Treatment of 20 cases of transverse humeral fracture with double-bolt internal fixation Xin Xin 1 Huang Congchun 1 Jiang Zhixue 1 Fan Yanen 2 (1. Department of Orthopaedics, Second Affiliated Hospital of Jiamusi University; 2. Department of Orthopaedics, First Affiliated Hospital of Jiamusi University) Choice, there are traditional tension band wire fixation, wire or wire entanglement, to memory alloy tibia claws. Since 1999, our department has used double-thick bolts to treat transverse (longitudinal) fractures of the humerus. It has simple operation, strong pressurization effect, early bed movement and small incision, and has achieved satisfactory results.
1 Materials and Methods There were 16 cases of transverse humeral fractures, 4 cases of longitudinal fractures, 15 cases of closed fractures, 5 cases of open fractures, ages 20 to 55 years, 14 males and 6 females.
1.2 surgical methods under epidural anesthesia, take the supine position, routinely take the anterior transverse incision, layer by layer into the fracture, separate the exposed tibia, check the fracture end and the free bone in the joint, this group are Lateral or longitudinal fractures, a small number of lateral wedge-shaped bones, an anatomic reduction of the fixed forceps, and two parallel holes drilled through the tibia perpendicular to the fracture line. Select the appropriate bolt length and thickness of the bolts, rinsing, layer-by-layer suture, and only need to cut 4 small incisions in the nut to remove the bolts during the second operation.
1.3 Results 20 cases were followed up for 6 months to 3 years. Among them, 16 cases were found to have osteophyte growth after 5-6 weeks of operation. After the exercise, the active joint angle of the knee joint reached 60°-180* (extension). The remaining 4 cases had different degrees of tibia. 6~7 weeks of fragmentation, the epiphysis grew well, and the activity angle reached (b) 70°-170° (extension). After 6 months of functional exercise, it was reviewed and basically reached the angle of the healthy side. Excellent: 14 cases of postoperative knee Joint activity was painless; good: 4 cases were painless after mild activity.
There was pain after the increase of activity, and relief after rest; poor: 2 cases had no complete anatomical reduction of the articular surface, so the residual traumatic arthritis, the pain after the activity was more obvious, the excellent rate of this group accounted for 90%. 2 Discussion for the fracture of the tibia There are many researches and methods in the treatment of various parties. The effect of tension band wire method is more positive, the pressure is good, and it can be exercised early, but the internal fixation often affects the growth of local epiphysis, and the second operation has a large incision. The needle tail often pierces the skin or rubs during exercise, and the pain is greater.
Due to the choice of the hardness of the steel wire and the influence of the intraoperative technique, the cerclage method tends to increase the fracture gap at the patellofemoral joint surface, and the compression effect is weak, but it is still applicable to the comminuted fracture.
Memory alloy patella claw is a more advanced method, the price is acceptable, but the operation requirements are very high, it is also difficult to take out. The double-bolt method used in our department is simple and easy to operate, mainly because of strong pressurization, and can be used for early joint function. It greatly reduces the occurrence of complications. The skin is weaker than the steel needle at the nut, the patient suffers little, the bolt is easy to purchase, and only 4 small incisions can be taken for removal during the second operation. The disadvantage is that it is not suitable for smashing heavy ones. At the same time, it should be noted that the two bolts should be symmetrical, otherwise the gap at one end will increase, and the drilling position should be at the center of the upper and lower sides of the humerus.
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