Humeral shaft fracture

　　Direct violence, indirect violence, and rotational violence can all cause fractures of the humeral shaft. Let's take a detailed look at the introduction of these three causes.

　　1. Direct violence

　　Injuries such as blows, crush injuries, or firearm injuries, often occur at the middle third, and are mostly transverse fractures, comminuted fractures, or open fractures. Sometimes, multiple segmental fractures can occur.

　　2. Indirect violence

　　If the hand or elbow lands on the ground when falling, the reverse force from the ground is transmitted upwards and intersects with the weight pressing down during the fall at a certain part of the humeral shaft, causing oblique or spiral fractures. This type of fracture is often seen at the middle and lower third of the humerus, and the sharp end is prone to penetrate into the muscle, affecting the reduction technique.

　　3. Rotational violence

　　When throwing a grenade, javelin, or performing a wrist rotation to twist the forearm, fractures at the junction of the upper and lower third of the humerus can often occur, and the fractures caused are mostly typical spiral fractures.

　　After the humeral shaft fracture, due to the different muscle attachment points at the fracture site, the direction of the force of violence, and the position of the upper limb, the humeral shaft fracture can have different displacement conditions. If the fracture is above the insertion point of the deltoid muscle, the proximal fracture end is pulled medially by the pectoralis major, teres major, and latissimus dorsi muscles. The distal fracture end is pulled superiorly and laterally by the deltoid muscle. If the fracture is below the insertion point of the deltoid muscle, the proximal fracture end is pulled laterally and forward by the deltoid and coracobrachialis muscles. The distal fracture end is pulled upward by the biceps and triceps brachii muscles, resulting in an overlapping displacement. If the fracture is in the lower 1/3, due to the fact that the patient often hangs the forearm in front of the chest, it causes the distal fracture end to rotate medially. Attention should be paid to correct the displacement during manual reduction.

　　From 1 cm below the distal end of the humeral surgical neck to 2 cm above the humeral condyle is the humeral shaft. Fractures of the humeral shaft are more common in young and middle-aged people, and they are prone to occur in the middle, followed by the lower part, and the upper part is the least. What diseases are prone to complicate humeral shaft fractures?

　　1. Nerve injury

　　Radial nerve injury is the most common, and the middle and lower 1/3 of the humeral fracture is prone to incomplete radial nerve injury caused by compression or contusion at the fracture ends. Generally, if there is no recovery of nerve function in 2 to 3 months, surgery should be performed for exploration. During the observation period, the wrist joint should be placed in a functional position, and an active splint that can extend the fingers should be used to move the joints of the fingers on the injured side, in order to prevent deformity or stiffness.

　　2. Vascular injury

　　It is not uncommon in complications of humeral shaft fractures. Generally, injury to the humeral artery does not cause limb necrosis but can cause insufficient blood supply, so it is still necessary to repair the blood vessels surgically.

　　3. Non-union of fractures

　　Fractures in the middle and lower 1/3 of the humerus are prone to non-union, and there are many reasons for non-union of fractures, among which there is a significant relationship with the force of injury, the anatomical position of the fracture, and the treatment method. Fracture healing is a continuous process, and there should be no interference from adverse stresses such as shearing and rotational stresses throughout the process, so the fracture ends must be fixed reasonably.

　　4. Malunion

　　Because the range of motion of the shoulder joint is large, although the humeral fracture has some angular, rotational, or shortening deformities, it does not greatly affect the function of the injured limb. However, if the displacement of the humeral fracture is particularly severe and does not meet the requirements of functional reduction of the fracture, it seriously destroys the biomechanical relationship of the upper limb, which may lead to traumatic arthritis of the shoulder or elbow joint in the future. Therefore, for young and middle-aged patients, when conditions permit treatment, osteotomy should still be performed to correct malunion.

　　5. Dysfunction of the shoulder and elbow joints

　　It is more common in elderly patients. Therefore, it is not advisable to use extensive range of fixation for a long time in elderly patients. Muscle and joint function activities should be strengthened as soon as possible, and if there is already a dysfunction of the shoulder or elbow joint, the functional activity exercises should be strengthened, and assisted by physical therapy and rehabilitation, so that the joint function can be restored as soon as possible.

　　6. Limited function of the shoulder and elbow joints.

　　7. Iatrogenic fractures

　　Fractures of the greater tuberosity of the humerus, surgical neck fractures, split fractures at the fracture ends, and split fractures at the entry point of the nail are often related to improper operation.

