Radial and ulnar shaft fractures

　　1. Bilateral fractures of the radius and ulna

　　1. Direct violence: Commonly seen in blows or machinery injuries. The fracture is transverse or comminuted, and the fracture line is on the same plane.

　　2. Indirect violence: When falling, the palm touches the ground, the violence is transmitted upwards to the middle or upper 1/3 of the radius fracture, and the residual violence is transferred to the ulna through the interosseous membrane, causing a fracture of the ulna. Therefore, the position of the fracture line is low. The radius is transverse or serrated, and the ulna is short oblique, with fracture displacement.

　　3. Twisting violence: While subjected to external force, the forearm is also subjected to a twisting force causing a fracture. When falling, the body tilts to the same side, the forearm is excessively pronated or supinated, resulting in spiral fractures of both bones. Most of them are oblique from the ulna medially to the radius laterally, with the fracture lines in the same direction, the fracture line of the ulna shaft is above, and the fracture line of the radius is below.

　　2. Fracture of the radius shaft in children is mostly greenstick fracture

　　When an adult has a fracture above the upper 1/3 of the radius, the proximal segment of the fracture is displaced posteriorly due to the attachment of the biceps brachii to the radial tuberosity and the supinator muscle to the upper 1/3 of the radius. When the middle or lower 1/3 of the radius shaft is fractured, the fracture line is below the insertion point of the pronator quadratus muscle. Due to the equal forces of pronation and supination, the proximal segment of the fracture is in a neutral position, while the distal segment is pulled by the pronator quadratus muscle, leading to pronation displacement. There is little superimposed displacement in a simple radius shaft fracture.

　　3. Fracture of the ulnar shaft

　　Sole ulnar shaft fractures are extremely rare, mostly occurring in the lower 1/3 of the ulna, caused by direct violence, with minimal displacement at the fracture ends.

　　The common complications and possible causes of this disease are as follows:

　　1. Non-union of fracture:The anatomical relationship between the radius and ulna is complex. The lower 1/3 segment of the radius and ulna is mainly surrounded by tendons, with poor blood supply to the surrounding soft tissues. Both ends of the radius and ulna form joints, and during pronation and supination, the two ends of the bone move in unison around the ulna as the axis, without bearing rotational force. However, the ends of the ulna can twist relative to each other, affecting the healing of the fracture;粉碎性骨折骨质缺损，周围软组织损伤严重；骨膜微小血管栓塞，致骨膜坏死，影响成骨；内固定所有方法和材料欠妥。

　　2, Infection:It is mainly related to the long exposure time of the wound after injury, incomplete debridement, and severe soft tissue injury.

　　3, Forearm muscle interval syndrome:It is mostly caused by severe soft tissue injury, improper manipulation during reduction, rough surgery during open reduction, and not taking timely and active measures to reduce swelling and stop bleeding, as well as the pressure inside the muscle interval continuously rising due to too tight splint or plaster fixation during external fixation.

　　4, Limited rotation function of the forearm:It often occurs in patients who have been reduced and closed, the fracture end has not reached anatomical reduction, cross healing, or bridge connection between two bones. Interosseous membrane contracture, soft tissue scar adhesion, and contraction of superior and inferior joint capsules are also important reasons.

　　5, Decubitus ulcer:It often occurs after closed reduction fracture, due to casting or separation pad compression. Local edema and poor skin blood supply are also important reasons.

　　The main manifestations of this patient are local swelling, deformity, and tenderness, there may be crepitus and abnormal movement, limitation of forearm movement, children are often green branch fractures, with angular deformity, without end of bone displacement, sometimes combined with median nerve, ulnar nerve, radial nerve injury, attention should be paid to inspection.

　　During the period when the general symptoms of the fracture patient are obvious, a 'soft food' diet between normal diet and semi-liquid diet should be provided. The food provided should have little residue, and fried or fried foods should not be eaten. To better promote fracture healing, appropriate diet should be matched according to the early, middle and late stages of fracture healing and the changes of the condition.

　　Prognosis: fracture healing, complete or basic recovery of function.

　　The initial diagnosis of this disease can be made according to the history of trauma and clinical manifestations, but some auxiliary examination methods should still be used to help further diagnosis. X-ray films can clearly indicate the type and displacement of the fracture, and the photograph should include the elbow and wrist joints to understand whether there is rotational displacement and dislocation of the upper and lower radius and ulna joints.

　　One, Food therapy formula

　　1, Appropriate amount of red bean, decoct and take with a little red sugar, warm and take, suitable for the stage of promoting blood circulation and removing blood stasis.

　　2, 1000 grams of pork bone, 250 grams of soybeans, boil in water over low heat until soft, season with salt and ginger, take as food.

　　3, One set of pork spine bone, wash clean, 120 grams of red dates, 90 grams of lotus seeds, 9 grams of Xiangxiang and raw licorice, boil in water over low heat until soft, season with ginger and salt, drink in several doses.

　　4, Two fresh Hu crab, take the meat (with yolk), when the Congmi porridge is cooked, add the crab meat, add a moderate amount of ginger, vinegar and soy sauce, take regularly.

　　5, A black rooster (about 500 grams), remove the skin, feathers and internal organs, wash clean, 5 grams of 'Sanqi' (Panax notoginseng) sliced, put into the chicken's belly, add a small amount of yellow wine, steam over water, after it is cooked, dip in soy sauce and serve, take regularly.

　　6, Raw Huangqi 30-60 grams, decoct to get the juice, add 100 grams of粳米, cook into porridge, take in the morning and evening.

　　7, Danggui 20 grams, Huangqi 100 grams, a tender hen chicken, boil in water to make soup for consumption.

