Radial shaft fractures at the lower third and dislocation of the ulnar and radius joints

　　When the distal radius and ulnar styloid joint are dislocated, the most common cause of injury is a direct force from extreme pronation of the forearm, and an indirect force from wrist extension and the palm side of the hand touching the ground. The force passes through the radiocarpal joint to cause a radius fracture, while tearing the triangular fibrocartilage or the ulnar styloid process avulsion fracture, resulting in dislocation of the ulnar styloid joint. Fractures are mostly short oblique or transverse, and a few are comminuted.

　　Distal radius fractures below the 1/3 and dislocation of the ulnar styloid joint are a complex injury, and the condition is often complex and severe, prone to complications such as other fractures and nerve injuries. The combined injury of the ulnar nerve is relatively common. It can also be accompanied by rupture of the palmar and dorsal lateral ligaments of the ulnar styloid joint, and rupture of the triangular fibrocartilage disc.

　　For patients with this disease, those with不明显 displacement have only pain, swelling, and tenderness, and the rotation of the forearm is limited. Those with明显 displacement have shortening and angular deformity of the radius, tenderness at the ulnar styloid joint, and bulging of the ulna head. X-ray imaging shows a transverse or short oblique fracture at the junction of the distal 1/3 of the radius, mostly without severe comminution. If the radius fracture is significantly displaced, the ulnar styloid joint will be completely dislocated. In the anteroposterior X-ray film, the radius is shortened, the distance between the distal radius and ulna is reduced, and the radius is close to the ulna. In the lateral view, the radius head is angulated towards the palm side, and the ulna head is protruding towards the dorsal side.

　　Before the clinical healing of the radius fracture, the rotation of the forearm should be prohibited. During the early stage of fracture, when performing the fist exercise, the flexion and extension of the fingers should be as forceful as possible. In the middle stage of fracture, maintain the neutral position of the forearm, gradually activate the function of the shoulder and elbow, that is, the action of small Yunshou and Da Yunshou, until clinical healing. In the late stage of fracture, carry out a comprehensive activity of the shoulder, elbow, and wrist joints, especially focusing on the action of reversing the hand, and carry out the rotation of the forearm.

　　The auxiliary examination method for this disease is mainly X-ray examination:X-ray imaging shows a transverse or short oblique fracture at the junction of the distal 1/3 of the radius, mostly without severe comminution. If the radius fracture is significantly displaced, the ulnar styloid joint will be completely dislocated. In the anteroposterior X-ray film, the radius is shortened, the distance between the distal radius and ulna is reduced, and the radius is close to the ulna. In the lateral view, the radius head is angulated towards the palm side, and the ulna head is protruding towards the dorsal side.

　　The diet for patients with distal radius fractures below the 1/3 and dislocation of the ulnar styloid joint should be: Pay attention to nutrition supplementation, eat more vitamin-rich foods to enhance nutrition, eat more protein-rich foods such as fish, eggs, bean products, and appropriately increase calcium. Drink more water, eat more vegetables and fruits such as green vegetables, celery, bananas, etc. Eat more vitamin C, calcium, and iron-rich foods, avoid greasy, spicy, and刺激性 foods, and reduce smoking and alcohol.

　　Fracture of the lower 1/3 of the radius, the distal segment of the fracture rotates medially and ulnarly due to the contraction of the pronator quadratus muscle and the traction of the interosseous membrane. Whether it is children or adults, the more the displacement of rotation, the more serious the functional disability. The reduction method is that closed or open reduction should require the radius-ulna fracture to reach anatomical reduction. Closed reduction needs to be completed under brachial plexus block anesthesia. The use of the method of splitting the fracture top can generally correct the lateral and palmar-dorsal displacement, if the rotational displacement is not corrected, a threaded S-shaped needle is inserted medially into the distal radius of the radius under disinfected and local anesthesia, but attention should be paid to avoid vascular and nerve injury. Under the C-arm monitoring, traction and rotation reduction are performed with the S-shaped needle held in hand, and the puncture site is tightly wrapped with sterile gauze after the cast is fixed. After the cast is cut short, the needle tail is wrapped with adhesive tape for removal after the fracture healing. For unstable fractures of the distal radius, due to the continuous compression of the forearm muscles, there is a trend of axial shortening, and the fixation method should be sufficient to counteract the muscle force. Intramedullary nails and ordinary plates are difficult to meet this condition.

　　The plate is often placed on the palmar side, for two reasons: the palmar surface of the radius is relatively flat and easy to operate, and the soft tissue conditions are good. Chronic dislocation of the distal radioulnar joint is another pathogenic factor for the occurrence of distal radioulnar joint dislocation. In the late stage, excision of the radial head is attempted to improve the rotational function of the forearm and the limited extension and flexion of the wrist joint, but at the same time, changes such as ulnar deviation, instability, and weakness of the wrist joint may occur, so it is very important to restore the normal anatomical relationship of the distal radioulnar joint as soon as possible. For those who have a successful closed reduction, the cast fixation allows the ligaments and joint capsules around the distal radioulnar joint to fully heal. For those who undergo open reduction and repair of the surrounding ligaments and joint capsules, the distal radioulnar joint is fixed percutaneously or by incision and Kirschner wire fixation across the ulna. Practice has proven that this method of fixation is stable and reliable. Some authors have reported that the use of the Liebort method to reconstruct the ligaments, joint capsules, and interosseous membrane of the joint has achieved satisfactory results. For open fractures, in addition to requiring good alignment and strong internal fixation of the fracture, how to close the wound should not be ignored. The common mistake is to force the suture in the case of extremely high skin tension or defects on the forearm, which can lead to skin necrosis.二期缝合 or the use of free flap移植 with vascular anastomosis is an ideal surgical method for closing the wound.