Separation of the epiphysis at the upper end of the humerus

　　1. Etiology

　　This type of epiphysis separation often occurs due to the relationship between the outstrengthening and forward flexion, external rotation and internal rotation of the upper limb during a fall, with violence transmitted upwards along the humerus and acting on the epiphysis plate or the anatomical neck of the humerus.

　　2. Pathogenesis

　　The anatomical structure at the upper end of the humeral epiphysis is relatively weak before it closes at the age of 18. It can be separated due to direct violence acting on the shoulder, or indirect violence transmitted upwards through the elbow and hand. When the external force is small, it only causes damage to the epiphysis line, and the ends are not displaced. When the force is large, the epiphysis is in a separated state, and often a triangular bone fragment is torn off. Depending on the degree of displacement of the epiphysis end, it can be divided into stable and unstable types. The former refers to the case where the epiphysis end is not displaced; the latter refers to the case where the angle forward is greater than 30°, and the anterior and posterior displacement exceeds 1/4 of the cross-section, which is mostly seen in older adolescents.

　　In addition to general symptoms, it may also cause other diseases, and avascular necrosis of the humeral head may occur concurrently. Therefore, once discovered, it requires active treatment, and preventive measures should also be taken in daily life. It should attract the high attention of clinical doctors and patients.

　　The age is mostly below 18 years old, and some cases can reach 20 years old.

　　1. Swelling:Because the fracture is located outside the joint, there is obvious local swelling and subcutaneous ecchymosis may occur.

　　2. Pain:Especially when moving, accompanied by annular tenderness and conductive percussion tenderness.

　　3. Limited activity.

　　Pay attention to safety, prevent falls. Pay attention to nutritional balance in diet. The patient's diet should be light and easy to digest, eat more vegetables and fruits, reasonably balance the diet, and pay attention to sufficient nutrition. In addition, patients also need to pay attention to avoid spicy, greasy, cold foods.

　　At the time of diagnosis, in addition to relying on clinical manifestations, auxiliary examinations are also needed. This disease has no related laboratory tests, and X-rays can show fractures and displacement. This disease seriously affects the daily life of patients, so it should be actively prevented.

　　What is good for the body to eat with proximal humerus epiphysial separation

　　1. Early stage (1-2 weeks):The injured area has blood stasis and swelling, meridians and collaterals are blocked, and Qi and blood are blocked. During this period, treatment focuses on promoting blood circulation and removing blood stasis, and dissipating Qi. 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 removing swelling and blood stasis is the primary factor for fracture healing. The principle of diet coordination is to focus on lightness, such as vegetables, eggs, soy products, fruits, fish soup, lean meat, etc.

　　2. Intermediate stage (2-4 weeks):Most of the ecchymosis is absorbed. During this period, treatment focuses on harmonizing the camp to relieve pain, removing blood stasis and promoting new growth, and joining bones and tendons. In terms of diet, it should shift from light to moderate high-nutrition supplementation to meet the needs of bone callus growth. It can add bone soup, Cordyceps chicken stew, animal liver, etc. 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 in the fracture area is basically absorbed, and bone callus has begun to grow, which is the late stage of fracture. Treatment should be supplemented to promote the formation of more solid bone callus through the nourishment of the liver and kidney, Qi and blood, and to relax the tendons and collaterals, so that the adjacent joints of the fracture can move freely and flexibly, restoring the previous function. On the diet, you can lift the taboos, and the recipe can be supplemented with old hen soup, pork bone soup, lamb bone soup, deer tendons soup, stewed water fish, etc. Those who can drink can choose Du Zhong bone碎补酒、chicken blood vine wine、tiger bone papaya wine, etc.

　　(Dietary information is shared by netizens,未经医生审核，for reference only.)

　　First, treatment

　　1. Manual reduction and external fixation

　　(1) Anesthetize the hematoma with 1% to 2% procaine.

　　(2) The injured limb is in an abducted and flexed position of the upper arm while the patient is sitting or lying on their back.

　　(3) Apply an opposing traction to the healthy side using a bandage from the injured side's axilla, chest wall, and back. An assistant bends the injured limb at the elbow to 90° and traction along the longitudinal axis of the humerus.

　　(4) The operator presses the distal fracture end backward with the hand, which is generally enough to reduce the fracture. After reduction, slightly relax the traction to allow the fracture ends to abut each other.

　　(5) Use an abduction brace and cast to maintain the alignment of the fracture ends.

　　2. Open Reduction and Internal Fixation:Open reduction and internal fixation can be performed for those who fail manual reduction or have dislocated humeral heads. The surgical reduction operation is not difficult. Using a shoulder anterior and medial incision, the fracture end is exposed, and it is easy to achieve a satisfactory reduction. Internal fixation can be performed with screws or Kirschner wires, the wound is sutured, and early activity can be achieved. Generally, the injured limb is only suspended with a triangular bandage, and no special external fixation is performed. Aseptic necrosis of the humeral head may occur.

　　3. Artificial Shoulder Joint Replacement:Older patients have more severe osteoporosis and severe fracture of the humeral head, which cannot be effectively fixed, and it is difficult to achieve sufficient stability for early functional exercise by open reduction and internal fixation, with a high incidence of late complications such as non-union, malunion, and avascular necrosis of the humeral head. The blood supply to the upper end of the humerus mainly comes from the ascending branch of the anterior humeral recurrent artery, which enters the humeral head at the intertubercular groove (intermuscular groove of the biceps brachii). Injury to this artery due to trauma and fracture displacement can lead to non-union and avascular necrosis of the humeral head. Artificial shoulder joint replacement surgery is an effective treatment for such patients. The vast majority of artificial shoulder joint replacements are humeral head replacements, and it is generally not necessary to replace the joint盂.

　　Total shoulder replacement should only be considered in special cases such as shoulder joint degenerative changes, joint盂 wear and tear or fracture, malformation, etc. However, for young patients, the long-term follow-up results show that the application of artificial shoulder joint replacement surgery can significantly improve the patient's pain symptoms and improve the range of motion to a certain extent. However, when evaluating, nearly half of the young patients are not satisfied with the results. And some patients who have not undergone artificial shoulder joint replacement surgery, although there is avascular necrosis and collapse of the humeral head, if the reduction is good and reaches approximate anatomic healing, the patient's pain relief and functional recovery can be similar to the results of artificial shoulder joint replacement. Artificial shoulder joint replacement should be used with great caution in young patients, and the method of open or closed reduction and internal fixation should be used as much as possible, but the fracture must be well reduced. If satisfactory reduction cannot be achieved during surgery, it should be changed to artificial shoulder joint replacement.

　　II. Prognosis

　　After manual reduction and external fixation, followed by active functional exercise, the prognosis is still good.