Almost any child, and, therefore, his parents, faces the problem of a fracture sooner or later. In order to correctly assess the severity of the situation and seek qualified help in time, one should be guided in the features of fractures in children. Parents often underestimate the severity of the condition because some children are not very sensitive to pain; other adults consider this to be almost the norm, explaining the mobility of the child. Is it that simple?
Relevance of the issue
As is known from medical statistics, fractures in children are about 15% of all injuries and injuries that are sought for qualified medical care. The problem is caused by the structural features of the human body: biological mechanics, anatomy, and even the physiology of a minor are very different from those of an adult, as the body is actively growing and developing. Trauma fractures, including a violation of the integrity of the pineal gland, are an urgent problem in modern medicine. Updated approaches to refined diagnostics are being developed, treatment strategies are being formulated that would fully satisfy the particularities of the case.
A key feature of fractures in children is the structure of bone tissue. The musculoskeletal system contains not only a rather large amount of cartilaginous tissue, but also differs by the presence of locking plates, which normally do not exist in an adult. Such sites are called growth areas. Children's bones are characterized by increased strength and have a reliable periosteum, which forms bone marrow in a short time. A study of biomechanics has shown the ability to absorb large energy volumes. Scientists explained this by the porosity of the elements and low mineral density. The abundance of pore bone tissue is associated with numerous large haversian channels, due to which the elastic modulus decreases, and strength decreases. Growth and adulthood are accompanied by a decrease in porosity and a thickening of the cortical block, which makes the skeletal system stronger.
Anatomy and injury
Another feature of fractures in children is due to the attachment of ligamentous blocks to the bone epiphyses. Therefore, trauma to the limb can damage the bone growth site. The strength of the elements is ensured by the plexus of the annular blocks and mastoid bodies, but in any case, the growth area is characterized by relatively low strength. This is noticeable if we compare the anatomical features and qualities of the metaphysis, ligamentous fibers, growth zones. Such sections are relatively tensile, but are subject to the negative influence of torsion force. From statistics it is known that the violation of the integrity of the growth plate is most often explained by angular action or rotation.
Another feature of a fracture in children is the possibility of an offset format, and the probability directly depends on the quality and parameters of the periosteum. The thicker this block, the lower the risk of closed reposition. After changing the position, it is she who is responsible for maintaining the fragments in the correct and stable state.
Healing process
Fractures in children are accompanied by bone remodeling. The process is ensured by resorption of the periosteum, accompanied by the generation of new bone tissue. Anatomical reposition is needed only in a limited number of cases. Many injured children do not need such an event at all. The regeneration process depends on several factors: age, localization of the injury relative to the joint, the presence of obstacles to its activity. Remodeling is due to the potential ability of the bone to grow, and the greater the possibility, the less age.
If the injury is localized near the growth block, the restoration will require a minimum of time, especially in the case when the deformation coincides with the articular axis of movement. An intraarticular fracture, in which the areas are displaced, heals more slowly. Considerable time is required to restore the diaphysis. Possible rotational trauma or worsening of articular motility. These heal more slowly than others.
Bones: do they grow in moderation?
One of the features of bone fractures in children is the risk of excessive bone growth. For relatively long bones, this is due to the effect on the growth sites - in this area, blood flow is activated to restore damaged tissues. It is noted that a fracture of the femur in a child under the age of ten is often accompanied by an elongation of the bone by several centimeters in the next couple of years. To minimize the undesirable consequences of rehabilitation, it is necessary to bayonetly combine bone fragments. For patients older than this age, excessive development is less dangerous, the process is relatively weak. If a fracture occurs, help is needed by making a simple reposition of the blocks.
About the nuances
Known to doctors, a feature of bone fractures in children is the progress of deformation. Sometimes the injury is accompanied by damage to the pineal gland. As a result, the site may close by several percent or absolutely. This leads to angular deformation, can provoke a shortening of the bone element. Both types of complications are likely. The level of deformation depends on the specificity of the bone, determined by the ability of bone tissue to grow.
Studies have shown that in children, fractures heal faster than in adult patients with traumatology. The reason for this is the ability of the child’s bone system to grow rapidly and increase the thickness of individual blocks. The periosteum of a minor is an area of ​​localization of active metabolic processes. The older the person, the lower the healing rate.
Do I need help?
Sooner or later, bone fractures in children become a problem for almost any family. The more restless the child, the higher the risk of serious injury. Parents should be guided in the manifestations of the problem, know how to provide first aid to the victim. In many ways, the speed and quality of the rehabilitation period depend on it. They determine what kind of help is needed at first, based on the cause of the fracture and the factors that determine the specifics of the situation. However, the general tactics are uniform for all cases.
