External pathology fractures the arm bone

2021-01-30 12:00 AM

The fracture between the grip of the large pectoral muscle and the delta muscle attachment: The upper head closes (pulled by the large pectoral muscle), the lower head moves up and out (pulled by the delta muscle).

Outline

Fracture of the brachial limb accounts for about 3% of general fractures, a variety of treatment options are available, although the results of conservative and surgical treatment are similar. Before a specific fracture and patient, however, it is necessary to have a basic knowledge of the anatomy and function of the arm in order to choose the right treatment that delivers optimal results.

Reason

Often due to indirect trauma mechanisms such as falls on hands, due to domestic accidents. Direct injury mechanisms encountered in occupational accidents, traffic accidents, social evils such as fighting, stabbing, or fire injuries, often cause open fractures.

Pathology

Broken line

The brachial body is limited from the upper edge of the pectoral muscle attachment down to the upper limit of the upper muzzle of the brachial bulge. Broken lines include:

Horizontal broken line.

Diagonal fracture line.

Spiral fracture line

Broken fragments.

Crumble.

Deviation direction

Depending on the location of the fracture, the force exerted on the body of the bone differs, leading to the following specific deviation directions:

Fracture on the grip of the large pectoral muscle: The upper head is displaced and rotated outward due to the pull of the rotating muscle mass (upper spine muscle, inferior muscle, sub shoulder muscle).

The fracture between the grip of the large pectoral muscle and the delta muscle attachment: The upper head closes (pulled by the large pectoral muscle), the lower head moves up and out (pulled by the delta muscle).

Delta muscle fracture: Upper head-shaped; lower head moved upwards due to muscle contraction (no opposing muscles).

Symptoms and diagnosis

Symptom

Clinical symptoms

The victim with the main symptoms of fracture such as pain, loss of arm muscle function, bruising, swelling, deformity, sharp pain, scratching, short limbs and abnormal movement at the fracture are also common symptoms. In addition, special attention should be paid to damage to nerves and blood vessels involved, including common signs of rotational nerve damage, or damage to the brachial artery, which often presents a difficult or inaccessible rotating circuit. If there are abrasions, tears, sudden wounds, they must think of open fractures, requiring emergency treatment.

Subclinical symptoms

Standard X-ray imaging takes all the shoulder joints and elbow joints at two squares perpendicular to each other, often to change the patient's position to take, not just rotate the arms to take pictures. The location of the fracture, fracture line, displacement, fragment ... is recorded on the film, in case of pathological fracture, it is necessary to examine more bone tomography, computerized tomography (CT Scanner), magnetic resonance imaging (MRI) to understand the limits of the pathological bone before indicating treatment.

Diagnose

Based on specific clinical symptoms such as deformity, abnormal movements, scratching sounds and diagnostic images (X-rays, MRI ...).

The principles of treatment

There are many different methods that can be used to treat a brachial fracture, with great results. In the literature, there is much mention of a slow rate of bone healing and no healing in the conservative method. However, recent advances in osteopathic techniques, limb immobilization with cast braces, castings, plastic braces ... have significantly reduced these complications and made conservative treatments become the method of choice in the treatment of brachial fractures. Meanwhile, advances in bone immobilization techniques over the past twenty years have made the surgical treatment of a brachial fracture ideal, especially early functional results.

Conservative treatment (no surgery)

Usually does not achieve the good anatomical shape, but Klenerman showed that a forward angle of 200 and an inward bend of up to 300 is acceptable for the brachial body. It takes regular monitoring and testing to bring out the best results. Depending on the type of fracture, the mechanism of injury, the severity of the injury, the severity of the injury, the severity of the swelling, the soft tissue damage, the physical needs and the patient's requirements, the options for different. Conservation methods include:

Powder arm hanging

This method was introduced by Caldwell in 1933, today is still considered as the basic method in the treatment of arm fractures. It is best applied in cases of short overlapping, torsion or transverse fractures. In the first time, it is significant to straighten the axis and correct the short-stack displacement, when checking that the manipulation is satisfactory, you can switch to another treatment method or continue to be maintained. Once the option of maintaining the arm amalgamation is continued, then follow-up X-ray examination of the state of the bone is stretched and the possibility of not healing.

The basic technique of this method is a relatively light cast, from 2cm above the fracture to the wrist with the elbow 90 0 intermediate posture, the 2-3 kg hook just below the elbow, time 8-10 week. Instruct the patient to always keep the arm upright or semi-vertical, so that the arm bone can always be stretched, to have a weekly X-ray check for the first 3-4 weeks. Limitations of this method include limb shortening, angular flexion, rotational deformity, delayed bone healing or failure to heal. These complications are common in obese patients who do not cooperate in the treatment process. However, most authors have reported a cure rate of 93-96% when using this method.

Triangular tape

As described by Gilchrist, it is a simple, inexpensive, easy-to-do method, applicable to non-displacement fractures or less displacement for children under 8 years old, or in the elderly who cannot tolerate other methods. A variety of different types of wedge pads can be used in the armpit to correct the angular bend of the fracture

Coaptation splint (Coaptation splint)

Indicated in the new fracture, temporary initial treatment, in cases of non-displacement fractures or less displacement, cases of patients who cannot tolerate the suspended arm cast. The dough hugs the armpits wraps around the Delta muscle mass and hugs the elbows. The advantage is that the hands and wrists move freely, the elbows can move apart. The downside is uncomfortable stimulation of the armpit, often healing the bones with slightly angled positions or a little short of the limbs, the patient is uncomfortable.

