Humeral fractures

Humeral fractures in children is the most common fractures, was particularly prevalent in the 5 to 8-year-old children. Children often pick, shoring by hand and forearm straight indirectly caused by the violence, displacement fracture of the distal backward, the most common type of extension supracondylar fractures of the humerus. The other is when children pick elbow flexion was the direct cause violence, displaced fracture of the distal forward to see less buckling of supracondylar fractures of the humerus.

Shortly after the elbow injury swelling, pain, skin congestion bruising, deformity and dysfunction there, but also with blood circulation obstacles and nerve injury symptoms, such as pulse was affected or even disappear, finger numbness.

X-ray can determine fracture and the Department of displacement situations.
Treatment principles: to approach the whole complex and external fixation mainly to a reduction in anesthesia. If the extension type supracondylar fractures of the humerus, then elbow flexion cast immobilization. If the buckling type, while gypsum fixed elbow Extension 4 ~ 6 weeks. If severe swelling, skin blisters or reset after a stump position instability may bedside for traction. If the fracture with blood vessels and nerve injury, vascular surgical exploration available, nerve, and the entire complex fractures.

The menopausal osteoporosis

Osteoporosis is a common disease of older persons worldwide, particularly in women. The resulting fractures, especially hip fractures a serious threat to the lives and safety of the elderly has greatly reduced their quality of life. Therefore, the prevention and treatment of osteoporosis has become a pressing issue.

So, what is osteoporosis? Osteoporosis refers to the unit volume decreased bone mass and bone tissue microstructure degradation, the brittle bone increase, making it easy for a fracture disease.
Postmenopausal women are more prone to osteoporosis, the main factor is the endocrine imbalance, especially estrogen levels decline. Recession postmenopausal ovarian function, the lower the level of estrogen in vivo, the first arising from the formation of vitamin D and decreased activity, and interfering with intestinal absorption of calcium. Secondly, the bone loss of the protective effect of estrogen to enhance the sensitivity of parathyroid hormone, increased bone resorption. In addition, lower levels of calcitonin, increased osteoclast activity.

Postmenopausal osteoporosis often leads to decreased bone strength, when the minor outside, even in the absence of obvious external circumstances may occur fracture. The fracture is common site of the distal forearm, spine and hip. The distal forearm fracture in postmenopausal vulnerable to the initial stage, some data reveal that between 40-65 years old increased incidence of a linear trend; Spine fractures occurred in more than 60 years, the vast majority of such fractures of the non-hit, the most vulnerable is the involvement of thoracic vertebra and lumbar 1,4 8,12, 5; serious consequences of hip fracture, morbidity and mortality rates very high, often standing position falls, the cause of hip. According to a survey in Beijing women over the age of 50 hip fracture incidence rate was 9 / 100000, we can see that the incidence not low.

Impact of osteoporosis in postmenopausal women is a serious health problem, the current use of estrogen replacement therapy in the treatment of women with osteoporosis have been identified.
Front said, postmenopausal osteoporosis is the main reason for decline in the level of estrogen, then the patients with postmenopausal osteoporosis appropriate supplementary estrogen may maintain the existing bone mass and prevent further degradation of bone microstructure. Experiments show that: estrogen can inhibit osteoclast cells in the bone caused by the illustration, thereby reducing resulting from osteoporosis to prevent fractures and reduce body shortened. The currently used mainly natural estrogen hormones such as estradiol, estrone, estriol; Semi-synthetic estrogen, such as ethynylestradiol; Synthetic estrogen, such as diethylstilbestrol, nylestriol, etc..

In order to improve the estrogen replacement therapy treatment, should be aware of the added calcium. The body of the calcium requirement :25-50-year-old women’s 1,000 mg / day, postmenopausal women 1000-1500 mg / day, 1,500 women over the age of 65 mg / day, but most people’s calcium intake far below this standard. The method to solve the dietary calcium deficiency, drug-combination. TCM treatment of postmenopausal osteoporosis and there have been noticeable effects in the Chinese medicine theory renal main bone under the guidance available Liuweidihuang Decoction to fill bone filling accuracy; Hu also available Jianbu unspoken pill or treatment of bone Gushukang particles, to fill bone Yiqi, Yangxue Zhuanggu to increase bone mineral density; Bone can be used more Capsules, its a Blood Circulation, swelling pain, increase bone calcium volume, improve microcirculation, and promote the effectiveness of fracture healing; pearl calcium capsules to maintain the natural characteristics of the calcium and effective.
In short, the first human ovarian senescence is the organ, women’s osteoporosis and changes in ovarian function is closely related to estrogen replacement therapy and calcium supplementation in the treatment of postmenopausal osteoporosis has important significance