From statistical observations it is known that the most common concern is a broken arm in a child; the incidence of leg fractures is half as low. If the injury is severe, it is immediately clear what happened, but more often children suffer minor injuries, and only a qualified doctor can diagnose correctly. Some do not pay enough attention to the situation, since the functionality of the affected limb, although impaired, is weak. You can easily confuse a fracture, bruise, dislocation. The first in the upper limbs are often localized in the forearm, elbow joint.
Closed fracture
If a child’s fracture (arms, legs or other part of the body) is observed in this form, it is necessary to give the victim peace and immobility. This step is the first in providing emergency care immediately after injury. Parents should lay the patient, then calm down, because chaotic panic actions will only harm the baby. A cold compress is applied to the affected area. This alleviates the condition and helps ease internal bleeding. The next stage is immobilization. The term refers to measures to prevent movement of the sick area. The limb must be kept on a hill. Then the patient is given an analgesic. Doctors recommend the use of medicines containing ibuprofen, paracetamol. Other medicines are prohibited until the doctor arrives.
Fracture open
Treatment for children with open fractures must be provided to the doctor. The task of those next to the victim is to provide first aid. A distinctive feature of the injury is an open wound, which means that it is necessary to treat it as soon as possible and prevent large-scale blood loss. To stop bleeding, the area of ​​damage is covered with a tight bandage. If the area is dirty, you must clean it with soapy water. Then they apply a cold compress, provide immobility to the victim, and if necessary, give an analgesic.
About commit
Given the brief features of bone fracture in children described above, the importance of providing correct first aid is understood, since unsuccessful measures and the lack of suitable treatment can adversely affect a person’s future, lead to skeleton asymmetry and other complications. A key aid measure is to immobilize the affected area. To do this, impose a tire. Any first-aid kit for a car owner is equipped with such a product. It is always at the disposal of the ambulance crew. Parents, providing first aid to the affected child, must prepare the tire from improvised means. Finding something suitable is easy - just use dense material, to which the injured part of the body is attached.
As with a fracture in a child accompanied by a displacement, without such a complication, the task of first aid providers is to find suitable means for immobilizing. You can use thick cardboard or plywood. If you have a small board or stick at hand, such items are also suitable. If a very small baby is injured, it is better to use cardboard, wrapping it with cotton wool. To fix the affected area, a bandage is used. It is necessary to stabilize the position of the joints above and below the affected area. Clothing, shoes do not need to be removed. It is advisable to take wide objects for applying tires - they are more reliable than narrow ones. If a limb has suffered, it is necessary to fix it in its current position, without adjusting it to a more familiar or seemingly convenient, correct one. It is strictly forbidden to send the injured block of the support system - the doctor will do this.
First Aid: Nuances
If there is a fracture with displacement in the child, if the injury is not accompanied by displacement, it is necessary to call a doctor as soon as possible. If the situation occurred when the family was in the village where it is possible to call an ambulance crew, you can not immobilize the limb. Parents urgently need to seek medical support, and while waiting for the car with doctors to guarantee the victim peace and stillness. Do not touch the affected area.
There is a situation when a child is injured, but elders do not have anything suitable for splinting at hand. It is necessary to fasten the affected area to a healthy part of the body.
Strictly forbidden
One of the features of treating fractures in children is a strict ban on heating and rubbing the affected area. Parents should monitor the behavior of the victim: he should not move. In no case should you make the injured move or encourage movement. It will be dangerous to try to correct the zone on your own. Do not treat the area with gels, ointments.
The rules for providing primary care in case of damage to the upper and lower extremities are almost the same. If the arm is damaged, it should additionally be fixed with a kerchief bandage. If the injury is localized in the leg, such measures are not required. If femoral damage or injury involving the pelvic blocks is suspected, four joints will be immobilized instead of two.
Subtleties of the question
Doctors, figuring out the peculiarities of fractures in children and adults, have established: when an equal force is applied, an older person is more likely to get injured than a child. The support system in childhood has high elasticity, its forming elements are flexible. To some extent, the fracture is similar to a broken tree branch. Fragments do not move, which means regeneration requires a minimum of time. It is most difficult to clarify the case if the fracture is localized in the growth area. When examining a part of the body in x-ray, it is impossible to see the cartilage tissue, therefore, it is problematic to clarify the fracture.
