If the fracture has been healed for more than three times, the fracture end still has abnormal activity, and the X-ray shows that the fracture ends are separated from each other, the bone crust is scarce, the fracture end is sclerotic, the density is increased, or the fracture end is resorbed, the fracture end is rounded, and the bone marrow cavity is closed, it is called fracture disjunction.
1.Clinical symptoms and signs
(1) Abnormal activity at the fracture end: If there is abnormal activity at the fracture end, the diagnosis of bone disconnection can be made. Earlier fresh fractures, of course, have abnormal mobility and should be distinguished, time is 9 months for bone nonunion.
(2) Pain: the fracture end produces pain when moving or when trying to do weight-bearing.
(3) Deformity and muscular atrophy: unconnected fractures may have angular, shortening and rotational deformities. (3) deformity and muscle atrophy: unattached fractures may have angulation, shortening and rotation deformity.
(4) Loss of weight-bearing function: the bone is not connected to the weight-bearing function loss after the fracture of the backbone, but some femoral neck fractures have claudication.
2.Radiographic examination
(1) gap at the fracture end.
(2) Sclerosis of the fracture end and smooth and clear fracture surface.
(3) closure of the bone marrow cavity.
(4) osteoporosis.
(5) No trabecular formation between the bone scabs.
(6) Pseudarthrosis formation.
(7) No further healing tendency of the fracture has been continuously observed for 3 months.
3.TCM treatment
(1) Weak qi and blood type
After fracture, qi and blood are often depleted and liver and kidneys are attacked, resulting in weakness of qi and blood and deficiency of liver and kidneys, so the late treatment of fracture is to nourish qi and blood, benefit qi and blood, and strengthen liver and kidneys, so that the fracture heals solidly and the tendons and bones are strong by nourishing qi and blood, liver and kidneys.
Care and conditioning: Diet should be light: soybean products, green vegetables, winter melon, eggplant, lean meat, eggs, apples, bananas, watermelon, papaya, bitter melon, kiwi, celery, rice porridge, dairy products, etc. Avoid spicy, fatty products, such as chili, pepper, etc.
(2) Qi stagnation and blood stasis type:
After the fracture, injury and stasis blocking the meridian, qi stagnation does not work, stagnation is long, then the new is not born. The treatment is to remove stasis, and to relieve pain.
Usage: 1 dose of decoction daily, 15 days for 1 course of treatment.
Nursing care: diet should be easy to digest, high nutrition: ribs, eggs, dairy products, soy products, shrimp, fish, walnuts, almonds, kiwi, oranges, apples, hawthorn porridge, glutinous rice porridge, black rice porridge, skin egg and lean meat porridge, fungus, spinach, beans, broccoli, wolfberry stewed chicken, astragalus stewed squab, animal liver, etc.
(3) Liver and kidney deficiency type:
Liver and kidney deficiency, loss of essence and blood, tendons and bones without nourishment and deficiency, treatment to nourish the liver and kidney, benefit Qi and nourish blood.
Usage: 1 dose every 1 day, decoction with water, 15 days as a course of treatment.
Nursing care: diet should be high in protein, vitamins and calcium: soy products, dairy products, ribs, beef soup, mutton soup, donkey soup, pig’s trotters, cow’s trotters, black fish soup, shrimp, crab, red dates, wolfberry, cinnamon meat, cordyceps stewed chicken, various fresh vegetables, etc.
4. Local treatment of the fracture end.
There are more reasons for fracture disconnection, separation due to excessive traction of fracture ends, or soft tissue embedding between fracture ends, excessive removal of broken bone fragments in open fracture reaming, resulting in bone defect, poor local blood flow or repeated rough manipulation to rectify and destroy the blood supply to the fracture part, extensive surgical destruction of periosteum, poor blood supply or internal fixation, improper fixation at the fracture and frequent exposure to harmful injury forces. They should be treated accordingly.
(1) Fracture end cleaning + bone grafting. For patients with fracture ends separated by excessive traction, or with soft tissue inlay between the fracture ends, with relatively stable fracture or solid internal fixation.
(2) Plate or intramedullary nail fixation + bone grafting. (2) Plate or intramedullary nail fixation + bone grafting for patients with unstable or relatively unstable fracture ends of various bone discontinuities.
(3) external fixation or internal fixation loosening failure, immediate replacement of external fixation or internal fixation + bone grafting.
(4) Different bone grafting methods are used according to different sites and local conditions, such as cancellous bone grafting, slip grafting, capped bone grafting, musculoskeletal flap, free grafting bone flap with blood vessels, etc.
(5) For patients with delayed infection, bone cement chain implants containing sensitive antimicrobial agents should be added.
(6) Replacement of appropriate internal fixation in cases of inappropriate choice of internal fixation.
(7) For patients with surgical intervention, routine use of antimicrobial agents for 3-5 days postoperatively.
5. Clinical healing criteria of fracture
(1) No local pressure pain.
(2) No local longitudinal percussion pain.
(3) No local abnormal activity (automatic or passive).
(4) Radiographically, the fracture line is blurred and there is continuous bone scab through the fracture line.
Patients with bone discontinuity have a long course of disease and can basically be classified into three types through clinical observation: Qi and blood weakness type, Qi stagnation and blood stasis type, and liver and kidney deficiency type. The root of the disease is in the liver and kidney. The disease may be caused by the depletion of qi and blood, and the liver and kidney, resulting in weakness of qi and blood and deficiency of liver and kidney; or due to injury and stagnation of blood stasis, qi stagnation does not work, stagnation of blood stagnation, then the new does not grow; or due to deficiency of liver and kidney, essence and blood loss, tendons and bones are not nourished and insufficient. The fractures are healed and strengthened.
Due to the overtreatment of fractures and the expansion of the indications for surgical internal fixation, the diagnosis of bone discontinuity is more demanding, especially with the presence of internal fixation, and the diagnosis of bone discontinuity often relies on the experience of physicians.