Flexion of wrist and fingers

Introduction Patients with humeral fractures of the upper tibia have limited elbow joint activity, forearm pronation, flexion, and weakness. The internal humeral fracture is the most common type of elbow injury, accounting for about 10% of the elbow fracture, second only to the supracondylar fracture of the humerus and the external humerus fracture, accounting for the third place in the elbow injury. Fractures occur mostly in teenagers and children. In this age group, the upper iliac crest is a callus, which has not been fused with the lower end of the humerus, so it is easy to avulse, which is called avulsion fracture of the upper humerus.

Cause

(1) Causes of the disease

Often caused by falling or throwing sports.

When the elbow joint falls straight, the hand supports the ground, the upper limb is in the outreach position, the valgus stress causes the elbow joint to valgus, and the forearm flexor muscle group suddenly contracts, the inner upper jaw is avulsed, and the upper upper jaw is a closed comparison. Late epiphyses, the squall line itself is a potential weakness before it is closed. Therefore, the osteophyte can be separated, pulled down and forwarded, and rotated. At the same time, the medial space of the elbow joint is temporarily pulled apart, or the posterior lateral dislocation of the elbow joint occurs. The avulsed internal epicondyle (bone callus) is clamped in the joint and can be divided into 4 degrees according to the severity of the injury.

I° injury: only fractures or osteophytes are separated and the displacement is minimal.

II° injury: The bone block is displaced downwards and is rotated forward to reach the joint level.

III° injury: The fracture block is clamped in the joint and has a subluxation of the elbow joint.

IV° injury: posterior dislocation of the elbow or posterolateral dislocation, the bone is clamped in the joint.

(two) pathogenesis

The internal humeral fractures of the humerus are common in sports injuries such as falling or throwing on the ground. When the fall, the forearm extends and abducts, and when the forearm flexor contractes fiercely, the upper jaw of the humerus is pulled by the flexor muscles to cause avulsion fracture. The avulsed fracture block is displaced forward and downward and may rotate. Because the elbow joint is placed in the valgus position, the internal axillary avulsion fracture often coincides with dislocation of the elbow joint.

an examination

Related inspection

X-ray lipiodol imaging CT examination of extremities

[clinical manifestations]

Children are more common than adults. After the injury, the soft tissue around the medial and medial epicondyles of the elbow is swollen, or a large hematoma is formed. Clinical examination of the elbow joint isose triangle relationship exists. Pain, especially local swelling of the inside of the elbow, tenderness, and disappearance of the contour of the normal internal palate. Elbow joint activity is limited, forearm pronation, flexion, and weakness. In patients with dislocation of the elbow joint, the shape of the elbow joint was significantly changed, and the dysfunction was more obvious. The symptoms of ulnar nerve injury were often combined. In the case of avulsion fracture of the medial malleolus of the humerus, the medial tissues of the elbow joint, such as the collateral ligament, joint capsule, internal iliac crest and ulnar nerve, can be damaged. The inside of the elbow joint is swollen and painful, and localized subcutaneous can be seen as congestion. The tenderness is limited to the inside of the elbow. Sometimes it can touch the feeling of bone friction. Elbow joint flexion and rotation are limited. The medial epicondyle of the humerus was separated, displaced or rotated from the iliac crest of the lower end of the humerus, and the degree of displacement was judged according to the displacement of the fracture piece. Children with humeral fractures of the humerus are more likely to be confused with the medial malleolus of the humerus and the avulsion fracture of the humerus. Before the humerus of the humerus has not appeared (usually 6 years old), the signs of the ossification center cannot be on the X-ray. The film is shown, the osteophyte line is not closed, which increases the difficulty of differential diagnosis. If necessary, the contralateral elbow joint X-ray film is taken. Detailed physical examination, asking for injuries, combined with age characteristics. Only in this way can we accurately diagnose and select better surgical treatment methods.

X-ray diagnosis is very important and should be carefully observed.

