Radius Fracture

　　The causes of radial fractures are:

　　1. Extension-type fracture (Colles fracture)

　　The most common, mostly caused by indirect violence. Described in detail by A.Colles in 1814. When falling, the wrist joint is in extension and the forearm is pronated, and the palm touches the ground. The force is concentrated on the cancellous bone of the distal end of the radius, causing a fracture. The distal end of the fracture moves towards the dorsal and radial sides. Children can be epiphyseal separation; elderly people due to osteoporosis, even slight external force can cause a fracture, and it is often a comminuted fracture, and the fracture ends are shortened due to impaction. Comminuted fractures can involve the articular surface or be accompanied by ulnar styloid avulsion fracture and distal radioulnar joint dislocation.

　　2. Flexion-type fracture (Smith fracture)

　　Less common, first described by R.W.Smith in 1874. The cause of the fracture is opposite to that of the extension-type fracture, so it is also called the reverse Colles fracture. When falling, the back of the hand touches the ground, and the distal end of the fracture moves towards the palmar and ulnar sides.

　　3. Barton fracture (Barton fracture)

　　It refers to the transverse oblique fracture of the distal articular surface of the radius, accompanied by wrist joint dislocation. It was first described by J.R.Barton in 1838. When falling, the palm or back of the hand touches the ground, the force is transmitted upwards, and the radial articular surface fracture is caused by the impact of the proximal carpal bones. A bone fragment with articular cartilage is formed on the palmar or dorsal side of the distal end of the radius, and the bone fragment often moves towards the proximal side, and the wrist joint is dislocated or subluxated.

　　The complications that are easy to occur in patients with radial fractures include:

　　1. Median nerve injury

　　Median nerve injury patients have paralysis of some muscles in the wrist and elbow, and loss of sensation. The skin and nails have significant nutritional changes, and atrophy symptoms appear. The median nerve is relatively superficial at the wrist and is easily injured by sharp objects. Fractures of the humeral condyle and dislocation of the lunate bone often occur with median nerve injury, mostly contusions or crush injuries. Those secondary to shoulder joint dislocation are traction injuries. In addition, the median nerve can produce chronic nerve compression symptoms due to hyperplasia of the wrist bone, thickening of the transverse carpal ligament, or hypertrophy of the pronator teres muscle.

　　Early surgical suture is usually adopted, and the effect is generally good, but the recovery of hand muscles is often poor. If the nerve recovery is not good, it is possible to perform ring finger flexor superficial muscle or little finger abductor muscle transfer to thumb opposition formation surgery, or other tendon transfer surgery to improve the flexion and extension function of the fingers.

　　2. Infection

　　The main complications of median nerve injury patients with infection are mainly related to the long exposure time of the wound after injury, incomplete debridement, and severe soft tissue injury. Once a radial fracture occurs, it should be treated in a timely manner, and attention should be paid to wound hygiene to prevent infection.

　　Infection refers to the pathological phenomenon of pathogens entering the human body and reproducing within it (including the gastrointestinal tract). Infection can cause tissue damage and lead to different clinical symptoms. After pathogens enter the human body, the human body produces an immune response to them. Due to the different strengths of the human body's defense ability, the number and virulence of pathogens entering the human body are different, so the manifestations of the struggle are also different.

　　There is obvious swelling and tenderness in the wrist, and the movement of the hand and wrist is restricted. In extension-type fractures, there are typical fork and spear-like deformities, and the styloid processes of the radius and ulna are on the same plane, with a positive straight edge test. In flexion-type fractures, the deformity is the opposite of the extension type. Pay attention to whether there is a lesion of the median nerve.

　　Ensuring personal safety is the key to preventing this disease. One must pay attention to safety in production and life to avoid trauma. At the same time, attention should be paid to patients with elbow joint dislocation or fracture caused by traumatic factors, who should undergo X-ray examination to exclude the presence of the disease, so as not to delay treatment.

　　X-ray films can clearly show fractures and their types. In the case of extension-type radius fractures, the distal end of the radius moves medially and dorsally, and the angle of inclination of the articular surface medially and laterally decreases, disappears, or even reverses. The distal end of the radius is interlocked with the proximal end, and some may have scaphoid fracture and distal radius-ulnar joint dislocation. In the case of flexion-type fractures, the distal end of the radius moves towards the palm side. For elderly patients with minor trauma, bone density examination should be performed to understand the condition of osteoporosis.

