Lateral humeral condyle fracture

Introduction to the fracture of the external humerus The external humeral fracture refers to the intra-articular fracture of the humeral head or the external humerus with the humeral head and part of the trochlear epiphysis. Because some of the patients are only the radial fracture of the humerus, it is also called the humerus. Small skull sputum separation. The external humerus fracture is more common than the internal malleolus fracture. It is a common elbow joint injury in children. It is more common in children aged 5-10 years. The incidence rate is slightly lower than that of the supracondylar fracture of the humerus. The external iliac crest contains non-articular surface (including the upper part).) and the articular surface, the forearm extensor muscles attached to the external iliac crest. After the fracture of the external iliac crest, the fracture block can be displaced to varying degrees due to the stretching of the extensor muscle group. basic knowledge The proportion of illness: 0.001% Susceptible people: more common in children aged 5-10 Mode of infection: non-infectious Complications: elbow valgus deformity

Causes of external humeral fractures

Indirect violence factor (75%):

The disease is caused by indirect violence. When the child falls, the hand touches the ground first. The external force causes the fracture along the humerus and the external iliac crest. The fracture line extends from the inside to the outside and then extends. The fracture block can include the humerus. The small skull of the humerus, the lateral part of the trochlear and a part of the metaphysis of the humeral head, according to the displacement of the fracture block, can be divided into three types: non-displaced fracture, mildly displaced fracture and inverted displaced fracture. .

1 no displacement fracture: the effect of violence is small, only fractures, such as fractures or fractures of the external humerus fractures.

2 mildly displaced fracture: the fracture block is displaced outward, or there is a rotational displacement within 45, and the fracture block is still located between the small head of the humerus and the proximal fracture surface of the humerus.

3 Flip-displacement fracture: Flip-displacement fracture can be divided into backward-shifting type and forward-shifting type, and backward-shifting type is also called extension-flip-type. This type is relatively common; Known as the buckling flip type, this type is rare.

Pathogenesis

The fractures of the external humerus are caused by indirect violence. For example, when the palm of the hand falls, the humeral head and the external iliac crest (the humeral head) collide with each other and the violent contraction and traction of the forearm extension muscles cause fracture and displacement of the external malleolus. In fact, the impact is not only the humeral head, but the ulnar coronoid process also participates in the impact. Therefore, the fracture block is a sacral iliac crest containing half of the trochlear. Because the position of the elbow joint at the moment of injury is different, the direction and size of the bone block displacement are obvious. Differently, the severity of displacement is closely related to external force and muscle traction. When the forearm extension finger tendon origin and the periosteum above the fracture end are not completely broken, the fracture block is only displaced to the outside without rotation, when the joint is inside. When the position is closed, the fracture block may be completely separated and displaced forward and downward. The contraction of the extensor muscle may cause the fracture block to be further displaced and rotated, and may be turned outward by 90° and turned 90° backward.

Prevention of external humeral fracture

1, the disease is caused by traumatic factors, no effective preventive measures, usually pay more attention to production and life safety, to avoid injury is the key.

Complications of the external malleolus fracture Complications elbow valgus deformity

The disease may be complicated by the following complications:

(1) Elbow valgus deformity: Injury of the epiphyseal plate of the temporal humerus at the distal end of the tibia can lead to early closure, resulting in uneven development of the distal radius and elbow valgus, and the distal end of the humerus is a fishtail deformity.

(2) ulnar neuritis or paralysis: ulnar neuritis can be caused by the pulling of the elbow valgus deformity or the impact of the ulnar olecranon on the ulnar nerve.

(3) Fracture nonunion The non-healing factor of the fracture is the formation of local fiber connection after the fracture is displaced. Therefore, if the fracture is displaced within 2 weeks, it should be treated with open reduction and treatment. Do not wait for the nonunion to be operated again. In order to avoid surgery difficulties and dysfunction.

(4) delayed onset ulnar neuritis ulnar nerve palsy, multiple secondary to elbow valgus, long-term traction caused by ulnar nerve, in addition to attention to correct valgus deformity, when the ulnar nerve stimulation signs should be made ulnar nerve Forward surgery.

