Complete epiphysial separation of the distal humerus

　　The cause of the disease is mostly due to indirect trauma. Indirect trauma: fractures occur in areas far from the site of the direct application of force, rather than at the site where the force is directly applied. Fractures are caused by the transmission, lever, or rotational action of force. For example, an epicondylar fracture of the humerus is caused by the patient slipping and falling while walking, using the palm of the hand to support the ground, and the force being transmitted upwards, resulting in a fracture at the capitulum above the elbow joint.

　　Swelling, pain, tenderness, and limited range of motion of the elbow joint. This condition can lead to stiffness of the elbow joint, dysfunction, reduced range of motion, and in some cases, can be accompanied by injuries to the medial ligament. Fracture of the capitulum of the humerus is an intra-articular injury. If not diagnosed and treated in time, it can have a significant impact on joint function. It is only when advanced surgery, such as the excision of the distal radius, is performed that cartilage damage can be discovered.

　　Elbow swelling, pain, tenderness, and activity limitation. The distal end of the humerus with complete epiphysial separation is a relatively rare epiphyseal injury in children's elbow joints. The epiphysis separation occurs before the ossification center of this part of the epiphysis is fully developed, which is easy to be confused with the fracture of the lateral epicondyle of the humerus and the dislocation of the elbow joint.

　　1. Parents and guardians of children need to enhance their sense of responsibility and cannot be negligent. Teachers should strengthen protective measures for children during physical activities to prevent accidents, and should promote traffic safety knowledge and comply with traffic regulations.

　　2. Based on the knowledge of dental trauma that you know, educate the child to improve their self-help ability.

　　Physical exercise should conform to the characteristics of children's age, and the content of the exercises should be conducive to the comprehensive development of children's basic movements, including running, jumping, climbing, crawling, climbing, jumping, rotating, and hanging.

　　The X-ray characteristics are as follows:

　　1. Normal humeroulnar joint:The anteroposterior and lateral radiographs of the elbow all show that the longitudinal axis of the radius passes through the capitulum of the humerus.

　　2. The relationship between the radius and ulna remains unchanged:That is, the upper radioulnar joint maintains a normal relationship.

　　3. Abnormal alignment of the humerus and the radius and ulna:It is often the case that a fragment of the medial epiphysis of the radius and ulna or the ossification center of the capitulum of the humerus is displaced posteriorly and medially. If the ossification center of the capitulum of the humerus has not yet appeared, some people propose that the relationship between the distal end of the humerus and the radius and ulna can be diagnosed by contrast imaging.

　　I. Therapeutic diet for the distal end of the humerus with complete epiphysial separation

　　1. Early stage:Therapeutic diet can use 10 grams of Panax notoginseng, 10 grams of Angelica sinensis, 1 pigeon, and stew until tender. Consume the soup and meat together, once a day, for 7-10 consecutive days.

　　2. Middle stage:Therapeutic diet can use 10 grams of Angelica sinensis, 15 grams of Fructus seu Semen Dendrobii, 10 grams of Herba Epimedii, and 250 grams of fresh pork rib or beef rib, stewed for more than 1 hour. Consume the soup and meat together, and use it continuously for 2 weeks.

　　3. Late stage:Therapeutic diet can use 10 grams of Chinese wolfberry, 15 grams of Fructus seu Semen Dendrobii, 10 grams of Herba Epimedii, and 50 grams of Coix seed. First, decoct Fructus seu Semen Dendrobii and Herba Epimedii to remove the dregs, then add the remaining two ingredients to cook porridge for consumption. Take once a day, and 7 days constitute one course of treatment. There should be an interval of 3-5 days between each course, and 3-4 courses can be used.

　　What should be eaten for the distal end of the humerus with complete epiphysial separation to be beneficial to the body?

　　1. Early stage (1-2 weeks):The injured area has ecchymosis and swelling, the meridians and collaterals are blocked, and the 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 is not removed, the bone cannot grow' and 'if the blood stasis is removed, new bone will grow'. It can be seen that resolving swelling and blood stasis is the primary requirement for fracture healing. The principle of diet coordination is to focus on light foods, such as vegetables, eggs, soy products, fruits, fish soup, lean meat, etc.

