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Fractures in Children
26 января 2016
Features of bone fractures in children
In the bones of the child contains a large amount of organic substances (protein ossein) than in adults. The shell covering the outside of the bone (periosteum) thick, well supplied with blood. Also, there are areas in children bone growth. All these factors determine the specificity of children's fractures.
  • Often fractures in children occur on the type of "green branches". Outwardly, it looks as if the bone is bent and broke down. The displacement of bone fragments is small, the bone breaks down on one side, and on the other side of the thick nadkostitsa hold bone fragments.
  • Line fracture often passes through the zone of bone growth, which is located near the joints. Damage to the growth zone may lead to its premature closure and, subsequently, to the formation of curvature, shortening, or a combination of these defects in the growth of the child. The earlier in life is damage to the growth zone, the more severe the consequences it causes.
  • The children more often than adults, there are outgrowths of bone fractures, which are attached to the muscles. Essentially these fractures is the detachment of ligaments and muscles to bone fragments from the bones.
  • Fabrics fused bones in children faster than adults, due to a good blood supply to the periosteum and accelerating the formation of callus.
  • In children younger and middle age groups can be self-correction of residual displacement of bone fragments after a fracture, which is associated with the growth of bone and muscle function. While some self-correction are subject to bias, while others do not. Knowledge of these laws is essential to solve the problem of surgical treatment of fractures.
  • Forms fractures
    Depending on the condition of bone fractures distinguish traumatic and pathological. Traumatic fractures arise from exposure to unmodified bone short, large quantities of mechanical force. Pathologic fractures are the result of various disease processes in bone breaking its structure, strength, integrity and continuity. For the occurrence of pathological fractures fairly minor mechanical effects. Often referred to as spontaneous pathological fractures.

    Depending on the condition of the skin fractures are divided into indoor and outdoor. When closed fractures the integrity of the skin is not broken, bone fragments and the whole area of ​​fracture remains isolated from the external environment. All closed fractures considered to be aseptic, uninfected (uncontaminated). In open fractures has been a violation of the integrity of the skin. The size and nature of the damage to the skin lesions differ from the point to the vast soft tissue defects with their destruction, crushing and pollution. A special type of open fractures are fractures of the gunshot. All open fractures are initially infected, t. E. Having microbial contamination!

    Depending on the degree of separation of bone fragments distinguish fractures without displacement and with displacement. Fractures of the offset may be complete, when the connection between the bone fragments broken and has their full disunion. Incomplete fractures, when the connection between the fragments are not broken all along, the integrity of bone largely saved or bone fragments are held periosteum.

    Depending on the direction of the fracture line distinguish longitudinal, transverse, oblique, helical, stellate, T-shaped, V-shaped bone fractures cracking.

    Depending on the type of bone fractures distinguish flat, spongy and cortical bones. By the flat bones are the bones of the skull, scapula, ilium (pelvis form). The most common fractures in the flat bones of significant displacement of the bone fragments does not occur. By spongy bones are the vertebrae, heel, container and other bones. Fractures are characterized by trabecular bone compression (compression) of bone tissue and lead to compression of the bones (a reduction of its height). It includes a tubular bones that form the basis of the limbs. Fractures of the long bones are characterized by a pronounced shift. Depending on the location of fractures of long bones are diaphyseal (fracture of the middle part of the bone - diaphysis), epiphyseal (fracture of one of the ends of the bones - the pineal gland, usually covered with articular cartilage), metaphyseal (fracture of the bone - metaphyseal located between the diaphysis and epiphysis) .

    Depending on the number of damaged areas (segments) of limbs or other body systems distinguish isolated (fractures of one segment), multiple (fractures of two or more segments), Combined (fractures combined with traumatic brain injury, trauma, abdominal organs or chest).
    How to suspect a fracture?
    Suspect the presence of a fracture in a child is easy. Most often, the child is excited, crying. The main symptoms of bone fractures in children are severe pain, swelling, swelling, deformity of the damaged segment of course, impossible to function (for example, the inability to move his hand, stepping on the foot). The skin in the area of ​​the projection of the fracture may develop bruising (hematoma).

