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Abstract: When a pediatric patient falls in daily life and lands on the elbow or palm of the hand, the violence can fracture the humeral stem by conduction, mainly related to muscle contraction and weakened bone strength. In this case, the patient visited the clinic due to a fall and was diagnosed with a fracture of the humeral stem. Radiographs were taken to confirm a long oblique fracture of the humeral stem with poor stability, which was treated with surgical internal fixation to restore alignment of the fracture end and promote smooth healing of the humeral stem fracture.
Basic information】Male, 10 years old
Disease Type】Humeral Stem Fracture
Hospital】Harbin First Hospital
Date of consultation】December 2021
Treatment plan】Internal fixation with incisional repositioning screws
Treatment Period】7 days of inpatient treatment, 3 months of outpatient follow-up
Results】The fracture was fixed, the pain was relieved, and the range of motion of the shoulder joint was restored.
I. Initial consultation
The patient fell during the running exercise and the elbow joint directly touched the ground and the body twisted, and immediately went to the hospital. Due to the poor stability of the fracture end, the conservative treatment effect would not be satisfactory. The use of surgical incision and internal fixation could ensure the restoration of alignment of the fracture end and also prevent radial nerve injury caused by the instability of the humeral trunk fracture, therefore, the patient was recommended to be treated with surgical incision and internal fixation. The patient was also informed that the risk of radial nerve injury such as distraction injury may occur during the surgery, resulting in clinical symptoms such as drooping wrist and drooping fingers in the short term after surgery.
II. Treatment process
During the operation, it was confirmed that there was soft tissue embedded in the fracture end of the humeral stem, which affected the contact of the fracture end and there was a small amount of hematoma formation at the fracture end. After removal, the humeral fracture end was repositioned, and three screws were used to fix the fracture end and stabilize the humeral stem fracture site. The patient’s upper arm was moved passively without movement of the fracture end. The surgical incision was closed and a drainage tube was left in place to prevent hematoma formation. During the procedure, attention was paid to separating and protecting the radial nerve and avoiding excessive strain on the radial nerve. Postoperatively, a forearm sling was used for fixation to ensure the relative stability of the fracture end and to promote smooth healing of the humeral stem fracture. The patient started passive shoulder joint activities after the pain symptoms were reduced to avoid shoulder stiffness.
III. Treatment effect
The patient was discharged from the hospital about 1 week after the surgical internal fixation treatment with significant relief of pain and swelling, and under the guidance of the rehabilitation physician, he could complete the passive shoulder joint activities such as forward flexion, abduction and back extension, and the shoulder joint function gradually recovered without clinical symptoms such as joint stiffness and limitation of movement. The patient said that when turning in bed and moving around, it did not induce painful symptoms to appear, and he could resume basic life.
IV. Precautions
Patients can remove the immobilization of the forearm sling for 6 weeks after surgery, and resume shoulder and elbow joint activities, but the affected limb cannot bear weight until the humeral stem fracture is completely healed. However, it is necessary to inform the patients that they should not engage in antagonistic strenuous exercise within one year, otherwise another fracture may occur. Before the fracture heals, it is always necessary to exercise the muscles of the upper extremity, which needs to be adhered to for a long time to promote the healing of the humeral stem fracture and also to protect the fractured end of the humeral stem and prevent another fracture.
V. Personal insight
The reason for the humeral stem fracture in this case is mainly due to the trauma as well as the poor condition of his own bones and muscles compared to adults. And, during strenuous exercise, attention should be paid to strengthen limb protection. Strengthening muscle exercise can enhance bone strength and protect the humerus, which is important to prevent humeral stem fracture in case of fall injury, and before exercise, attention should be paid to warm-up exercise to increase muscle temperature and decrease viscosity to prevent the occurrence of sports injury.