Intercondylar humerus fracture

　　First, etiology

　　Direct and indirect violence can both cause intercondylar humerus fracture.

　　Second, pathogenesis

　　When falling, the elbow joint is in an extended position, the palm and the body's gravity are upward, transmitted downward and concentrated at the condylar part of the humerus, the force acts on the ulna, upward impact causes the medial and lateral condyles of the humerus to split and separate, causing fracture. The proximal end of the fracture is forwardly displaced, and the distal end of the fracture splits into 2 or more pieces and moves backward (Figure 1).

　　When the elbow joint is in a flexed position, it may directly collide with the ground, or it may be caused by the olecranon of the ulna colliding upwards. The cross-section of the olecranon is triangular. When the force is transmitted to this part, the olecranon of the ulna acts like a wedge, impacting the trochlear groove between the two condyles, causing separation and displacement between the two condyles, and the distal end of the humerus is forwardly displaced.

　　In addition to its clinical manifestations, intercondylar humerus fracture can also cause other diseases. This disease may be accompanied by nerve and vascular injuries, so it should be highly emphasized by clinical doctors and patients.

　　After trauma to the elbow joint, there is severe pain, widespread tenderness, obvious swelling, and may be accompanied by subcutaneous ecchymosis. In severe cases of fracture displacement, the transverse diameter of the distal end of the humerus may become wider, and in cases with severe overlap displacement, there may be shortening and deformity of the upper arm. The elbow joint is in a semi-extended position, the forearm is supinated, the triangular bony structure behind the elbow is disordered, the fracture fragments can be felt, and there is a marked grinding sensation. Sometimes, nerve and vascular injuries may also occur, which should be paid attention to during examination.

　　Type I:The fracture has no separation and displacement.

　　Type II:The fracture has slight separation and displacement, but the two condyles do not rotate.

　　Type III:The fracture has separation, and the two condyles have rotational displacement.

　　Type IV:The fracture is comminuted, and the articular surface is severely destroyed.

　　Prevention:Prevention: Avoid trauma, this disease is caused by traumatic factors, so attention to safety in production and life is the key to preventing the disease. In social production activities, through the harmonious operation of people, machines, materials, environment, and methods, various potential accident risks and injury factors in the production process are always kept under effective control, and the life and health of workers are protected in earnest. In addition, it is necessary to strictly implement various preoperative and postoperative nursing measures, pay attention to psychological care, closely observe the condition, and do a good job in pain relief and functional exercise.

　　At the time of diagnosis of humerus condylar fracture, in addition to relying on its clinical manifestations, it is also necessary to rely on auxiliary examinations. Anteroposterior and lateral X-ray films of the elbow can clearly diagnose the fracture and show the type and degree of displacement.

　　Firstly, therapeutic diet for humerus condylar fracture (the following information is for reference only, and detailed information should be consulted with a doctor)

　　1, 150 grams of cow bone marrow. 500 grams of flour fried, 100 grams of eggshell dried and ground into powder, 250 grams of black sesame seeds fried, 250 grams of sugar ground into fine powder, mix well. Take 2 spoons a day and dilute with boiling water to eat.

　　Used for those with kidney deficiency and cold limbs.

　　2, Astragalus 20 grams, 5 dates, boil the soup as tea, or you can also extract the juice to cook rice or porridge.

　　Used for those with delayed healing of fractures due to inherent weakness. For those who are prone to catching colds, add 5 grams of Fang Feng and boil it into a decoction to drink as tea.

　　3, 300 grams of chestnuts (shell removed and meat taken out), 1 tender grass chicken (killed, cleaned, and cut into pieces), add soy sauce, cooking wine, sugar, stew until the chicken is soft and the chestnuts are glutinous, and eat in several servings as a side dish.

　　Used for those with deficiency of both spleen and kidney.

　　5, Dog meat 500 grams (soaked and pounded while washing until the white water is clean, drained), 300 grams of grass chicken, 150 grams of pork knuckle, add water, stew until the chicken and pork knuckle are soft and tender, add 15 grams of Chinese wolfberry, 10 grams of Asparagus, 10 grams of prepared rehmannia, 3 grams of licorice, steam until the dog meat is soft and tender, season to taste, and eat in moderate amounts.

　　Used for those with aversion to cold, weakness, lumbar and knee weakness, and general debility with reduced appetite.

　　Secondly, what to eat for humerus condylar fracture

　　1, Early period (1-2 weeks): The injured area has ecchymosis and swelling, the 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 dispersing Qi and resolving stagnation. According to traditional Chinese medicine, "if the blood stasis does not go away, the bone cannot grow" and "if the blood stasis is removed, new bone will grow." It can be seen that reducing swelling and resolving blood stasis is the primary goal for fracture healing. The principle of diet配合 should be light in taste, such as vegetables, eggs, dairy products, fruits, fish soup, lean meat, and so on.

