Direct violence, such as impact, collision or indirect violence, such as falls and injuries, can lead to fractures of ulna and radius. "PuJiFang? He broke the door and said, "Whoever breaks the bones of both arms will break their bones, and those who break them will have no bones. "After injury, forearm swelling, pain, deformation, tenderness, abnormal activity, bone friction, forearm rotation function is impaired. If it is a branchial cleft fracture in children, there is generally only angulation deformity, and X-ray film can make clear the fracture type and displacement direction.
Reset method
The patient was supine, with 90 degrees of shoulder abduction and 90 degrees of elbow flexion. Two assistants pulled and stretched, the upper 1/3 fracture, the forearm should be placed in supination position, and the middle and lower 1/3 fracture, and the forearm should be placed in neutral position for pulling and stretching. According to the principle of distal to proximal, rotation, angulation and overlapping displacement can be corrected. If the fracture segments are angled to each other and move towards the middle, it is feasible to squeeze and divide the bone. For transverse or short oblique fractures with lateral displacement, hold the proximal fracture end with one hand and the displaced distal fracture end with the other hand to keep the fracture protrusion straight. If the overlapping displacement is not improved, it can be folded and straightened in reverse. For children with branchial cleft fracture and angular displacement, in the straight position, press down with the palm of your hand at the angulated top to make the correction slightly correct to avoid rebound and displacement.
Because the fracture of ulna and radius needs high reduction, it is not necessary to repeatedly reduce the fracture that is unsuccessful in reduction or unstable fracture that is displaced again, so as not to aggravate the soft tissue injury. Under the supervision of C-arm X-ray machine, after closed reduction, Kirschner wire and elastic intramedullary nail were used for fixation, which was minimally invasive, easy to operate, less bleeding and good curative effect.
Fixing method
After successful reduction, four forearm splints were fixed under traction, and paper pressure pads were used according to angulation and lateral displacement. After binding, the forearm was fixed with a column splint, the elbow joint was bent 90 degrees, and a triangular towel was hung. In principle, the forearm is placed in a neutral position, and it is reviewed regularly every week for 4-5 weeks. The splint can't be removed until the fracture is healed clinically.
Pay attention to guiding functional exercise. At first, children were encouraged to do fist clenching, finger flexion and extension activities and upper limb muscle relaxation and contraction activities; In the middle stage, the shoulders, elbows and wrists should move slightly, and the forearm rotation is not suitable; Later, the range of motion gradually increased, and the forearm rotated after the fixation was released.