Surgery of the lower end of the humerus
The lower end of the humerus fracture can be divided into the lower end of the humerus - Colle fracture, flexion - Smith fracture and Barton fracture according to the fracture site and the direction of distal flap displacement. According to reports in the literature, Colle fractures accounted for 6.5% of total body fractures, ranking second. Smith fractures accounted for 0.24% and Barton fractures accounted for 0.13%. The lower part of the humerus was divided into 0.75%, and the lower end of the humerus was fractured or the epiphysis was separated. Most of them were not tired and their joint surface. If there is a longitudinal fracture at the same time, it will constitute a comminuted fracture of the joint or a fracture of the orbital bone. Barton fracture refers to the large fracture of the dorsal rim of the lower end of the humerus. The distal flap includes more than 1/2 of the lower articular surface. The proximal carpal bone is also displaced to the dorsal and temporal sides, forming a fracture and dislocation of the joint. It is rare. The vast majority of Colle fractures or osteophytes can be treated with manual reduction and external fixation, and most can achieve good results.Treatment of diseases: dislocation of the lower ankle joint Indication
The operation of the lower end of the humerus is applicable to:
1. Large comminuted Colle fracture involving the lower end of the humerus and with significant displacement or dislocation of the lower ankle joint. Feasible maneuver reduction, closed needle internal fixation. Or open reduction and internal fixation.
2. Very unstable Barton fracture, failure of manual reduction, feasible open reduction and compression screw internal fixation.
3. There is a significant displacement of the old Colle fracture deformity healing, feasible lower extremity osteotomy and bone grafting.Contraindications
Severe crushing of Colle fractures can not be done internally and should not be treated surgically.Preoperative preparation
Prepare the appropriate internal fixation equipment and tools. Such as compression screws, K-wires, etc.Surgical procedure
1.Colley Reduction and Internal Fixation with Closed Pinning for Colle Fracture
Injury side forearm pronation. The field is routinely disinfected and spread. The first method is to pull and reverse the traction, and then the wrist joint is biased. The operator uses the thumb to push the distal flap to the palm and the ulnar side to reset it. If necessary, you can use the TV X-ray machine to reset under fluoroscopy. After the fracture reduction is satisfactory, the assistant maintains the wrist joint in the palm of the hand. The surgeon poked a small mouth with a sharp knife on the ulnar side of the ulnar styloid 1 to 1.5 cm, and drilled a 1.5 mm Kirschner needle. The needle tip was placed under the cortical bone of the sacrum, about 2.0 cm on the first needle. At the same time, the same method is drilled into another Kirschner wire, and the fracture is fixed through the proximal humerus flap to the distal flap. Cut the needle tail and bend it, place it under the skin or outside the skin, and wrap it with sterile gauze.
2.Barton fracture Open Reduction and Compression Screws Fixation for Barton Fracture
(1) The operation is performed under the balloon tourniquet. The forearm is fully rotated. Make an S-shaped skin incision on the dorsal side of the lower end of the humerus.
(2) Incision of the deep fascia and the dorsal carpal transverse ligament, revealing the extensor digitorum extensor tendon, the total extensor tendon and the long extensor tendon of the radial side of the wrist, and respectively leading to the ankle and ulnar side, revealing the fracture end. Tilt the wrist as far as possible. Clear the blood and press the distal flap under direct vision to reset it accurately. Then drill from the midpoint of the distal flap to the proximal side with a 3~3.5mm drill bit. The drill is at an angle of 30° to the longitudinal axis of the humerus. Then screw a cannulated bone compression screw with a diameter of 4 mm. The degree of the cortical bone just passing through the proximal flap is the degree. The incision was sutured by layer, and the thick dressing was pressure-wrapped to loosen the tourniquet.
3. Colle fracture open reduction and T-Plates Fixation of Colle Fracture
(1) The operation is performed under the balloon tourniquet. The forearm is fully rotated, and an inverted L-shaped incision is made on the dorsal side of the lower end of the humerus.
(2) The method of reducing the fracture end and under direct vision is the same as the above-mentioned Barton fracture open reduction and compression screw internal fixation.
(3) Place the T-shaped or L-shaped bone plate on the dorsal side of the distal end of the humerus. Drill a hole in the proximal side of the fracture line with a drill with a diameter of 3.0 mm, and then screw a screw with a diameter of 4.0 mm. Then drill and screw in the distal side of the fracture line. The incision was sutured by layer, the thick dressing was pressure-wrapped, and the blood strip was loosened.
4. Osteotomy and Bone Graft of Distal Radius (Campbell Operation)
(1) The operation is performed under the balloon tourniquet. Make a curved incision on the dorsal side of the humerus.
(2) The exposure method is the same as the Barton fracture open reduction and compression screw internal fixation. The fracture is treated with a narrow bone knife from the dorsal aspect of the ankle to the volar side of the humerus. The distal bone mass is pushed away toward the palm and the ulnar side to form a wedge-shaped void having a wide back side and a narrow palm side.
(3) A 4 cm long straight incision was made on the ulnar side of the ulna until the periosteum was removed. The ulnar collateral ligament was cut off to reveal the ulnar half of the lower ulna. The bone lumps of the same size as the aforementioned wedge-shaped voids were cut with a bone knife.
(4) The wedge-shaped bone block is embedded in the space of the lower end of the humerus, and the assistant maintains the wrist joint in the palm-foot deviation position until the plaster is fixed. T-shaped bone plates can also be used for internal fixation if available. The incision was sutured by layer and the dressing was wrapped.complication
The main complication of the lower end of the humerus fracture is the stiffness of the wrist joint, especially in elderly women with osteoporosis (severe osteoporosis should not be treated surgically), so the external fixation time should not be too long, promptly guide the patient to do active functional exercise.