Among the different types of disorders that occur in the integrity of the parts of the skeleton, in children, the subperiosteal fracture is considered the most common. This is pretty serious damage. With such an injury, tissue damage and preservation of the integrity of the periosteum located around the bone are noted. Often, a fracture is not accompanied by displacement of fragments, which makes therapy and recovery faster and easier. This damage is also defined as injury by the type of green twig.
What should you know about this injury?
It should be noted that in children, a subperiosteal fracture is very common, since the structure of their tissues differs significantly from adults in a significant way. At a young age, they are more elastic and thin, as they consist of more collagen and minerals.
The tissue of the periosteum in children is better supplied with blood, due to this, the elasticity of the cartilage located between the pineal gland and the metaphysis allows reducing the force of action and pressure intensity directly on the base itself. This injury leads to a violation of the integrity of the element responsible for softening impacts and good cushioning.
Mechanism of occurrence
The main mechanism for the occurrence of a subperiosteal fracture in children is the presence of strong pressure localized in the region of the longitudinal axis of the bone. First of all, it is worth paying attention to the fact that during adulthood, such a force is the cause of a fracture of the limbs. In children at this time, it is only a violation of the integrity of the periosteum.
Is there a subperiosteal fracture on the forehead? Epiphysiolysis and osteoepiphysiolysis occur at the site of attachment of the articular bag to the cartilage of the bone, that is, in the ankle and wrist joints. This violation does not happen in the hip part of the skeleton and in other places where the joint bag covers the sprouting cartilage, which, in turn, does not serve as a place for its attachment.
In most cases, such damage can affect the lower leg, and, in addition, the forearm. Violations in the integral structure of the radial bone occupy a leading position among childhood injuries. On x-rays, damage can resemble a bent green twig cracking under the skin.
What is the danger?
Despite the fact that the subperiosteal fracture is considered simple in the field of current traumatology, it nevertheless turns out to be very dangerous for the health of the child. Characteristically, in young patients, significantly more complications arise precisely after such an injury. Now let's try to figure out what causes are the key factors provoking the occurrence of such an injury.
Causes
Among the main reasons that can lead to a subperiosteal fracture, it is necessary to pay attention to the following:
- Occupation by active games. Most often, the periosteum can be injured due to human activity. These are ordinary street games or sports. A very common reason is riding a bike, skateboard, roller skating, ice skating, and in addition, dancing. Thus, any active exercises during which you can inadvertently fall, provoke such a fracture.
- The result of the fall. Due to the fragility of bone tissue, any fall can provoke a periosteum injury.
- Receiving impacts of even a small force on a solid object leads to a subperiosteal fracture of the radius.
- Participation in a traffic accident is rarely the cause of such an injury. But, according to statistics, in these cases there is a complete fracture of bone tissue with the appearance of displaced fragments.
Next, let's talk about the symptoms that accompany the occurrence of such a fracture, regardless of age.
Fracture symptoms
Symptomatic manifestation of a complete fracture and a closed subperiosteal fracture of the radial bone radically differ from each other. It is necessary to be able to distinguish an absolute violation of bone integrity from small damage that can occur without the presence of displaced fragments of the injured part of the skeleton. In the adult, as well as in the children's body, the following patient complaints will indicate the presence of a complete fracture:
- The presence of limited movement.
- The occurrence of pathological mobility in the area of the received blow.
- The presence of swelling of the soft tissue around the site of injury.
- The presence of a visually deformed damaged limb.
- The presence of general hyperemia in the patient.
- The formation of subcutaneous hematoma and hemorrhage due to shock or pressure.
- A crunch of bone fragments may be observed during the attempted movement.
It should be emphasized that the subperiosteal fracture of the radial bone in children does not have similar symptoms, which is a common reason that adults take such damage as a severe bruise. In most situations, this trauma leads to the appearance of a minor pain syndrome.
Despite the fact that children can rely on a damaged limb, this can be accompanied by a strong painful sensation. Unlike an absolute fracture, the subperiosteal can occur with little or no swelling.
Diagnostics
As diagnostic methods for determining the type of fracture that occurred, the doctor will not be able to perform only palpation of the lesion area, since the child’s body is distinguished by developed subcutaneous fatty tissue.
After conducting an external examination of the patient, the specialist will need to appoint an X-ray examination, due to which it is possible to diagnose the presence of incomplete violation of bone integrity or periosteum injury. Cases that are particularly difficult to diagnose need to compare images of a healthy limb with an injured one in order to determine impaired integrity.
Treatment
Today, the treatment of subperiosteal fracture is conservative or surgical. A conservative method of treatment of the diagnosis in question consists in performing general or local anesthesia, under which simultaneous closure of fragments is performed.
This eliminates the arisen deflection of injured bone tissue. After the doctor restores the damaged bone in its normal anatomical position, a plaster cast is required to fix it. As for surgical treatment methods, their cost due to complexity, as a rule, is relatively higher than conservative repositions. Surgical intervention for such a fracture can be of the following types:
- Closed reposition with fixation of the bone fragment in closed form (this is done if the rupture occurred inside the joint capsule, the femoral neck was injured or a subperiosteal collar fracture occurred).
- Performing an open reduction with fixation of a fragment of an injured bone. This method of therapy is used if the pineal gland has been displaced, and at the same time it has been ascertained that intraarticular damage, an unstable fracture or an open subperiostal injury has been received.
- The implementation of external fixation. This is considered necessary for the treatment of complicated injuries, accompanied by ruptures of nerve endings and blood vessels, and in addition, burns of varying severity. Also, a similar measure is required in the presence of violations of the integrity of bone tissue in an unstable form.
After the doctors perform the operation, they apply plaster to fix the injured area. In addition, the doctor prescribes the use of special medications that differ in anti-inflammatory and analgesic effects ("Ibufen", "Nalgesin", "Ketorol").
Using crutches, patients are allowed to move around the second day after the initiation of therapy. Despite this, given the difficulty in developing crutches, patients often need to lie for an extended period in order to restore the integrity of the periosteum. In such situations, it is considered mandatory to take expectorant medications that prevent pneumonia due to prolonged immobility of the patient after the injury.
Treatment duration
The duration of therapy in the presence of subperiosteal trauma directly depends on how old the victim is, as well as on the area of the fault line. It is characteristic that small patients do not have to be so immobile for a long time for fusion of the periosteum in comparison with older children.
Recovery period
There are probably no specific figures for the healing time of the closed subperiosteal fracture, since the recovery period is different for everyone, it depends on the location, and also on the nature of the damage. On average, a fracture of the upper extremities grows from one to one and a half months. The restoration of the lower extremities usually takes from one and a half to two months, and the pelvic bones need up to three months. In the event that a compression fracture occurred, the patient will need up to one year for therapy and rehabilitation.
After removing the cast
The full-fledged rehabilitation process starts from the moment when the patient is completely removed from the cast, along with other types of fixations. The rehabilitation period, as a rule, includes a set of movements that can strengthen muscles, restoring support ability in the limbs.
Such procedures include visits to special physical education sessions, massages, and physiotherapy. It is also necessary to visit the pool. As a rule, twelve sessions are prescribed for visits to massages and physiotherapy. In particular, attention should be paid to proper nutrition, it is important to include only those products that are equipped with vitamins and minerals. Separate preference is given to products with calcium. As a rule, patients begin the recovery period directly in the hospital, and then gradually switch to outpatient conditions.