagnosis is easy. In addition, according to X-ray examination, the extent and location of the injury can be well determined, but clinically Attention should be paid to distinguishing different types of fractures, so that the correct method can be used to correct the displacement. Various types of fractures include the displacement of spiral fractures and the overlapping displacement of transverse fractures.
