November 6, 2023
As a 68 year old fan of the "nutshell patient", I have to go on the official account almost every day to see the new articles, but I never thought I would have the impulse to contribute.
Due to an accident, I was admitted to the hospital and underwent my first surgery in life (giving birth naturally). I wrote this experience down to give a reminder to people of our age: as we get older, we need to slow down our pace of life. First, we should eat slowly, and then walk slowly. No matter what we do, we should remember to "take it easy, take it slow"!
Suddenly, one stumbled and fell freely
It was a Sunday, and after breakfast, I said to my 94-year-old mother, "I'll buy a fish and make you steamed fish for lunch!" Then I happily carried the grocery bag downstairs.
Along the way, I hummed the new song "Slow Voice" that only senior college students learned. Thinking that there were more people buying vegetables at this time, I couldn't help but accelerate my pace. Suddenly, I stumbled and fell freely. I struggled to sit up, but couldn't stand up at all. In the end, two other elderly people who also came to buy groceries helped me stand up.
Thinking that I hadn't bought the fish yet, I slowly walked towards the vegetable market. Eh, it seems something's wrong. The entire left sleeve is hanging down like a pocket, completely unable to move . At this moment, a sharp pain ran down the shoulder, and a burst of cold sweat seeped out from each pore. It seems that I can't buy the fish anymore. I have to take a break and go back home. When I got home, I told my husband that I had fallen and now I need to go to the hospital. He immediately drove me to a nearby hospital for treatment.
Upon arriving at the emergency department, the first step was to take a film and wait for 30 minutes to receive the results,
It's a dislocation and fracture
.
Fracture of large tuberosity of left humerus, dislocation of left shoulder joint | Image provided by the author
At this moment, two doctors asked me to lie down and said they wanted to help me reposition. One of them pressed down on my ribs, while the other pulled my arm out, but it didn't pull for half a day. My eyes were filled with pain, and my ribs were a bit unbearable. I said, " I have osteoporosis. Don't let your shoulders fall off, you broke your ribs. " The doctor asked me to hold on a little longer, and pulled for a while. Suddenly, I heard two clear clicking sounds. Finally, the reset was completed, and the shoulder pain decreased by half. My fingers could also move slightly.
Re filming:
Left humeral tuberosity fracture, left shoulder joint subluxation
. The doctor explained that I had a tear in my left shoulder tendon and a piece of my humerus fell off, so the reduction was incomplete and I had to be hospitalized for surgery.
In this fall, everything pressed the pause button
I checked into the orthopedic ward, and the bed doctor immediately reviewed my film and said that the situation was a bit serious. The torn tendon caused incomplete reduction, and I needed to be cast first to avoid secondary injury due to activity .
Then he immediately put me in a cast and fixed my hand position. The plaster of the polymer splint is very convenient to apply. When opened, it looks like a large wet thick cotton piece, directly wrapped from my wrist joint to the shoulder. The elbow joint is bent about 90 degrees, and two gauze strips are pulled diagonally through the front chest and back neck to the right armpit for fixation.
The plaster quickly hardened, and the part beyond my left shoulder looked like a wooden board. If I tilted my head slightly, it would hit my cheeks, which was very uncomfortable. Previously, I used to sleep on the left side, but now I can't get hurt anymore. Plus, I've been in a cast and it's incredibly heavy. I can't even sleep on the right side, so I can only lie flat.
On the first day, it was already over seven o'clock in the evening when the three bags of intravenous injections were completed. After reading the medication instructions, one bag was used to relieve pain, one bag was used to reduce swelling, and the other bag was used to protect the stomach. The infusion has been completed and the pain has been relieved a lot. I just have time to visit the ward where I am staying. This is a newly built comprehensive hospital with a ward of two people and a large window facing south. Standing in front of the window on the 15th floor, looking out, the view is very broad. Before the rush hour, there are many cars on the bridge, and the stars are like the Milky Way. My daughter smiled and said, "Not bad, I still live in a lake view room
For three consecutive days, three bags of anti swelling, pain relieving, and stomach protecting medication were administered in the morning and afternoon each day. During the hospitalization period, there were constant WeChat messages. Table tennis friends notified us to start practicing at 4pm, community choirs notified us to practice "Pastoral Song" in the activity room at 2pm, senior college choir class started at 10:10 pm, saxophone band captain notified us to practice "Entering the New Era" together... After three years of staying at home due to the epidemic, the quality of life has greatly declined. After experiencing the path of health that the whole country has gone through together at the end of last year, spring returns to the earth, and everything recovers, People also walked out of their homes in high spirits. In February of this year, universities and cultural venues for the elderly gradually opened, and we retired elderly people have also signed up for interest classes to participate in various activities we enjoy. But with this fall, everything pressed the pause button. Fortunately, there is a TV in the ward, and Sister Li and I, who are in the same ward, enjoy watching it.
