A “green branch” type of fracture is a very common occurrence, when only the bone breaks and the periosteum surrounding it remains intact. These types of injuries are scientifically called subperiosteal fractures. Mostly they suffer in childhood due to structural features of the still fragile skeleton. In this article, we will talk about the symptoms of this damage, how to treat it, and the likely consequences.
Features
A closed fracture of the "green branch" type is one of the most common types of injuries among minors. It received such an unusual name due to the significant similarity of damage to a broken branch of a young tree when it bends, but because of the dense skin, the very place of the fracture is held.
It is important to remember that the skeleton of a minor is fundamentally different from an adult. The bones of children are more elastic and thin, and the periosteum is very thick. This ensures a good depreciation effect. A thick layer of cartilage reduces the effect on the bone itself.
A fracture of the type of "green branch" is formed, as a rule, along the longitudinal axis of the bone. In this case, the periosteum itself remains intact. The displacement of fragments occurs completely insignificant, and in some cases it may not exist at all. When such a fracture occurs, the deformation of the bone is also minimal, its fragments are thus held in one place.
Varieties
In most cases, a fracture of the type of "green branch" occurs in the region of the lower leg or forearm. Most of all, young children should be wary of such an injury. The younger the child, the more serious and dangerous the probable consequences can be. So a baby’s fracture of the “green branch” type is an injury that needs to be paid close attention.
This is explained by the fact that the place of the breakdown often coincides with the intersection of the bone growth area in the immediate vicinity of the joints. Such damage can lead to curvature or shortening of the bone when the child grows up. This is the most dangerous consequence, which should beware of during a fracture of the type of "green branch" in children.
There are several varieties. Epiphysiolysis, apophyseolysis, and osteoepiphysiolysis — these are the types of bone fractures of this type that experts identify.
During apophysiolysis, a rough ossification site, which is called apophysis, comes off. It plays an important role in the growing body of the child, as it is directly involved in the attachment of the musculo-ligamentous apparatus. Among the types of bone fractures, osteoepiphysiolysis and epiphysiolysis should be noted. With such injuries, the articular surface, called the pineal gland, is damaged. It forms a joint along with the adjacent bone.
Symptoms
This type of injury is particularly dangerous because it often proceeds almost asymptomatically or signs of damage are extremely weak. Outwardly, everything may look like a severe bruise.
Here are the main symptoms in which an ordinary person will not be easy to suspect a fracture:
- the pain the child experiences is minor;
- significant discomfort appears only when a broken limb is directly pressed;
- swelling may be completely absent or minimal;
- a hematoma forms at the site of the injury.
However, in most cases, the limb does not lose its motor function, which misleads the parents. As a result, they may not even guess what kind of trauma their child has received, and not understand that this is a bone fracture of the “green branch” type. To avoid troubles, you should definitely contact a traumatologist, no matter what the child is injured. Even if you are sure that this is a normal bruise.
Diagnostics
Only a doctor can accurately diagnose a subperiosteal fracture by the type of "green branch". Therefore, parents should seek medical attention at the slightest suspicion of a fracture. The victim should be promptly taken to a doctor. An appropriate diagnosis can only be made using an x-ray.
It is especially difficult to diagnose such fractures in infants. Difficulties arise due to fatty tissue located under the skin, which significantly complicates palpation. Swelling and soreness, which are accompanied by a high temperature, can lead to suspicions of this damage. All this can lead to the development of inflammation, in particular, osteomyelitis. So it is important to send the patient to an x-ray in a timely manner.
If the victim is small and the displacement during the injury is minimal, then even radiography may not always give an accurate picture of what kind of damage the patient received. In such situations, you need to clarify the diagnosis. Other diagnostic tests may be prescribed for this. This is an accurate measurement of the relative and absolute length of the limbs, computed magnetic resonance imaging, determination of the volume of mobility in the joints and some other methods. In some cases, two x-rays are taken. One injured, and the second a healthy limb. They are carefully compared in order to identify a fracture.
Treatment
There are two ways to treat this type of fracture. It can be surgical and conservative. If the doctor is inclined to conservative therapy, then the patient is given local or general anesthesia, and then a parallel reposition of bone fragments begins. Thus, the doctor eliminates the resulting deflection. As soon as the bone damaged as a result of the fracture becomes anatomically correct, gypsum is applied to the limb.
Surgical intervention is required in certain cases. Here are the most common ones:
- intraarticular damage, accompanied by a shift in the pineal gland;
- trauma to the fingers, femoral neck or end of the humerus;
- fracture, which is complicated by burns, rupture of blood vessels and nerves.
In such situations, surgery should be prescribed. After it is carried out, a plaster cast is applied to the damaged limb. For some time after this, the patient should be given anti-inflammatory and analgesic drugs.