    A special group of fractures in children are vertebral compression fractures that occur when an atypical injury, usually in the fall on his back from a low altitude. Intrigue of these fractures is that the diagnosis of their children is difficult even when hospitalized in the trauma department of children's hospitals. Pain in the back are minor and disappear completely in the first 5-7 days. X-ray examination is not always possible to make a correct diagnosis. The difficulties of diagnosis of this group of fractures due to the fact that the main radiological signs of damage to the spine as a result of trauma - its wedge shape, that child is a normal feature of the growing spine. Currently, the diagnosis of vertebral compression fractures in children are becoming increasingly important modern methods of radiation diagnosis - computer and magnetic resonance tomography.

    Pelvic fractures are severe injuries and soreness occur, the inability to get to his feet, swelling and deformation of the pelvis, sometimes there is crepitus (crunching, creaking) of bone fragments in the kicking motion.
    First Aid
    First aid for fractures of the extremities is the immobilization of the damaged segment using available tools (boards, sticks and other similar items), which are secured with a bandage, shawls, scarves, cloth and so on. N. It is necessary to immobilize not only the damaged area, but two adjacent joint. For example, bone fractures of the forearm is necessary to fix the damaged segment of the limbs and wrist, and elbow joints; shin bone fractures - a damaged segment of the limb with the knee and ankle joints. For pain relief can be given to the victim on the basis of the analgesic acetaminophen or ibuprofen. It should try to calm the child, first of all, his calm demeanor. Then call "ambulance" (it can be called even before the first aid) or yourself to go to a nearby children's hospital (at the reception office), emergency station. Since open fractures have a violation of the integrity of the skin, the wound is infected and may start bleeding from the damaged bone fragments of blood vessels, before immobilizing the limb, it is necessary to try to stop the bleeding, treat the wound (if conditions allow) and apply a sterile dressing.

    The damaged area of ​​skin is freed from clothes (hand of assistance providers should be washed or treated in an alcoholic solution). When arterial bleeding (bright red blood flows pulsating jet), you must press the bleeding vessel above the bleeding - where there is more muscle mass, where the artery is not very deep, and can be pressed down to the bone, such as the brachial artery - the elbow . When venous bleeding (dark-colored blood pours continuously and uniformly, not pulsating) bleeding should be pressed below the bleeding vein and secure in the raised position the damaged limb.
    If the bleeding does not stop, close the wound with a large piece of gauze, clean diapers, towels, sanitary napkins (clamp the wound should be before the arrival of the doctor).

    If bleeding is not open fractures, with the surface of the skin, remove dirt, bits of clothing, ground. The wound can be rinsed under running tap water or pour hydrogen peroxide (formed foam must be removed from the edges of the wound with sterile gauze). Further, the wound should impose a sterile dry dressing. An open fracture is an indication for vaccination against tetanus (if it has not been done before or has expired since the last booster) that needs to be done in the emergency room or hospital.

    First aid for falls from a height is the immobilization of the spine and pelvis, which in this case is often damaged. The victim must be put on a firm, flat surface - a board, boards, stretchers, and so hard. D. If you suspect a fracture of the pelvis in the popliteal area of ​​the legs fit cushion. All this leads to a relaxation of the muscles and prevents secondary displacement of bone fragments.

    If a child is damaged arm and he can move independently, you should contact the Children's emergency station, which tend to have at each children's clinic and the hospital.

    If a child is injured leg, spine or pelvis, it can not move independently. In these cases it is advisable to call the ambulance, which will take the injured child to the receiving department at Children's Hospital.

    Hospitalization is carried out in cases of fractures with displacement requiring repositioning (matching fragments) or surgery, and fractures of the spine and pelvis.