On the second day after admission, further magnetic resonance imaging examination was conducted : fracture of the greater tuberosity of the left humerus with bone marrow edema, injury to the anterior lower glenoid lip of the left shoulder joint, bone marrow edema of the scapula, injury to the left scapular and supraspinatus tendons, extensive edema of the left shoulder perimuscular group and subcutaneous soft tissue, edema of the left shoulder axilla sac, synovitis of the tendon sheath of the long head of the biceps brachii tendon... It seems that there are indeed many problems.
Elderly people, take it easy
After three days of swelling and pain relief treatment, I am finally able to undergo surgery. The full name of the surgery is“
Open reduction and screw internal fixation of left humeral tuberosity fracture+fascial tissue flap plasty
”.
I woke up at 6 o'clock in the morning and walked quickly in the corridor of the ward, thinking that I couldn't sleep on my legs anymore. I still need to ensure my daily activities, not to mention having to support myself × Donating steps on the treasure for public welfare. At 8:30, someone came to pick me up and took me downstairs. The anesthesiologist put on a mask for me in the operating room, and after a while, I didn't know anything.
It was already 10:30 am when I opened my eyes and the surgery was successfully completed. I only felt extremely uncomfortable in my throat and asked the doctor hoarsely. It turned out that I had a tube inserted. The doctor told me that the surgery involves general anesthesia and local anesthesia, and it will take another 6 hours for my left arm to regain consciousness, so I don't have to worry. It's already 11:30 when I returned to the ward, except for feeling numb in my left hand and feeling a bit uncomfortable after inserting a catheter, everything else is okay.
On the morning after the surgery, the doctor informed me to take a postoperative X-ray. Due to the inability to lift my hand to the required angle, it took a lot of time, but I eventually called my daughter into the filming room. With her assistance, I reluctantly completed the task.
Postoperative follow-up X-ray provided by the author
After the surgery, only daily pain relief and anti-inflammatory measures are needed, and low-molecular-weight heparin sodium is injected into the abdomen to prevent thrombosis. After the surgery, everything felt good, but I couldn't sleep well in the hospital environment. After repeatedly asking the bed doctor, I was finally discharged.
Before changing the hospital uniform, take a selfie of the mirror as a token of remembrance.
Take a selfie before taking off the hospital uniform, provided by the author
The above is my unforgettable life experience, and the painful lesson reminds the elderly: as they age, whether it is nerves, bones, muscles, or internal organs, they will undergo degenerative changes, and their ability to move and think will also be weakened to varying degrees. So elderly people need to slow down their pace of life, get up slowly, eat slowly, and walk slowly, in order to avoid sudden illnesses and prevent their own money bags from suddenly losing too much. A happy life in old age comes from a healthy body, and one should not put too much pressure on oneself, set unattainable goals, or engage in physical overload. Instead, live a relaxed and moderate life in self entertainment.
My fall cost me over 18000 yuan for the first phase of hospitalization, and I also need regular outpatient check-ups, perhaps rehabilitation treatment, and hospitalization to obtain built-in steel nails. The money was spent a lot, and people also suffered along with it. By slowing down the pace of life to protect one's physical health and making one's life journey smoother and longer, one can have more time to appreciate the beautiful and colorful sunset in this world.
Doctor's comments
Chu Xiaojun | Attending Physician of the Orthopedics Department of the Fifth People's Hospital Affiliated to Fudan University
Shoulder joint dislocation combined with humeral tuberosity fracture is a common shoulder injury that typically occurs in young people and athletes,
It is not uncommon among the elderly, mainly related to the decrease in bone strength caused by osteoporosis in the elderly
Timely treatment is required.
