Fracture of the greater tubercle of the humerus

　　First, Etiology

　　Mostly caused by direct violence and indirect violence.

　　Second, Pathogenesis

　　According to the type of injury-causing violence and associated injuries, it can be divided into four types:

　　1. Simple fracture of the greater tubercle of the humerus without displacement:This type of fracture is mostly caused by direct violence impacting the greater tubercle of the humerus, that is, when falling, the lateral aspect of the shoulder hits the ground, causing a fracture. The fracture fragments rarely have severe displacement or no displacement.

　　2. Fracture of the greater tubercle of the humerus combined with anterior shoulder joint dislocation:This fracture is caused by the greater tubercle impacting the anterior inferior margin of the scapula during the anterior dislocation of the shoulder joint. Since the periosteum of the greater tubercle and humerus has not been broken, after the anterior dislocation of the shoulder joint is reduced, the greater tubercle of the humerus is also automatically reduced.

　　3. Displaced simple avulsion fracture:This type of fracture is mostly caused by indirect violence, that is, when falling, the upper limb is abducted and externally rotated upon landing, and the冈上下肌, 小圆肌, and shoulder cuff suddenly contract and pull the greater tubercle of the humerus, causing a avulsion fracture. If it is a complete avulsion fracture, the fracture fragments can contract to above the articular surface of the humeral head.

　　4. Fracture of the greater tubercle combined with a fracture of the surgical neck of the humerus:Mostly caused by indirect violence, such as when falling, the hand or elbow hits the ground, and the force along the upper limb impacts the shoulder, which can cause fractures of the surgical neck and greater tubercle of the humerus.

　　1. Swelling:Local swelling occurs after trauma, reaching its peak after 72 hours, and then gradually subsides. After swelling occurs, the affected limb should be elevated, preferably above the heart level, and appropriate ice packs should be applied to promote the subsidence of swelling.

　　2. Plaster Compression:After simple fractures are reduced manually and fixed with plaster casts, as the limb swelling gradually worsens, plaster compression may occur, leading to obvious swelling, bruising, and numbness in the distal parts of the limbs such as fingers and toes. It is necessary to visit a medical institution to relieve pressure in time to prevent limb necrosis due to compression.

　　1. Pain:There is pain and tenderness below the acromion, but there is no obvious conductive percussion pain.

　　2. Swelling:Due to local bleeding and traumatic reaction after fracture, swelling is shown below the acromion. The shoulder with limited activity

　　3. Limited activity:The range of shoulder joint movement is limited, especially when it is abducted and externally rotated.

　　This disease is caused by traumatic factors, so paying attention to safety in production and life is the key to preventing this 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 lives and physical health of laborers are effectively protected. In addition, it is necessary to strictly implement all preoperative and postoperative nursing measures, pay attention to psychological care, closely observe the changes in the condition, and do a good job in pain relief and functional exercise.

　　At the time of diagnosis, in addition to relying on clinical manifestations, auxiliary examinations are also needed. X-ray films of this disease can show the fracture and displacement. This disease seriously affects the daily life of patients, so it should be actively prevented.

　　One:食疗方 for humerus head fracture

　　1. Take an appropriate amount of red bean and decoct it, add a little brown sugar, and take it warm. This recipe is suitable for the blood-activating and blood-stasis stage.

　　2. Take 1000 grams of pork bone and 250 grams of soybeans, simmer them in water over low heat until they are soft, season with salt and ginger, and eat them in several doses.

　　3. Clean one set of pork spine, add 120 grams of red dates, 90 grams of lotus seeds, 9 grams of xiangshen, and 9 grams of raw licorice root, and simmer them in water over low heat until they are soft. Add ginger and salt for seasoning and drink it in several doses.

　　4. Take the meat of two fresh lake crabs (with the yolk), add it to the cooked glutinous rice porridge, and then add an appropriate amount of ginger, vinegar, and soy sauce for consumption. It is recommended to take it regularly.

　　5. Take one male chicken (about 500 grams), remove the skin, feathers, and internal organs, wash it, slice 5 grams of 'Sanqi', put it into the chicken's belly, add a small amount of yellow wine, steam it over water, and serve it with soy sauce after it is cooked. It is recommended to take it regularly.

　　6. Take 30 to 60 grams of raw astragalus, boil it to make a concentrated decoction, add 100 grams of glutinous rice, and cook it into porridge for morning and evening meals.

　　7. Take 20 grams of angelica sinensis, 100 grams of astragalus, and one tender hen, boil them in water to make a soup for consumption.

　　8. Take 50 grams of purple salvia, wash it, boil it in water, and take the juice. Boil the juice with 1000 grams of pork long bone and 250 grams of soybeans until they are tender, then add a small amount of cinnamon and salt to make it.

　　9. Grind 500 grams of fresh crab, mix it with 250 grams of hot yellow wine, apply the remaining residue to the affected area, and it will be fine after about half a day of 'ge ge' sound. It is used for fracture healing.

