Open reduction and internal fixation of radial and ulnar diaphysis fractures

In addition to the length of the forearm, the ruler and the tibia also constitute the ankle joint, the ankle joint, the wrist joint, and the upper and lower scales and ankle joints. Except for the extensor and flexor muscles of the forearm, the biceps and supinator muscles of the supinator muscle stop at the upper third of the tibia; the pronator and the anterior muscle of the pronator muscle stop at 1/3 of the tibia and the lower 1/4 of the tibia. In addition to the above-mentioned muscles and joints, the ulna and the tibia can be flexed and flexed, and the tibia can be rotated around the ulna. Because the function of the ruler and the tibia is complicated and important, the treatment policy of the fracture should be anatomical reduction, strong fixation, prevention of complications, and early recovery of function. Therefore, the indications for open reduction of the ulnar and humeral shaft fractures are: 1. Closed reset failure Or manually reset the external fixation and then shift. 2. The fracture has been 1 to 2 weeks, and there are still severe displacements. Treatment of diseases: humeral head fractures, ulna and ulna styloid fractures Indication In addition to the length of the forearm, the ruler and the tibia also constitute the ankle joint, the ankle joint, the wrist joint, and the upper and lower scales and ankle joints. Except for the extensor and flexor muscles of the forearm, the biceps and supinator muscles of the supinator muscle stop at the upper third of the tibia. The pronator and the anterior muscle of the pronator are stopped. 1/3 of the tibia and the lower 1/4 of the tibia. In addition to the above-mentioned muscles and joints, the ulna and the tibia can be flexed and flexed, and the tibia can be rotated around the ulna. Because the function of the ruler and the tibia is complex and important, the treatment strategy for the fracture should be anatomical reduction, strong fixation, prevention of complications, and early recovery of function. Therefore, the indications for open reduction of the ulnar and humeral shaft fractures are: 1. Close reset failure or manual reset after external fixation. 2. The fracture has been 1 to 2 weeks, and there are still severe displacements. Preoperative preparation 1. Position: The position is different due to the location of the fracture. The general requirements are: 1 to facilitate surgical exposure and operation. 2 does not hinder the surgical reduction of the fracture. 3 patients are comfortable. For example, the open reduction of the posterior dislocation of the hip joint, when the posterior approach is used, the prone position can be used, but the prone position will hinder the hip traction during the reduction, so it is better to use the lateral or lateral prone position. In addition, when tissue transplantation is performed to repair tissue defects, two groups of people are often required to perform surgery at the same time. At this time, the position and consideration should be considered for the needs and convenience of the donor and recipient surgery. 2. Incision: Requirements for selection of incision site: 1 Full exposure, easy operation, less damage, less bleeding, and scar does not affect function after healing. 2 Do not choose the area under the skin that has bones or bone protrusions to avoid adhesion and pain in the future. 3 The incision is best not to pass the joint. When it is necessary to pass the joint, a squat-shaped incision should be used to prevent the scar from contracting and affecting the joint function. 3. Expose the fracture end: According to a certain exposure route, cut the skin, subcutaneous tissue and fascia, separate the muscles along the muscle gap or cut the muscles and reach the periosteum. The periosteum is cut and subperiosteal is separated to reveal the fracture end. The exposure process should be observed as follows: 1 Enter as much as possible from the muscle gap. In this way, the anatomical level is clear, the damage is small, the bleeding is small, the surgical field is clear, and the nerves and blood vessels are not easily injured. 2 Try to keep the soft tissue and periosteum in contact, and maintain the blood supply to the fracture end as much as possible. 3 As long as the range of the exfoliated membrane can meet the reduction and internal fixation, do not peel too much, so as not to damage the blood supply at the fracture end and affect the healing. 4. Treatment of the fracture zone: Treatment of the fracture zone includes: 1 removal of clots and damaged tissue. 2 The broken bone fragments connected with the soft tissue should be preserved in principle. The free small bone fragments or bone fragments should be removed. The completely free large bone fragments should not be removed. It should be reset and fixed to avoid bone defects (large broken bone fragments for open fractures). Wash with physiological saline, then immerse in 1:1000 Xinjie and let liquid for 5 to 10 minutes and then reset). 3 The soft tissue embedded between the two fracture ends should be loosened and reset. 4 The fracture of the fresh fracture does not need to be trimmed, but for the old fracture or the fracture is not healed, the end of the fracture should be trimmed with a bone knife, cut into a new wound, and drilled through the marrow cavity. 