Open reduction and internal fixation of humeral condyle fractures

There are 4 to 5 ossification centers and epiphyseal lines at the lower end of the humerus in childhood, which occur at different ages [Fig. 44-40]. Moreover, there is a coronal fossa before, and there is an olecranon fossa in the back. The bone support of the ankle is relatively weak and prone to fracture. Because the extensor muscles are attached to the external malleolus of the humerus, the flexor muscles are attached to the internal malleolus, so the fracture of the ankle is easily reversed and displaced; and after displacement, it is difficult to reset by hand; even if the manipulation is successful, it is very easy to be affected by the muscle. Pull and then shift. In addition, ankle fracture often involves the articular surface and epiphysis. If not treated properly, it can affect the joint flexion and extension function, and can also affect the development of the epiphysis and the growth deformity. Common humeral condyle fractures include humeral external malleolus fracture and internal malleolus fracture. Internal iliac crest fracture is easy to be complicated with ulnar nerve injury, should pay attention to the examination. These two types of ankle fractures are mostly cartilage, and the x-ray films are not developed and sometimes easily overlooked. Treatment of diseases: upper humerus epiphysis separation of the external humerus neck fractures of the humerus fractures of the humerus fractures of the external humerus fractures of the humerus Indication 1. Fresh humeral condyle fractures have displacement, failure of manual reduction, or displacement after manual reduction. 2. For a later fracture of the humerus, there is a shift. Contraindications 1. The general situation of the wounded is not good, or the concomitant shock, must first rescue, until the shock is stable, the general situation can be improved before surgery. 2. If there is a life-threatening head, chest or abdominal cavity and other important organ damage, it must be treated first. The treatment of the fracture should be relegated to the secondary position. Temporary external fixation can be performed first, and the fracture should be treated after the condition is stable, or non-surgical treatment can be used. Try to get a better reset as much as possible. 3. There are more than 8 to 12 hours of open wounds in the fracture. Preoperative preparation 1. The fracture is caused by severe trauma. The patient has severe pain and blood loss. Analgesic and blood matching should be given before surgery. For patients with poor general condition or existing shock, anti-shock treatment such as infusion and blood transfusion should be given, and the operation should be performed after the condition is stable. 2. Preoperative fracture site should be taken with positive lateral x-ray film to determine the location, shape and displacement of the fracture, which is convenient for determining the surgical procedure and internal fixation. For those who need to take x-rays during surgery, they should inform the radiology department and the operating room in advance to prepare. 3. The surgeon should propose the special equipment to be used and check whether the preparation of the equipment is complete, so as to avoid temporary preparation and prolong the operation time. 4. Open fractures should be treated with antibiotics and tetanus antitoxins; or if the original open fractures were delayed for more than 2 weeks, antibiotics and repeated injections of tetanus antitoxin should be used. 5. After the reduction and reduction, the internal fixation or bone graft should be used. The antibiotic should be intravenously administered immediately after anesthesia, and once every 6 hours, share 4 times. 6. The fracture site should have sufficient range of cleaning and disinfection preparations. The surgeon should avoid contact with the suppurative wound on the same day, and strictly follow the hand washing procedure to prevent the wound infection. 7. Patients who need to delay surgery for the first time should be towed first, can be reset, temporarily fixed, and can overcome soft tissue contracture, reducing the difficulty of resetting during surgery. 8. Need to simultaneously bone fractures, such as delayed bone fractures, slow healing fractures, etc., should be prepared for the bone area after surgery. Surgical procedure (a) fracture of the lateral malleolus 1. Position, incision supine position, injured limb placed on the chest. The arcuate incision on the lateral side of the elbow, starting from the upper iliac crest 5 cm, stops at the humerus neck [Fig. 2 (1)]. 2. After the skin is cut and the subcutaneous tissue is exposed, the diaphragm is separated from the iliac crest muscle and the triceps muscle. The phrenic nerve is inserted from the diaphragm to the anterior side of the diaphragm and the incision is separated. At the upper end, care should be taken to avoid damage), and the front and back should be pulled apart to reveal the fracture. The fracture blocks rotate to varying degrees, often with rough fractures facing the outside of the elbow joint, while smooth joints face the fracture surface of the humeral shaft and the trochlear [Fig. 2 (2)]. The fracture block is much larger than the size developed by the x-ray film (including the external upper eyelid, the small skull of the humerus, the part of the trochlear bone and the small metaphyseal bone). When exposed, be careful not to cut off the attachment of the forearm extensor tendon of the fracture block to preserve the blood supply of the bone. 3. Resetting Sometimes it is difficult to identify the fracture displacement of the surgery for several weeks after surgery. After removing the hematoma in the joint, the granulation of the end, the callus and the bone fragments, the x-ray film should be used to repeatedly identify the appearance of the bone defect and the displaced fracture surface. After confirmation, the elbow flexed to relax the forearm extensor muscle, and the displaced bone piece was clamped with a towel clamp to reverse the reset. 4. Internal fixation Under the maintenance of the towel clamp, the two external Kirschner wires are used to fix the external malleolus to the humeral shaft. The direction is from the outside to the inside, and the angle is 40°~60°. Figure 2 (3)] fixed. (B) the fracture of the humerus and the separation of the epiphysis 1. Position, incision supine position, the injured limb is placed on the small table next to the bed, or the elbow is placed on the chest. The medial incision of the elbow is centered on the upper iliac crest and is longitudinally incision, 5 cm long [Fig. 3 (1)]. 2. Reveal the deep fascia, and you can see the rough fracture surface in the upper iliac crest. The ulnar nerve located in the posterior medial ulnar nerve groove was explored and separated and then opened for protection. 3. The reduction of the internal malleolus fracture block is often sandwiched between the ulnar half-moon notch and the tibial block, so the fracture block is not visible. Only the flexor and aponeurosis can be seen in the joint with the joint capsule [Fig. 3 (1)]. Carefully use the curved hemostatic forceps to pick out the muscles and fractures [Fig. 3 (2)]. The fracture block is sometimes not embedded in the joint and is easier to find. The elbow should be flexed during the reduction to relax the flexor of the forearm, and the fracture block can be completely reset. 4. Internal fixation After the fracture block was reset and maintained in position, the Kirschner wire was drilled from the center of the fracture block upward and obliquely to the contralateral side of the humerus for internal fixation. After the fracture has healed, the ulnar nerve groove will become narrow or uneven due to hyperplasia of the bone, and late onset ulnar nerve may occur later. Generally, the ulnar nerve should be advanced after internal fixation [Fig. 3 (3)]. complication Infection: If you do not pay attention to hygiene or anti-infection, it is easy to cause wound infection. If it happens, you should seek medical advice immediately.