　　Two: What foods are good for the humerus head fracture

　　1. Foods should be easy to digest and absorb, and it is advisable to avoid spicy foods that may irritate the respiratory and digestive tracts, such as chili, scallions, mustard, pepper, pickled bamboo shoots, ginger, and hot and spicy foods. When systemic symptoms are prominent, soft food, which is between normal and semi-liquid food, should be provided. The food must contain little residue, making it easy to chew and digest.

　　2. Properly supplement calcium, get plenty of sunshine, maintain a balanced diet, and cook scientifically. If possible, eat more foods that are beneficial to the recovery of fractures, especially for comminuted fractures: tofu, shrimp, kelp, seaweed, pork brain, eggs, quail eggs, preserved eggs, celery, carrots, black fungus, mushrooms. Apples, black dates, dried mulberries, peanuts, lotus seeds.

　　3. Add more water when cooking, and the cooking time should be short. Do not chop the vegetables too finely.

　　4. If you eat vegetables with a high content of oxalic acid, you must soak them in hot water for 5 minutes to remove the oxalic acid first, so as not to combine with calcium-rich foods to form insoluble calcium oxalate, such as spinach, lotus root, and chives are vegetables with a high content of oxalic acid.

　　5. Eat some coarse grains such as sorghum, buckwheat, oatmeal, and corn.

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

　　1. Avoid acidic, spicy, dry, and greasy foods in the early stage, and do not apply rich and nourishing substances prematurely: such as bone soup, fatty chicken, stewed fish, etc. 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 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 after a fracture not only does not promote early healing but may even 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, and the periosteum and bone marrow can only better exert their functions under the condition of increasing bone collagen. The main components of meat bones are phosphorus and calcium. If a large amount of them is consumed after a fracture, it will promote an increase in the inorganic component content of the bone, leading to 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 can stimulate appetite, so eating a small amount is not harmful.

　　3. Avoid dietary imbalance: 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 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 activity caused by the fixation of plaster or splints, and the swelling and pain at the injury site, as well as mental distress, often have a poor appetite and constipation.

　　5. Avoid excessive sugar intake: After consuming a large amount of sugar, the body will experience a rapid metabolism of glucose, resulting in intermediate metabolic substances such as pyruvate and lactic acid, leading to acidosis. At this time, alkaline ions such as calcium, magnesium, and sodium 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 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. Deficiency of vitamin B1 will greatly reduce the activity of nerves and muscles, and also affect the recovery of function. Therefore, fracture patients should avoid consuming excessive sugar.

　　6. Avoid long-term use of Sanqi tablets: In the early stage of fracture, there is internal hemorrhage locally, blood stasis, swelling, and pain. At this time, taking Sanqi tablets can contract the local blood vessels, shorten the coagulation time, increase the thrombin, which is very appropriate. But after one week of fracture reduction, bleeding has stopped, and the damaged tissue begins to repair. Since 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 conducive to fracture healing.

　　7. Prohibit drinking fruit juice: The raw material of fruit juice is made up of sugar water, flavoring, colorants, etc. 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.

　　I. Treatment

　　I. Fracture of the greater tuberosity of the humerus without displacement:No special treatment is needed, and the injured limb can be suspended with a triangular bandage for 2 weeks, and the function of the injured limb should be strengthened as soon as possible. If there is also anterior dislocation of the shoulder joint, after the shoulder joint is reduced, and the greater tuberosity fracture is also reduced, it can be treated according to the treatment for anterior dislocation of the shoulder joint.

　　II. Fracture of the greater tuberosity of the humerus with displacement:If there is a fracture of the surgical neck of the humerus, it can be treated according to the reduction and fixation of the fracture of the surgical neck of the humerus. If the fractured fragment of the greater tuberosity of the humerus moves upwards to the upper part of the humeral head, affecting the external rotation function of the shoulder joint, it is necessary to perform fracture reduction and fixation treatment:

　　(1) Injured person sitting: with the arm of the injured limb abducted 90°, externally rotated 60°, and flexed forward 40° under local hematoma anesthesia;

　　(2) And place the injured limb on the abduction brace, the operator pushes the supraspinatus muscle towards the greater tuberosity of the humerus with the thumb to force the fracture fragment to reduce;

　　(3) For those with good reduction, the abduction brace and the injured limb are fixed with plaster strips for 4 weeks.

　　If the reduction of the fractured greater tuberosity of the humerus fails due to displacement, or if the greater tuberosity fracture is pulled to the upper part of the humeral head, open reduction and internal fixation treatment should be performed. Generally, a shoulder anterior and medial incision is used to expose the lesser tuberosity and the intertubercular sulcus of the humerus, and the upper arm is externally rotated and abducted, and the greater tuberosity is clamped downward with a bandage clip to reduce it, fixed with screws, sutured in layers, and the postoperative limb is fixed with an abduction brace and the function of the injured limb is strengthened.

　　II. Prognosis

　　The general prognosis is good.