Complete epiphysial separation of the distal humerus

　　Complete epiphysial separation is commonly seen in extension ulnar deviation type, caused by indirect external force, mostly when falling, the affected arm is extended to support the ground, at the same time, the trunk rotates to the affected side, the elbow joint is hyperextended, and the body's center of gravity falls on the affected arm, resulting in a strong internal rotation (actually the humerus is externally rotated) and varus and hyperextension stress. The strength of the growth plate in children is weaker than that of the joint capsule and ligaments, so it is easy to cause complete epiphysial separation rather than elbow joint dislocation.

　　Flexion type complete epiphysial separation is relatively rare, caused by an external force impacting the olecranon in the position of flexion of the elbow and then transmitted to the condyle. This type of injury often occurs in older children and may be related to the change in the direction of the growth plate (increased obliquity).

　　Severe complete epiphysial separation of the distal humerus can cause malformation of the elbow varus or functional disorder of the elbow joint. One of the reasons is that the displacement caused by the fracture itself, especially the ulnar deviation and rotational displacement. The second is the developmental imbalance caused by epiphysial injury and blood supply obstruction, which is the reason why the anatomical alignment still appears joint deformity in clinical practice.

　　The typical manifestation of complete epiphysial separation of the distal humerus is that the separated distal humerus, along with the ulna and radius, moves backward and medially, while the lateral epiphysis of the humerus maintains a good alignment with the proximal radius. If the lateral epiphysis of the humerus has not yet ossified, it is easy to be confused with elbow joint dislocation. For mild displacement, a healthy side X-ray film should be taken for comparison. After the humeral lateral epiphysis ossifies, its X-ray image is the basis for diagnosis. The X-ray characteristics are as follows:

　　1. The humeroradial joint is normal, and the elbow joint is in the correct position and the lateral view shows the longitudinal axis of the radius passing through the humeral head.

　　2. The relationship between the radius and ulna remains unchanged, that is, the superior radius-ulna relationship is normal.

　　3. Abnormal alignment of the humerus and radius-ulna, often with a fragment of a diaphyseal fracture of the radius-ulna or the humeral epicondyle displaced posteriorly and superiorly.

　　Distal radial physeal separation of the humerus is caused by traumatic factors, so special attention should be paid to the safety of children's lives to avoid trauma. Once they fall, they should always pay attention to whether there are any abnormal signs in children and seek medical treatment actively. For children diagnosed with this disease, active treatment should be carried out to avoid leaving serious sequelae.

　　The most common examination method for distal radial physeal separation of the humerus is X-ray examination, which is also the diagnostic basis for the disease. The X-ray characteristics are as follows:

　　1. The humeroradial joint is normal, and the elbow joint is in the correct position and the lateral view shows the longitudinal axis of the radius passing through the humeral head.

　　2. The relationship between the radius and ulna remains unchanged, that is, the superior radius-ulna relationship is normal.

　　3. Abnormal alignment of the humerus and radius-ulna, often with a fragment of a diaphyseal fracture of the radius-ulna or the humeral epicondyle displaced posteriorly and superiorly.

　　Dietetic methods and dietary taboos for patients with distal radial physeal separation of the humerus

　　One: Dietetic recipes for distal radial physeal separation of the humerus

　　1. Take 1000 grams of pork bone, 250 grams of soybeans, add water, and simmer over low heat until they are soft. Season with salt and ginger, and eat it as a meal.

　　2. Take one set of pork spine, wash it, add 120 grams of red dates, 90 grams of lotus seeds, 9 grams of Ding Xiang (Costus), and 9 grams of raw licorice root, add water, and simmer over low heat until they are soft. Season with ginger and salt, and drink it in several doses.

　　3. Take two fresh lake crabs, remove the meat (with the yolk), add the crab meat to the cooked glutinous rice, and add a moderate amount of ginger, vinegar, and soy sauce for consumption. Take it regularly.

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

　　5. Take 30 to 60 grams of raw Astragalus membranaceus, boil it to make a concentrated juice, add 100 grams of glutinous rice, cook it into porridge, and take it in the morning and evening.

　　6. Take 20 grams of Angelica sinensis, 100 grams of Astragalus membranaceus, and one tender hen, boil them together with water to make a soup for consumption.

　　7. Take 50 grams of Salvia miltiorrhiza, wash it, boil it with water, and take the juice. Boil the juice with 1000 grams of pork long bones and 250 grams of soybeans until they are tender. Add a small amount of cassia bark and salt, and it is ready.

　　Two: Foods that are good for the body in the case of distal radial physeal separation of the humerus

　　1. The principle of diet coordination is to focus on light and healthy foods, such as vegetables, eggs, soy products, fruits, fish soup, lean meat, etc.

　　2. Add bone soup, Panax notoginseng chicken stew, and animal liver to the initial diet to provide more vitamin A, D, calcium, and protein.

　　Three: Foods to avoid for distal radial physeal separation of the humerus

　　1. It is advisable to avoid partial diet for fracture patients, as they 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 muscle in long bones, the formation of callus, and the removal of blood stasis and swelling depend on various nutrients. Therefore, ensuring a smooth healing of fractures is crucial, and nutrition plays a key role.

　　2. Avoid indigestible foods Fracture patients are restricted in movement due to the fixation of plaster or splints, and added pain and swelling at the injury site, as well as mental distress, often lead to a poor appetite and constipation.

　　3. Avoid excessive intake of sugar. After excessive intake of sugar, a rapid metabolism of glucose will occur, thus producing intermediate metabolites 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 immediately be 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. Insufficient vitamin B1 greatly reduces the activity of nerves and muscles and also affects the recovery of function. Therefore, fracture patients should avoid eating excessive sugar.

　　4. Abstain from drinking fruit juice. The raw materials of fruit juice are made up of sugar water, flavoring, colorants, etc. It does not contain 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.

　　This disease is caused by traumatic factors, so special attention should be paid to the safety of children's lives and to avoid trauma. Once a fall occurs, constant attention should be paid to whether the child shows any abnormal signs, seek medical attention actively, and treat children diagnosed with this disease actively to avoid leaving serious sequelae.

　　The treatment methods are basically the same as those for supracondylar fracture of the humerus. Generally, closed reduction and external fixation is performed. Under manual traction, the lateral displacement is first corrected, followed by the anterior and posterior displacement. The elbow is fixed at 60-90 degrees for three weeks. External fixation is not easy to prevent the recurrence of fracture displacement and secondary valgus deformity of the elbow. Therefore, some people advocate changing to an extended position early. Local splint fixation supplemented with traction therapy is effective. Some people fix the fracture through the skin with finer steel pins after closed reduction. Open fractures are fixed with finer steel pins after debridement. For old fractures, no special treatment is generally performed, and osteotomy correction is performed after growth and development is mature in cases of secondary deformity.