I degree fractures may sometimes be missed, but the following conditions should be considered:

1 When there is a fat pad sign, that is, bleeding or exudate after the elbow injury pushes the fat pad in the coronal socket and the olecranon to an "eight" shape;

2 The epiphysis is not parallel with the metaphysis; 3 the edge of the epiphysis is unclear, especially the thin layer of metaphyseal fractures are found;

4 The inner and outer protrusions of the lower end of the humerus are symmetrical. Because the shape of the inner and outer protrusions of the lower end of the normal humerus is asymmetrical, the inner upper jaw is more inwardly protruding.

III, IV degree fracture should pay attention to the presence of internal humeral condyle. If you have difficulty, you should emphasize the imaging of the lateral or oblique X-ray of the same position on both sides, and observe whether the bilateral joint space is equal width, bilateral internal iliac crest. Whether it is symmetrical. In children under 5 years of age, the ossification center of the upper jaw of the humerus has not yet appeared, so it is more difficult to distinguish it from the fracture of the humerus. In the case of severe injury, attention should be paid to the presence or absence of a humeral head, an olecranon, and an external humeral fracture.

The ulnar nerve travels in the ulnar nerve groove behind the iliac crest. When the fracture occurs, the ulnar nerve may be pulled, smashed, and even inserted into the joint space together with the fracture block, causing ulnar nerve injury.

Type of injury: According to the displacement of the avulsed fracture piece and the change of the elbow joint, it can be divided into four degrees.

I degree of humeral fracture of the upper tibia, mild separation or rotational displacement.

In the second degree of upper ankle fracture piece, the traction displacement is obvious, reaching the level of the elbow joint, and there may be a rotational shift, which is difficult to reset.

At the moment of avulsion of the III degree fracture piece, the valgus violent is large, and the inside of the joint is opened. The fracture piece is embedded in the joint space. The fracture piece is stuck with the joint capsule, such as a button-like joint, which is difficult to rectify. .

IV degree of humeral epicondyle avulsion fracture with elbow dislocation, the most serious injury of internal iliac crest fracture, a small number of ulnar nerve injury.

diagnosis

History of trauma, swelling of the medial elbow joint, pain, subcutaneous congestion and localized tenderness, sometimes touching the fracture piece, X-ray examination can confirm the diagnosis. At the same time, attention should be paid to the presence or absence of other injuries, such as the humeral head, neck, and olecranon fracture.

Differential diagnosis

Fingers can not flex and stretch: Finger flexor tenosynovitis can cause fingers to bend and stretch. Mainly manifested as limited pain in the volar side of the metacarpophalangeal joint and restricted finger movement. As the stenosis of the tendon sheath is aggravated and the tendon is swollen after the tendon is compressed, most of the swelling will be difficult or impossible to slide through the narrow tendon sheath, and the finger stays in the extension or flexion position, and the interlocking phenomenon occurs.

Finger, the extension function of the thumb and ankle is completely lost: it is one of the clinical symptoms of extensor tendon injury in the hand.

The stretching system of the finger is a combination of tendon and fascia, aponeurosis and ligament. Its function and structure are far more complicated than the flexor tendon system. It is called anatomical dorsal aponeurosis, also known as extensor apparatus. ). The interphalangeal joint cannot be flexed: the symptom of the extensor tendon injury is that the interphalangeal joint cannot flex.

Thumb adduction malformation: Clinical manifestations of sacral nerve injury in exercise: When the upper arm sacral nerve is injured, each extensor muscle is extensively sacral, triceps, diaphragm, radial wrist extensor, supinator, and extension Muscle, ulnar wrist extensor muscles and index finger, small finger intrinsic extensor muscles are uniform. Therefore, the wrist is drooping, the thumb and fingers are drooping, the knuckles cannot be extended, the forearm has a pronation deformity, and the thumb cannot be rotated, and the thumb is deformed.

Can not flex to the ulnar side of the wrist and the distal ring of the flexor ring of the little finger: common in the ulnar nerve injury, other symptoms include the injury on the elbow, the ulnar wrist flexor and the deep flexor ulnar side.

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