Total epiphysis separation of distal humerus
Introduction
Brief introduction of the separation of the distal humerus Separation of the distal radius of the humerus is a rare osteophyte injury in the elbow joint of children. The ossification center of the epiphysis has not completely appeared before the osteophyte separation, which is easily confused with the fracture of the lateral malleolus and the dislocation of the elbow; all the ossification centers appear. After the separation of the whole epiphysis, it is easy to be misdiagnosed as a transforaminal fracture. The distal epiphysis of the humerus is composed of the external iliac crest, the trochlear, the upper iliac crest and the external iliac crest. The external tibial and tibial carpal humerus are connected by means of cartilage. Therefore, the Department is weak. Usually, violence can cause the fracture of the external cartilage of the humerus to fracture. It is a fracture of the external humerus, but sometimes the external force can separate the osteophytes of the distal radius. The two are not exactly the same in treatment. The former often requires open reduction of the operation, and the separation of the whole bone can be reduced by closed manipulation. Such damage is easy to be misdiagnosed and missed. If the treatment is improper, it will cause severe elbow varus in the elbow joint deformity and affect the function. basic knowledge The proportion of illness: 0.001% Susceptible people: good for children Mode of infection: non-infectious complication:
Cause
Separation of total osteophytes at the distal radius
(1) Causes of the disease
Mostly caused by indirect violence.
(two) pathogenesis
Separation of the entire epiphysis of the distal radius, mostly due to the elbow joint stretching or slight flexion, the palm of the hand is injured, the bottom-up external force and the body's gravity are transmitted to the elbow, but the situation cannot be clearly expressed when the child is injured. Therefore, it is difficult to make a diagnosis reference for the history of injury.
Prevention
Proximal humerus separation
Prevention: Prevention of trauma.
Complication
Complications of distal humerus Complication
There is no complication of this disease.
Symptom
Symptoms of total osteophyte separation at the distal end of the humerus Common symptoms Wrist pain and palmar flexion... Intense pain in the elbow,... The hand is weak and the elbow is swollen and tender.
Elbow swelling, pain, tenderness and movement disorders.
Examine
Examination of the separation of the entire epiphysis of the distal radius
Its X-ray film features are as follows:
1. The normal elbow and lateral radiographs of the ankle joint show that the longitudinal axis of the humerus passes through the humeral head.
2. The relationship between the ruler and the ankle is normal, that is, the upper ankle joint maintains a normal relationship.
3. The dysplasia of the humerus and the ulna and the ulna is often the medial metaphyseal fracture of the ulna and the medial metaphyseal fracture of the humerus. The sacral small skull center has not yet appeared. The relationship between the ulnar and the ulna can be diagnosed.
Diagnosis
Diagnostic diagnosis of the distal humerus
diagnosis
History of trauma, elbow swelling, pain, tenderness and movement disorders, according to the characteristics of the X-ray display, can establish a diagnosis.
Differential diagnosis
1. Dislocation of the elbow joint is not easy to distinguish when there is no sacral skull degeneration center. Careful clinical examination can be found that when the distal radius of the humerus is separated, the three points behind the elbow are normal, but there is a change in dislocation. During the recovery process, the hand feels the sound of cartilage collision, which helps the diagnosis of sputum separation. If the sacral small skull center has appeared, it can be identified according to its relationship with the tibia. If the relationship is abnormal, it is dislocation.
2. The true pathological change of the external humerus fracture is the separation of the external humerus and humerus. At this time, the alignment of the humeral shaft and the humeral shaft is normal, while the sacral small skull center is displaced to the outside, and the physical activity can be touched on the lateral side of the elbow. The nephew.
3. Elbow joint dislocation combined with internal or external malleolus fractures is often difficult to diagnose before the appearance of the sacral skull degeneration center. When the lateral dislocation has an external malleolus fracture, the relationship between the three points of the elbow changes and the elbow can touch the normal side. The relationship between the external hemorrhoids and the humeral head, the medial dislocation and the medial malleolus fracture, is similar to the above situation, that is, the relationship between the olecranon and the internal hemorrhoids is normal.
4. The intercondylar fracture of the humerus is more common in adults, and there are few children. The skeletal skeleton of the child has not been ossified. The fracture line can not be seen directly from the X-ray film. The diagnosis is difficult. The X-ray features are similar to those of the external malleolus fracture. For example, compared with the healthy side, the proximal end of the humeral shaft and the proximal ulna can often be found close to each other. For difficult cases, the joint angiography can be clearly diagnosed. Fortunately, there are few such injuries in children, and there are few opportunities for clinical identification.
5. The supracondylar fracture of the humerus usually relies on the separation of the X-ray film and the whole iliac crest. It is not difficult to distinguish it only when the size of the iliac crest bone is unclear. In this case, the X-ray film after the reduction should be combined. Seeing and then making a diagnosis, this type of misdiagnosis has no effect on treatment, but is statistically significant.