The high ability to regenerate inherent in the child's body is known. Bone marrow changes to the corresponding tissue as soon as possible. Comparing the features of fractures in children and adults, it was found that the former appear much less likely to have scarring areas. It was revealed that in children who received a fracture, an insignificant displacement can be maintained - it will disappear on its own as the body grows.
Fractures: forms
It is customary to divide all cases into pathological and due to trauma. In everyday life, the latter are usually observed. In a child, fractures of the clavicle, limbs, other parts of the body are provoked by strokes, falls, jumps. They are not uncommon during games, can be explained by tucking a leg or a long run. Pathological cases are provoked by diseases. Such are observed with dysplasia, bone tuberculosis, and may indicate abnormal formation of bone tissue at the embryonic stage of development. A possible cause is a lack of calcium. Sometimes a fracture indicates an inflammatory process localized in bone tissue.
All cases of injuries are divided into open, closed (general rules for first aid are discussed above). Do not underestimate the dangers of an open form, since damage to the skin is accompanied by the danger of infection of the body. In a child, a fracture of the clavicle, limb, rib, or any other block of the supporting system is accompanied by ruptures, and the dimensions of the damage vary from case to case. Sometimes they are small, while others are large, leading to the destruction of soft tissue. In addition to dirt, there is a danger of crushing tissue. Cases of open fracture are divided into those accompanied by displacement and without it. The first involves the movement of bone fragments to the sides, the second option is characterized by a stable position of the fragments in the initial location. Fractures with displacement are incomplete, complete. The connection of fragments is partially broken, while bone integrity is preserved - these are features of an incomplete fracture. The second option involves the complete separation of the elements.
The main percentage of cases is an isolated injury, in which one segment is damaged. Multiple, combined cases affecting several areas of the body are less commonly observed.
How to notice?
The task of parents is to know the symptoms of a fracture in a child in order to call a doctor in time and provide first aid. There are common signs inherent in any injury of this type, regardless of location. All manifestations are divided into probable, reliable. The first category includes skin swelling, hematoma, soreness, accompanying movements, palpation. The mobility of the hand, foot, finger is impaired. Reliable manifestations include deformation of the site, crepitus. The term refers to a crunch that is heard due to bone fragments.
This is curious: injuries and celiac disease
Not so long ago, the medical community became interested in the case of a child who often suffered from fractures. In just a couple of years, the seven-year-old child received three fractures of the upper limbs, not accompanied by preliminary pressure. Doctors could not find the prerequisites for bone fragility, the patient ate well and led an active life. Laboratory studies have shown adequate concentrations of trace elements, minerals in the blood. The only doubtful result of the study was the level of antibodies, allowing to suspect celiac disease. The diagnosis was confirmed by gastroenterologists.
As studies have shown, in a child, fractures of the radial bone, collarbone and other parts of the body against the background of celiac disease are more likely than in the absence of this disease, since it affects the mineral density. A curious reliable study was organized in the 2011th year. It turned out that about a quarter of all people diagnosed with celiac disease had suffered a fracture shortly before.
Why is this happening?
Celiac disease is a pathological condition in which the performance of intestinal villi is impaired. The absorption function of the tract is inhibited, the body does not receive the necessary components. This leads to deficiency of iron, vitamin compounds, folic acid. One of the features of fractures of tubular bones in children (like any other elements of the supporting system) is low density, which is provoked by a lack of nutrients.Accordingly, celiac disease leads to a decrease in bone strength. At the same time, the level of inflammation is growing, which also negatively affects the health of the supporting system.
Finding out the features of fractures in children of the jaws, limbs and other parts of the body against the background of celiac disease, doctors considered: the only reliable method of prevention is proper nutrition. It is necessary to completely eliminate gluten from the patient's diet. As the researchers of the case mentioned above noted, such a measure with respect to the child allowed in the next 3.5 years (exactly after how many parents brought the child to the clinic for a preventive examination) without fractures. It is noted that the restructuring of the new food system for children is not easy, but the results are worth it.
Causes and consequences
If you do not touch on the topic of rare congenital and hereditary diseases, you have to admit: the main percentage of fractures in minors is due to industrial society and the characteristics of social interaction. It is not easy for children to learn to observe household rules, behave correctly in transport, which means that the risk of damage is growing. Doctors involved in the diagnosis and treatment of fractures in children note: about 70% of all cases are caused by riding bicycles, skateboards, scooters, and rollers. Many children ride where it is prohibited, jump in dangerous places, fall. Even vehicles do not injure minors as often as they do for domestic reasons. On average, the probability of injuries due to transport in an adult is higher than in a child, but the severity of damage usually dominates in the latter. Studies have shown that on average per thousand children there are 248 people with bruises, 30 with dislocations and about 57 with bone fractures.