　　2. Middle stage (2-4 weeks):Most of the ecchymosis has been absorbed. The treatment during this period focuses on harmonizing the blood and relieving pain, removing blood stasis and promoting the formation of new tissue, and joining bones and tendons. In terms of diet, transition from light to moderately high-nutrient supplementation is recommended to meet the needs of callus growth. Bone soup, Cordyceps chicken stew, animal liver, and other foods 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 swelling and ecchymosis at the fracture site are basically absorbed, and the growth of callus has begun, which is the late stage of fracture. Treatment should focus on tonifying, through tonifying the liver and kidney, and Qi and blood, to promote the formation of a more solid callus, and to relax tendons and activate collaterals, so that the adjacent joints of the fracture site can move freely and flexibly, and recover the previous function. Diet can be unblocked, 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 supplement wine, chicken blood vine wine, tiger bone papaya wine, etc.

　　Three, what foods should be avoided for the complete diaphyseal separation of the humerus?

　　1. Early avoidance of sour, spicy, dry, and greasy foods, and especially not to apply excessive greasy and nourishing substances prematurely:Such as bone soup, fat chicken, braised water fish, etc., otherwise blood stasis will accumulate and be difficult to disperse, resulting in the delay of the course of the disease, the slow growth of callus, and affecting the recovery of joint function in the future.

　　2. Avoid eating too many meat bones:Some people believe 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 not only cannot promote early healing but can also delay the healing time of fractures. The reason for this is that the regeneration of bone after injury mainly relies on the functions of the periosteum and bone marrow. Only when the bone collagen is increased can the periosteum and bone marrow better exert their functions, while the main components of meat bones are phosphorus and calcium. If a large amount is ingested 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, thus producing a hindering effect on the early healing of fractures. However, the fresh meat bone soup tastes delicious and has a stimulating effect on appetite, so eating a small amount is harmless.

　　3. Avoid partial eating:Fracture patients often have local edema, congestion, hemorrhage, and muscle tissue damage, among other conditions. The body itself has resistance and repair capabilities for these. 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 indigestible foods:Fracture patients, due to the restriction of movement caused by the fixation of plaster or splints, and the swelling and pain at the injury site, as well as mental anxiety, often have a poor appetite and constipation from time to time.

　　5. Avoid overeating sugar:Excessive intake of sugar can lead to a sharp metabolism of glucose, thereby 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. Insufficient vitamin B1 greatly reduces the activity ability 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:During the early stage of fracture, local bleeding occurs, blood stasis, swelling and pain appear. At this time, taking Sanqi tablets can contract the local blood vessels, shorten the coagulation time, increase the 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 contraction, blood circulation is not smooth, which is not beneficial to the healing of the fracture.

　　7, Do not drink fruit juice after fracture:The raw materials of fruit juice are made by mixing sugar water, flavoring essence, colorants, etc. It does not contain the vitamins and minerals needed by the human body. Because it contains a lot of sugar, it presents a physiological acidic state in the body after drinking.

　　Prompt and appropriate treatment should be given to the epiphysis injury after the injury. During closed reduction, different techniques should be applied according to the different types of epiphysis separation, generally using general anesthesia. The child should be placed in a supine position, the shoulder joint slightly abducted, the chest and axilla fixed with a bandage, the forearm placed in a pronated position, the operator pulls the forearm, and then the elbow is flexed 90°. The hand's metacarpal area can be used to push the distal separated epiphysis to reduce and correct the lateral deviation. X-ray examination confirms the reduction, and then the upper limb plaster cast is immediately fixed, the forearm placed in a pronated position to correct the ulnar deviation, and the forearm placed in a supinated position to correct the radial deviation.

　　After injury, the elbow is obviously swollen. After manual reduction, the olecranon of the ulna can be first tractioned with Kirschner wires, and then the reduction and plaster fixation can be performed according to the above method after 3-5 days of swelling subsidence, and the abduction brace can be used to prevent recurrence of displacement.

　　Special attention should be paid to the complete epiphysis separation with displacement towards the ulnar side during reduction, to completely correct it, in order to avoid the formation of an angular deformity on the medial side of the distal epiphysis and humerus lower end due to incomplete reduction. For those with radial displacement, it is not necessary to strive for anatomical alignment, because the mild displacement of this type will not cause obvious deformity of the elbow. After reduction and fixation, it is generally used to use the abduction brace, fix the affected limb at the shoulder joint abduction 90°, and flexion 45°. This has both traction and fixation effects, and can prevent the rotation and displacement of the fracture ends.