5. Fracture reduction: generally under direct vision, using instruments and techniques. Slight overlap and lateral displacement, can be inserted between the fracture ends by periosteal stripper, use the lever to open the fracture end, while the assistant gently pulls the distal end of the limb and corrects the rotation into angular displacement, the surgeon uses The finger or another periosteal stripper corrects the lateral displacement. More obvious overlap shift and side shift. After the two assistants' manual traction and reverse traction correction overlap shift and rotational shift, the two fracture ends were clamped with a rongeur after surgery, and the force was reversed to correct the lateral shift. Bit. Old displaced fractures can be adjusted gradually by means of a fracture reduction device. 6. Internal fixation or bone grafting: In addition to severely contaminated and open fractures of more than 12 hours, internal fixation is usually performed at the same time as open reduction (see internal fixation). After 2 weeks of fractures, old fractures, and fresh fractures with poor blood supply and difficulty in healing, bone grafting should be performed at the same time as open reduction to promote fracture healing. 7. Stitching: Completely stop bleeding, and after suspending the wound, suture layer by layer. If the incision is large and the bleeding is more, the negative pressure drainage should be performed. Surgical procedure 1. Position: supine position, upper extremity abduction or placed on the chest. 2. Incision and exposure: Two incisions were used to expose the ankle and ulna respectively. The upper part of the humerus should be exposed to protect the phrenic nerve. . The tibia is usually treated after exposing and treating the ulna. 3. Reduction and internal fixation of the ulnar fracture: After the end of the ulnar fracture, the surgeon used the periosteal stripper to open the fracture end for reduction. Then, according to the intramedullary nail retrograde needle insertion method, the Kirschner wire was drilled into the medullary cavity by hand and fixed. If it is a 1/3 horizontal fold on the ulna, it can also be fixed with an intramedullary nail. If the ulna is obliquely folded, or a spiral fracture, the fracture end is unstable and easy to be displaced, it can also be fixed with a steel plate. Generally, the middle and upper 1/3 of the ulna are fractured. The plate is best placed on the posterior side of the ulna. The lower third of the fracture is placed on the anterior side of the ulna, so that the plate has soft tissue coverage. After the ulnar fracture was fixed firmly, the wound was covered with gauze, and the internal fixation of the tibiofibular fracture was performed. 4. Reduction and internal fixation of the humeral shaft fracture: The humerus is essential in the rotation of the forearm. Therefore, the reduction of the humeral shaft fracture requires not only an anatomical reduction, but also the restoration of the convex curvature to the temporal side. When resetting, not only traction and squatting are required, but also the forearms are placed in different positions according to different parts of the fracture. The elbow joint is first flexed to relax the muscles. When the humeral shaft is fractured in the upper third, the proximal segment is rotated due to the pulling of the biceps and supinator muscles, and the distal segment should be placed in the supination position for easy reduction. For the 1/3 or lower 1/3 fracture of the humeral shaft, the proximal segment is in the neutral position of rotation due to the traction of the pronator and the supinator, and the distal segment should also be placed in the middle to facilitate the reduction. If the operation is as described above, if there is still difficulty in the reduction, the fracture of the ulna should be checked for the reduction of the fracture of the tibia and the displacement occurs. If there is a shift, it should be re-reset and then fixed with a bone holder, and then the reduction of the tibial fracture. After the tibia is correctly aligned, use a prepared automatic compression plate or ordinary steel plate to bend into a certain arc to conform to the shape of the tibia and fix it with screws. Anatomically, the upper 1/3 of the humerus is bent outward, and the lower 1/2 is bent inward to form an arc that is convex toward the temporal side. If the curvature is broken, it will affect the rotation function of the forearm. Therefore, the steel plate should be placed in front of the tibia. 5. Bone graft: delayed or non-union of fracture, or old fracture, or 1/3 of the ulna or fracture of the middle and lower third of the humerus, bone graft should be applied, and the graft bone should be taken from the tibia. It is best to implant bone in the medullary cavity. If a broken bone graft is used, the broken bone piece can be placed on the front, back and side of the fracture site to avoid breaking the bone piece between the ruler and the tibia to prevent cross healing. After the bone graft is completed, suture layer by layer.

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