manipulative therapy of Supracondylar fracture of humerus Zheng

manipulative therapy of Supracondylar fracture of humerus Zheng Runjie Ruian Hospital of Traditional Chinese Medicine, Zhejiang 肱骨髁上骨折的手法治疗 郑润杰 浙江省瑞安市中医院

CONCEPT Supracondylar fracture of the humerus refers to the fracture of the humerus’s inside and the external condyle. It is one of the most common fractures in children, accounting for 50% to 60% of the elbow joint injuries, and occurs in children of 4~10 years of age. 概念 肱骨髁上骨折，系指肱骨内、外髁之上所� 生的骨 折。是小儿最常� 的骨折之一，占肘关� � � 的50%～ 60%，多�生于 4～ 10�的儿童。

MECHANISM The lower end of the humerus is flat and wide and flexed forward. There is a coronal fossa in front of the humerus, and there is an olecranon fossa in the posterior fossa. There is only a thin layer of bone between the two nests, so it is prone to fracture. 机制 肱骨下端扁薄而� ，向前屈曲，前有冠状� ，后有 �嘴�，两�之��有一�薄的骨片，故容易�生骨折。

CLASSIFICATION According to the difference in violence, fractures were displaced differently and were clinically classified into two types: (1)Fracture extension type supracondylar extension type: the most common, accounting for about 90% of the total number of this kind of fracture to fall 95%. fought, the elbow in the semi flexion or hyperextension position, a palm, the violence of the forearm conduction to the humeral condyle, backward and upward impact; at the same time because of weight the strength of the humeral shaft from top to bottom, lower to the front of the bottom, the former under oblique fracture line above the distal end backward and upward displacement. 分型 根据所遭受暴力的不同，致骨折�生不同的移位，�床上分�两型。 （1）伸直型：最多� ，� 占� � 骨折� 数的90%～ 95%。跌倒 前仆� ，肘关� � 于半屈曲位或� 伸位姿� ，掌部着地，暴力� 前臂� � 至肱骨髁部，向后向上冲� ；同� 由于体重的力量自上而 下，将肱骨干下部推向前下方，使骨折� 从前下方斜向上方，� 断 端向后上方移位。

CLASSIFICATION (2) Flexion type: very rare, about 5% to 10%. of the total number of fractures, when the elbow joint flexion, elbow directly caused by the fracture line from the back of the lower oblique forward, far off the top forward shift. 分型 （2）屈曲型：很少� ，� 占� � 骨折� 数的5%～ 10%。受� � 肘 关� 屈曲，肘部直接着地所致。骨折� 自后下方斜向前上方，� 断 端向前上方移位。

MANIPULATIVE THERAPY Pushing and pressing method An assistant holding the limb arm, another assistant hold in the forearm, forearm supination, elbow extension posture under traction 2 to 3 minutes, and then with a hand fixed slightly above the elbow, the other hand holding the elbow slightly below, in the opposite direction and appropriate force to push, the lateral displacement correct. Finally, according to the fracture type, with the thumb pressing forward or backward fracture of the distal end, to correct the posterior shift (Figure 1). 手法治疗 推�按�法 一助手握住患肢上臂，另一助手握住前臂，在 前臂旋后位、肘关� 伸直位姿� 下� 引 2～ 3分� ， 然后� 者一手固定肘关� 稍上方，另一手握住肘关 � 稍下方，以相反的方向和适当的力量推� ，使� 方移位� 正。最后根据骨折� 型的不同，� 者用大 拇指向前或向后按� 骨折� 断端，以� 正前后移位 Figure 1 � 1

MANIPULATIVE THERAPY Pushing and pressing method Elbow flexion extension type fracture should be fixed for 3 weeks; should unbend fixed flexion type fracture, fixed time for about 2 weeks, the callus growth slightly, bone the broken end has been basically in a stable state, and then the elbow is fixed 1 weeks. 手法治疗 伸直型骨折� 屈肘固定 3周；屈曲型骨折� 伸直位固定，固 定� � � 2周左右，待骨痂稍有生� ，骨断端已基本� 于� 定状 ��，再屈肘固定 1周。

