Humeral head fracture

　　One, Etiology

　　It is mostly caused by strong direct violence.

　　Two, Pathogenesis

　　Similar to the mechanism of injury caused by direct violence to the greater tuberosity of the humerus fracture, that is, the violent force from the side is too strong, which can cause both the greater tuberosity and the humeral head fracture at the same time; or this violence does not cause a greater tuberosity fracture, but continues to conduct inwardly to cause a humeral head fracture, the former fracture is mostly in a粉碎状, while the latter is more common in the form of pressure.

What complications can humeral head fracture easily lead to

1. Vascular nerve injury: The serious complication of humeral head fracture is vascular injury.

2. Ischemic muscle contracture: When the humeral artery spasm or is compressed, the blood supply to the distal part of the limb is severely obstructed. The muscles become edematous due to ischemia. Generally speaking, if the ischemia lasts for 6 to 8 hours or more, muscle necrosis may occur. The necrotic muscle fibers become fibrotic and contract.

　　Humeral head fracture has a significant impact on the patient's daily life, so it 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.

　　Patients with humeral head fracture have diffused swelling of the shoulder joint, with a large range, mainly due to local traumatic reaction and blood clotting from the fracture end accumulating in the shoulder joint cavity. In the diagnosis, in addition to relying on the clinical manifestations, auxiliary examinations are also needed. X-ray examination can determine the diagnosis.

　　1. Early stage (1-2 weeks):The injured part has ecchymosis and swelling, meridians and collaterals are blocked, and Qi and blood are stagnant. At this stage, the treatment is mainly to activate blood and remove blood stasis, and to promote Qi and dissipate. 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 the removal of swelling and blood stasis is the primary task for the healing of fractures. The principle of diet should be light in nature, such as vegetables, eggs, dairy products, fruits, fish soup, lean meat, etc.

　　2. Intermediate stage (2-4 weeks):Most of the ecchymosis has been absorbed. At this stage, the treatment is mainly to harmonize the nutrition, relieve pain, remove blood stasis and generate new blood, and to continue bone and tendons. In terms of diet, it should gradually shift from light to high-nutrient supplementation to meet the needs of bone callus growth. It can add bone soup, Shuanghuanglian chicken, animal liver, etc. 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 at the fracture site has basically been absorbed, and new bone callus has begun to grow, which is the late stage of fracture. Treatment should be supplemented, through nourishing the liver and kidney, and invigorating the Qi and blood, to promote the formation of a stronger bone callus, and to relax the tendons and collaterals, so that the adjacent joints of the fracture site can move freely and flexibly, and restore their former function. Diet can be relaxed, and the recipe can be supplemented with chicken soup with old hen, pork bone soup, lamb bone soup, deer tendons soup, stewed fish, etc. Those who can drink can choose Du Zhong Sui Sui wine, chicken blood vine wine, tiger bone papaya wine, etc.

　　In addition, fracture patients need to supplement trace elements such as zinc, iron, and manganese. Some of these elements participate in the metabolic activities of enzymes in the human body, and some are raw materials for the synthesis of collagen and myoglobin. The serum concentration of these substances in patients after fracture has been significantly decreased.

　　Therefore, appropriate supplementation in the early stage of fracture may be beneficial for healing. Animal liver, seafood, soybeans, sunflower seeds, mushrooms contain more zinc; animal liver, eggs, legumes, green vegetables, flour contain more iron; oatmeal, rapeseed, egg yolks, cheese contain more manganese, fracture patients can eat more appropriately. In addition, drugs containing these substances can also be taken.

　　(The above information is for reference only, please consult a doctor for detailed information)

      I, Treatment

　　The treatment requirements vary depending on the type of fracture and the age of the patient and other factors.

　　1.嵌入式: For those without displacement, only suspend and fix with a triangular bandage for about 4 weeks, for those with angular displacement, reduction should be performed first, and it is advisable for young adults to be fixed on an abduction brace.

　　2.粉碎型: After manual reduction, the affected limb can be fixed with an abduction brace for 4-5 weeks, for those with failed manual reduction, the affected limb can be placed in an abduction position for traction for 3-4 weeks, and functional activity should be started as soon as possible. Open reduction and internal fixation can also be performed, and internal fixation devices should not protrude into the joint cavity to prevent secondary traumatic arthritis. For those who still cannot maintain alignment or have severe joint surface defects (defect area exceeding 50%) after open reduction, artificial humeral head replacement surgery can be performed, which is particularly suitable for elderly patients over 60 years old.

　　3. With Floating Bone Fragments: Manipulative reduction is generally difficult to return, open reduction can be performed, and for those that are difficult to return, they can be removed.

　　4. Late Cases: Mainly focused on corrective surgery, including joint surface resection, resection of the groove of the biceps brachii tendons, arthroscopic removal of loose bodies, shoulder arthroplasty, and artificial joint replacement, etc.

　　II. Prognosis

　　Early diagnosis, early treatment, active functional exercise after treatment, general recovery is still good.