　　8, Locking nail fracture

　　If the patient has multiple injuries and cannot move the lower limbs freely, the bed activities mainly rely on the upper limbs for support. If the fracture has not healed, excessive weight-bearing can lead to the fracture of the proximal locking nail.

　　9, Other

　　Fractures in the middle and lower 1/3 are prone to radial nerve injury, and fractures in the lower 1/3 are prone to non-union.

　　Direct violence, indirect violence, and rotational violence can all cause humeral shaft fractures. What are the symptoms of humeral shaft fractures? Let's find out together.

　　1, The upper arm may swell, hurt, shorten, or become angularly deformed.

　　2, Abnormal movement or bone grinding sound may occur.

　　3, With radial nerve injury, there may be wrist drop, loss of extension of the thumb, and extension of the metacarpophalangeal joint function.

　　How to prevent humeral shaft fractures caused by direct violence, indirect violence, and rotational violence?

　　This disease is mainly caused by traumatic factors, so attention should be paid to safety in daily life. The focus of prevention is to prevent the occurrence of complications. Fractures of the middle and lower segments of the humeral shaft are prone to radial nerve injury, and detailed preoperative examination is required. Intraoperative care should be taken to avoid injury. Fractures at different levels have different displacement directions and must be reset and fixed according to X-ray films. Fracture ends that are too separated are prone to non-union and the formation of pseudo-joints. Early active contraction and relaxation of the upper arm muscles should be performed after fracture fixation, and shoulder and elbow joint movements should be performed 2-3 weeks after the injury to prevent joint dysfunction.

　　The examination of humeral shaft fractures generally includes the following:

　　1, X-ray films can show the fracture and displacement direction.

　　2, Laboratory tests show an increase in white blood cells and neutrophils.

　　3, Electromyography can be performed for patients with radial nerve injury to determine the degree of injury.

　　Humeral shaft fractures are more common in adults under 30 years old with a history of direct or indirect violent trauma, mostly seen in the middle part of the humeral shaft. Patients with humeral shaft fractures generally have local swelling, pain, shortening of the upper arm, abnormal movement when touched, and bone grinding sounds. Today, I will introduce the dietary preferences and taboos for patients with humeral shaft fractures, hoping to help everyone.

　　One, the following foods are recommended for patients with humeral shaft fractures:

　　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 to remove blood stasis and promoting Qi flow to dissipate. According to traditional Chinese medicine, 'If blood stasis is not removed, bones cannot grow' and 'if blood stasis is removed, new bones will grow'. It can be seen that reducing swelling and dissipating blood stasis is the primary factor for fracture healing. The principle of diet coordination is to focus on light foods, such as vegetables, eggs, dairy products, fruits, fish soup, lean meat, etc.

　　2, Intermediate stage (2-4 weeks): Most of the ecchymosis is absorbed, and the treatment during this period focuses on harmonizing the body and relieving pain, removing blood stasis to generate new blood, and setting bones and tendons. In terms of diet, it transitions from light to moderate high-nutrition supplementation to meet the needs of callus growth. This can be achieved by adding bone soup, loquat chicken stew, animal liver, and other foods 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 the growth of callus has begun, which is the late stage of fracture. Treatment should focus on nourishment, through nourishing the liver and kidney, and promoting the circulation of Qi and blood to promote the formation of a more solid callus, and to relax the tendons and meridians, so that the adjacent joints of the fracture site can move freely and flexibly, restoring the previous function. In terms of diet, the taboos can be lifted, and the diet can be supplemented with old hen soup, pork bone soup, sheep bone soup, deer tendons soup, stewed fish, etc. Those who can drink can choose Eucommia ulmoides bone broken alcohol, Spatholobus suberectus wine, and Ficus carica wood melon wine, etc.

　　Secondly, the following foods should be avoided in the case of humerus shaft fracture:

　　1. Avoid spicy, dry, and greasy foods in the early stage. It is especially forbidden to take greasy and nourishing foods such as bone soup, fatty chicken, and stewed fish too early, otherwise, blood stasis will accumulate and be difficult to disperse, which will inevitably delay the course of the disease, slow down the growth of callus, and affect the recovery of joint function in the future.

