Humerus surgical neck fracture

　　One, Etiology

　　This fracture is mostly caused by indirect violence, such as when falling, the hand or elbow hits the ground, and the force is transmitted upwards along the humerus shaft, causing a fracture; direct violence on the lateral side of the shoulder can also cause a fracture.

　　Two, Pathogenesis

　　The same external force acting on the proximal humerus can cause different types of injuries due to age factors and the varying strength of the bone and joint capsule ligament structures. The normal proximal humerus is composed of relatively dense trabecular cancellous bone. Its strength is greater than that of the joint capsule and ligaments. Therefore, in the youth and middle-aged period, shoulder外伤 is more prone to shoulder joint dislocation, and less likely to occur at the proximal humerus fracture. Unless severe trauma occurs, it can cause severe proximal humerus fracture and dislocation. During childhood, the epiphyseal plate of the proximal humerus is the weakest anatomical part, so外伤 is more likely to cause separation of the proximal humerus epiphysis, and less likely to cause joint dislocation. In middle-aged and elderly patients, the bone density of the proximal humerus decreases, and the bone strength is greatly weakened, so even slight external force can cause a fracture of the external collarbone of the humerus.

　　1. Vascular injury:It is relatively rare for patients with humeral proximal fractures to have vascular injuries. Generally, the incidence of axillary artery injury is the highest. Some reports show that the injury rate in patients with displaced fractures is 4.9%, mostly caused by high-energy injury fractures. Elderly patients are more prone to vascular injuries due to vascular sclerosis and poor elasticity of the vascular wall.

　　After the injury of the artery, a locally expanding hematoma is formed, with obvious pain. The limb may appear pale or cyanotic, with abnormal skin sensation. In some cases, due to collateral circulation, the distal part of the limb still has blood supply. Arteriography can determine the location and nature of the vascular injury. After confirming the diagnosis, it is necessary to perform surgery as soon as possible to explore. Fix the fracture and simultaneously repair the damaged vessels, which can be done by transplanting the great saphenous vein or artificial vessels.

　　2. Brachial plexus injury:The incidence of brachial plexus injury in patients with humeral proximal fractures is 6.1%. Some reports show that it can reach 21% to 36%, with the axillary nerve being most affected, and the suprascapular nerve, musculocutaneous nerve, and radial nerve injuries also occur occasionally. In cases of axillary nerve injury, there is a loss of skin sensation on the lateral side of the shoulder, but the measurement of the contraction of the deltoid muscle fibers is more accurate and reliable. When the axillary nerve is injured, electromyography can be used to observe the progress of nerve injury recovery. The vast majority of cases can recover function within 4 months. If there is no sign of recovery after 2 to 3 months after the injury, early nerve exploration can be performed.

　　3. Chest injury:In cases of humeral proximal fractures caused by high-energy trauma, multiple injuries often occur, so attention should be paid to exclude rib fractures, hemothorax, pneumothorax, and other conditions.

　　Humeral surgical neck fractures seriously affect patients' daily lives, so they should be actively prevented. However, there is currently no effective preventive method for this disease, so early detection and early treatment are of great significance for the treatment of the disease.

　　1. Plain X-ray of the bones and joints of the limbs.

　　2. Shoulder X-ray examination can confirm the diagnosis:The diagnosis of humeral surgical neck fractures is easy. According to the anteroposterior X-ray of the shoulder, it can show the type of abduction or adduction fractures. There must also be a lateral view (through the chest position) to understand whether the humeral head has rotation, impaction, or anterior and posterior overlapping displacement deformities, in order to clarify whether the fracture ends have forward angulation. It can be divided into three types: adduction or abduction type, extension type, and flexion type.

　　1. Early stage (1-2 weeks): The injured area has ecchymosis and swelling, meridians and collaterals are blocked, and Qi and blood are stagnant. The treatment during this period focuses on promoting blood circulation and removing blood stasis, and promoting Qi flow and dissipating stagnation. According to traditional Chinese medicine, 'If the blood stasis is not removed, the bone cannot grow' and 'If the blood stasis is removed, new bone will grow'. It can be seen that removing blood stasis and swelling is the primary requirement for fracture healing. The principle of diet coordination should be light, such as vegetables, eggs, soy products, fruits, fish soup, lean meat, etc.

　　2. Middle stage (2-4 weeks): Most of the ecchymosis is absorbed, and the treatment during this period focuses on harmonizing the营, relieving pain, removing blood stasis, and promoting new bone growth. In terms of diet, it should be shifted from light to appropriate high-nutrition supplementation to meet the needs of bone callus growth. Bone soup, Cordyceps chicken stew, animal liver, etc. can be added to the initial diet to provide more vitamin A, D, calcium, and protein.

　　3. Late stage (more than 5 weeks): After 5 weeks of injury, the ecchymosis of the fracture site is basically absorbed, and there is already bone callus growth, which is the late stage of fracture. Treatment should be supplemented, promoting the formation of more solid bone callus through the nourishment of the liver and kidney, Qi and blood, and relaxing the tendons and collaterals to allow the adjacent joints of the fracture site to move freely and flexibly, restoring the past function. On the diet, the ban can be lifted, and the diet can be supplemented with old hen soup, pork bone soup, sheep bone soup, deer tendons soup, braised fish, etc. Those who can drink can choose Du Zhong Bone Bruise Wine, Chicken Vine Wine, Tiger Bone Papaya Wine, etc.

　　(Dietary information is shared by netizens, not reviewed by doctors, for reference only.)

　　First, Treatment Principles

　　1. For crack fractures, impacted fractures, or fractures in the elderly, suspend the forearm at 90° in front of the chest for 2-3 weeks. Early functional exercise should be performed.

　　2. For displaced fractures, manipulation reduction and external fixation for 3 weeks. For external rotation fractures, suspend and fix with a triangular bandage in front of the chest, and for internal rotation, use an abduction brace.

　　3. For cases that are difficult to manipulate or not suitable for external fixation, needle牵引 reduction for 3-4 weeks can be performed using the olecranon of the ulna.

　　4. For a few cases where manipulation fails or it is too late for manipulation, timely incision reduction should be performed, using steel plates and screws or Kirschner wires for internal fixation.

　　Second, Principles of Drug Use

　　1. Manipulative reduction of the patient, analgesics or traditional Chinese medicine for blood circulation and stasis can be used when painful.

　　2. Anesthesia and antibiotics should be administered as needed for surgery, and infection prevention.