- Feature of children’s fractures
- Hand fracture: classification
- Injuries with or without bias
- How to identify this trauma in children
- Sequence of actions for fracture
- What treatment is shown for fracture
- Recovery period
The human arm consists of three parts, namely: radial bone, shoulder and elbow. Today, their fracture is the most common trauma. After all, no one is immune from falls and injuries, especially a child. In both adults and elderly people, half of the cases of injuries are at the hands fracture. As for children, according to statistics, they usually receive this trauma under banal circumstances, for example, at home or at the playground, when falling from a height, while walking or running, and the like. Bones of the hands of children hurt twice as often as compared to the feet. Superiority in “popularity” takes a turn in the elbow joint, and the second “sick” place in the child’s forearm. Severe multiple injuries, fortunately, are much less common-approximately 2.5% of 10% of all musculoskeletal system injuries.
Feature of children’s fractures
The child’s bones differ from adult bones in that they contain more organic substances, such as the protein ossein, and the shell covering them from the outside is thicker, plus it is well supplied with blood. Also, babies have tissue growth zones. It is these factors that determine the specific characteristics of trauma in children, which we will discuss below.
Most often the child can observe a fracture of the “green branch”. It has this name, because outwardly the bone looks like it was broken, and then bent. However, this is not the most serious trauma. After all, the displacement of bone fragments may not be strong, since the fracture occurs only on one side. On the second, the dense periosteum helps to avoid damage, which keeps the load-testing fragments.
Sometimes a fracture of the hand that occurred at a young age, in the future may have serious consequences. The point is that the joint line of the bone (radial, ulnar or brachial) often passes in the area of growth of connective tissue located near the joints. Its damage can lead to premature closure and the formation of shortening, curvature, or a combination of both defects in the process of the child’s growing up. Therefore, parents should monitor their child and in every possible way save him from possible falls and injuries.
Unlike adults, children are most often affected by outgrowths, on which the muscles are attached. In fact, such a break is the detachment of muscles and ligaments from the bone. However, the tissues of a child grow together much faster than in an adult. This is due to a good supply of periosteum with blood, as well as accelerated processes of corn formation. Therefore, any fracture (legs, arms) in a child will heal much faster than that of a representative of the older generation. Another feature of injuries at a young age is a possible self-correction of the consequences of bone fragments displacement after trauma. This is due to the functioning of the muscles and with the growth of the bone. However, it should be borne in mind that with one bias the body can cope and “model” it, but with another there. Knowledge of such patterns is important for every parent. Since in the case of a child’s injury, it is your last word in deciding on the question of surgical intervention and further treatment.
Hand fracture: classification
Let’s dwell on the types of such damages. They are traumatic and pathological. The latter arise as a result of painful processes occurring in the bone, breaking its structure, integrity, as well as strength and continuity. To obtain such damage, a small effort is required from the outside, for example, a light shock or impact, so sometimes they are called spontaneous. Well, a traumatic arm fracture is, on the contrary, a consequence of the impact on the bone of a short-term mechanical force of considerable magnitude. According to statistics, it happens much more often pathological.
Fracture can also be closed or open – it depends on the condition of the skin. The first is considered aseptic, that is, uninfected, since in this case the integrity of the upper tissues is not disturbed, and all bone fragments and the area of injury are isolated from the environment. An open fracture of the hand is marked by damage to the skin. It can be either a small wound, or, on the contrary, a huge rupture of soft tissues with their contamination and destruction. Such damage is initially infected!
Injuries with or without bias
In this case, everything depends on the degree of dissociation of tissues. A fracture (radius or other) with displacement is considered complete if the connection between the fragments is broken. The incomplete one is one in which the integrity is practically preserved (or the fragments are maintained), that is, the connection is not completely disconnected.
Hand fractures are also classified in the direction of the line of bone damage (ulnar, radial or brachial). Depending on this, they are divided into transverse, helical, longitudinal, as well as oblique, stellate, T- and V-shaped. Do not forget that a child can have a fracture of the flat (skull, pelvis, scapula), spongy (vertebrae, talus, heel and others) and tubular bones. The problem is that they form the basis of the limbs. Often, with the displacement, traumas of tubular bones occur, which, depending on their location, are diaphyseal (damage to the middle part), epiphyseal (disruption of the final site), and metaphyseal. In view of the affected area, fractures are isolated (one part), multiple (two or more segments). Also, combined injuries are possible, when, for example, a hand injury is “supplemented” by others (craniocerebral, abdominal cavity, and so on). Each case is distinguished not only by possible consequences, but also by the method of treatment. So watch your baby, tell him about the rules of behavior on the playgrounds. After all, everyone knows that trauma, like a disease, is easier to prevent than cure!
How to identify this trauma in children
Recognize if there is a broken arm in your child, it’s quite simple. In this case, the clinical manifestations of complete damage to bones (radial, ulnar and others) with displacement of their fragments practically do not differ from those of adults. A kid in an unhealthy state is usually excited, crying and capricious. A clear symptom of a fracture is pain in the injured area, swelling and swelling, there may be a deformity of the hand and an inability to act, for example, to move a damaged segment. In the projection zone, the skin often forms a hematoma. In the first few days after the injury, the child’s temperature rises to 37-38 degrees, which is due to the absorption of the contents of the bruise.
However, the errors in the diagnosis are far from uncommon, especially in the case of injuries in young children. So in the case of a fracture, epiphysiolysis, osteoepiphiseolysis and subperiosteal fractures that do not differ in bias, limb mobility can be maintained, its contours remain unchanged. Only when palpating is there pain in a limited area. Therefore, often such a fracture is diagnosed as a bruise, which is fundamentally wrong. Other factors are also difficult to recognize: insufficient anamnesis, well expressed subcutaneous tissue, which greatly complicates palpation, fragments that are not characterized by displacement, as a consequence – the inability to identify trauma under the periosteum. The danger of such unqualified conclusions is the wrong treatment, which in the future can lead to the curvature of the limb and impaired functions of the hand. Therefore, in order to make the correct diagnosis and be confident in the prescribed methods of recovery, it is best to conduct an X-ray examination.
