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Abstract: The patient was brought to the emergency room by 120 emergency due to a sudden deformity, swelling and pain in the upper arm caused by an arm wrestling competition. Taking radiographs, the fracture could be seen to be located right at the lower end of the humerus, and multiple fracture blocks were locally present, which confirmed the diagnosis of lower humerus fracture and decided to be hospitalized for surgery. The patient underwent internal fixation surgery with fracture incision, and was reviewed 1 year after the surgery.
Basic information】Male, 26 years old
Type of disease】Fracture of the lower end of the humerus
Hospital】The First Hospital of Harbin Medical University
Date of consultation】July 2021
Treatment plan】Medication (compound mannitol injection, horse chestnut seed extract tablets, parecoxib sodium for injection) + surgery (fracture incision and internal fixation)
[Treatment period] 12 days of hospitalization and 1 month of postoperative review
Treatment effect】The fracture healed, and the movement of the elbow joint returned to normal.
I. Initial consultation
The patient was a young guy who heard a click during an arm wrestling competition, and his upper arm suddenly became deformed, swollen and painful, and was brought to the emergency room by 120 emergency after temporary splinting. On examination, the patient’s upper arm was found to be significantly deformed, with swelling and pressure pain in the middle and lower segments, and a localized sensation of obvious bone rubbing could be felt. The skin of the patient’s forearm and hand felt normal, with no numbness, and the radial artery pulsation of the forearm could be felt. The patient was diagnosed with a fracture of the lower end of the humerus and decided to be hospitalized for surgery.
II. Treatment history
After the patient was hospitalized, the upper extremity was braced and braked, and compound mannitol injection was given intravenously to remove edema, oral horse chestnut seed extract tablets were given to reduce swelling, and injectable parecoxib sodium was given intravenously to relieve pain. While decreasing swelling and relieving pain, CT 3D reconstruction of the elbow joint was improved to clarify the type and extent of fracture. Further improvement of routine pre-surgical examinations such as upper limb vascular ultrasound, blood routine, liver function, coagulation, etc. The patient underwent internal fixation with fracture incision and reduction on the 3rd day after admission, focusing on restoring the flatness of the joint surface and exploring the nerve travel area at the same time, and the stitches were removed every other day after surgery, and the internal fixation was removed 1 year after surgery.
III. Treatment results
There was no infection, necrosis or abnormal exudation in the incision after surgery, and the incision healed 2 weeks after surgery. On the second day after surgery, the patient’s pain in the forearm fracture area was significantly relieved, accompanied by mild pain in the incision, swelling of the upper limb, normal skin sensation in the forearm and hand, good arterial pulsation, good wrist and finger flexion and extension mobility, and passive flexion and extension activities of the elbow joint without significant pain. 12 days later, the patient was discharged from the hospital, at which time the swelling of the forearm was relieved and the mobility of the elbow joint basically reached normal. The patient was instructed to review the patient in 1 month to observe the postoperative recovery. The fracture healed 1 year after surgery, and the function of the elbow joint returned to normal.
IV. Notes
We are glad that the patient’s fracture was healed after treatment. It is very important for the patient to exercise the functional rehabilitation of the elbow joint after discharge, and the patient was instructed to perform passive flexion and extension exercises of the elbow joint early after surgery to avoid joint stiffness. After the initial healing of the fracture, the active functional exercises of the elbow joint can be started, at this time, the joint flexion and extension activities should be the main focus, not strain. After the fracture is healed, the elbow joint can perform normal activities. During the fracture healing period, increase the intake of protein and calcium to promote fracture healing. The internal fixation plate can be removed after the fracture has healed.
V. Personal insight
The fracture of the lower humerus is close to the radial nerve, and the fracture end can easily irritate and contaminate the nerve, resulting in numbness of the skin and difficulty in dorsal extension of the thumb. Fortunately, this patient did not show symptoms of nerve injury after the fracture, but the fracture affected the elbow joint, so the surgery was not only to reset and fix the distal humeral fracture, but also to repair the elbow joint surface and to explore the nerve injury. Through surgical treatment, the patient had no residual neurological deficits and recovered well from the elbow function, and the internal fixation was removed after 1 year, and the patient was satisfied with the outcome.