The greater tuberosity of the humerus is a small bone mass on the humeral head, which serves as the common insertion point for the supraspinatus, infraspinatus, and teres minor muscles in the rotator cuff. Shoulder joint dislocation refers to the detachment of the humeral head from the scapula. When shoulder joint dislocation occurs, the humeral head rapidly shifts towards the lower part of the scapula, and the greater tuberosity is strongly pulled by the rotator cuff (especially the supraspinatus tendon), which may lead to avulsion fractures of the greater tuberosity of the humerus.
The greater tuberosity of the humerus is a small bone mass on the humeral head, which serves as the common insertion point for the supraspinatus, infraspinatus, and teres minor muscles in the rotator cuff. According to Tencent Medical Dictionary
Shoulder joint dislocation combined with humeral tuberosity fracture is usually caused by strong impact or rotational motion on the shoulder. This type of injury may cause severe pain, swelling, and instability of the shoulder joint, thereby affecting shoulder function.
The clinical manifestations and characteristics of this disease are as follows:
①
Severe pain in the shoulder joint area
Patients are completely afraid to move their shoulder joints, and even experience obvious pain due to pulling during walking. To alleviate the pain, many patients use their healthy hand to support the dislocated elbow joint.
②
Elastic fixation of the shoulder joint
(i.e., the dislocated joint remains in a special position), thin patients can even touch the dislocated humeral head in front of the shoulder joint.
③
Positive Dujia sign in clinical examination
The specific manifestation is that the elbow on one side of the dislocation is touching the chest, and the palm cannot reach the healthy shoulder, or when the palm on the dislocation side is touching the healthy shoulder, the elbow cannot touch the chest wall.
④ The type of fracture can be further determined through shoulder joint X-ray, shoulder joint CT, MRI, etc.
⑤ Most fractures in this area require
Reduction and internal fixation treatment
And good joint rehabilitation exercise is required after surgery, otherwise it is easy to develop shoulder joint dysfunction.
Shoulder joint dislocation combined with humeral tuberosity fracture usually requires surgery.
In the emergency department, the doctor will first perform manual repositioning of the shoulder joint to alleviate the patient's pain symptoms. For the elderly, especially those with osteoporosis, special care should be taken during manual reduction to avoid new fractures. If direct manual reduction is difficult, the patient's muscles can be completely relaxed under intravenous anesthesia, which makes the reduction much easier.
After manual reduction, surgery is performed to restore the stability of the shoulder joint and repair the fracture of the greater tuberosity of the humerus. Surgery can use traditional incisions or arthroscopic surgery to reduce surgical trauma and recovery time. During the surgery, traditional Chinese medicine doctors will investigate whether the patient has combined rotator cuff injury. If there is a need to repair the damaged rotator cuff at the same time, to avoid instability of the shoulder joint after surgery, which may lead to recurrent dislocation or even habitual dislocation.
Postoperative patients need to pay attention to shoulder care to avoid excessive shoulder movement and external impact. After surgery, it is generally necessary to use a shoulder joint abduction stand, placing the shoulder joint in the abduction position can reduce the traction of the shoulder sleeve on the large tubercle of the humerus and prevent the displacement of the large tubercle from occurring again.
After 3-4 weeks of fixation of the shoulder joint after surgery, patients need to undergo rehabilitation training to restore shoulder function and strength.
Rehabilitation training usually includes movements such as shoulder extension, flexion, and rotation, and in addition, rehabilitation training needs to be carried out under the guidance of a professional physician.
Elderly people over 70 years old are prone to systemic osteoporosis as their overall bone mass decreases. They often have no symptoms in the early stages and are silent killers.
Elderly patients with osteoporosis should actively supplement vitamin D and calcium in their daily lives, while also paying attention to the occurrence of fractures caused by falls.
In summary, shoulder joint dislocation combined with humeral tuberosity fracture is a common shoulder injury that requires timely treatment. Through surgical treatment and postoperative rehabilitation training, we can restore shoulder function and strength, avoid shoulder function damage and pain, and maintain a healthy shoulder.
Personal experience sharing does not constitute diagnosis and treatment advice, and cannot replace doctors' personalized judgment of specific patients. If you need to seek medical treatment, please go to a reputable hospital.
Author: Homeward Journey
Editor: Yuan Ye, Li Xiaoqiu
This is a fruit shell patient, focusing on telling health stories.
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