Recovery process
It is worth noting that the recovery period in children proceeds quite quickly, bone tissue is well restored. This is facilitated by several factors. This preserves the nutrition of soft tissues in the region of the bone and in the bone itself; the blood circulation process is not interrupted. In the children's body, in general, the processes of regeneration of all types of tissues proceed in an accelerated mode.
In addition, collagen production begins, bone marrow is quickly formed on the damaged area. Finally, this contributes to the complete absence or small number of fragments.
In most cases, the plaster cast from the damaged area is removed after four weeks. After this, you can not do without a full rehabilitation course.
Plaster removal
The doctor releases the limb from the cast as soon as it heals. Immediately appointed all the necessary procedures. With their help, it is possible to develop joints and strengthen muscles, restore motor functions. Among such procedures, physiotherapy exercises, massage, physiotherapy, classes in the pool, treatment in a sanatorium should be highlighted.
At this time, providing a child with nutritious nutrition, which should include a variety of foods rich in trace elements and vitamins, is of great importance. First of all, calcium. The child should provide comprehensive care, lack of stress. All this will allow you to recover as quickly as possible.
To prevent such injuries, from the first years of life, one should explain to the baby the importance of observing elementary safety rules during sports and outdoor games.
Radius damage
Another common type of damage is a fracture of the radius in a typical location. By this definition is meant a fracture of the distal metaepiphysis of the radius.
This trauma is very common, because this bone is considered the thinnest in the human body. In addition, it has a characteristic structure - the cortical layer is very thin, and the spongy inner part is characterized by reduced strength.
Menopause women are most affected by such damage. This happens due to the characteristics of the hormonal system. During this period, representatives of the weaker sex develop osteoporosis, the amount of calcium in the bones is significantly reduced. All this greatly increases the risk of fractures.
Fracture mechanism
In most cases, this damage can be encountered when a person extends his arm forward when falling. There are two types of fracture of the radius in a typical place, depending on the position of the wrist. A fracture is a flexion, then the bone moves inward. If it is an extensor, in such a situation the fragment moves outward.
An extensor fracture is considered more common, since people who fall more often nevertheless extend the hand.
Signs
Patients with such a fracture immediately experience severe pain. Mobility in the joint is impaired, swelling appears at the site of damage.
In some cases, the entire limb may be deformed, and when trying to make movements, a crunch of fragments is heard.
With an open fracture, parts of the bone are visible in the wound.
First aid
At the first suspicion of this type of fracture, you must immediately call an ambulance. If there is no way to quickly get to the hospital, you need to give your hand immobility using any means at hand. It can be a board, a stick, a branch. You should also apply a cold.
The diagnosis is made after an x-ray at the emergency room or hospital. Usually, with this diagnosis, the patient is hospitalized. The treatment tactics in each case are determined individually.
When the cast is removed, it is important to adhere to the rules of how to develop a hand after a fracture. If the radius is damaged, the Elizarov apparatus is installed. This will help to avoid the displacement of fragments. After removing the apparatus, wounds may remain in the soft tissue, so vigorous movements should be avoided to prevent bleeding. Only after healing of all wounds does full recovery begin.
Shin fracture
Fracture of the lower leg refers to significant damage to the tibia and tibia due to exceeding the load that they could not withstand. This is a common injury, including among children and adolescents.
In ICD 10, a leg fracture has the code S82. The injury may be closed or open. The method of treatment depends on its complexity and nature.
Closed fracture
A closed fracture is considered very significant damage. In this situation, the condyles of the tibia, ankle bones often suffer.
With such a fracture, the limb mobility is sharply limited in the patient. The patient is unable to raise his leg. When you try to raise the lower leg, the end of the tibia under the skin begins to protrude. Also, when you feel it, a characteristic crunch is heard.
In the process of treatment using the extension method, that is, the extension of the damaged bone. It can be glue or skeletal.
Among other methods of therapy, the operational method is distinguished. It involves intraosseous fixation using metal knitting needles, rods or plates. The fixation method is also applied by applying a plaster cast.
If the minor was injured, he cannot do without crutches.
Open fracture
With an open fracture, bleeding appears. The patient experiences a traumatic shock, he has a gaping wound with bones to the outside, which broke through the soft tissue and skin. Such damage is accompanied by severe pain, limited mobility, dizziness and weakness.
If the fracture is primary, one reduction is enough. If the nature of the damage is screw-shaped or oblique, seams are fixed with fixation on the wire. In the treatment of open fractures of the leg, the victim is usually inserted metal rods. On each side they have openings through which special substances, for example, antibiotics, are fed into the medullary canal. After this, gypsum is applied.