Open reduction and internal fixation of surgical neck fractures of humerus

An orthopedic surgery for the treatment of surgical neck fracture of the humerus. After surgically cutting the affected area, the fractured humeral surgical neck is fixed with a steel nail. The internal fixation is very accurate and firm, and it is easy to recover from the fracture end. Treatment of diseases: surgical neck fracture of the humerus Indication In the elderly, the surgical neck fracture of the humerus is easy to stimulate the inflammation around the shoulder joint after surgery, and the function recovery is poor. The operation should be carefully considered. Other indications are as follows: 1. Displacement of the obvious adductor-type fracture, the joint capsule or biceps tendon is sandwiched between the two fold ends, hindering the manual reduction. 2. There are displaced abduction fractures, complicated by large nodular fractures, and broken bone pieces embedded under the shoulders, affecting the abduction function. 3. There are displaced adduction fractures, abducted fractures or osteophyte fractures, and those who fail to reset the procedure. 4. The fracture has been 2 to 4 weeks, but the person who is not satisfied with the reduction. 5. Surgical neck fracture of the humerus combined with dislocation of the humeral head. 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 1. Position: supine position, the shoulder of the injured side is 30° high. 2. Incision, exposure: use the anterior side of the shoulder joint to reveal the way, cut the skin in a curved shape. Separate from the deltoid and pectoralis major muscles and pull the deltoid muscle outward to reveal the anterior side of the shoulder joint. Then, the biceps tendon is separated upwards to reveal the fracture end. 3. Fracture reduction: The proximal segment of the fracture is mostly external rotation and abduction, and the distal segment of the fracture is adducted and displaced upward. Therefore, the assistant should pull the injured limb downward and rotate the upper arm to align with the internodal groove. The surgeon uses the periosteal stripper to insert the fracture end and open it, and use the lever to restore the fracture end [Fig. 1 (1)]. If there is difficulty in resetting, especially for the wounded in the evening of medical treatment, the surrounding tissue should be properly separated, and the scar and callus between the two fold ends should be removed before resetting. After the reset, the assistant continues to pull, or clamp the fracture end with a towel clamp to maintain the alignment. 4. Internal fixation: After the reduction, 1 or 2 screws or steel needles can be used, and the lateral part of the tibia is 2 to 3 cm below the fracture line, and the humeral head is inserted obliquely. If the fracture is unstable, a person can be displaced after a little activity. Part of the deltoid muscle should be cut off, and the large sacral nodule should be exposed, and the appropriate length of intramedullary nail should be selected [Fig. 1 (2)]. If the humeral skull is separated, it should be fixed with 1 or 2 Kirschner wires to reduce the damage to the epiphysis. 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.

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