Wrist scaphoid fracture

　　This disease is often caused by indirect violence. Falling with the palm of the hand touching the ground, the wrist is strongly extended, slightly radial deviation, and the scaphoid is cut off by the radial side edge of the radius.

　　Indirect violence: Fractures occur at a location far from the site of direct violence, rather than at the site where the violence is directly applied. Fractures are caused by the transmission, lever, or rotational action of violence. For example, an elbow fracture above the humeral condyle is caused by the patient slipping and falling while walking, supporting the ground with the palm, and the violence transmitted to cause a fracture above the elbow joint.

　　During wrist scaphoid fractures, the blood supply to the proximal fractured segment of the scaphoid is blocked, which is prone to bone resorption and necrosis, causing delayed healing or nonunion of fractures.

　　1. Fracture with fresh displacement and instability Fracture displacement exceeding 1mm is considered to be an unstable scaphoid fracture with displacement, because this type of fracture usually involves ligament and vascular injuries, with a high risk of complications, and surgical treatment is often chosen.

　　2. Nonunion Due to the anatomical characteristics and adjacent relationships of the scaphoid bone itself, the risk of misdiagnosis or missed diagnosis after fracture, and improper treatment and fixation, delayed healing or nonunion of fractures often occurs.

　　3. Osteonecrosis The incidence of ischemic necrosis of the scaphoid bone is closely related to the location of the fracture and the degree of displacement. The ischemic necrosis rate of the distal bone block in lumbar fractures is over 30%, while the ischemic necrosis rate in proximal fractures is almost 100%.

　　After injury, there is local swelling, pain, limited wrist joint movement, and increased pain. There is tenderness at the nasopharyngeal fossa and scaphoid tubercle, and there is percussion pain along the metacarpal heads 2 and 3.

　　To prevent wrist injuries and falls, it is also necessary to actively treat to prevent the occurrence of complications. Osteoporosis is prone to occur in the elderly. In addition, long-term high-salt, high-protein diet, smoking, drinking, lack of exercise, insufficient sun exposure, long-term liver and kidney diseases, hypertension, diabetes, long-term use of corticosteroids, anticancer drugs, diuretics, and other factors can lead to calcium loss in the human body, causing osteoporosis. In daily life, even minor collisions or falls can cause fractures, known as osteoporotic fractures. Fracture sites are commonly found in the proximal femur, spine, and distal radius.

　　The examination of this disease mainly includes a comprehensive physical examination and X-ray examination:

　　1. Comprehensive physical examination should pay attention to whether there is shock, soft tissue injury, bleeding, check the size, shape, depth, and contamination of the wound, whether the end of the bone is exposed, whether there is nerve, vascular, cranial, visceral injury, and other fractures. For severe injured personnel, rapid treatment must be carried out.

　　2. The method of wrist scaphoid mobility test: the patient's wrist joint on the affected side is passively ulnar deviated, the examiner holds the patient's wrist with one hand, uses the thumb to compress the scaphoid tubercle, and the other hand holds the patient's palm to gradually turn the wrist towards the radial side. If the wrist pain is severe, it is positive.

　　2. X-ray examination, in addition to the anteroposterior and lateral X-ray films, should also take special position films according to the condition of the injury, such as the opening position (upper cervical injury), dynamic lateral (cervical vertebrae), axial (scaphoid, calcaneus, etc.), and tangential position (patella) and so on. For complex pelvic fractures or those suspected of having intraspinal fractures, a tomography or CT examination should be considered.

　　Firstly, what foods should fracture patients eat that are good for their bodies:

　　The growth of bones requires collagen, calcium, phosphorus, as well as vitamin C and D, which are essential for bone formation. Therefore, after a fracture, these substances should be supplemented, especially for the elderly.

　　1. High-energy, high-protein diet:

　　It is helpful for recovery, but it is advisable to eat it after 2 weeks after a fracture. In the early stage of fracture, light diet should be preferred.

　　2. Vitamin D:

　　If fracture patients have been indoors for a long time without exposure to the sun, they are prone to a lack of vitamin D. Therefore, after a fracture, it is necessary to eat more foods rich in vitamin D (such as fish, liver, egg yolks, etc.) and try to get more sun exposure as possible.