Sugar too much will lead to fractures

Sweets for our presence is always a temptation. The World Health Organization (WHO) has investigated the population of the 23 countries of the cause of death, concluded: victims of sugar, rather than smoking, long-term consumption of food with a high sugar content will significantly shorten the life span, and made “reduced sugar” slogans. However, in recent years, Chinese people’s high consumption of sugar, Sugar hazards have not been more people recognize that.

It is a completely reject Sugar difficult, so in their daily life, how much we eat in the end the sugar, what kind of sugar more healthy?

Every day it is best not more than 40 grams

“Sugar” concept has broad and narrow distinction. Generalized digestible sugar refers to the variety of carbohydrates, including the sweetness of sugar and no sweetness of starch; Narrow refined sugar refers to the sugar and food and beverage processing commonly used in the syrup. Sugar major harm to the human body it is the latter.

Almost all sweet foods, contain large sugar or syrup made with the sweetener. Therefore, some like to eat desserts, biscuits, snacks, beverages children and young women, the daily intake of 100 grams of sugar more than it is a very common thing. But nutritionists have recommended total daily intake of sugar is about 30-40 grams daily intake that is not to exceed 10% of total carbohydrates.

30-40 grams of sugar What is the concept? The people ate the sweets, one Tbsp sugar jam about 15 grams, about 1 cans of Coca Cola sugar 37 grams, about three small pieces of chocolate sugar nine grams, about an ice-cream shop 10 g sugar, a few biscuits about 10 grams sugar content … if not the attention so ,30-40 Ketangning quantitative restrictions on very easy breakthrough.

Sugar too much will lead to fractures

Refined sugar after the very high purity, can achieve more than 99%, which means that almost no one other nutrients, only a lot of energy. Eating more sweets, people will be too much for the energy intake of saturated arising from abdominal flu impact on other rich protein, vitamins, minerals and dietary fiber food intake. If things continue this way, will lead to nutritional deficiencies, stunting, obesity and other diseases.

On the other hand, the in vivo metabolism of sugar consumption needs of a variety of vitamins and minerals, therefore, often Sugar will cause a lack of vitamins, calcium deficiency, potassium deficiency, and other nutritional problems. Japan nutritionist that children eat too many sweets cause is the rise in the rate of fracture important reasons; The United States nutritionist also pointed out that the children to eat sweets fracture rate higher.

Nutrition survey also found that despite Sugar may not directly lead to diabetes, but long-term eating a lot of sweets make excessive insulin secretion, carbohydrate and fat metabolism disorder, caused imbalance in the human body environment, thereby promoting a variety of chronic diseases, such as cardiovascular and cerebrovascular diseases, diabetes, obesity , senile cataract, dental caries, myopia, rickets from happening. Eat sweets tend to be acidic blood to the body, to the detriment of blood circulation, and the defense weakened immune system function.

Sweet and drug addiction of the same physiological reaction

You shall sweets, it may cause physical and psychological dependence. The study shows that, after the birth of human sweetness is the first to accept and pursue the taste, likes to eat sweets is a human instinct reaction.

Medical experiments prove that, in a sense, contains large quantities of sugar confectionery and the role of the brain are similar to the drug effect. If we allow animals to habitual intake sweets, it will stimulate their brain type opioid substances produced, which makes them feel happy. Once stopped sweets supply, they will feel the pain, irritability, and the chemicals in the brain lose their balance. This phenomenon of drug addiction response was very similar.

When the Sugar

Although a large number eat sweets harmful, but if a small amount of time and suitable for human consumption, also have certain health benefits. For example, the lower the blood glucose concentration, a small amount of Sugar can be added emergency. Patients with low blood sugar will feel hungry black eyes, limbs, legs, the best way is to immediately drank a cup of syrup. The bad delicious breakfast, often approaching noon and will be placed, attention can not be focused, thinking ability decline, then if a snack sweets, we can quickly restore brain function.

