Smith fracture

　　1. Etiology:

　　Mostly caused by direct violent blows. The force acts directly on the limb to cause a fracture, and the fracture site is often accompanied by varying degrees of soft tissue injury, including injuries to nerves and blood vessels, such as open comminuted fractures of the tibia and fibula caused by firearm injuries.

　　2. Pathogenesis:

　　The most common cause in the past was that the driver of a car suddenly let go of the handle while cranking the engine, and was struck directly by the reversed handle. This phenomenon has disappeared, and it is more common in collision injuries (such as collisions between electric bicycles or motorcycles) or wrist and back landing when falling.

　　1. Swelling:After trauma, local swelling occurs, reaching a peak after 72 hours, and then gradually subsiding. After swelling occurs, the affected limb should be elevated, preferably above the heart level, and appropriate ice application should be given to promote swelling subsidence.

　　2. Plaster pressure:After simple fractures are复位石膏固定？Due to the gradual increase in limb swelling, there will be plaster pressure, causing obvious swelling, bruising, numbness, and other conditions at the distal ends of the limbs such as fingers and toes. It is necessary to go to a medical institution to release the pressure in time to avoid limb necrosis.

　　3. Joint stiffness:Long-term immobilization of the affected limb, poor venous and lymphatic return, serous fibrous exudation and fibrin deposition in the joint cavity, fibrous adhesion, and contracture of the surrounding soft tissue around the joint, resulting in joint dysfunction. This is the most common complication of fractures and joint injuries. Prompt removal of fixation and active functional exercise are effective methods for preventing and treating joint stiffness.

　　4. Muscle atrophy:Once the limb is immobilized or lacks movement, muscle atrophy will occur. Active muscle searching can reduce the degree of muscle atrophy. The specific method is: if the joint can move, you can do isometric contractions (that is, the muscle exerts force but the limb does not produce movement) and isotonic contractions (the muscle exerts force and produces movement). If the joint is fixed, then you can do isometric contractions exercises.

　　The symptoms are similar to Colles' fracture, but the wrist deformity is opposite. The distal end of the fracture shifts medially, and the wrist is flexed. The proximal end of the fracture sticks out dorsally, and the distal end of the radius articulation is tilted medially. An X-ray film of the wrist in anteroposterior and lateral positions can clearly diagnose the condition.

　　In clinical practice, it can generally be divided into the following two types.

　　1. Extra-articular type:Refers to fractures where the fracture line does not affect the joint surface, which is the most common. The fracture line is mostly transverse, with a few oblique. The latter is more difficult to maintain alignment after reduction, and often requires finger traction.

　　2. Joint involvement type:All fractures affecting the joint belong to this type. Since Smith fractures are rare in clinical practice, there is no need to further classify such patients.

　　Several methods for the prevention and protection of fractures:

　　1. Strengthening the body through exercise:It is necessary to persistently exercise for a long time, increase outdoor activity time, breathe fresh air more, and promote overall blood circulation and metabolism. Walking, jogging, Tai Chi, health exercises, and other projects can be chosen. More activities can make more calcium in the blood stay in the bones, thereby increasing bone hardness and effectively reducing the occurrence of fractures.

　　2. More sun exposure:Sunlight can promote the synthesis of vitamin D, and calcium metabolism depends on the effect of vitamin D; ultraviolet light in sunlight can promote the formation and absorption of calcium in the body, maintain normal calcium-phosphorus metabolism, increase calcium in the bones, and improve bone hardness.

　　3. Prevention before illness:The elderly should not go to places with many people and cars, and should not go out during rain, snow, or when there is water accumulation or ice on the ground to avoid falling and fracturing. Do not climb ladders or engage in high-altitude activities, and it is not advisable to walk on steep slopes because the lower limbs of the elderly are weak and their reactions are slow, making them prone to falls. When going out, the elderly should walk slowly and carefully. If there are symptoms such as blurred vision, deafness, dizziness, etc., they should try to reduce going out. If they must go out, they should be accompanied by someone to walk or use a cane. Before going to the toilet at night, they should sit on the edge of the bed for a moment to keep the leg muscles in an excited state and prevent transient hypotension caused by changes in position. When taking a bath, a small stool should be prepared to sit down and put on pants and shoes to prevent falls.