To understand how to distinguish these cases, it is necessary to consider their features, at least in general terms.
About terms and situations
A bruise is a closed injury in which organs, tissues suffer, but the structure remains intact. Sites do not come off, do not burst, but a violation of the integrity of blood vessels is possible. The result is hematomas, bruises. Bruising is visible visually as crimson spots, the shade of which gradually transforms to green and yellow. Usually the reason is a collision, fall, blow. The mobility of the diseased part of the body persists, but the area responds with soreness. To help the victim, a cold compress is applied to the area and provide peace.
As studies show, it is possible to get a fracture by a baby, but ligamentous sprains appear in people only older than three years of age. Classical localization is the ankle joint. The child makes an awkward movement, the foot tucks up. This is possible when a person runs, walks. Especially high risk when running up stairs. Stretching indicates acute pain, followed by swelling of the affected area. Skin tint sometimes changes to cyanotic, palpation brings pain. Movements in the joint are possible, but the victim tries to spare the diseased limb, and therefore practically does not rely on it.
Parents should attach ice to the affected area, fix it with an elastic bandage and show the injured doctor for an X-ray examination. There is a high risk of a bone crack, similar in symptoms to a sprain. X-rays are the only way to clarify the condition.
Dislocation: what is it?
The word denotes an injury in which the articular contour is disturbed. More often the reason is a fall. Movement of the affected area is limited, soreness becomes stronger, the ability to move is inhibited. A limb affected by a fall becomes longer or shorter than a pair. There is a possibility of deformation.
Parents should provide the patient with peace, fix the affected area with a tire, bandage. Seek help from a qualified doctor. On their own, dislocation can not be corrected.
Very often in practice there is a subluxation, and a typical area is the elbow joint. More often this is observed in children of the age group from one to three. The adult holds the child tightly by the hand, but the child stumbles, suddenly slips or falls, and this leads to injury. The moment is sometimes accompanied by a specific crunch.
With a subluxation, the affected area responds with pain, the child does not move the limb, stretches it along the body, sometimes slightly bends. If you rotate your forearm or elbow, the pain becomes especially severe. Parents should ensure peace in the affected area and take the patient to pediatric traumatology.
Crack
Considering the features of bone fractures in newborns, infants, and older children, one cannot ignore the cracks. This term refers to partial damage to bone tissue, a fracture that has not completed. It is not easy to identify him, as young children are not able to formulate complaints. From the side there is a general concern of the child. The probability of injury is especially high due to the small weight of the child. If the child falls, the soft tissues somewhat weaken the aggressive effect, so the likelihood of a crack is greater than a fracture.
An older child can describe the manifestations of the situation. The injured area is disturbed by pain, especially severe in movement, with palpation, pressure. If rest is provided to the affected area, the pain becomes dull, the zone pulsates, and in some it tingles. Tissues swell, and the symptom can progress quickly. Swelling will subside one day after receiving the crack or later. Often the area is marked by a hematoma. Limited mobility of the victim is noticeable, due to pain, swelling.
The spine suffers
A relatively common diagnosis is a compression fracture. In a child (as well as an adult), this is explained by compression of the elements of the spinal column. This is possible when falling, due to a blow to the back, somersault, gymnastic practice. In children, it is known that muscles are sometimes stronger than the skeletal system. When they are intensively reduced, a compression effect is formed that affects individual blocks of the column in the lateral projection. Functionality, sensitivity are not violated, since there is no spinal injury, but the structure of the column is violated. The clinical symptoms of the condition are often blurry. At the time of the injury, he takes his breath, his back gives off a slight soreness, while the child does not even pay attention to the manifestations and continues his games and activities.
Without adequate treatment, a compression fracture leads to complications. Such are more often observed after years. The consequences of the situation are sciatica, osteochondrosis, vertebral destruction and other similar pathological processes. In order to prevent the consequences, it is necessary to take the victim to the trauma department of the clinic with the slightest back injury, where they will take an X-ray, assess the danger of the condition and select a therapeutic program. Inpatient treatment is often indicated. Rehabilitation is accompanied by a special daily routine aimed at unloading the spinal column. Such treatment is quite long in time.
To correct a compression fracture, it is necessary to do therapeutic exercises. From the age of three, swimming is recommended. Without adequate support of the body, as you grow older and increase in weight, the risk of a hernia in the affected area increases.