Shoulder arm chest powder

Powder hugging the chest, shoulders and arms, arms in a posture, the advantage is relatively immobile arm, but is rarely used because it is too heavy and uncomfortable for the patient, it also limits shoulder movement and Hands in long posture are very uncomfortable. Today, the dough is replaced by a lighter and more convenient abduction splint.

Arm embracing

As the most modern conservative treatment, initiated by Sarmiento in 1977. The cuff only embraces the arm body and is pressed by hydraulics. This method represents excellence in conservative treatment without fracture of the limb trunk. Indicated when the bruise is gone (previously immobilized by one of the above techniques), the patient is instructed to let the arm run down the torso as much as possible. When the patient reaches 90 by himself, the media can be removed. The advantage is that it allows movement of the entire upper limb, the rate of bone healing is reported to reach 96-100%.

Surgical treatment

Includes the following techniques:

External fixed

Indicated in open fractures, with skin and software defects, multi-fragment fractures in patients with early motor needs, patients with fractures with burn injuries in other areas need skin transplantation, or inpatient with a unilateral forearm fracture.

Surgery combined with a screw brace

Application of AO / ASIF (Arbeit gemeinschaft Fur Osteosynthesefragen / The Association for the Study of problems of Internal Fixation) technique gives good results. However, there may be infection, spinal nerve palsy or sometimes a bone combination that fails.

Crucifixion

Indicated in cases of orthopaedic failure, the middle third of bone fracture, fragmentary fracture, old fracture without healing, pathological fracture, cross or torsion fracture, in the multi-traumatic patient. Contraindicated in fracture with nerve damage, grade III open fracture.

Symptoms

Rotating nerve paralysis

Meeting 18% of algae closed body and arm bones, of which 90% are functional paralysis (neurapraxia), patients usually recover spontaneously after 3-4 months. Transient or mechanical rotational nerve paralysis is common after transverse or short cross fractures of the brachial limb. Rotating nerve transverse fractures are common in open fractures, fractures associated with puncture wounds and has historically been referred to as far arm fractures (Holstein-Lewis fractures). Transient paralysis of the anterior CNS, medial nerve and the cylindrical nerve is rare if any, it recovers spontaneously after 10 weeks. Medial palsy associated with fibroids on the staphylococcus, it is necessary to release the related fibres to improve paralysis completely.

Can bone bad posture

Usually, 20-30 0 angle folding or 2-3 cm short limbs leave little sequelae. The wide range of motion of the shoulder reduces the impact of bad cans due to rotation, and even larger distortions are adapted to a negligible mechanical limitation. Cosmetic problems are seldom considered as an indication for surgery. When indicated for surgery, osteotomy and the strong bone combination will bring about satisfactory results.

No bone healing

2-5% in patients on conservative treatment and 25% in patients receiving surgical treatment at the beginning. No bone healing is more common in open fractures, fractures due to high-speed trauma, fractures with fragments, fractures that are not well manipulated, fractures that are operated but not immobilized. Favourable factors are pre-existing shoulder or elbow stiffness, poor software coverage, the patient is obese, has metastatic cancer, alcoholism leads to osteoporosis, is being treated with corticosteroids, or has multiple injuries.

The infection does not heal the bone

The direct relationship between immobility and infection, especially in open fractures. Immobilization, thorough cutting of dead tissue including bone, cleaning the wound and systemic antibiotic therapy will lead to bone healing in most cases. Putting antibiotic beads or injecting antibiotics in place is sometimes necessary to get the root of the infection under control. Immobilization with an endoscopy or a screw brace is contraindicated during an infection but can be used once the infection is gone.

Does not heal bone with bone defect

When a bone fracture occurs with bone defect above 5cm, surgery is required. It is recommended to have a thick spongy bone graft with a shell or a bone graft with a stem. The technique involves removal of fibrous tissue, dead tissue including the ends of the bone, re-opening the canal at both ends of the bone, inserting the grafted bone between the fractured ends and immobilizing it firmly.

Vascular complications

It is seen in closed fracture, or an open fracture, fracture due to guillotine or fire. If the vascular injury is suspected or in fractures with a high risk of vascular damage, an artery should be taken to locate the lesion to restore it. The restoration of blood vessels is considered an absolute indication in cases of bone immobilization with a brace or external fixation. In most cases, fracture immobilization is performed prior to vascular surgery, and amputation in the arm, forearm or hand is sometimes needed after blood flow has been re-established.

Preventive

Propaganda and education in the community about traffic and labour laws.

It is necessary to educate students in elementary schools about the causes of fractures in order to limit accidents occurring in daily life and in schools.

It is necessary to educate the community to provide good on-the-spot first aid in fracture cases to limit complications in fracture and to restore function after a fracture treatment.

The grassroots health facilities need early diagnosis and correct handling of arm fractures.