Similar skin-drawn shoulder flap method has been reported for the treatment of proximal humerus fractures [2], but many physicians are still accustomed to external fixation with traditional freehand repositioning and internal fixation with incisional repositioning. Although surgery solves the fracture repositioning and fixation, the surgical trauma disrupts the soft tissue blood flow and aggravates the local adhesions. Longer external fixation also affects the recovery of joint function, and the treatment effect is not ideal. Xin Linwei, Department of Hand Surgery, Affiliated Hospital of Guilin Medical College
The mechanism of skin traction arm swinging method is: following the principle of combining motion and static in Chinese medicine, it integrates repositioning, fixation and functional exercise, avoiding soft tissue trauma and adhesions caused by surgery and joint dysfunction caused by external fixation. The skin traction counteracts the fracture overlap and angular deformity caused by muscle contraction. The swinging arm moves in the direction of the longitudinal axis of the humerus, so that no matter where the fracture is displaced, it may be reset in the direction of the axis in the swinging arm, maintaining the dynamic balance of the fracture. This kind of functional exercise in the swinging arm style reduces soft tissue adhesions, joint contracture, muscle atrophy and restores joint function in the largest amount.
Related points: (1) If the fracture is not displaced or the condition does not allow skin traction, the upper limb can rely on its own gravity or hold a heavy object to perform arm swing treatment directly. (2) The starting time of arm swinging has different expert opinions, some propose 24 h after injury [3], some advocate 5-7 days after injury [4], and the authors are accustomed to start 48-72 h after the traumatic pain is reduced. (3) The earlier the arm swinging time and the greater the arc, the better the therapeutic effect, but the principle of gradual progress should be followed to avoid excessive pain. Especially for old and frail patients, combined with other injuries and diseases, pain medication can be given and guidance and care can be strengthened to prevent cardiovascular and cerebrovascular diseases and accidents. (4) Do not force the fracture to reset anatomically during the treatment process. Even if the fracture is not satisfactorily repositioned, there is usually no deformity in appearance, non-union of the fracture and serious impact on the shoulder function.
This method is simple, minimally invasive, with rapid functional recovery and low cost. Except for a few special cases such as severe fracture dislocation and combined neurovascular injury, it is an effective treatment method for humeral surgical neck fracture. It can be used for different patients in the clinic.