In addition, sports medicine research confirmed that the former athletes in vigorous exercise if a small amount of added sugar beverages, can help them improve performance; Timely campaign after meeting sugar, can eliminate fatigue. If ordinary people in a bath, hunger, the need to raise a small amount of attention when the Sugar, it is also beneficial.

Eat more healthy brown sugar

What to eat sugar can choose, if they wish in the sweets and find a balance between healthy, the best to eat the following types of sugar:

Brown sugar. It is also called “brown”, “brown sugar”, containing more iron, calcium, potassium, magnesium and other minerals, has high nutritional value, but also beneficial to the human body acid-base balance. Chinese medicine practitioners believe that there Huoxue casual brown sugar deposition, the temperature in the cold-dispelling such role. But brown sugar warm in nature, often were mentioned, hungry people should eat less.

Oligosaccharides. If fructooligosaccharides, oligomeric lactose, Isomaltooligosaccharide, etc.. Their low heat, had “adjusted balance” role, and some referred to as “Bifidobacterium factor”, the body that can promote the growth of bacteria, pathogens and corruption inhibition of intestinal bacteria proliferation.

Sugar alcohols sweeteners. Including xylitol, sorbitol, mannose alcohol, maltitol, sweeter slightly lower than white sugar. Their low-energy, causing dental caries, do not increase blood glucose, a healthy sweeteners. But the best daily consumption of other more than 20 grams, as they will promote intestinal peristalsis, excessive consumption can cause mild diarrhea.

The home care after fracture

Fracture patients in the hospital for treatment of different methods fixed, the vast majority of patients to return home for rehabilitation. Fracture patients home care is good or bad, in the early healing of the fracture is essential. Should pay attention to the following aspects:
1, attention to the observation of fracture fixation, the distal limb should be observed at any time (referring, of toe) color, temperature, and the feeling of movement, and so on. After fracture fixation too tightly, easily oppressed vascular, nerve or bone sudden location of the ulcer may occur oppression, repression of nerve injury, severe distal limb can lead to avascular necrosis. Therefore, once found a continued limb pain, swelling, numbness, a cooler, bruised and activities restricted, and so on, should be dealt with promptly seek medical checks.
2, patients take appropriate Chigaohuanshi sitting or sleeping at night when appropriate elevation fixed limb. Let the body of the remote location of the position slightly higher than the heart, this will be conducive to the venous blood flow back to reduce the swelling limb.
3, to prevent complications should pay attention to maintaining the fixed site sanitation. The bedridden patients should be given time to stand up, and often massage compression site, the prevention of the occurrence of pressure sores. Meanwhile, we should encourage patients often do deep breathing, coughing and sputum assist patients, in order to prevent the occurrence of pneumonia.
4, appropriate activities on the limb should be fixed to strengthen the muscle contraction; Not yet fixed location and other body parts, joint activities should also be strengthened so that can promote local circulation and prevent fractures of the limbs of disuse atrophy, osteoporosis, ankylosis, and other complications occurred, faster and limb function restored.