　　4. Diet adjustment:Eating more vegetables, proteins, and vitamin-rich foods can prevent the occurrence and development of osteoporosis. In the early stage of fracture, a light diet is recommended to promote the removal of blood stasis and reduce swelling. In the later stage, the diet should be heavy-flavored, choosing appropriate foods to nourish the liver and kidney, which is beneficial for the healing of fractures and the recovery of function.

　　5. Close observation:After suffering an injury, if there is a suspicion of a fracture, it is necessary to go to the hospital for treatment in a timely manner. During the transport, necessary temporary fixation measures should be taken. For upper limb fractures, the arm should be fixed with a board, the length of which should exceed the upper and lower articular surfaces of the fracture site. The fractured arm can also be tied to the chest to fix it. For lower limb fractures, the injured limb can be tied together with a long board, the length of which should reach above the armpit and below the heel, or the affected limb can be tied to the healthy limb to fix it. For spinal fractures, the patient should be moved parallel by two people to the board and tied down. For cervical spine fractures, sandbags should be placed on both sides of the head, limiting head movement, and then the patient can be sent to the hospital. If there is bleeding, the wound should be temporarily bandaged with clean cloth, and then a tourniquet should be tied. Generally, the tourniquet should not be tied for more than 1 hour at a time, and the tourniquet can be relaxed for 1 to 2 minutes every hour to see fresh blood flowing out, which can prevent limb ischemia and necrosis due to prolonged tourniquet time. After the fracture is fixed with plaster or other methods, the skin color changes and swelling at the distal part of the injured limb should be closely observed within 24 hours. If swelling increases or there is ecchymosis on the skin, it should be seen immediately, and the plaster should be loosened or removed to prevent limb ischemia and poor blood return due to too tight fixation. During the period of fracture fixation, regular follow-up should be conducted according to the doctor's instructions.

　　6. Functional exercise:Under the guidance of a doctor, actively exercise the uninjured joints every hour, 100 times a day, which can prevent joint stiffness, contracture, and muscle atrophy. Self-massage using light massage methods can promote local blood circulation, which is beneficial for the recovery of fractures.

　　In addition to clinical manifestations, related auxiliary examinations are also indispensable for the diagnosis of Smith fracture. Patients can take wrist joint anteroposterior X-ray films or bone CT to confirm the diagnosis.

　　Firstly, what foods are good for Smith fracture patients?

　　1. Eat more vegetables rich in fiber, and eat bananas, honey, and other foods that promote gastrointestinal digestion and defecation.

　　2. In the early stage, eat more foods that promote blood circulation, remove blood stasis, and dissipate qi, such as vegetables, soy products, fish soup, eggs, etc.

　　3. In the middle stage, eat more foods that help nourish and relieve pain, remove blood stasis and generate new tissue, and promote bone healing and muscle repair, such as bone soup, Panax notoginseng chicken stew, animal liver, etc.

　　4. In the later stage, eat more foods that nourish the liver and kidney, invigorate the qi and nourish the blood, and relax the tendons and collaterals, which can help the formation of callus, such as old hen soup, pork bone soup, sheep bone soup, etc.

　　Secondly, what foods should be avoided for Smith fracture?

　　1. Avoid blind supplementation of calcium.

　　2. Avoid indigestible foods.

　　3. Avoid eating too much meat and drinking braised bone broth.

　　(The above information is for reference only, please consult a doctor for details.)

　　1. Treatment

　　Closed reduction under local anesthesia within the hematoma or brachial plexus block. In contrast to the Colles fracture reduction, the operator stretches the injured wrist, the assistant performs reverse traction at the elbow, and at the same time, the operator pushes the distal fracture end from the palmar side to the dorsal side to reduce the fracture. This type of fracture reduction is relatively easy, but it is difficult to maintain the reduction position. After reduction, the wrist is fixed in a slightly extended position with a short arm front and back plaster splint for 2 weeks, and then changed to a wrist joint neutral position for 2 weeks. For fractures with extremely unstable positions or those that dislocate again after reduction, consider open reduction, using small 'T' shaped plate screws for internal fixation, or using a brace plate for internal fixation.

　　2. Prognosis

　　In most cases, the functional recovery is ideal, and those with poor reduction due to joint involvement may have sequelae.