Senile brachial scaphoid fracture
1。 Anatomical features The carpal bones consist of eight pieces, divided into two rows, four in each row. The proximal carpal bones are arranged from the thumb side (radial side) to the little finger side (ulnar side) in the order of scaphoid (bone), triangular (bone), and bean (bone). The distal row of wrist bones is arranged in the order of large (polyangular), small (polyangular), head (bone), and hook (bone). The scaphoid bone is the most easily damaged in the wrist bone.
2。 Cause of injury When the servant fell, the palm of the hand touched the ground to the side and back of the body, the wrist was forcefully extended to the radial back, and the external force of the impact of the ground was transmitted downward, causing the scaphoid bone to be cut off by the radial styloid process, and a fracture occurred.
3。 SymptomsYixian scaphoid bone fracture is often swollen in the nasal fossa and has obvious tenderness. When the thumb or index finger is pushed longitudinally, there is often significant tenderness in the scaphoid bone. Functional movement of the wrist joint is significantly restricted.
X-rays are required to confirm the diagnosis. Sometimes X-rays are taken immediately after the injury. Because if the X-ray fracture line is not taken in time and covered by bleeding, it will be blurred, so that people can not see the fracture phenomenon temporarily, and it is necessary to wait for 10~14 days to take X-rays when symptoms appear, at this time the fracture line is easy to recognize.
4. There are three common types of fractures divided into scaphoid bone fractures.
(1) Scaphoid nodule fracture has a relatively abundant blood supply to the proximal and distal bone pieces of the fracture line, and this type of fracture heals faster.
(2) The blood supply of the distal bone fragment of the scaphoid lumbar fracture is good, while the blood supply of the proximal bone fragment may be partially disrupted, and the fracture hysteria is slow. In a small proportion of cases of this type, ischaemic necrosis can occur in the proximal bone piece.
(3) Scaphoid bone body fracture This fracture has good blood flow to the distal bone piece, while most of the blood supply to the proximal bone piece is lost, so ischemic necrosis can occur in the proximal bone piece.
5。 For the treatment of fresh scaphoid fractures, short-arm casts are generally used to fix, and the wrist joint is extended 15~20°, which is the functional position of the wrist joint. Fixation in this position is very important for the recovery of future rehabilitation exercises. The length of the cast should depend on the fracture. Generally, nodular fractures are fixed for about 6 months, and lumbar and body fractures are fixed for 3~6 months. In addition to fixation, elderberry pills, activation pills, etc. can be taken internally to help fracture hysteria.
Delayed synthesis, nonhysis, or aseptic necrosis may occur after a fracture of the scaphoid bone. This is mainly due to problems with the blood supply or unreliable fixation. Do not remove part of the cast or truncate the cast during immobilization, which will cause unreliable fixation, resulting in nonunion fracture or aseptic necrosis. When the latter is set, surgery should be considered, otherwise traumatic arthritis will form, and there will be sequelae pain and wrist dysfunction.
Therefore, once the elderly accidentally have a scaphoid fracture, they must patiently carry out reasonable fixation treatment to overcome the various inconveniences caused by wrist fixation, otherwise they will delay recovery.
6. After the diagnosis of scaphoid fracture, it is generally possible to go home after fixing with a cast or with a small splint, and the exercise of non-fixed parts and healthy limbs can be carried out during the fixation period. This rehabilitation exercise helps to heal the fracture site.
Obvious impairment of wrist function is often left after removal of the fixation. At this time, if the fracture hysteria is good on the X-ray, it is necessary to actively carry out rehabilitation exercises to restore the function of the wrist as soon as possible. Rehabilitation exercises are carried out by:
(1) Wrist heat, Chinese medicine external application. The heat count can be towel or hot water bottle. Washing method: frying water, smoking and washing hands on the wrist, twice a day, each bag can be used for 5~7 days.
(2) Finger and wrist function exercises are the best It is good to carry out finger flexion and extension, bifurcation, clenching fists, left and right rotation, wrist back extension, wrist flexion, left and right tilt, rotation and other functional exercises after hot compresses or washing with Chinese medicine, each time for 5~10 minutes, 3~4 times a day, hand fitness balls can continue. When the function of the fingers and wrists has been significantly restored, it can be replaced by strength exercises and fine motor exercises in the hands and wrists. Strength exercises can be performed with small dumbbells.
For the elderly, the fine motor requirements of the hands are not as high as those of young people, but proper exercise is still good for maintaining hand function. The exercise methods are stacking blocks, kneading plasticine, sewing clothes, and lesbians can also knit sweaters and embroidery. The purpose is not to make a finished product, but to practice the coordination of various fine movements of the hand in order to restore function.