　　8. Take 50 grams of Danshen, wash it clean, boil it in water, and then take the juice. Boil the juice with 1000 grams of pork long bones and 250 grams of soybeans until they are soft. Add a small amount of cinnamon and salt before serving.

　　9. Grind 500 grams of fresh crab, mix it with 250 grams of hot yellow wine, and apply the remaining residue to the affected area. The sound 'gege' indicates that it is ready. This is used for fracture healing.

　　Two, what not to eat for radial and ulnar shaft fractures

　　1. Avoid blind supplementation of calcium: Calcium is an important raw material for bone formation. Some people believe that increasing calcium intake after a fracture can accelerate the healing of broken bones. However, scientific research has found that increasing calcium intake does not accelerate the healing of broken bones. For fracture patients who are bedridden for a long time, there is also a potential risk of increased blood calcium levels and decreased blood phosphorus levels. This is due to the suppression of calcium absorption and utilization on one hand and the increased reabsorption of calcium by the renal tubules on the other hand. Therefore, for fracture patients, the body does not lack calcium. As long as they follow the doctor's advice, strengthen functional exercises, and start moving as soon as possible, they can promote the absorption and utilization of calcium by the bones, accelerate the healing of broken bones. Especially for patients who are bedridden after a fracture, blind supplementation of calcium is not beneficial and may even be harmful.

　　2. Avoid eating too much meat and bones: Some people believe that eating more meat and bones after a fracture can promote early healing. However, modern medicine has proven through multiple practices that eating more meat and bones after a fracture does not promote early healing but may actually delay the healing time. The reason for this is that the regeneration of bone after injury mainly relies on the functions of the periosteum and bone marrow, which can only better exert their functions under conditions of increased collagen. The main components of meat and bones are phosphorus and calcium. If a large amount is consumed after a fracture, it will promote an increase in the inorganic component of the bone, leading to a disorder in the proportion of organic matter in the bone, thereby hindering the early healing of the fracture. However, the fresh meat and bone soup has a delicious taste and can stimulate appetite, so eating a small amount is not harmful.

　　3. Avoid unbalanced diet: Fracture patients often have local edema, congestion, hemorrhage, and muscle tissue injury. The body itself has the ability to resist and repair these conditions. The body's repair of tissues, the growth of long bones, and the formation of calluses depend on various nutrients. Therefore, ensuring adequate nutrition is the key to the smooth healing of fractures.

　　4. Avoid indigestible foods: Fracture patients often have limited movement due to the immobilization of the cast or splint, and the swelling and pain at the injury site, along with mental distress, often lead to a loss of appetite and constipation. Therefore, the food should be both nutritious and easy to digest and defecate. Foods that are prone to cause flatulence or indigestion, such as sweet potatoes, taro, and glutinous rice, should be avoided, and more fruits and vegetables should be eaten.

　　5. Avoid drinking too little water: Bedridden patients with fractures, especially those with spinal, pelvic, and lower limb fractures, find it very difficult to move around. Therefore, they try to drink less water to reduce the frequency of urination. Although this may reduce the frequency of urination, it also brings about even greater troubles. If the bedridden patients have less activity, the intestinal peristalsis weakens, and with reduced water intake, constipation is more likely to occur. Long-term bed rest can also lead to urinary retention and increase the risk of urinary tract stones and urinary system infections. Therefore, bedridden patients with fractures should drink when they feel thirsty without any concerns.

　　6. Avoid excessive intake of sugar: After excessive intake of sugar, rapid metabolism of glucose will occur, thus producing intermediate metabolites such as pyruvate and lactic acid, causing the body to be in an acidic poisoning state. At this time, alkaline calcium, magnesium, and sodium ions will be immediately mobilized to participate in neutralization to prevent the blood from becoming acidic. Such a large consumption of calcium is not conducive to the recovery of fracture patients. At the same time, excessive sugar will also reduce the content of vitamin B1 in the body. Vitamin B1 is a necessary substance for the conversion of sugar into energy in the body. Insufficient vitamin B1 will greatly reduce the activity of nerves and muscles, and also affect the recovery of function. Therefore, fracture patients should avoid eating too much sugar.

　　7. Avoid long-term use of Sanqi tablets: In the early stage of fractures, local internal bleeding occurs, blood stasis, swelling, and pain. At this time, taking Sanqi tablets can constrict local blood vessels, shorten coagulation time, increase thrombin, which is very appropriate. However, after one week of fracture reduction, bleeding has stopped, and the damaged tissue begins to repair. Repair requires a large amount of blood supply. If Sanqi tablets are continued to be taken, the local blood vessels are in a state of constriction, blood circulation is not smooth, which is unfavorable for fracture healing.

　　8. Prohibit drinking fruit juice after fractures.

　　Prevention:

　　1. The reduction requirement should be accurate, and it is best to achieve anatomical reduction;

　　2. Debridement should be timely and thorough, and the emphasis is on the application of antibiotics before and during surgery;

　　3. Grasp the indications for surgery;

　　4. According to the principle of fracture fixation, select internal fixation materials. The length of the steel plate should be greater than 5 times the diameter of the shaft, and the length of the medullary needle should exceed 8-10 cm from the fracture end to achieve relatively firm fixation;

　　5. Try to plant autologous cancellous bone when there is a defect in bone quality;

　　6. The best position for external fixation is to rotate the forearm backward by 20 degrees before fixation, at this time the interosseous membrane is tense to prevent contraction, and fixation is most stable. The function of the supinated joint is also the best for recovery;

　　7. Gentle manipulation during surgery, minimize the stripping of the periosteum;

　　8. Elevate the affected limb appropriately after surgery and use diuretics reasonably to reduce swelling. Use antibiotics to prevent infection.