Fracture of the radial head of the humerus

　　Fracture of the radial head of the humerus is caused by shearing stress, that is, when the elbow joint is extended and falls with the hand touching the ground, the external force is transmitted along the radius to the elbow, the radial head moves upwards and collides the radial head of the humerus, and at the same time, the external rotation stress can cause injury to the soft tissue on the medial side. According to the degree of injury and the range of fracture, it is divided into the following 3 types.

　　1, Complete fracture:That is, a coronal fracture of the base of the radial head of the humerus, the fracture fragment itself includes the entire radial head and the lateral third or half of the trochlea, but sometimes it is limited to the radial head itself.

　　2, Partial fracture:The fracture fragment only includes the radial head, joint cartilage, and a small amount of bone below it.

　　3, Contusion of the radial head joint cartilage:The force causing the injury is not enough to cause a fracture, but only causes contusion of the radial head joint, which cannot be shown by X-ray and is difficult to diagnose. Cartilage injury can be found only when the radial head excision is performed in late surgery.

　　Pathogenesis

　　Mostly caused by indirect violence, the radial head is located on the radial side of the distal end of the humerus, a rounded and smooth tubercle projecting forward; when the elbow joint is flexed, the radial head rotates on the anterior articular surface; after the elbow is maximally flexed, the edge of the radial head just touches the radial head fossa above the radial head; when extended, the radial head rotates on the lower articular surface of the radial head; after falling, the elbow joint is slightly flexed, and the external force is transmitted to the elbow along the radius, and the radial head moves upwards like the piston of an internal combustion engine, colliding the radial head of the humerus.

　　Fracture of the radial head of the humerus can cause stiffness of the elbow joint, dysfunction, and a limited range of motion in the joint; in some cases, it can also be accompanied by injuries to the medial ligament, etc. Fracture of the radial head of the humerus is an intra-articular injury. If it is not diagnosed and treated in time, it can have a significant impact on joint function.

　　Swelling behind the elbow joint is within the joint, so it is not obvious, but there is significant limitation of movement and tenderness at the radial head, and in cases with medial ligament injury, there is tenderness and increased extension. After injury, there is swelling and pain in the elbow, which often occurs on the lateral side and in the elbow fossa. Pain and tenderness are limited to the lateral or anterior aspect of the elbow, with limitation of extension and flexion of the elbow joint, especially when flexing 90° to 100°, which often causes increased pain and resistance.

　　Type I:Complete fracture (Hahn-Steinthal fracture), including the radial head and part of the patella.

　　Type II:Complete radial head fracture (Kocher-Lorenz fracture), which is sometimes difficult to detect on X-ray films due to small fracture fragments.

　　Type III:Comminuted fracture, or both the radial head and the patella are fractured and separated from each other.

　　Type IV:Radial head joint cartilage injury.

　　Prevention of radial head fracture should pay attention to not overexerting labor intensity, not carrying heavy objects for a long time, not washing too many clothes at one time, and preventing muscle strain of the extensor muscle of the radial head. Pay attention to physical exercise in daily life, actively move the upper limb joints, strengthen muscle strength, and help prevent the occurrence of this disease.

　　There are no related laboratory tests. The main auxiliary examination method for radial head fracture is X-ray examination:

　　X-ray findings are often characteristic. Anteroposterior X-ray films can help determine the size of associated patellar fragment fractures, but only lateral X-ray films can reflect the characteristics of this injury, which is characterized by the appearance of a 'double arc sign'. However, if the lateral X-ray film is slightly tilted, the distal humerus may cover the fracture fragment, leading to missed diagnosis. It is necessary to carefully observe the anteroposterior and lateral X-ray films to make a diagnosis. Since the bone fragments contain articular cartilage, X-ray films cannot reflect their true size. The actual fracture fragments are much larger than the images shown on X-ray films. In some cases, both the radial head and the patella may be fractured simultaneously. If the fracture fragments displace and overlap with the distal humerus, it is easy to miss the diagnosis. CT scanning and three-dimensional reconstruction can be performed for confirmation.

　　Dietary taboos in daily life for patients with radial head fracture.

　　Patients should eat:

　　1. Foods should be easy to digest and absorb, and avoid spicy foods that may irritate the respiratory and digestive tracts (such as chili, scallions, wasabi, pepper, pickled bamboo shoots, ginger, and hot foods) and other irritants. When systemic symptoms are pronounced, provide soft food between normal and semi-liquid diets, which should contain less residue and be easy to chew and digest.

