Traumatology of traditional Chinese medicine: treatment of humeral shaft fracture

1. Manual reduction and external fixation with small splint. This method is suitable for all kinds of humeral shaft fractures, and can generally achieve anatomical reduction or close to anatomical reduction. The splint only fixes the fracture, and the shoulder and elbow joint can still move, which not only ensures the function of the shoulder and elbow joint, but also absorbs the stress caused by limb activity, greatly reducing the shear force of limb activity on the fracture site. Unless the broken end of the fracture is separated or clamped by soft tissue, the fracture generally does not delay healing or nonunion.

2. Recovery method

The patient takes a sitting position (children and the elderly can take a supine position). Two assistants are resisting traction along the longitudinal axis of the body. One person pulls up through the armpit with a cloth belt, the other person holds the forearm, and the neutral position pulls down.

Except for transverse fractures with more overlapping displacement, the traction should not be too large, otherwise it will easily lead to excessive traction and separation and displacement. After overlapping displacement correction, the operator holds two fracture segments with both hands and performs reduction according to the fracture displacement.

Upper 1/3 fracture (the fracture line is above the deltoid muscle stop): under the maintenance traction, the operator stands on the affected side, with two thumbs against the distal outer side of the fracture and the other four fingers around the proximal inner side. First, lift the proximal end outward to make the broken end slightly outward at a certain angle, and the thumb can be reset inward from the extrapolated distal end.

Middle 1/3 fracture: Under the maintenance traction, the operator pushes inward with two thumbs against the outside of the proximal end of the fracture, and pulls outward with the other four fingers around the distal end. After correcting the displacement, the operator holds the fracture, and the assistant slowly relaxes the traction, so that the broken ends touch each other, and slightly swings the distal end of the fracture, so that you can hear or touch the rubbing sound of the broken ends, and the sound gradually becomes smaller and the broken ends tend to be stable.

Inferior 1/3 fractures: Most of them are spiral or oblique fractures, which can be corrected by slight traction. Squeeze the two inclined planes tightly and tighten the helicoids, so that there is a little overlap between the two fracture ends, which can increase the contact surface of fracture segments and is beneficial to fracture healing.

3. Splint fixation

* * * Four front and rear splints. The upper13 fracture exceeds the shoulder joint, the lower13 fracture exceeds the elbow joint, and the middle13 fracture does not exceed the upper and lower joints. It should be noted that the lower end of the front splint cannot compress the elbow socket. If the fracture displacement has been completely corrected, a flat pad can be placed on the front and back sides of the fracture site to tightly surround the upper and lower fracture ends. If there is still slight displacement, two-point pressure method can be used to correct it, that is, a paper pressure pad is placed at the distal and proximal fracture ends, and the placement position is the same as that collected by HKUST website. If the proximal fracture segment is inward and forward, the pressure pad should be placed on the front inner side and the distal folded end should be placed on the rear outer side. If the lateral displacement is large and angular, three-point compression method can be used, that is, in addition to direct compression at the upper and lower fracture ends, a third pressure pad can be placed inside the distal end of the fracture to realize indirect compression.

4. Preventive measures

The paper pad should not be too thick to prevent the skin from being compressed and necrotic.

No pressure pad can be placed in the groove of radial nerve to prevent the radial nerve from being paralyzed by compression.

5. Polisel's therapy

After fixation, the elbow joint should be flexed 90, the forearm should be placed in a neutral position with a wooden support plate, and the affected limb should be hung on the chest. After 1 week, you can see through 1 ~ 2 times, and then review 1 time every week. The fixed time is about 6 to 8 weeks for adults and 3 to 5 weeks for children. 1/3 fracture is a common part with slow healing and nonunion, and the fixation time should be extended appropriately. X-ray reexamination showed that there was enough callus growth before the fixation could be lifted.

6. Functional exercise

Patients should be encouraged to hold fists frequently after operation, which is conducive to promoting blood circulation and strengthening splint fixation. Patients should have a biopsy as early as possible, clench their fists when collecting active shoulders and elbows on big websites, and keep the fracture site relatively stable. If the broken ends are found to be separated, the operator should press the shoulder with one hand and the elbow with the other hand along the longitudinal axis, so that the broken ends of the fracture gradually contact, and the hanging date of the wooden splint should be appropriately extended until the separation disappears and the fracture heals. After the external fixation is released, it can be fumigated with drugs to restore the functional activities of shoulder and elbow joints as soon as possible.

7. Drug therapy

Medication according to the three stages of fracture.