Femoral fractures

History Collection
1. 24 hours must be completed within the history of collecting.
2. Content must include trauma occurred at a time, the injury factor, trauma mechanism, whether complications, the nature and extent of pain, functional activities obstacles, had experienced after the treatment and effect, whether a similar history of the past.
Check
1. The importance of the timely completion of a medical examination (in accordance with the expectations of conflict dynamic, in procedures).
2. Supplementary examination:
(1) conditional to certain perturbation injury lateral X-ray film.
(2) blood, blood type and blood coagulation time inspection. Elderly patients ECG and urine sugar check.
[Diagnosis]
1. A history of trauma.
2. Limb pain and dysfunction.
3. Fracture proprietary signs: deformity, bone rubbing flu (Music), abnormal activities.
4. Complications signs.
5. X-ray signs of fractures.
Treatment principles:
1. Manual reduction, external fixation: choice gypsum, sliding skeletal traction.
Indication:
(1) children.
(2) poor health of patients, not tolerance surgery.
(3) fracture suspicious, the former X-ray inspection to external fixation.
2. Emergency surgical indications:
(1) open fractures.
(2) accompanied by an important nerve, blood vessel, muscle injury.
(3) the merger other important organ damage, the patient can still normal circumstances, after surgery to move.
3. Deadline surgical indications:
(1) merger decompensated shock, and other extreme failure patients.
(2) There is no objective conditions for emergency surgery.
(3) reduction approach can not achieve functional reduction or unable to maintain functional reduction.
(4) - articular fractures.
(5) fracture nonunion or delayed union.
(6) on children seriously considered.
4. Surgery Methods:
(1) intertrochanteric fracture: the choice gooseneck nails, wings nails, “gamma” nails, etc..
(2) above the middle of femoral shaft fracture: The plum blossom needles, plates, etc..
(3) the middle of femoral shaft fractures following: the choice of plate, nail and other functional fixation with locking device.
(4) femoral condyle and supracondylar fracture: the choice of “L” plate, “T” plate, bone suppositories, and other special-shaped plate.
5. Adjuvant therapy:
(1) of antibiotics.
(2) anti-shock: painkillers, blood transfusions, rehydration.
(3) to prevent complications.
(4), referring to other organs, tissue injury of drugs.
(5) physical therapy.
(6) Functional Exercise can be used auxiliary equipment and the installation.
Efficacy standards:
1. Cure: not walk three minutes crutches, and not less than 25-30.
2. Surprised me: not meet the above criteria.
Discharge standards:
Fracture reduction and functional, reliable fixation, no complications, can be discharged from hospital, out-patient follow-up.

Femoral neck fracture care

Clinical data
78 cases of patients in the male 32 cases, 46 cases of women, the largest age 93, while the youngest 25-year-old, with an average age of 61.2, including 47 cases of outreach, in the resumption of 16 cases, 15 cases of the middle. The treatment, outreach no obvious fractures or displacement of inserting fracture, sustained skin traction 6 to 8 weeks, and maintain outreach limb in standing, three on crutches after walking; Admission within the fracture or displaced femoral neck fracture first skin traction or tibial tubercle skeletal traction, according to the situation after the trade-operation to maintain internal rotation limb outreach neutral position; 65 patients over the age of the femoral head fracture, with a clear shift, or rotating in ischemic necrosis of femoral opportunities, such as systemic conditions permit, can be used for artificial replacement of the femoral head, three weeks after walking crutches Shimoji.