　　X-ray film is also known as 'X-ray photograph'. In medicine, X-rays are used for examination of the human body due to their penetrating ability and the ability to cause the film to be photosensitive. It is a record of the condition and also a basis for the diagnosis and treatment of diseases. It is generally stored by the hospital X-ray department, and the examination report is part of the patient's medical record.

　　The issues that should be paid attention to in the diet for radius fractures:

　　1. Eat more fresh vegetables and fruits.

　　2. Eat more vegetables rich in vitamin C, such as green peppers, tomatoes, amaranth, green vegetables, cabbage, and radishes, to promote the growth of bone calluses and the healing of wounds.

　　3. Supplement trace elements such as zinc, iron, and manganese. Animal liver, seafood, soybeans, sunflower seeds, and mushrooms contain a lot of zinc; animal liver, eggs, legumes, green vegetables, and wheat flour contain a lot of iron; wheat bran, turnip, egg yolk, and cheese contain a lot of manganese.

　　4. Avoid blindly supplementing calcium. Increasing calcium intake does not accelerate the healing of broken bones, and for long-term bedridden fracture patients, there is a potential risk of increased blood calcium levels, accompanied by decreased blood phosphorus levels.

　　5. Avoid eating too much meat and bone: Some people believe that eating more meat and bone after a fracture can promote early healing of the fracture. In fact, modern medicine has proven through multiple practices that eating more meat and bone after a fracture not only cannot promote early healing but may also delay the healing time of the fracture.

　　6. Avoid eating foods that are easy to cause bloating or indigestion, such as sweet potatoes, taros, and glutinous rice.

　　8. Avoid not drinking water: Bedridden fracture patients have less activity and weakened intestinal peristalsis. If water intake is reduced, it is easy to cause constipation. Long-term bed rest can also lead to urinary retention, which is prone to urinary tract stones and urinary system infection.

　　9. Avoid excessive sugar intake: After consuming a large amount of sugar, the body may enter an acidic intoxication state. Alkaline calcium, magnesium, and sodium ions will immediately be mobilized to participate in neutralization. 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.

　　10, Avoid long-term use of Sanqi Shang: In the early stage of radial head fracture, taking Sanqi Shang is beneficial to the healing of the fracture. However, after one week of reduction of radial head fracture, if Sanqi Shang is continued to be taken, the local blood vessels are in a state of constriction, and blood circulation is not smooth, which is unfavorable for the healing of the fracture.

　　The main clinical manifestations of radial head fracture are elbow joint dysfunction and localized swelling and tenderness on the lateral side of the elbow. The classification method of fracture can represent the degree of injury and provide a basis for selecting treatment methods. The classification treatment of radial head fracture is as follows:

　　1, Type I:Conservative treatment can be performed, using a long arm cast brace, fixing the elbow joint at 90° flexion for 4 weeks.

　　2, Type II:There are many treatment methods, and the views of various experts differ, generally as follows:

　　(1) Surgical treatment is indicated when the fracture fragment occupies more than 1/4 of the radial head (Mason) or more than 2/3 (Radin).

　　(2) Surgical treatment is indicated for fractures with more than 30° inclination or more than 3mm collapse.

　　(3) Perform radial head resection when there is limited spontaneous activity after 2 weeks (Charnley) or 8 weeks (Adler) after injury. For larger fracture fragments, AO small screw internal fixation can be used to achieve good efficacy.

　　3, Type III:In some cases, although the radial head is comminuted, there is no obvious displacement, and the shape of the radial head is still intact, conservative treatment can be performed; otherwise, it is a indication for radial head resection. The specific timing of resection is also controversial. Some advocate for resection after 3 weeks of injury, but most people believe that it should be done within 24 hours after the injury. When combined with injury to the distal radioulnar joint and the medial collateral ligament of the elbow, it is an indication for Swanson radial head replacement.

　　4, Type IV:Due to severe soft tissue injury and a high possibility of heterotopic ossification, the radial head should be removed or observed for 3 to 4 weeks within 24 hours, and the excision should be performed again if heterotopic ossification does not occur.