　　2. Adequate calcium supplementation, more sun exposure, balanced nutrition, and scientific cooking. If possible, consume more foods that are beneficial for fracture healing, especially for comminuted fractures: tofu, shrimp, kelp, nori, pork brain, eggs, quail eggs, preserved eggs, celery, carrots, black fungus, mushrooms. Apples, black jujubes, dried mulberries, peanuts, lotus seeds.

　　3. Add more water when stir-frying, and the cooking time should be short. The vegetables should not be cut 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 chive are vegetables with a high content of oxalic acid.

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

　　Patients should avoid eating:

　　(1) It is forbidden to eat sour, spicy, dry, and greasy foods early. It is especially forbidden to apply rich and nourishing foods such as bone soup, fatty chicken, and braised fish too early, 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) It is forbidden to eat too much meat bone. Some people think 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 does not promote early healing but may also delay the healing time of fractures. The reason for this is that the regeneration of bone after injury mainly relies on the function of the periosteum and bone marrow. The periosteum and bone marrow can only better exert their function under the condition of increasing collagen. The main components of meat bones are phosphorus and calcium. If a large amount of intake is consumed after a fracture, it will promote the increase of inorganic components in the bone, leading to a disorder in the proportion of organic components in the bone, thus hindering 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) It is forbidden to have a biased diet. Fracture patients often have local edema, congestion, hemorrhage, and muscle tissue damage. The body itself has resistance and repair capabilities for these conditions. 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) It is forbidden to eat indigestible food. 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) It is forbidden to overeat sugar. After excessive intake of sugar, a rapid metabolism of glucose will occur, resulting in intermediate metabolites such as pyruvate and lactic acid, causing the body to be in 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 will also reduce the content of vitamin B1 in the body, as vitamin B1 is a substance necessary 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 eating too much sugar.

　　(6) It is forbidden to take Sanqi tablets in the early stage of fracture. Local internal hemorrhage may occur, with blood stasis, swelling, and pain. At this time, taking Sanqi tablets can constrict local blood vessels, shorten coagulation time, and increase thrombin, which is very appropriate. However, after one week of fracture reduction, bleeding has stopped, and the damaged tissue begins to repair. The 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 constriction, and blood circulation is not smooth, which is not beneficial for the healing of the fracture.

　　(7) Do not drink fruit juice after a fracture. The raw material of fruit juice is made up of sugar water, flavorings, pigments, etc. It does not contain vitamins and minerals needed by the human body. Because it contains a lot of sugar, it presents a physiological acidosis in the body after drinking.

　　For non-displaced cartilage injury of the humeral head or crack fractures, the elbow joint can be immobilized at 90° for 3 to 4 weeks with a plaster splint. For displaced fractures, manual or lever reduction should be attempted first; if it fails, open reduction and internal fixation should be performed.

　　1. Manual Reduction:The assistant maintains the affected limb in an extended elbow position or straightened supinated position, and the operator uses the thumb to hold the bone fragment and push it back to its original position. After successful reduction, immobilize the elbow joint at 90° of flexion with a plaster splint or small splint for 3 to 4 weeks.

　　2. Percutaneous撬拨复位：For cases where closed reduction fails, Kirschner wires can be passed through the skin and biceps brachii at the superior anterior margin of the humerus under anesthesia to reach the bone fragments. Under X-ray screen monitoring, adjust the tip position of the needle to support the superior anterior aspect of the bone fragments and push the bone fragments into reduction. After successful reduction, immobilize the elbow joint in the functional position with a plaster splint for 3 weeks.

　　3. Open Reduction and Internal Fixation:Applicable to cases of displaced fractures where the above methods have failed. The operation adopts the lateral or anterolateral approach to the elbow joint, exposes the fracture ends, clears blood clots, identifies the various directions of the bone fragments, pushes the bone fragments back to their original position, and observes before closing the incision. If the distal radial condyle shallow concave articular surface can maintain the stability of the bone fragments when the elbow is flexed, internal fixation may not be required. For poor fracture reduction stability, fine steel needles can be used to fix from the outside anterior to the inside posterior. The plaster splint is fixed for 3 to 4 weeks after surgery, and functional exercise is performed after the needle is removed. Larger bone fragments can also be fixed internally with cancellous bone screws from the dorsal aspect of the humeral lateral epicondyle, paying attention that the tip of the screw cannot penetrate the articular cartilage surface. Because the screw fixation is strong and reliable, functional exercise can be started 3 to 5 days after surgery.

　　4. Bone Fragment Excision:Small bone fragments are difficult to fix, and bone fragments can be removed early to facilitate joint movement. Old displacement fractures that hinder flexion of the elbow should have bone fragments or radial head resected to prevent the occurrence of traumatic arthritis, causing pain and dysfunction.