2. Classification and Differentiation of Nursing
2.1 Early (hematoma of the deposition period after injury 1 ~ 2 weeks): the patient falls injuries, injuries to hip, blood gas machine illogical, General Clauses pain, it is pain; Excess blood veins, parked in the grounds of skin originated, and see subcutaneous bleeding spots. Broken bone tendon injury, bone loss supporting role, it can not be activities.
2.1.1 symptomatic care: after the patient is admitted, according to the extent of damage, the nature of arrangements suitable beds to help the smiling posture, in accordance with a general orthopedic conventional care. To observe the injured legs and the feeling of acromegaly blood supply, closely observe the conditions change, found complications, timely processing. Good bone and skin traction traction care, observation of the concept of traction device is falling out of translocation, and maintain effective traction. Pay attention to the wound dressing change skeletal traction to avoid infection. The period could not sleep because of pain, pain due to some sedative drugs relieve pain.
2.1.2 emotional care: the mental and health are closely related, particularly the elderly, their sudden ability to lower stress injury. Their injuries are a result of fear, pessimism, fear maimed affect future life, fear drag their families, in particular fear of the abandoned children, after admission, they become agitated unrest. Against such an emotional, care, we should avoid stimulating, and the emotional stability of the patient, through talking with them, understand their family situation, ideological trends, and patiently and carefully taught them to comfort and explain the work. While making family, to spend more time visiting patients to prevent them feel lonely. Nursing for people to eliminate adverse emotional patients, and help them to establish confidence, and consciously with the treatment.
2.1.3 diet care: the initial injury, spleen and stomach weak lack of appetite, patients often do not think diet, so eating to light, heat, rich in vitamin mainly bogey greasy, cold, hot, eat more vegetables, carrots, rice, lean meat soup, fruit. Because the shelter of the country, and certainly stems from drinking. Dietary intake of nutrition is to maintain the body life activities indispensable conditions, it should encourage consumption.
2.1.4 medication care: Blood Circulation, the main bone continued reinforcement, after an instant reset, and topical analgesics San Ho swelling, continued broken bone powder, Oral pain-ling.
2.1.5 functional exercise: asking patients isometric quadriceps and toes activities, each 15 minutes, two times a day, and to assist knee massage, and promote blood circulation, prevent muscle atrophy, bone adhesion.
2.1.6 skin care: As long illness qi and blood loss in this group less, because bedridden, not mobile, viscera function decline, not nutrition skin, running blocked qi and blood, blood, coupled with the skin compression and other reasons, prone to cause skin damage. It should strengthen skin care, maintenance bedding dry cleaning, massage sacrococcygeal commonly used safflower alcohol, and promote local blood circulation, increase body resistance and prevent the occurrence of pressure sores. In addition Kurashiki Chinese medicine powder, the little patient will pruritus, allergic reactions, such as pain, if allergies, after stopping topical medicated Slavery Seoul.
2.2 medium-term (original bone callus period after injury three to six weeks): This period of stasis began to threads by Qualcomm, it alleviate pain, bone-being, bone formation with cartilage, but not solid.
This period should be temperature-meridian, and promote fracture healing, and topical Ho continued broken bone powder, analgesics Zhuanggu casual, Oral Bone continued reinforcement Dan, it takes another conditioning diet, nutrition and encourage more easily into high-protein food, the elderly spleen and stomach weak, encourage more try congee, bone soup, chicken soup, fish, animal liver, kidney, skin care and also strengthen functional training, quadriceps contraction continue to do so, each for 30 minutes, two times a day, to strengthen the knee, preventing knee stiffness.
2.3 late (bone callus transformation period, after six weeks after injury): This period connectivity fracture, but the injury was meridian qi and blood, viscera of gas have not yet been resumed. It fracture hard enough, the functional activities yet to resume, qi and blood deficiency is not wetting their bones, joints do not sliding profits, while Ma hot and cold feeling unwell. This period should be topical Ho Health bone powder, analgesics Zhuanggu casual to promote bone callus growth, bone repair, is still Nursing strengthen skin and diet Nursing, functional training, strengthen nutrition, enhanced physique, the Organization for damage repair. Diet saves Tonifying liver and kidney, Spleen and stomach, digest high-protein food. Air Canada service benefits of Chinese medicine blood, External Effects of Shujin soup Fumigating and Washing lower extremities, while bone and joint exercises mainly joints gradually resume normal activities.

3. Discharged guidance
3.1 new patients more soon, upright yet fully restored, to discharge more than bed rest for the benefit of bone callus growth strong, cold-proof shelters to prevent influenza.
3.2 continuing injured legs functional training, such as the quadriceps systolic and diastolic activities, knee, ankle flexion and extension activities of the bed to the hip flexion activities. Shimoji activities between your crutches to help, not slow to load, to be 5-6 months before gradually after the crutches, walking exercise load.
3.3 Effects of Shujin continued compliance with lower limb soup Fumigating and Washing injured legs, smoked after the first washing, the wash-edge activities massage joints or muscles every other day, the 1st, rational drug use, re-directed by your doctor regularly.
3.4 enhancing dietary care, and more eating liver and kidney, strong bones and tendons food.

Avascular necrosis of the femoral head prevention?

① on the femoral neck fracture fixation using strong, and the first application of vascularized bone graft, at the femoral neck promote healing, increase blood circulation to his head to prevent bone necrosis, postoperative follow-up should be regular, proper oral medicine and the promotion of the blood supply calcium, prevention avascular occurred.

② because of hormone-related diseases must, it is necessary to have adequate short-term principle and in the expansion of vascular medicine, vitamin D, calcium, and so on, do not listen to doctor’s orders not to attribute to abuse of hormone drugs.

③ should remove the bad habit of long-term alcohol abuse or alcohol, from the pathogenic factors contacts environment, the chemical removal of alcohol toxicity, and prevent squandering fine absorption.

④ Sham on occupational factors such as divers, pilots at high altitude, high-pressure work environment, the staff should pay attention to labor protection and improve working conditions, and has indeed sick of the work should be changed and timely medical treatment.

