Shoulder Acromion Fracture

　　First, etiology

　　Both direct and indirect violence can cause this fracture.

　　Second, pathogenesis

　　Because this bone fragment is strong and the bony prominence is short and not easy to fracture, it is less common. It mainly includes the following two mechanisms:

　　2. Indirect transmission of violence when the shoulder is abducted or adducted and falls, caused by the lever lifting effect of the greater tubercle of the humerus, resulting in fracture. The fracture line is often located at the base of the acromion.

　　1. Direct violence is the vertical downward force from above the acromion, and the fracture line is often located on the lateral side of the acromioclavicular joint.

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

　　2. Plaster pressure:After simple fractures are reduced by manipulation and fixed with plaster, as the limb swelling gradually increases, there will be plaster pressure, causing obvious swelling, ecchymosis, numbness, and other symptoms at the distal parts of the limb such as fingers and toes. It is necessary to go to a medical institution to release the pressure in time to avoid limb necrosis.

　　3. Joint stiffness:Long-term immobilization of the affected limb, poor venous and lymphatic return, synovial fluid fibrinous exudation and fibrin deposition in the joint cavity, fibrous adhesion, and surrounding soft tissue contracture around the joint, resulting in joint movement disorders. This is the most common complication of fractures and joint injuries. Prompt removal of fixation and active functional exercise are effective methods for preventing and treating joint stiffness.

　　4. Muscle atrophy in the limbs:Muscle atrophy will occur once the limb is immobilized or lacks movement. Active muscle searching can alleviate the degree of muscle atrophy, and the specific method is: if the joint can move, you can do isometric contractions (i.e., the muscle exerts force but the limb does not produce movement) and isotonic contractions (muscle exerts force and produces movement). If the joint is immobilized, then you can do isometric contractions exercises.

　　5. Decubitus pneumonia:They often occur in patients who have been bedridden for a long time due to fractures, especially in the elderly and weak patients with comminuted fractures of the humerus and chronic diseases. Sometimes, this can even threaten the patient's life, so it is necessary to encourage patients to get out of bed and move around as soon as possible.

　　6. Bedsores in patients with severe fractures after long-term bed rest:Long-term bed rest, pressure on the bony prominences of the body, and local circulatory disorders are prone to form bedsores. Common locations include the iliac region, the hip region, and the heel region.

　　1. Pain, local pain is prominent.

　　2. Swelling, as the anatomical location is superficial, local swelling is easily visible, often accompanied by subcutaneous ecchymosis or hematoma formation.

　　3. Restrictions on movement, abduction and elevation movements are limited, non-displaced fractures are relatively mild, while those with shoulder acromioclavicular joint dislocation or clavicle fracture are more obvious.

　　4. In addition to paying attention to the presence of associated fractures, it is also necessary to be aware of any brachial plexus injuries.

　　Under the control of actual external fixation force, active functional exercise can not only promote blood circulation, improve material metabolism, and restore joint function as soon as possible, but also, due to the full play of the opposite compressive effect generated between the fracture ends along the long axis of the骨干 during muscle contraction and relaxation, the fracture ends are in close contact and continuously interlocked, which often makes the fracture with long-term delayed healing obtain bony union. However, functional exercise should emphasize both positivity and safety, proceed step by step, and not be hasty, otherwise adverse consequences may also occur.

　　1. No related laboratory tests.

　　2. After taking an anteroposterior, oblique, and axillary view X-ray film, a more comprehensive understanding of the type and characteristics of the fracture can be obtained, and whether there is related fracture. Follow-up X-ray films after reduction can determine the reduction and understand other injuries.

　　3. MRI or shoulder joint arthrography can be performed to evaluate the condition of the glenoid labrum and ligaments, and to understand whether there is any soft tissue injury around the shoulder joint and the extent and location of the injury.

　　What foods should not be eaten for acromial fractures:

　　1. Avoid eating too much meat bones.

　　2. Avoid overeating sugar.

　　3. Avoid indigestible foods. Avoid eating foods that are easy to cause flatulence or indigestion, such as yams, taro, glutinous rice, etc., and eat more fruits and vegetables.

　　I. Treatment

　　Appropriate measures should be taken according to the type of fracture and associated injuries:

　　1. For those without displacement, the affected limb can be immobilized with a triangular bandage or a general sling.

　　2. For those who can be reduced manually, after the affected limb is flexed and pressed against the chest, upward pressure from the elbow can achieve the purpose of reduction, and shoulder-elbow-chest plaster fixation can be adopted, which generally lasts for 4 to 6 weeks.

　　3. For those who fail in closed reduction, open reduction + tension band fixation can be performed. Generally, it is not advisable to use simple Kirschner wire fixation to prevent its sliding and displacement to other parts.

　　II. Prognosis

　　Generally, the prognosis is good, but if reduction is not good, it can cause consequences such as limited abduction of the shoulder joint and periarthritis around the shoulder joint.