APPLICATION OF TRADITIONAL CHINESE MEDICINE Early stage: Using the medicine of active blood and Li Qi aiming to eliminate Hematoma. After 3 weeks, the fixation can be removed, then use SIzhi Xifang decoction fumigation, help the elbow joint function recovery. SIzhi Xifang: Composition of Centella 12 grams, epimedium, angelica, cassia, angelica, Loranthaceae, Lycopodii, Tougucao 9 grams, 5 grams of safflower. Use water, fried, smoked and washed. 中药应用 早期� � 予活血化瘀、理气止痛之� ，以助血� 消散，3周后可拆除固定， 以四肢洗方煎�熏洗，帮助肘关�功能复原。 四肢洗方: �成落得打 12克，淫羊藿、独活、桑寄生、桂枝、当�、伸筋草、 透骨草各9克，�花 5克。 用法水煎熏洗局部。

CONSIDERATIONS 1. The early fracture of humerus, swelling was not obvious and no blisters appear, the use of manipulative reduction and small splint external fixation , generally can be effective. (Figure 2). 注意事项 1. � 早期的肱骨髁上骨折，� � 不甚明� 且无� 力性水泡出� 者，运用 手法整复、小�板外固定（� 2），一般均能收效。 Figure 2 � 2

CONSIDERATIONS 2. We should closely observe the blood circulation of the limb in a fixed period, to prevent because of fracture caused by ischemic contracture in forearm, also known as the Volkmann's ischemic contracture (Figure 3). Figure 3 � 3 注意事项 2. 在固定期� � 密切� 察患肢的血液循� 状� ，以防出� 因骨折引起的 前臂缺血性肌��，也称伏克曼缺血性��（� 3）。

CONSIDERATIONS 3. To shift significantly, fixation failure cases, or blisters in the fixing process, should give up the external fixation with traction therapy, this is the best choice. In the process of skin traction, starting weight should be increased, between bone ends and the basic separation method after reduction, then the appropriate reduce weight for maintaining traction. At the same time, we must pay special attention to the direction of the longitudinal axis of humerus and traction to keep consistent, to correct the partial radial or ulnar deviation, to prevent after varus or valgus elbow. 注意事项 3. � 移位明� 、固定失效的病例，或在固定� 程中出� � 力性水泡者， �放弃外固定，改用�引�法，此�最佳��。 在皮肤� 引� 程中，开始重量� 加大一些，待骨断端之� 基本分离并予 以手法整复后，再适当减� 重量作� 持� 引。同� ，要特� 注意� 引方 向要和肱骨� � � 保持一致，以� 正� 偏或尺偏，防止日后出� 肘内翻 或肘外翻畸形。

CONSIDERATIONS According to the literature, for supracondylar fracture of the humerus traction therapy used, have suspended traction, traction and de Blanc Kangpei extended skin traction 3. The author uses the method of skin traction in the latter, but the reduction in the process of traction and fixation varies. Practice proves that this method is safe and effective, worthy of promotion. 注意事项 文献� � ，� 肱骨髁上骨折所采用的� 引� 法，有� 吊式� 引、康培白 朗脱� 引及伸直位皮肤� 引 3种。作者所采用的皮肤� 引取法于后者，但 在� 引� 程中所采用的具体整复及固定方法又有所不同。� 践� 明，此 法安全有效，�得推广。

CONSIDERATIONS 4. Based on the children had a large plasticity of fracture repair, so the supracondylar fracture of the humerus did not require anatomy registration, but more serious rotation is not allowed to exist. The author in Shanghai Ruijin Hospital during the work, had to visit the pediatric department of orthopedics ward, according to reports, the supracondylar fracture of humerus in children, rarely used surgical therapy, basically is the use of conservative therapy. Remember a supracondylar fracture of humerus in children, counterpoint, on line are not ideal, still be traction therapy treatment. The children have great plasticity, fracture of even alignment, not satisfied with the line, the traction, and will not be on the elbow joint function How much of an impact. 注意事项 4. 基于儿童� 骨折的修复有� 大的可塑性，因此� 肱骨髁上骨折不必强求 解剖�位，但���重的旋�移位�是不允�存在的。 作者在上海瑞金医院 作期� ，曾去参� 小儿骨科病房，据介� ， �小儿肱骨髁上骨折，极少采用手��法，基本上都是运用保守�法的。 � 得有一小儿肱骨髁上骨折，� 位、� � 均不理想，照� 予以� 引� 法 � 理之。� � 小儿� 骨折有� 大的可塑性，即使� 位、� � 不甚� 意， 通��引治�，以后也不会�肘关�的功能有多大的影响。