⑤ diet should be: do not eat hot pepper, but of alcohol, do not eat hormone drugs to increase calcium intake, the consumption of fresh vegetables and fruit, more sunbathing, prevent loading, regular activities such as necrosis of the femoral head were preventive role.

C-type femoral condylar fracture treatment

According to the Department of comminuted fracture of femoral condyle AO classified as C-type, often non-surgical treatment of malunion, ankylosis, surgical treatment for severe crush fractures, bone defects and more difficult. In our hospital since 1993, 38 cases of femoral condylar fracture type C treatment efficacy satisfied with the report are as follows:

1 clinical data

General information on the group 1.1 male 35 cases, three cases of women, aged 19 to 66 years old, with an average age of 42.5. Right 12 cases, 26 cases left. Injury reasons: traffic accident injury 20 cases, 14 cases of falling injuries, weights injured four cases. Fracture Classification and Mergers injury: All of fresh fractures, open fractures six cases, 32 cases closed fracture. C1 fracture of 18 cases, 12 cases of fracture of the C2, C3 fracture eight cases. Six cases of patellar fracture merger, the cruciate ligament injury two cases, one case of meniscus injury.

1.2 fixation methods (1) “L” plate + cancellous bone screws; (2) cancellous bone screw or bolt + rectangular nail; (3) cancellous bone screws + wire. Surgery points, with the exception of open fractures emergency surgery, while experts have surgery in a week: ① anterolateral incision general use should be fully exposed and outside the femur distal femoral condyle and to reset under direct vision and restore the integrity of anatomy. ② should cartilage defect repair. ③ should first restoration femoral condylar fracture block. ④ choice of the “L” - shaped plate fixed before, and by the distal femoral condyle cortical shape, the “L” plate for molding, following in the lateral femoral condyle from the articular surface of the 1.5 to 2 cm diameter of 4 mm by bit. Knee axis parallel to the drill 2-4 hole. Then bone knife cutting groove, into the “L” plate. To prevent separation between the hammer at the condyle, ahead of the plate before cancellous bone screw fixation condylar fracture block. ⑤ if firms rectangular nail, the first two with cancellous bone screw fixation femoral condyle and outside, and then inside and outside the femoral condyles were good blow to the pre-selected rectangular nails. Under open reduction and good after-fracture fixation, double-nail at the same time slowly upward into, filling nail blow to the nearly pack-marrow, such as marrow, less firmly fixed, the same road again with the original nails into a rectangular nails. ⑥ For more smash-fracture, that is unable to use the “L” plate, they can not use rectangular nails, then reset good, with several cancellous bone screws, wire, plaster after entrusted fixed. ⑦ postoperative adhesions in order to prevent quadriceps and knee infection, we conventional suction drainage device implantation, after 24 to 72 hours for removal.

2 Results

Early postoperative X-ray showed fractures reach nearly anatomic reduction or anatomical reduction to 34 cases, 4 cases of pre-curved plate in the femoral condyle, and the junction of radians enough, resulting in the femoral condyles and the relative bias. Follow-up of 10 to 62 months, with an average 22 months without a wound infection and osteomyelitis, all bone healing, functional recovery reference Neer [1] score standards, gifted 15 cases, good in 19 cases, three cases, one case of poor, the excellent and good rate 89.5%.

3 discussion

3.1 prevention or mitigation we believe that the incidence of complications in dealing with such fractures, to the following points, can play in preventing or slowing arthritis and osteoarthritis of the knee joint dysfunction: (1) Static restoration of the knee and dynamic stability in the handling of femoral condylar fracture, due the possibility of resuming femoral condyle physiological anatomy of integrity, and completed all the knee ligament injury repair. (2) should be the articular surface repair cartilage damage and fracture reduction and good is as important as the status of some of the rupture did not completely free set off the articular cartilage, be restored formation, after the fracture fixation, these new cartilage surface coverage, and to give fixed. (3) The importance of early functional exercise.