　　3. Vitamin C::

　　Fruits rich in vitamin C include hawthorn, fresh jujube, kiwi, strawberry, longan, lychee, tangerine, etc., and vegetables include yellow clover (grass head), chili, bell pepper, rapeseed, cauliflower, kohlrabi (soup vegetable), bitter melon, watercress, green cauliflower, and green amaranth, etc.

　　4. Water:

　　Due to prolonged sitting and inactivity after a fracture, constipation is easy to occur, and at this time, more water should be drunk to ensure the smooth passage of the intestines.

　　Two weeks after a fracture, dietary supplements can include bone broth, Cordyceps chicken soup, animal liver, etc., to provide more vitamin A, D, calcium, and protein. After 5 weeks of fracture, the diet can be further supplemented with old hen soup, pork bone soup, sheep bone soup, deer tendons soup, stewed fish, etc. Those who can drink can choose Du Zhong bone shattered tonics, chicken blood vine wine, and tiger bone papaya wine, etc.

　　Secondly, what should fracture patients avoid eating:

　　1. Bone broth:

　　Many people believe that bone broth can replenish calcium, but the calcium in the bones cannot be absorbed directly by humans. The main nutrients in bone broth are collagen, and eating more collagen is beneficial to fracture patients, but it is not advisable to eat too much in the first 1-2 weeks after a fracture due to its richness, which may cause blood stasis and affect recovery.

　　2. Calcium supplementation:

　　Although calcium is an important component of bones, supplementing calcium does not benefit the treatment of fractures and may even cause an increase in blood calcium levels. Fracture patients who do not lack calcium should only strengthen functional exercises to promote the absorption of calcium by the body, accelerate the healing of broken bones, and should not blindly supplement calcium.

　　3. Indigestible Foods:

　　Due to long-term home rest and swelling and pain at the injury site, the appetite of fracture patients is often poor. Eating too much nutritious and greasy food not only makes the taste worse but can also cause constipation. Therefore, after a fracture, it is recommended to eat more foods that are easy to digest and defecate, and avoid foods that are easy to cause flatulence or are difficult to digest, such as taro, taro, glutinous rice, etc.

　　4. Sugar:

　　Excessive consumption of sugars after a fracture can lead to significant calcium loss, which is unfavorable for the recovery of fracture patients. Excessive white sugar can also reduce the content of vitamin B1 in the body. Insufficient vitamin B1 will greatly reduce the activity of nerves and muscles, affecting the recovery of function.

　　5. Sanqi Tablets:

　　Taking Sanqi tablets in the early stage of a fracture can constrict local blood vessels and treat fracture hemorrhage. However, after one week of fracture recovery, the bleeding has stopped, and the injured area needs fresh blood supply to quickly recover. If Sanqi tablets are still taken at this time, it will cause the blood vessels to remain in a state of constriction, leading to poor blood circulation and being unfavorable for fracture healing.

　　1. Fresh Fractures:For fresh navicular bone fractures or fractures that have exceeded a month, the principle of treatment is strict immobilization. Generally, a short arm cast is used. The range of immobilization extends from below the elbow to the distal palmar transverse crease, including the proximal phalanx of the thumb. During the immobilization, it is necessary to persist in finger functional exercises to prevent joint stiffness. Lumbar fractures are immobilized for 3 to 4 months, sometimes half a year or even a year, with regular radiographs every 2 to 3 months. Fractures at the tubercle are immobilized for 3 to 4 months.

　　2. Old Fractures:For those with asymptomatic or mild pain, treatment is not required initially, and wrist joint activity should be appropriately reduced. Follow-up observation of those with obvious symptoms but no ischemic necrosis can continue with plaster fixation, which often requires 6 to 12 months to heal. For those with bone nonunion or ischemic necrosis, surgical methods such as bone drilling and bone grafting, radial styloidectomy, or proximal bone block resection are adopted according to the situation. The nutrient vessels of the navicular bone mainly enter from the tubercle and the lateral middle part. Most of the navicular bone is covered with cartilage, without periosteum attachment. Fractures rely on internal callus for union, and the fracture damage to the nutrient vessels can lead to avascular necrosis at the proximal end due to ischemia. Clinically, there is a lack of satisfactory treatment methods for this condition.