Forearm volar compartment incision decompression

Forearm volar fascia decompression for the surgical treatment of complications of supracondylar fracture of the humerus. 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 Forearm volar fascia decompression is suitable for: 1. When the supracondylar fracture of the humerus combined with neurovascular injury, the edema and ischemic lesions of the muscle tissue in the forearm fascia can continue to develop after the elbow incision decompression and treatment of the radial artery injury. Incision of the periosteal compartment decompression can block the edema-ischemic malignant circulation of the forearm. 2. The supracondylar fracture of the humerus is closed and reset, and after plaster or splint fixation, there are signs of early forearm compartment syndrome, such as severe swelling of the forearm, skin sensation and finger pain. Preoperative preparation Regular preoperative examination. Surgical procedure 1. Incision in the humerus to the ulnar styloid process on the side of the line, take the proximal 2 / 3 to make a longitudinal skin incision. 2. Cut the skin and subcutaneous tissue, and release them to the sides. The deep fascia is cut longitudinally, and the ulnar wrist flexor and the superficial flexor muscle are separated and pulled to the sides to reveal the ruler indicated by the deep flexor. Exercise, vein and ulnar nerve, be careful not to damage. In addition, the superficial flexor and the deep flexor are separated, and the median nerve running deep in the superficial flexor is explored. If the blood supply to the muscles has returned to normal, only the full-thickness of the skin is sutured. If the muscle is grayish white, indicating that the muscle is still in an ischemic state, the deep fascial incision should be enlarged. If necessary, a part of the deep fascia can be removed to relieve the pressure in the entire fascia. The skin incision is not sutured, and it is reserved for the second stage suture or Skin grafting.

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