Sequence of actions for fracture
If your child injures his arm in this way, the very first thing to do is to immobilize the limb. In this case, it is necessary to fix not only the injured area, but also two adjacent joints. For example, if a fracture occurred on the forearm, then the injured segment of the arm, as well as the radial and ulnar joints, should be immobilized. This will reduce pain and reduce the risk of further displacement. And this can happen with any bone: ray, shoulder, elbow – it all depends on where the blow hit. Then you need to put a tire on the limb from improvised materials (use a ruler, stick and the like) and hang it on a bandage from a scarf or kerchief thrown over the neck. If the hand looks unnatural, do not try to bring it into its original appearance and align it. So you just cause extra pain to the victim. In addition, if the bones are displaced, by their actions you can strengthen this effect, and even damage the soft tissues.
If there was an open fracture of the arm and a violation of the integrity of the skin, the wound is infected. In this case, bleeding may begin from the vessels damaged by bone fragments (radial, ulnar or humeral, depending on the injury). Therefore, before immobilizing the limb, you need to stop bleeding, treat the wound and apply a bandage (necessarily sterile)! To do this, first wash your hands (or someone who will provide first aid) and free the damaged area from clothing. The symptom of arterial bleeding is the bright scarlet color of blood flowing from the pulsating stream. In such a case, press the vessel slightly above the site of the injury – where there are no dense muscle masses, where the artery lies close to the surface. In case of bleeding from the vein, press it below the place where the blood flows (dark and not pulsating) and fix the arm in a slightly elevated position. If the blood loss does not stop, before the doctor arrives clamp the wound with a clean towel, a piece of cloth, gauze or other improvised means.
If a child has an open fracture, but there is no bleeding, just remove from the surface of the skin scraps of clothing, dirt and other external stimuli. Rinse the wound under running water, and ideally – peroxide of hydrogen. In the latter case, foam may form, remove it from the edges of the injured area with a clean piece of tissue and apply a dry sterile bandage. An open fracture (of the radius and others) is an indication for vaccination against tetanus. Consider this point if the vaccine has not been vaccinated or has expired.
Give the child an anesthetic (usually using drugs based on ibuprofen or paracetamol), but in no case do not feed and do not drink, because the hospital may need anesthesia. The further depends on the correct diagnosis and the prescribed treatment, so as soon as possible, take the baby to the nearest clinic. Inspection of children is conducted in the emergency centers, in some cities in the hospital reception rooms, surgeons and traumatologists. At the same time, an x-ray examination is mandatory!
What treatment is shown for fracture
Bones in children fuse fairly quickly, especially in younger school years (up to 7 years), so the most common method of planting is conservative. If the fracture is not accompanied by a displacement of the fragments, a simple imposition of the so-called gypsum langete is sufficient. It does not cover the entire circumference of the injured limb, but only a part of it. Conventional fractures without displacement do not require hospitalization and are treated on an outpatient basis.
With the normal fusion of the radial and other bones of the injured arm, a traumatologist will have to visit the rehabilitation during the rehabilitation period every five to seven days. With the correct application of the bandage, the child gradually reduces pain, and in the future they completely disappear. Disturbances of movements and sensations on the fingers of the hand should be absent. If the dressing has been imposed unprofessionally and the limb is squeezed, such “disturbing” symptoms as aching pain, swelling, loss or exacerbation of sensitivity can be observed. If any of these occur, consult a doctor!
Unfortunately, the simple application of gypsum does not always help. In severe fractures with displacement (for example, intra-articular radius), an operation under general anesthesia may be necessary – closed reposition of fragments with further application of gypsum. This surgery lasts only a few minutes, but because of anesthesia the child is left in the hospital under the supervision of a doctor.
For prevention of repeated displacement with unstable fractures, fixation with metal spokes can be used. Initially, fragments of bone (radial or ulnar, forearm, depending on the injury) are fixed by them, and then they impose a plaster bandage. This method requires special care and dressing, so children are put in the hospital for three to five days, and after prescribing treatment on an outpatient basis.
The timing of the fusion of the radial, ulnar and humerus bones is affected by several factors: the age, nature and location of the fracture. On average, the recovery of the hands takes 1-1.5 months. A complex case with an offset will take a little longer.
The active period of rehabilitation begins after the removal of gypsum or other types of fixation (say, spokes with a severe fracture of the radius). At this time, it is necessary to force the child to develop movements in adjacent joints, to increase muscle tone, to restore the supporting abilities of the limb injured. For this, therapeutic physical training, special massage, swimming and physiotherapy are shown. All these procedures need to take place throughout the course of recovery, without taking breaks. The course of massage and physiotherapy is designed for approximately 11 sessions – it improves the circulation of lymph and blood in the damaged area, restores muscle function and promotes the development of joint movements.
Particular attention during treatment should be given to the nutrition of children. Include in the diet of the child supplements containing the necessary groups of minerals and vitamins.
With open fractures, which are complicated by a violation of blood circulation, oxygen treatment is recommended – hyperbaric oxygenation. This method is used to prevent infection and promotes the activation of metabolic processes in the child’s body. Initially, treatment begins in the hospital, and afterwards it continues in the ambulance setting. Sometimes, after a complex fracture, there may be a violation of the function of the injured hand and pain syndrome. In such cases, treatment can be carried out in special rehabilitation centers.
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