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Abstract: In this case, the patient fell with the elbow in semi-flexion and the palm of the hand touching the ground. The violence transmitted through the forearm caused the lower end of the humerus to push the humeral condyle posteriorly, and the humeral stem pushed anteriorly due to gravity, resulting in a supracondylar fracture of the humerus and a combined intercondylar fracture of the humerus. The fracture was treated with an incision and internal fixation to restore the alignment of the fracture end and accelerate the healing.
Basic information】Male, 50 years old
Disease Type】Supracondylar fracture of humerus and intercondylar fracture of humerus
Hospital】Harbin First Hospital
Date of consultation】November 2021
Treatment plan】Surgical treatment (incision and internal fixation) + rehabilitation (passive flexion and extension of elbow joint)
Treatment period】7 days of inpatient treatment, 3 months of outpatient follow-up
Results】Fracture repositioning and fixation, pain relief, restoration of elbow range of motion
I. Initial consultation
Mr. Li visited the hospital after a fall and reported that he had a certain degree of osteoporosis, and then he fell down the stairs, holding his hand on the ground, and then his arm was in severe pain with a certain degree of deformation. After understanding the basic situation of the patient, I instructed the patient to immediately perform a front and lateral radiograph, which showed a supracondylar fracture of the humerus with obvious displacement of the fracture end. Due to the serious separation of the fracture end, the conservative treatment effect was poor. The use of surgical internal fixation treatment could ensure the stability of the fracture end and restore the movement of the elbow joint as soon as possible.
II. Treatment process
After communicating with the patient, the patient opted for surgical treatment. Since the postoperative rehabilitation of the elbow joint required the patient’s full cooperation, the patient was informed of the possible clinical symptoms such as pain and swelling during the rehabilitation process, and that the postoperative rehabilitation process of the elbow joint was slow. The patient underwent surgery, and during the incisional repositioning and fixation process, it was confirmed that a fracture occurred in the supracondylar and intercondylar humerus, and the fracture end was significantly misaligned, and the stability of the fracture end could not be maintained through manual repositioning, so titanium plate screws were used for fixation to restore the alignment of the fracture end. Damage to the muscles and other tissues around the fracture occurred and was repaired at the same time. After detailed exploration, no vascular or nerve injury was found, and the operation was concluded after confirming that the fracture was firmly fixed. Postoperatively, temporary protective fixation was performed using a brace. After the pain and swelling of the elbow joint was relieved, the rehabilitation physician assisted the patient to complete passive flexion and extension of the elbow joint, gradually increasing the range of motion of the joint and improving the flexibility of the elbow joint.
III. Treatment effect
The patient gradually relieved the swelling and pain of the elbow joint 5-7 days after surgery, and was able to complete the flexion and extension activities of the elbow joint on his own with the help of the rehabilitation physician, and the range of motion of the elbow joint was gradually restored without significant stiffness and adhesions of the elbow joint, and no ossification myositis formed around the elbow joint. The surgical incision healed well, and there was no purulent exudation or abnormal congestion. The elbow joint X-ray confirmed that the internal fixation titanium plate screw did not loosen or break, and the stability of the fracture end was ensured.
IV. Precautions
The patient was treated with timely surgery to reset the fracture end and recovered well after surgery, and was truly happy that the elbow joint functioned normally. After discharge from the hospital, the patient was advised to follow up promptly if the pain and swelling gradually disappeared, remove the external fixation, resume the flexion and extension of the elbow joint, and gradually increase the range of motion of the elbow joint. During the self-rehabilitation process at home, the principle of gradual progress should be followed. Avoid violent flexion and extension of the elbow joint and forceful increase of the elbow flexion and extension angle during the rehabilitation process, otherwise it will easily form a hematoma around the elbow joint, which will eventually lead to serious consequences such as ossifying myositis. If swelling occurs during the rehabilitation process, use an ice pack for 20-30 minutes to apply cold compresses and give the elbow joint adequate rest. Until the fracture is completely healed, no weight should be put on the elbow joint to avoid affecting the smooth healing of the supracondylar humerus fracture.
V. Personal insight
The fracture of the supracondylar area of the humerus, which is already osteoporotic, is caused by the force on the elbow joint during the patient’s fall, and is manifested by local swelling and pain, restricted movement, and even accompanied by local fracture deformity. After confirming the fracture, choose the treatment as soon as possible according to the degree of fracture, and try to restore the range of motion and function of the elbow joint. In normal life, attention should be paid to enhancing bone strength, balanced nutrition, and strengthening physical exercise. Improving muscle strength can prevent the phenomenon of accidental falls.