3.2 selecting suitable fixation because of femoral condylar fractures are unstable, often three-dimensional nature of intra-articular fractures, coronal, sagittal, axial have fracture, internal fixation difficult and the knee muscle groups through the powerful, multi-forward displacement fracture proximal, distal backward shift . Therefore shall first consider the implant of choice to obtain and maintain anatomical reduction for early functional exercise. C-type femoral condylar fracture treatment should be the first choice “L” plate because it is a piece of the overall materials, its fixed-strong, three-dimensional planar maintain reduction in general without external fixation, and early activities to meet the needs of the knee, there are 34 cases in this group use the “L” plate + cancellous bone screws . But for serious C crush fractures, “L” plate can not be firmly fixed condylar, clinical application, we cancellous bone screws 1 ~ 3 condylar fixed internal and external, will be complex condylar fracture into a condylar fracture, but also can be used more nail root rectangular cross-fixed, the group has three cases. As for femoral shaft oblique, spiral-shaped fracture of the elderly patients, we just wire tied, cancellous bone screw fixation, one case of this group, of the 65-year-old patients, postoperative care for gypsum fixed. For serious bone defects caused by the crushing impact of the bone healing patients, we give autologous iliac bone grafting, with a view to a healing fracture, a serious crush on the case, while shortening supracondylar area, but not more than 2 cm principle. Fragments of bone were filled to the healing.

Treatment of femoral condylar fracture

No transfer or mildly displaced femoral condylar fractures, intra-articular plot extract blood pressure bandaging. Entrusted with traction or gypsum fixed 4 to 6 weeks after knee activities.

Along with internal fixation devices continue to improve, so that more complex femoral condylar fractures, can also be more reliable internal fixation, the current treatment in the general trend, tend to surgery.

In addition to general surgery indications of intra-articular, bone fractures adjacent to the total, are in this position the following situations.

Merger ligament or meniscus injury, severe vascular nerve injury, and fractures of free blocks, bad blood supply.

Internal fixation methods are as follows:

(1) Steel plate angle was 95 ° angle, the fracture site can guarantee stability.

(B) including specialized plate screws for femoral condyle fracture plate screws and artificial bending it after the femoral condyle and in line ordinary plate. Characterized by a strong adaptability, easy to use simple. But in the plate and screws connecting parts easy to loosen, or even fracture, fracture is difficult to guarantee the stability of the site, with plaster frequently fixed at the same time. To overcome these shortcomings, it has designed a new type of plate screws. In addition to “AO” T-plate, such distal plate width, and a number of Screw Hole so that the screws from the front or rear hole into bone, fixed femoral condyle.

(C) The screw, bolt, screw.

(4) Needle Steinmann pin fixation in the bone mass can be no serious cases smash application. Eiffel Tower needle can be used for femoral condylar fracture with supracondylar fracture cases.

Cross-pin and bone suppository treatment of comminuted fracture of femoral condyle

Condylar fracture of the femur often serious injury, treatment difficulties, more complications, the effect dissatisfied with the current traffic is a more common serious injury. Our hospital since January 1995 from the cross-pin and bone used in the treatment of comminuted fracture of femoral condyle 28 cases, to achieve a satisfactory effect. Presented below.

1 clinical data

This group of men and 28 cases of 23 cases, female five cases; Age 16 to 55-year-old, right 16 cases, 12 cases left; Fresh fractures 26 cases, two cases of old fractures; Open fractures eight cases, 20 cases of fracture closure; With bone defects in 18 cases, with six cases of vascular nerve injury, anterior cruciate ligament injury with three cases.

Treatment 2

2.1 preoperative preparation of open fractures are emergency operation, closed fractures to the tibia bone nodules traction 7 ~ 14 days, local symptoms improve after surgery.

2.2 medial knee surgery Methods, lateral incision, or femur, lateral longitudinal incision, about 10 cm, exposed fractures end, 90 ° knee flexion, exposed femoral condyle, with a femur bone will be inside and outside condylar fracture fixation, and then lateral femoral condyle fibular collateral ligament just point and knee and patellofemoral joint surface parallel to the entrance of a Kirschner wire to a bone suppository pressurized fixed, then T - or Y-type fracture into supracondylar fracture; under the reduction in traction, with 3.5 mm needle bone yen since posterior bone suppository 0.5 mm, and the same plane and bone bolt from the inner and outer condyle TAC fork fixed supracondylar fractures, bone defects, or to have serious trip to crush bone graft.

2.3 limb after home after treatment in Brown’s shelf, as soon as possible isometric quadriceps after two weeks removing functions were performed legs in plaster fixed up, six weeks after the removal of gypsum care, began to practice the knee, crutches and walking limb not load. X-ray confirmed that bone healing, it can strengthen the knee flexion and extension activities, and weight-bearing and walking disposable Shui, healing firmly small incision after implant removal.

