Flexor, flexor carpi tendon displacement or tendon lengthening

Surgical treatment of complications of supracondylar fracture of the humerus with flexion of the flexor or flexor tendon or tendon lengthening. Compared with adult resting and mature bones, children's bones are structurally and functionally distinct; developmental bones are susceptible to varying degrees of damage both physiologically and biomechanically. Childhood fractures may result in secondary anatomical changes depending on the location of the affected area (bone, tarsal, metaphyseal, and diaphysis). In order to understand the damage of the musculoskeletal system in children, it is necessary to be familiar with the anatomical knowledge of the developing bones and the changes in the ratio of cartilage to bone formation during development leading to changes in physiological functions and biomechanics, such as the high biological elasticity of neonatal bones. As the growth and development gradually decrease, the youth and youth have gradually turned into hard bones with little elasticity. To deal with fractures in children, it is necessary to be familiar with the mechanism of injury and the short-term and long-term biological changes of the injured site, especially the growth mechanism, and guide the treatment accordingly. Compared with adults, children's fractures have many different characteristics: 1 children have osteophytes, osteophytes have longitudinal and lateral growth ability, fractures such as involving the epiphyseal or osteophytes can lead to early or late skeletal development disorders; 2 children with fractures are more common; 3 Children's joint damage, dislocation and ligament separation are very rare; 4 children's periosteum is thicker and tougher. The periosteum of the child is loosely attached to the backbone and the metaphysis, and is closely attached to the epiphysis. Therefore, when fractured, the periosteum is easily separated from the backbone and metaphysis. In addition, children's periosteum has a strong osteogenesis biological activity. Due to the above characteristics, when the fracture is broken, the concave periosteum is separated from the backbone and remains intact, which has a certain restriction on the displacement of the fracture; the above characteristics can help the reduction of the fracture; due to the above characteristics, the subperiosteal callus after the fracture The formation is faster; and when the fractured bone is completely lost, as long as the periosteum sleeve is relatively intact, it is possible to regenerate the lost bone. Since the X-ray can penetrate the cartilage and bone tissue to varying degrees, it is difficult to diagnose the osteophyte injury by ordinary X-ray films unless special examinations such as arthrography and MRI are used. Some fractures are difficult to diagnose in early X-ray examination until the subperiosteal formation is confirmed by follow-up. Bone scan and MRI can increase the accuracy of diagnosis in rare trauma. However, due to the lack of coordination of young children, basic anesthesia is often needed, and the cost of diagnosis and treatment is greatly increased. Therefore, it cannot be used as a routine examination. In developing children, the shaping of the bone occurs at the diaphysis and metaphysis, especially in the latter, which allows the dislocation-healing fracture end to self-correct to achieve anatomical alignment and restore normal biodynamic lines. However, this shaping is conditional, and accurate anatomical reduction is the basic purpose of any fracture treatment. The ability to shape bone and cartilage depends on normal body weight stress, muscle contraction, joint motion stimulation, and intrinsic control mechanisms such as periosteum. The younger the age, the closer the fracture end is to the tarsal plate, and the closer the angular deformity is to the plane of joint motion, the greater the potential for complete correction. This shaping characteristic is particularly pronounced when the fracture is close to the hinge joint, such as the knee joint, the ankle joint, the elbow joint, and the wrist joint. When the fracture occurs near the above joint, if the angular deformity is in the plane of the joint motion direction, the shaping is rapid and complete; otherwise, the shaping ability is limited. Such as the humeral fracture of the humerus fracture, it is difficult to correct it by itself. Similarly, rotational deformities are usually not self-correcting. After the fracture occurs, the excessive growth of the bone is stimulated by increasing the blood circulation of the metaphysis, the epiphyseal plate and the epiphysis. Therefore, within a certain age group, a certain degree of shortening deformity (back-to-back alignment) is acceptable, even reasonable, especially for femoral shaft fractures. Because the children's periosteum is thick, blood supply is rich, and the periosteum is active, the fracture healing is faster. The age of the sick child is the most important factor affecting the rate of fracture healing. The younger the age, the faster the fracture heals. For a femoral shaft fracture, the newborn can heal in just 3 weeks, while the younger needs at least 20 weeks. The healing time of the epiphyseal injury is half of the fracture of the diaphysis and metaphysis. Non-healing may occur after a fracture, but it is absolutely rare in children. Compared with adults, indications for open reduction and internal fixation of fractures in children are more stringent because they may affect the normal healing process. For example, femoral shaft fractures in children under 10 years of age can be fixed with early cast, and clavicle fractures are fixed with "8" bandage. However, some fractures can only achieve satisfactory results through surgery, such as external humeral fractures, femoral neck fractures and open fractures. At least 6 to 12 months after the fracture, the secondary bone growth disorder should be detected early. In children, the most common sites of joint dislocation and subluxation are the elbow and shoulder joints, followed by the hip joint. There are several types of fractures that are unique to children. That is, arch fractures, green branch fractures, and protuberance (bamboo-like) fractures. A bow fracture is when the bone deforms under the action of an external force, exceeding the deformity left by its rebound back to normal elasticity. The younger the sick child, the greater the probability of this type of fracture, which is common in the humerus and ulna. The branch fracture is a common injury in children. The fracture is not completely broken, and the cortical bone and periosteum are still continuous in the compression side. Protrusion (bamboo-like) fractures occur in children with invasive injuries, often occurring at the metaphysis. Treatment of diseases: supracondylar fracture of the humerus Indication Flexion of the flexor or flexor tendon or tendon extension is applicable to: 1. Moderate or severe forearm muscle Volkmann contracture. 2. Forearm extensor muscles with muscle strength above grade IV. 3. The wrist extension is slightly limited. Preoperative preparation Regular preoperative examination. Surgical procedure Incision From the lateral side of the elbow joint, along the lateral edge of the wrist of the forearm ulnar wrist, it stops at the lateral wrist. Cut the skin and subcutaneous tissue, pay attention to retain the superficial superficial vein and cutaneous nerve, longitudinally cut the forearm fascia, free the ulnar nerve from the starting point and the stopping point of the ulnar wrist flexor, be careful not to damage the nerve branches. 2. The starting point of the flexor group is released The subperiosteal peel was removed from the anterior humerus and the starting point of the pronated round muscle and the flexor digitorum extensor. At the same time, the palmar long muscle and the radial flexor tendon are exposed, and the elbow joint capsule and interosseous membrane are exposed to protect the median nerve, the ulnar nerve and its branches. Sometimes the fibrotic muscle should be removed, and the starting point of the flexor group can be obtained at this time. Shift down 3cm, the ulnar nerve can be moved forward to the elbow. 3. Flexor tendon extension After the starting point of the forearm flexor group is released, if the passive extension of the wrist and the extension finger are still unsatisfactory, the flexor digitorum, the superficial tendon or the flexor longus tendon may be prolonged in the plane of the wrist joint. 4. Surgery to stop the bleeding band, carefully stop bleeding, suture layer by layer.