How to deal with the suspected humeral shaft fracture? Pray for the great gods.

There are mainly the following aspects in the exam: 1. Physical examination can find abnormal activity and bone friction. 2.x-ray photos can determine the type and displacement direction of fracture. 3. For patients with suspected nerve injury, pay attention to nerve exploration. Diagnosis of trauma history, local swelling, pain and conduction percussion pain, abnormal activity and angulation and shortening deformity. Ortholateral X-ray can diagnose the fracture site and displacement. Treatment 1. Non-surgical treatment of humeral shaft has more muscle wrapping, and slight angulation or shortening of fracture does not affect appearance and function, so non-surgical treatment can be adopted. (1) Hanging plaster on the upper arm depends on the weight of plaster to achieve fracture reduction and maintain counterpoint. When hanging plaster is used, X-rays should be taken every week to correct the fracture end separation or angulation deformity in time. After 2 ~ 3 weeks, other external fixation should be used. (2)U-shaped splint is suitable for transverse fracture and oblique spiral fracture without obvious displacement, which can maintain the fracture alignment and is beneficial to fracture healing. (3) Wilbur's upper limb support band immobilization is suitable for humeral shaft fractures that are rarely displaced in children and the elderly. It is used to keep the fracture aligned, and the patient feels comfortable without manual reduction of the fracture. (4) Small splint fixation is suitable for middle humeral shaft fractures with small displacement and angular deformity and good alignment. After the splint is placed on the injured limb, it should be bandaged with 3 ~ 4 pieces of cloth tape, and the tightness of the bandage should be adjusted at any time to avoid affecting the blood circulation of the injured limb and causing pressure sores. (5) In order to maintain the reset position after the fracture of shoulder herringbone plaster, it is necessary to use shoulder herringbone plaster when abduction and external rotation of upper limbs need to be braked. However, gypsum is heavy, which affects breathing, and it is easy to sweat in hot weather. Moreover, the patient feels very uncomfortable, so the shoulder abduction bracket has been rarely used or replaced. (6) Olecranon traction is suitable for patients with long-term bed rest and open comminuted humeral shaft fracture, or patients who cannot be treated surgically in a short time. (7) Functional scaffold is a device for repairing fracture by traction of soft tissue. However, functional stents are not suitable for patients with extensive soft tissue injury, bone defect, poor alignment of fracture ends and uncoordinated. Functional stents can be used in early fracture or 0 ~ 2 weeks after injury. Attention should be paid to the degree of limb swelling and neurovascular conditions when using in acute stage. The upper arm should be hung above the chest to prevent the fracture from angulating. Functional stents should be followed up for 4 weeks every week. The stent should be kept for at least 8 weeks. 2.( 1) The surgical treatment of open fracture should be early debridement of soft tissue and bone and internal fixation of fracture. (2) Fracture with vascular and nerve injury should be fixed internally and repaired with neurovascular. (3) When the middle and lower humeral shaft fracture of floating elbow 1/3 with internal fracture of elbow joint, manual reduction and maintenance reduction are difficult, so open reduction and internal fixation should be performed. (4) Non-surgical treatment of bilateral humeral shaft fractures will cause inconvenience to patients' life and difficulties in nursing. Internal fixation should be performed. (5) Unsatisfactory fractures, such as spiral fractures, have soft tissue incarceration between the fracture ends, even if the fracture is satisfied with the line, it will lead to nonunion, and internal fixation should be carried out. (6) The effect of non-surgical treatment is not ideal. If the transverse fracture is treated with hanging plaster, the fracture will not heal due to excessive traction; Short oblique fracture was treated by non-operation. If there is obvious displacement of the fracture end, surgical internal fixation is also needed. (7) Non-surgical treatment of multiple injuries complicated with humeral shaft fracture is difficult to maintain satisfactory fracture end-to-end alignment. Once the condition is stable, active surgery should be performed. (8) Surgical treatment of pathological fractures can make patients feel comfortable and increase the function of upper limbs. There are many kinds of surgical treatments. Clinicians should choose the most favorable method for patients according to their own experience, equipment, fracture type, soft tissue condition and general condition: 1. Rush pin fixation is suitable for middle and lower humeral fractures. At present, it is not suitable. 2.Kuntscher fixation pin is a kind of intramedullary nail, which is suitable for the fracture of middle and upper humerus 1/3. The needle tail left outside the bone will affect the activity of shoulder or elbow joint, so it is not widely used in clinic. 3. External fixator is suitable for open fractures with extensive soft tissue contusion or burn. It is also suitable for patients who can't perform rigid internal fixation and have infection at the fracture. After using external fixator, X-ray examination should be carried out regularly, the alignment of fracture end should be adjusted in time, and functional exercise should be carried out early to obtain satisfactory results. 4. Shoulder joint function should be exercised early after interlocking intramedullary nail fixation. 5.AO dynamic compression plate and screw internal fixation According to different parts of humeral shaft fracture, plates with different shapes, widths and thicknesses are used.