　　2, Middle period (2-4 weeks): Most of the ecchymosis is absorbed. The treatment during this period focuses on harmonizing the body's nutrition, relieving pain, removing blood stasis, and promoting the growth of new bones. In terms of diet, shift from light to moderately high-nutrient supplementation to meet the needs of callus growth. You can add bone soup, Cordyceps 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 subcutaneous edema of the fracture has basically absorbed, and there has been growth of calluses, which is the late stage of fracture. Treatment should be supplemented, promoting the formation of stronger calluses and promoting the flexibility of joints near the fracture site through the nourishment of the liver and kidney, Qi, and blood. The diet can be unrestricted, and the diet can be supplemented with old hen soup, pork bone soup, sheep bone soup, deer tendons soup, braised water fish, etc. Those who can drink can choose Du Zhong bone broken wine, chicken blood vine wine, tiger bone papaya wine, etc.

　　Three, what foods should be avoided for intercondylar fracture of the humerus

　　1. Avoid spicy, dry, and greasy foods in the early stage, especially avoid premature application of greasy tonifying foods such as bone soup, fatty chicken, and braised water fish. Otherwise, blood stasis will accumulate and be difficult to disperse, resulting in delayed course of disease, slow growth of calluses, and affecting the recovery of joint function in the future.

　　2. Avoid eating too much meat and bones Some people think that eating more meat and 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 and bones by fracture patients not only cannot promote early healing but may 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, and the periosteum and bone marrow can only better play a role under the condition of increasing collagen. The main components of meat and 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, leading to a disorder in the proportion of organic matter in the bone, so it will hinder the early healing of fractures. However, the fresh meat and bone soup has a delicious taste and can stimulate appetite, so eating a little is not a problem.

　　3. Avoid excessive dieting Fracture patients often have local edema, congestion, hemorrhage, and muscle tissue damage. The body itself has resistance and repair ability to these conditions. The raw materials for the repair of tissues, the growth of long bones, the formation of calluses, and the resolution of blood stasis depend on various nutrients. Therefore, it can be known that the key to the smooth healing of fractures is nutrition.

　　4. Avoid indigestible foods Fracture patients, due to the restriction of movement caused by the fixation of plaster or splints, as well as swelling, pain, and mental distress at the injury site, often have a poor appetite and constipation.

　　5. Avoid excessive consumption of sugar. Excessive intake of sugar can lead to a rapid metabolism of glucose, producing intermediate metabolic substances such as pyruvate and lactic acid, causing the body to present an acidic poisoning state. At this time, alkaline calcium, magnesium, and sodium 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 fracture patients. At the same time, excessive sugar can 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. Deficiency of vitamin B1 greatly reduces the activity of nerves and muscles, and also affects the recovery of function. Therefore, fracture patients should avoid eating excessive sugar.

　　6. Avoid long-term use of Sanqi tablets in the early stage of fracture. Local internal bleeding occurs, with blood stasis, swelling, and pain. At this time, taking Sanqi tablets can constrict local blood vessels, shorten coagulation time, and increase thrombin, which is very appropriate. However, after one week of fracture reduction, 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 constriction, and blood circulation is not smooth, which is not beneficial to fracture healing.

　　7. Avoid drinking fruit juice. The raw materials of fruit juice are sugar water, flavoring, colorants, and other ingredients. It does not contain the vitamins and minerals needed by the human body. Because it contains a lot of sugar, it is physiological acidic in the body after drinking.

　　1. Manual Reduction and Plaster Splint Fixation

　　Applicable to type I and II fractures with slight separation, the two epicondyles should be compressed first to reduce them, then the displacement of the upper epicondyle should be corrected, and finally the elbow joint should be fixed in a neutral position for 4 to 6 weeks with a long arm plaster splint.

　　2. Traction

　　For open injuries that cannot be closed reduction or for open injuries that were not treated in a timely manner due to other reasons, ulnar olecranon traction can be performed, combined with closed reduction, and functional exercises can be started early during the traction process. Traction usually lasts for 4 to 6 weeks, or 4 weeks after traction, and then a plaster splint is used to protect and immobilize for 2 weeks.

　　3. Open Reduction

　　For accurate reduction and early functional exercise, open reduction can be used for type III and IV fractures, with plates and screws for fixation, trying not to use external fixation, and肘关节功能锻炼 can be started within a few days to 2 weeks after surgery.

　　4. Elderly Patients

　　For patients with severe comminuted fractures and other diseases that are not suitable for surgery or long-term fixation, a cervical wrist sling can be used to immobilize the elbow joint at a flexion of 90°, and functional exercises should be started early.