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Abstract: A 50-year-old middle-aged female fell and landed on her right elbow while cleaning at school, and subsequently developed pain and swelling in her right elbow, which was diagnosed as a right supracondylar humerus fracture after examination. In order to treat the fracture and improve the function of the right elbow joint, the patient was given an artificial elbow joint replacement surgery on the right side, together with medication, and after active treatment, the patient’s right elbow joint function improved significantly.
Basic information】Female, 50 years old
Disease Type】Supracondylar fracture of the right humerus
Hospital】Liaocheng Second People’s Hospital
Consultation time】March 2021
Treatment plan】Surgical treatment (right elbow arthroplasty) + medication (injectable hepaticoside sodium, flurbiprofen ester injection + injectable cefazolin sodium)
Treatment period】17 days of inpatient treatment, 1, 3 and 6 months of outpatient follow-up
Treatment effect] Right elbow joint function improved significantly
I. Initial consultation
At 8:00 p.m. on the night shift of the emergency clinic, a middle-aged female patient with a painful face and left hand supporting the right elbow joint walked into the clinic accompanied by her colleagues. The patient’s right elbow joint was found to be slightly swollen with no obvious deformity, while the proximal interphalangeal joints of both hands were found to be severely deformed. The patient’s right elbow joint was obviously painful when tapped with the hand, and the possibility of fracture was considered, and a frontal and lateral view of the right elbow joint was taken, which showed a supracondylar fracture of the right humerus.
II. Treatment history
After the arrival of the family, the patient and family members were explained the injury, the X-ray findings were explained, and treatment options were provided. However, the patient had rheumatoid arthritis in the past and the 4 weeks of braking and fracture might cause serious loss of the right elbow joint function, which would seriously affect his daily living ability; Option 2: treatment of the fracture by incision and internal fixation of the bone plate, which has the advantage of not requiring external fixation of the cast after surgery. However, this option will not improve the function of the right elbow joint very much; Option 3: right elbow arthroplasty, which has the advantage of dealing with the fracture and achieving the function of the elbow joint at an early stage, and will significantly improve the function of the right elbow joint after the operation. After considering all three treatment options, the family and the patient chose the artificial elbow joint replacement and were admitted to the hospital. After admission, he was treated symptomatically with injectable hesperidin sodium to reduce swelling and flurbiprofen ester injection to relieve pain. On the second day after admission, routine blood tests, six coagulation tests and four preoperative tests were completed, and the patient was actively prepared for surgery. On the third day after admission, the patient underwent right elbow arthroplasty under general anesthesia. The patient was discharged 14 days after surgery, i.e. 17 days after hospitalization.
III. Treatment effect
The patient’s incision healed well 14 days after surgery, and the stitches were removed successfully. After surgical treatment, the patient’s right elbow joint regained its normal anatomical correspondence, and the artificial elbow joint prosthesis was well positioned. One month after discharge, the patient’s right elbow joint had no obvious swelling, pain had basically disappeared, function had improved significantly, and he could flex his elbow up to 100°, and started to practice eating and combing his hair with his right hand.
IV. Notes
The patient recovered from the treatment, and I am happy for the patient. After discharge from the hospital, the patient should strengthen nutrition, improve body resistance, and keep the incision clean to prevent infection around the prosthesis caused by skin or other parts of the body infection, resulting in surgical failure. The elbow joint flexion and extension training should be carried out 1-2 weeks after surgery with the help of family members or rehabilitation workers. The exercises should not be done with excessive force to avoid local secondary injuries to the elbow joint (e.g. avulsion fracture, tendon ligament strain, etc.), which may affect the later function. Active elbow flexion and extension exercises were started 3 weeks after surgery, and the right hand was used consciously for daily activities such as eating and combing hair. After discharge from the hospital, you need to come to the hospital for regular review in 1, 3 and 6 months to get the guidance of functional exercise from the doctor and to clarify the effect of treatment.
V. Personal insight
Supracondylar fractures of the humerus are common in children under 10 years of age, and can also occur in adults under greater violence. However, some patients with previous elbow joint disease (such as rheumatoid arthritis) may also fracture under low-energy external force, and these patients often do not have significant local swelling and pain of the fracture, so it is recommended to routinely perform radiographic examinations to avoid any missed diagnosis. For patients with supracondylar humerus fracture combined with rheumatoid arthritis, in order to restore the maximum movement function of the patient’s elbow joint, it is recommended to choose artificial elbow joint replacement, especially when the fracture occurs in the right dominant limb, after the operation, the affected limb can basically resume eating and combing hair and other movements.