    Diagnosis of bone fractures in children is carried out in the emergency room or offices foster children Trauma Hospital or surgery. Of great importance for a correct diagnosis check-up, a survey of parents, witnesses or the circumstances of the child's injury. Be sure to carry out X-ray examination. Also, quite often (especially in cases of suspected fracture of the spine) is a computer or magnetic resonance imaging. In the case of associated trauma to diagnose the state of internal organs carried ultrasound (US), blood, urine, and so on. N.
    Due to the fairly rapid coalescence of bones in children, especially those under the age of 7 years, the leading treatment for fractures is conservative. Fractures without displacement of bone fragments treated by imposing plaster splints (optional plaster bandage covering not the entire circumference of the limb, but only part of it). Typically, bone fractures without displacement are treated as outpatients and do not require hospitalization. Outpatient treatment is carried out under the supervision of trauma. The frequency of visits to the doctor during the period of the normal course of healing of fractures is 1 every 5-7 days. The criterion for the correct casting of a subsidence of pain, lack of sensory disturbances and movements of the fingers or toes. "Alarming" symptoms that bandage compresses the limb pain are expressed edema, disturbance of sensitivity and movement in the fingers or toes. When these symptoms should immediately seek traumatologist. Treatment of fractures by casting of a simple, safe and effective, but, unfortunately, not all fractures can be treated only in this way.

    For fractures with displacement, in severe comminuted, intra-articular fractures of the surgery is performed under general anesthesia - closed reduction of bone fragments, followed by casting of. The duration of surgical procedure - a few minutes. However, the conduct of anesthesia does not allow the right to release the child home. The victim must be retained in the hospital for a few days under the supervision of a physician.

    With unstable fractures for prevention of secondary displacement of bone fragments often used Transosseous fixation of metal spokes, t. E. The bone fragments are fixed with needles and an additional plaster cast. As a rule, reduction and fixation technique determines the physician prior to manipulation. When fixing the fracture spokes subsequently need care and bandaging the spokes where they exit from the course, this method provides reliable fixation of the fracture, and after 3-5 days the child can be discharged to outpatient treatment.

    In pediatric traumatology widely used method of continuous skeletal traction, which is most often used for fractures of the lower limbs and is to hold the spokes through the calcaneus or tibial tubercle (shin bone) and the extension of the limb load for a period of fracture healing. This method is simple and effective, but requires in-patient treatment and constant supervision of a physician to complete fracture healing.
    The recovery period
    Timing fracture healing in children depend on the age of the patient, the nature and location of the fracture. On average, upper extremity fractures grow together in a period of 1 to 1.5 months, fractures of the lower extremity - from 1.5 to 2.5 months after injury, fractures of the pelvis - from 2 to 3 months. Treatment and rehabilitation of compression fractures of the spine depends on the child's age and can last for up to 1 year.

    Active recovery period begins after removing the plaster immobilisation or other fixation. His goal is to develop movement in adjacent joints, strengthening muscles, restoring the ability to support the injured limb, and so on. By means of rehabilitation treatment are physiotherapy (physical therapy), massage, physiotherapy, pool. Physiotherapy and massage courses to 10-12 sessions and contribute to the improvement of blood circulation and lymph flow in the damaged area, the restoration of muscle function and movement in the joints.

    Of particular importance to fracture healing in children have a balanced diet. In this connection it is expedient to include a regimen of vitamins and minerals, which contain all vitamins and calcium group.

    In severe open fractures, complicated by poor circulation, it is recommended treatment with oxygen under high pressure in the chamber - the method of hyperbaric oxygenation (used to prevent infection and promotes the activation of metabolic processes in the body).

    Reducing treatment (rehabilitation) begins in the hospital, and then continues on an outpatient basis. In severe injuries, accompanied by severe disorders of the damaged segment being treated in rehabilitation centers, as well as spa treatment.
    Complications fractures
    When complex fractures may express violation of the damaged limb pain. Open fractures are often accompanied by blood circulation. The consequences of undiagnosed compression fractures of the spine in children leads to the development of juvenile osteochondrosis - degenerative (associated with malnutrition tissue) diseases of the spine that affects the intervertebral discs, accompanied by their deformation, change in altitude bundle. Also, these fractures may lead to deformities of the spine, disorders of posture and persistent pain syndrome. Pelvic fractures can be accompanied by damage to the hollow organs such as the bladder.
    Vladimir Merkulov, Professor, head of the clinic of children's traumatology CITO them. Priorov Dr. med. sciences.

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