3 Treatment Results

There are 26 cases in this group received follow-up, time after 8 ~ to 36 months, of which one case of nonunion, after autologous iliac bone healing, healing of fractures of the remaining cases healing time 10 weeks to 16 months with an average of 4.2 months. Adhesion of which knee devices, scope of activities <80 ° to three cases, the trauma of patellofemoral arthritis two cases, after one case of displaced fracture, with one case of infection, mild varus knee two cases, one case of implant loosening. Wulff fracture by Kolmert and the evaluation criteria [1], 26 cases, the gifted 13 cases, good in eight cases, three cases, and poor in 2 cases, the excellent and good rate 81%; Typical cases see figure 2.

4 discussion

4.1 injury mechanism (1) direct violence: femoral condyle role in the direct violence often stress the patella will double into a condylar fracture of the wedge, when the level of violence was acting on the direction of supracondylar areas, often causing supracondylar fracture. (2) indirect violence: the shares so that the tibia knee buckling site impact, first of all, to a maximum knee flexion, and the femur under paragraph Yousheng rational forward radians weak position, in the cortical bone transitional into femoral condyle honeycomb cancellous bone, then if a supracondylar fracture is continuing violence, will inserting in the fracture of the proximal femur, between the lateral condyle, femoral condyle split; anatomy of the femoral condyle and the weak points in the intercondylar Waterloo, the patella triangular wedge at the intercondylar like Waterloo, will be easy to split the two condyles, if violence powerful, end-proximal fractures can be pierced muscle, skin create an open fracture.

4.2 intraoperative Note (1) For intraoperative femoral, lateral condyle articular surface anatomic reduction; If intracondylar smash serious, longitudinal axis, the difference should not be greater than 2 mm, precise anatomical reduction is the best function of the knee was a prerequisite, if any joints left over from the mutual relations can not adapt , the weight-bearing joints, the joints can cause swelling, pain and functional constraints, and lead to osteoarthritis from happening. (2) should be in operation by the pin inside and outside the posterior condyles, and make this pin and proximal femur in the back of a plane, the resistance inside and outside the condyle caused by traction after flexor gastrocnemius (dumping). (3) the majority of patients due to the proximal femur, “inserting” roles, inner and outer condyle more cancellous bone defect, a “shell” to become future nonunion important factors should be reset so as to protect the periosteum, the reservations attached to bone-soft tissue, so fracture healing while a bone graft.

Distal femur, especially condylar fractures, previously used ordinary plate, “T” - shaped plate, and so on, because of fixed collapses due to the high incidence of complications has not. Later, the use of improved “L” - shaped plate, and achieved certain effects, but more difficult placement, positioning, and could easily lead to knee varus deformity and outside of C-type fracture fixation result is not satisfactory [2]. Scattered screw fixation with the dynamic condylar screw with a strong anti-torsional strength [3], but inflict larger, fixed sagittal plane is not solid enough, C2 and C3 fracture should not be used [4]. At present, based on the intramedullary nail fixation of the center more in line with the biomechanical characteristics of the femur, not the near-destruction of fracture blood supply, called the “biological” internal fixation technology [5]. This method condylar plate with AO compared to surgery is simple and effective, femoral condyle bone - mostly non-rotating shift, a more proximal “inserting” and the distal after flexor, and after dumping and cross pin and posterior femur in the same plane, which can effectively resist the distal after flexor, after dumping displaced fracture far, and the proximal cross-pin formation of a stable local mechanical systems. In particular, this method with the use of nerve, vascular injury cases, could significantly reduce the operation time. Cross-pin compared with condylar plate may retain more proximal fractures periosteum, which is the great fracture healing role, if proximal femur, “inserting” serious, induced femoral condyle formed an “empty shell”, or femur, the lateral condyle after tangent fractured, and then fixed with a condylar plate the difficulty with this method can be successfully fixed. This method secondary operation simple and workable small incision removed implant.

It is not difficult to see that the cross-pin and bone used in the treatment of femoral condyle comminuted fracture simple, effective wide indication, after suffering small, worthy of promotion and application.