What Is a Supracondylar Humerus Fracture?

Humeral fractures often occur in the humeral surgical neck, the humeral shaft, the humeral condyle, the humeral condyle, the humeral condyle, and the humeral epicondyle. Among them, especially the former three are more and can occur at any age. It is mostly caused by direct and indirect violence, such as landing on the hand or elbow when a heavy object hits, squeezes, hits, or falls. Violence is transmitted to each part through the forearm or elbow. X-ray examination can confirm the diagnosis and indicate the type of fracture.

Basic Information

English name: humeral fracture
Visiting department: orthopedics
Common locations: Humeral surgical neck, humeral shaft, humeral condyle

Common causes: Caused by violence or indirect violence
Common symptoms: Localized ecchymoses, slightly shorter than the healthy side, deformed bone fricatives; severe swelling and pain in the affected arm, obvious tenderness, loss of upper arm function, etc.

Causes of humeral fractures

Humeral fractures can be caused by violence or indirect violence. Direct violence often strikes the humerus shaft laterally, causing horizontal or comminuted fractures. Indirect violence is usually caused by the landing of the hands or the elbows, the upward transmission of force, and the shearing stress caused by the body dumping, resulting in fractures in the middle and lower thirds, sometimes due to throwing movements or "wrists". One-fracture.

Clinical manifestations of humeral fractures

Humeral surgical neck fracture

Locally, ecchymosis often occurs. When the left upper arm longitudinal axis taps, there is an acute angle at the fracture. The affected limb is slightly shorter than the healthy side, and deformed bone fricatives may appear.

2. Humeral shaft fracture

The affected arm is severely swollen and painful, with obvious tenderness and loss of upper arm function. Patients often attach the forearm to the chest wall.

3. Supracondylar fracture of humerus

The elbow is swollen and painful, and even tension blister appears. The elbow tenderness is very severe. The elbow joint function is lost. The fracture site has abnormal activities and bone fricatives.

Humerus fracture examination

Diagnosis of humeral surgical neck fracture is easy. The X-ray of the shoulder can show the type of abduction fracture or adduction fracture. You must also have a lateral radiograph (through the chest) to understand whether the humeral head is rotated, inserted, and anterior-posteriorly overlapped and deformed in order to determine whether the fracture end is angled forward. There are three types of adduction or abduction, extension and flexion.

Diagnosis of humerus fracture

It is not difficult to make a diagnosis based on clinical manifestations and related examinations.

Humerus fracture complications

Vascular injury

Fractures of the proximal humerus with vascular injuries are rare. In general, the incidence of axillary artery injury is highest. Elderly patients are more prone to vascular injury due to vascular sclerosis and poor elasticity of the vascular wall. After the arterial injury, a swollen hematoma was formed locally, and the pain was obvious. The limbs are pale or cyanose, and the skin feels abnormal. Arteriography can determine the location and nature of vascular injury.

2. Brachial plexus injury

Fractures of the proximal humerus with brachial plexus injury are most affected by the axillary nerve, and injuries to the superior scapular, musculocutaneous and radial nerves also occur occasionally. When the axillary nerve is injured, the skin on the outside of the shoulder is lost, but it is more accurate and reliable to determine the contraction of deltoid muscle fibers. In the case of axillary nerve injury, electromyography can be used to observe the progress of nerve injury recovery. In most cases, the function can be restored within 4 months, and if there is no sign of recovery 2 to 3 months after the injury, early neurological exploration can be performed.

3. Chest injury

Fractures of the proximal humerus caused by high energy are often complicated by multiple injuries. Care should be taken to exclude rib fractures, hemothorax, and pneumothorax.

Treatment of humerus fracture

The humerus surgical neck is close to the glenohumeral joint, and fractures often occur in middle-aged and elderly people, especially elderly patients, which can easily cause frozen shoulders. Therefore, understand the condition carefully, choose a treatment method, and maintain a certain degree of motion of the shoulder joints, which is necessary for treatment. considerate. For non-displacement fracture: suspend the affected limb with a triangle towel for 2 to 3 weeks, and start shoulder functional activities as soon as the pain is reduced; Suspend the affected limb for 2 to 3 weeks, and gradually start shoulder functional activities. Fractures without impact should be repaired manually, and then fixed with plaster or small splints for 3 to 4 weeks. Adductive fractures: those with displacement Both should be reset. There are two methods of reset and incision, and appropriate external or internal fixation.

1. Manual external fixation

Usually under anesthesia within the fracture hematoma. Commonly used are:

(1) External fixation of super-shoulder splint.

(2) Plaster bandage fixation Take the elbow flexion of the affected limb and fix it around the shoulder and elbow with plaster bandage; Later changed to other fixation, this method is only applicable to those who are difficult to correct the forward angle of the fracture.

(3) Abduction stent fixation If the fracture end is unstable and it is difficult to maintain alignment after reduction, the abduction stent can be used for fixation, and skin traction along the longitudinal axis of the humerus can be used to control the angular deformity of the proximal end of the fracture. This method is now rarely used.

No matter which method is used for fixation, functional activities need to be started early. Generally, fixation can be removed as appropriate in 4 to 6 weeks.

2. Incision reduction and internal fixation

(1) Indications Most surgical neck fractures of the humerus can be treated non-surgically. Surgery is considered in the following situations: severe displacement of the surgical neck fracture and instability after reduction; failure of external fixation by manual rehabilitation; comminuted fracture of humeral head in patients under 50 years old; displacement of avulsion fracture of the large tuberosity It is in conflict with the lower part of the acromion; The zygomatic plate fracture that cannot be reduced is separated (the biceps long head is embedded); the fracture that has been treated late and cannot be reduced.

(2) You can get up on the same day after surgery. After arm fixation for 2 to 4 days, the triangle is used to suspend the affected limb for 3 weeks.