Humeral stem fracture
1.Life conditioning
Patients can take care of themselves and do some simple work, such as sweeping the floor and wiping the table, watering the flowers, etc. You can take a shower only 3 days after the removal of internal fixation surgery. If it is stone fixation, plastic wrapped cast can be used, and then shower. Self-care of daily life is a better means of rehabilitation, and can be removed from the state of injury and illness as soon as possible. During the rest period, maintain the normal life pattern, work and rest on time, participate in more outdoor activities, such as walking, excursions, shopping, and participate in cultural and sports activities according to personal preferences.
2.Special care
Maintain the correct position: semi-recumbent, supine or health-side lying position. In semi-recumbent or supine position, the affected limb should be padded with a soft pillow to keep the affected limb elevated at the level of the heart, and a strap can be attached to the end of the bed so that the healthy hand can pull the strap to facilitate getting up and moving around, or the body can be turned to the healthy side before getting up and getting out of bed, and the affected limb can be suspended from the chest with a triangular towel.
Observe the blood circulation of the affected limb: pay attention to the sensation and movement of the affected limb, skin color and temperature and radial artery pulsation, and go to the hospital promptly if there are symptoms of circulatory disorders, i.e. cyanosis or pallor of the skin, impaired sensation and movement of the limb, and decreased skin temperature.
Treatment of pain and discomfort: Pain and discomfort may be felt in the early stage after fixation, and generally pain and discomfort can be gradually reduced to normal. Especially for children, parents should be patient, give comfort and encouragement, and participate in interesting activities to distract attention and eliminate pain and discomfort. Do not open the fixation by yourself, do not blindly apply painkillers, random application of painkillers can cover up the condition. The duration of external fixation is generally 6-8 weeks for adults and 4-6 weeks for children and adolescents. The duration of external fixation is usually 6-8 weeks for adults and 4-6 weeks for children and adolescents. The internal fixation can be removed after 1 year.
Prevention and management of complications
(1) Radial nerve injury: The fracture of the middle and lower humerus is prone to injury of the radial nerve, and the sensory and motor functions of the hand and wrist should be checked before and after repositioning.
(2) Infection: If the body temperature has been reduced to normal after the injury and fever or wound pain occurs for unknown reasons, the patient should be seen immediately at the hospital.
(3) Osteomyositis: fracture combined with elbow injury is prone to osteomyositis. When the injured limb is fixed for a long time without paying attention to functional exercise, it will cause poor venous blood and lymphatic return, resulting in fibrous adhesions of the internal and external tissues of the elbow joint, resulting in joint stiffness and loss of function. Therefore, early functional exercise should be carried out under the guidance of a doctor to prevent venous blood and lymphatic circulation disorders.
3.Functional exercise
After fixation, you can do finger, palm and wrist joint activities. The active muscle contraction activity of the upper arm of the affected limb is beneficial to blood circulation and elimination of swelling; it can strengthen the extrusion pressure of the two fracture ends on the longitudinal axis, prevent separation of the fracture ends, promote fracture healing and prevent decalcification; maintain certain muscle contraction movement to prevent disuse muscle atrophy. These activities are also beneficial to improve the patient’s mood, enhance metabolism, improve respiratory, circulatory and digestive system functions, and prevent the occurrence of comorbidities.
Shoulder and elbow joint activities: 2-4 weeks after injury, in addition to continuing the above training, shoulder and elbow joint activities should be done gradually by holding the wrist of the affected limb with the healthy hand, doing shoulder and elbow forward flexion and backward extension, then flexing the elbow joint while extending the upper arm backward.
Rotate the shoulder joint: The patient’s body is tilted to the affected side, the elbow joint is flexed by more than 900, and the affected wrist is held by the healthy hand, and the shoulder joint is rotated. This means a circular motion.
Abduction and external rotation: The upper arm is abducted and externally rotated, and the back of the head is touched with the hand.
Rotation of both arms: the affected limb is bent at the elbow and the forearm is placed in front of the chest with the palm backward and upward; the upper limb on the healthy side is straightened and abducted to the side of the body with the palm downward. The affected limb is arced upward to the outside and then inward to the original place; at the same time, the upper limb on the healthy side is arced downward to the outside via the inside and upward to the original place. So on and so forth. This method can make the shoulder, elbow, waist, legs, neck are exercised. The above exercise method should take at least 15 minutes each time, 3-4 times a day. The purpose of rehabilitation treatment is to restore maximum joint range of motion and muscle strength. In order to restore the ability to work in daily life as soon as possible.
4.Review
(1) For closed reduction external fixation, review 1-3 times in the first week after fixation, and then review once every 2 weeks in hospital. Keep the X-ray film taken every time for the doctor to judge the fracture healing.
(2) The stitches should be removed at the local hospital on the 10th day after the surgery, and the X-ray should be taken once every 4 weeks afterwards, and the internal fixation should be removed after the fracture has healed for 1 year.
(3) You can go to the hospital by bus, not by bicycle or car.