TYPICAL CASES Example 1: Zhang, 8 years old, May 18, 1999, first visit Chief complaint: Fell out from bed, left elbow swelling 1 hours. Check: the left elbow swelling, tenderness, deformity, elbow lateral radiographs showed left supracondylar fracture of the humerus, the distal end to the radial side and top. Suspected displaced fractures of humeral supracondylar fracture of left (extension). At first the whole complex traction under the lateral displacement, then press with the thumb fracture of the distal end forward, elbow flexion 90 degrees, plaster fixation. 典型病例 例1 �某， 8�， 1999年 5月18日初�。 主� ：从床上跌下，致左肘� 痛 1小� 。� � ：左肘� � 、� 痛，外� 畸形，肘关� 正� 位� 片提示左肱骨髁上骨折，骨折� 断端向� � 及后 上方移位。� � � 左肱骨髁上骨折（伸直型）。即在� 引下先整复� 向 移位，�而用拇指按�骨折�断端向前，屈肘 90度，石膏托固定。

TYPICAL CASES By radiography reexamination, fracture, good on the line, and use blood stasis, Li Qi analgesic medicine. 1 weeks after radiography reexamination, fracture position such as before. 3 weeks after the removal of fixed, and then use Sizhi Xifang hot compress, end. 典型病例 ��片复�，骨折�位、��良好，予以活血化瘀、理气止痛中�内服。 1周后再次� 片复� ，骨折位置如前。3周后拆除固定，以四肢洗方（附 方 13）�敷，善后收功。

TYPICAL CASES Example 2: Wang, male, 9 years old. 1998 in July 15 th first visit. Chief complaint: Fall in the sports class accidentally, causing swelling and pain of the right elbow for 2 days. The right elbow had to go to a hospital for treatment, diagnosis of supracondylar fracture of the humerus and manipulative, small splint external fixation. Because of pain and no improvement, forearm swelling has exacerbated the situation, but was transferred to our hospital. Check: the left elbow and forearm was swollen, elbow tension blisters. 典型病例 例2 王某，男，9�。 1998年 7月15日初�。 主� ：上体育� � 不慎跌倒，致右肘� 痛 2天。曾去某医院就� ，� 断 � 肱骨髁上骨折而行手法整复，小� 板外固定。因疼痛未� 改善，且前 臂� � 有加� 之� ，乃� 来本院就� 。� � ：左肘及前臂明� � � ， 肘部出��力性水泡。

TYPICAL CASES By radiography examination suggested that supracondylar fracture of the humerus, the distal end to the radial side and top displacement. Be in hospital, for the left forearm extension of skin traction, at the same time with intravenous antibiotics to prevent infection. 1 weeks after elbow swelling significantly subsided, but the first lateral displacement under traction reduction and, with the small splint and fixed pressure pad, following the Continued straight traction. 典型病例 � � 片复� ，提示肱骨髁上骨折，� 断端向� � 及后上方移位。予以住 院，� 行左前臂伸直位皮肤� 引，同� 用抗生素静脉滴注，以防感染。1 周后肘部� 痛明� 消退，乃在� 引下先行整复� 向移位，并用小� 板加 �力�固定，��保持伸直位�引。

TYPICAL CASES 2 weeks film review, is a good position, but the side still owe satisfaction, remove traction pressing corrected, with plaster external fixation. After elbow radiography reexamination, alignment, on the line are satisfactory. 4 weeks after removal of external fixation, and then use Sizhi Xifang hot compress. After. 2 months of follow-up, the function is good. 典型病例 2周左右� 片复� ，正位位置良好，但� 位仍欠� 意，用按� 法予以� 正，除去� 引，改用石膏托屈肘外固定。� 再次� 片复� ，� 位、� � 均� � 意。4周后除去外固定，用四肢洗方� 敷。2个月后随� ，功能良 好。

TYPICAL CASES/典型病例 Flexion type before manipulative/ 屈曲型 手法整复前

TYPICAL CASES/典型病例 Flexion type after manipulative/ 屈曲型 手法整复后

TYPICAL CASES/典型病例 Flexion type manipulative/ 屈曲型 手法

TYPICAL CASES/典型病例 Extension type after manipulative/ 伸直型 手法整复前

TYPICAL CASES/典型病例 Extension type after manipulative/ 伸直型 手法整复后

TYPICAL CASES/典型病例 Extension type manipulative/ 伸直型 手法

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