External humeral fracture symptoms Common symptoms Elbow dislocation elbow joint can not flex elbow valgus angle increase simple fracture

The outer side is swollen and gradually spread, which can cause the whole joint, the fracture and dislocation type of swelling is the most serious, the ecchymosis occurs on the outer side of the elbow, and gradually spreads to the wrist. The skin appears blisters 2 to 3 days after the injury, the lateral elbow is tender, and even the tibia can occur. Tenderness around the lower end, displaced fractures, may touch bones and active bones, elbow valgus deformity, elbow widening, three points behind the elbow change, elbow joint activity loss, pain increased during passive activities, The rotation function is generally not limited.

The violence that causes the fracture of the external humerus is similar to the violence that causes the supracondylar fracture of the humerus. In addition, the ulnar varus is caused by the violence. According to the displacement and degree of the fracture block, it is divided into 4 types.

Type I: There is no displacement of the external humerus fracture.

Type II: The fracture block is displaced to the lateral rear side but does not rotate.

Type III: The fracture block is displaced to the outside, and is turned backwards and backwards. In severe cases, it can be inverted by 90° to 180°, but there is no change in the ulnar joint.

Type IV: displacement of the fracture block with dislocation of the elbow joint.

Examination of the fracture of the lateral malleolus

The auxiliary examination method for this disease is mainly X-ray examination:

X-ray examination performance: X-ray photograph shows that the fracture line of the humeral head is more than 1/2 of the nucleus of the nucleus, or does not pass through the small nucleus, but the cartilage of the humeral head and the sliding chamber is at the metaphysis There is a fracture line, the fracture block can be displaced to the lateral side, the fracture and dislocation type X-ray film, the positive position piece shows that the fracture block and the ulnar and metatarsal bone can be displaced to the temporal or ulnar side, and the lateral position piece can be displaced to the posterior side, even It can be seen that the forward displacement, the external humeral fractures on the X-ray film are diverse, and the performance of the same fracture type is also often different.

In addition to positive, lateral X-ray film, should also be based on the injury to shoot a special body phase, such as the opening position (upper cervical spine injury), dynamic lateral position (cervical vertebra), axial position (scaphoid, calcane, etc.) and For tangential position (tibia), complex pelvic fractures or suspected intraspinal fractures, orthodontic or CT examination should be performed as appropriate.

Diagnosis and diagnosis of external humerus fracture

diagnosis:

Traumatic history, elbow pain, swelling, elbow flexion, elbow lateral limitation or extensive tenderness, bone rubbing.

Adult X-rays can show the fracture line and type. X-ray photographs show that the fracture line of the humeral head is more than 1/2 of the nucleus of the nucleus, or the cartilage of the sacral head and the slippery sulcus. There is a fracture line at the metaphysis end. The fracture block can be displaced to the lateral side. The fracture and dislocation type X-ray film shows that the fracture block and the ulnar and metatarsal bone can be displaced to the temporal or ulnar side, and the lateral position piece can be displayed backward. Lateral displacement, even visible forward displacement, humeral external malleolus fractures on the X-ray film showed a variety of manifestations, the performance of the same fracture type is also often different.

Differential diagnosis

1, fractures on the jaw.

2. The lower part of the humerus is separated.

3, due to children's osteophytes insufficiency, especially in children under 2 years of age, should pay attention to the separation of the lower part of the humerus and the separation of the humeral small skull sputum: 1 the lower end of the humerus is characterized by general swelling of the elbow joint and peripheral tenderness The shape is similar to the supracondylar fracture of the humerus or the dislocation of the elbow joint. The triangle relationship between the elbow and the posterior elbow is normal. The triangular relationship of the lateral humeral fracture with dislocation is abnormal. The lower end of the humerus is separated. The X-ray film shows that the dry end has a thin strip. The fracture piece or the lower end of the humerus has a triangular bone piece. The external humerus of the humerus is accompanied by the same rule. The humerus is displaced inward and backward. The corresponding relationship between the small head of the humerus and the small head of the humerus is normal. The separation of the small skull of the humerus is accompanied by displacement or rotation. The corresponding relationship between the humeral head and the humeral head is abnormal, and further identification should be performed intra-articular angiography. The contrast agent is confined in the elbow joint cavity for the lower end of the humerus.

X-ray examination can be used to identify, for difficult to distinguish cases, CT examination can be used to help diagnose.

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