RU2024246C1 - Method for treating transcondylar extension fracture of humerus in children - Google Patents

Abstract

FIELD: medicine, particularly traumatology and orthopedics. SUBSTANCE: method involves repositioning of splinters, applying bandage to the neck and radiocarpal articulation, attaching forearm to front surface of chest in the position wherein elbow joint is bent at an angle of 50-90 deg. Novelty resides in that after repositioning of splinters the forearm is set in full-prone position, withdrawing force is formed by rigidly fixing the palmar surface of radiocarpal articulation to bandage. EFFECT: prevention of complications by eliminating rotary displacement of splinters.

Description

 The invention relates to medicine, namely to traumatology, and can be used in the treatment of trans-alkaline extensor shoulder fractures with residual rotational displacement of fragments.

 Known in medical practice is a method for the treatment of trans-alkaline shoulder fractures by bending the forearm at an acute angle in the elbow joint after eliminating the displacement of the fragments along the length, width and rotation. In this case, the fixation of fragments is carried out by tensioning the triceps muscle of the shoulder using a special bandage consisting of leather elements with fasteners for the neck and forearm.

 Closest to the proposed method is the Blount method, the essence of which is to fix fragments of the humerus in the position of flexion of the forearm in the elbow joint at an acute angle. Matched fragments are held by pulling the triceps muscle of the shoulder. The limb is immobilized by a soft bandage, which consists of 2 loops on the neck and wrist joint. The loops are made of a cotton-gauze strip 60-70 cm long and 5-6 cm wide. One end of the dressing is fixed around the neck (sewn) and then an loop around the wrist is created in an 8-shaped way. As a result, the forearm is fixed to the front surface of the chest motionless. The average fixation period is 3 weeks.

 However, the known methods of treatment have complications in the form of varus deformity of the elbow joint in 16-20% of cases, which is the result of timely unrepaired rotational displacements of fragments during a shoulder fracture.

 The aim of the invention is to prevent complications by eliminating the rotational displacement of fragments.

 The essence of the method is as follows.

The Blount bandage in our modification consists of two loops on the neck and wrist joint. The loops are made of a cotton-gauze strip with a length of 50-70 cm and a width of 5-6 cm. One end of the dressing is fixed around the neck (stitched) and then looped around the wrist in an 8-shaped way. As a result, the forearm is fixed to the front surface of the chest motionless in the average physiological position. The angle of flexion of the forearm in the elbow joint can vary from 90-50 ^about , depending on the severity of edema. After x-ray control and the presence of residual rotational displacement, the forearm is set to the full pronation position, forming a deflecting force by fixing the palmar surface of the wrist joint and the bandage. In this case, the long edge of the bandage is released, the palmar surface of the wrist joint is lubricated, for example, with medical glue and the free edge of the bandage is glued so that it extends from the elbow side. Then, in a state of tension, the ends of the dressing are stitched. With continued fixation, the forearm is actively penetrated. Within 2-3 days there is a correction of the residual rotational displacement. After that, the bandage from the wrist joint can be removed and continued fixation in the normal physiological position for 3 weeks.

 The proposed method is illustrated by a clinical example.

 Patient S., 6 years old, N case history 1675. Fell on the street on an almost fully extended arm. Delivered to the hospital 02/23/91. After a clinical and radiological examination, the diagnosis was made: trans-alkaline extensor fracture of the right shoulder with displacement of fragments. Under general anesthesia, a closed reposition and fixation with a Blount bandage (in a cotton-gauze version) was performed. On the X-ray control from 02.23.91 revealed residual rotational displacement of the distal fragment of the shoulder inwards. After that, the patient’s palmar surface of the wrist joint was smeared with medical glue, gluing the free edge of the bandage. In the tension position, the edge of the dressing was connected to the cervical end, setting the forearm in the full pronation position. Fixation continued for 4 days. On the X-ray control from 02.27.91 the standing of the fragments of the shoulder returned to normal. The bandage was removed and the forearm was set in the physiological position for 3 weeks. Long-term result after 2.5 months: there is no deformation of the shoulder, the full range of movements in the elbow joint has been restored.

 Thus, the proposed method for the treatment of shoulder fractures in children can reduce the number of complications due to the timely elimination of rotational displacement in trans-alkaline extensor shoulder fractures.

Claims (1)

 METHOD FOR TREATING TRANSMISSIBLE RIBBATIVE FRACTURE OF THE HUMAN BONE IN CHILDREN by reposition of fragments, applying a bandage to the neck and wrist joint, securing the forearm on the front surface of the chest in the bent position in the elbow joint at an acute angle, which eliminates the complications due to the fact that rotational displacement of fragments, the forearm is fixed in the position of maximum pronation.