　　2. Avoid eating too much meat bone. Some people think that eating more meat bones after a fracture can promote early healing. In fact, this is not the case. Modern medicine has proven through multiple practices that eating more meat bones by fracture patients will not only not promote early healing but will also delay the healing time of fractures. The reason for this is that the regeneration of bone after injury mainly relies on the function of the periosteum and bone marrow. The periosteum and bone marrow can only better exert their function under the condition of increasing bone collagen, while the main components of meat bones are phosphorus and calcium. If a large amount is consumed after a fracture, it will promote the increase of inorganic components in the bone, causing a disorder in the proportion of organic matter in the bone, thus hindering the early healing of fractures. However, the fresh meat bone soup tastes delicious and has a stimulating effect on appetite, so eating a little is harmless.

　　3. Avoid one-sided diet. Fracture patients often have local edema, congestion, hemorrhage, and muscle tissue damage. The body itself has resistance and repair capabilities for these conditions. The raw materials for the repair of tissues, the growth of long bones, the formation of callus, and the removal of blood stasis and swelling rely on various nutrients. Therefore, it can be known that the key to the smooth healing of fractures is nutrition.

　　4. Avoid undigested food. Fracture patients, due to the restriction of movement caused by the fixation of plaster or splints, plus swelling and pain at the injury site, and mental anxiety, often have a poor appetite and constipation.

　　5. Avoid excessive consumption of sugar. After a large intake of sugar, it will cause a rapid metabolism of glucose, thereby producing intermediate metabolites such as pyruvate, lactic acid, etc., causing the body to present an acidic poisoning state. At this time, alkaline calcium, magnesium, sodium, and other ions will be immediately mobilized to participate in neutralization to prevent the blood from becoming acidic. Such a large consumption of calcium is not conducive to the recovery of patients with fractures. At the same time, excessive sugar intake will also reduce the content of vitamin B1 in the body, as vitamin B1 is an essential substance for the conversion of sugar into energy in the body. Insufficient vitamin B1 will greatly reduce the activity of nerves and muscles, and also affect the recovery of function. Therefore, patients with fractures should avoid eating excessive sugar.

　　6. Avoid long-term use of Sanqi tablets, as local internal bleeding occurs in the early stage of fracture, leading to blood stasis, swelling, and pain. At this time, taking Sanqi tablets can contract local blood vessels, shorten clotting time, and increase thrombin, which is very appropriate. However, after the fracture is reduced for one week, bleeding has stopped and the damaged tissue begins to repair. Repair requires a large amount of blood supply. If Sanqi tablets are continued to be taken, the local blood vessels are in a state of contraction, blood circulation is not smooth, and it is not conducive to fracture healing.

　　7. Avoid drinking fruit juice, as the raw material of fruit juice is made up of sugar water, flavoring, pigments, etc. It does not contain vitamins and minerals required by the human body. Because it contains a lot of sugar, it presents a physiological acid in the body after drinking.

　　Humerus fractures are common in adults and can show different directions of displacement. If the external force is too great, the bone may produce symptoms such as comminuted and oblique fractures. Generally, fractures are treatable and can continue to be treated in the hospital. The surgical treatment methods for humerus fractures are as follows:

　　1. Open Fracture

　　Early debridement of soft tissues and bones and internal fixation of fractures should be performed.

　　2. Fractures with Associated Vascular and Nerve Injuries

　　Apply internal fixation of fractures and repair of nerves and blood vessels.

　　3. Floating Elbow

　　Fractures of the middle and lower third of the humerus with intra-articular fractures of the elbow joint are difficult to reduce and maintain reduction by manipulation, and open reduction and internal fixation should be performed.

　　4. Bilateral Humerus Fracture

　　Non-surgical treatment can cause inconvenience in the patient's daily life and difficulties in nursing. Internal fixation surgery should be performed.

　　5. Fractures with Unsatisfactory Manipulative Reduction

　　For spiral fractures, if soft tissue is interposed between the fracture ends, even if the fracture alignment is satisfactory, it can lead to non-union, and internal fixation surgery should be performed.

　　6. Unsatisfactory Results of Non-surgical Treatment

　　If a transverse fracture is treated with a hanging plaster cast, it can lead to non-union of the fracture due to excessive traction; for oblique fractures, if the fracture ends have obvious displacement, surgical internal fixation should also be performed.

　　7. Multiple Injuries with Humerus Fracture

　　Non-surgical treatment is difficult to maintain satisfactory alignment and alignment of the fracture ends. Once the condition is stable, active surgical treatment should be performed.

　　8. Pathological Fracture

　　Surgical treatment can make the patient feel comfortable and increase the function of the upper limb.