The human hand consists of three parts, andnamely: the radius, humerus and ulna. Today, their fracture is the most common injury. After all, no one is immune from falls and injuries, especially a child. Both in adults and in the elderly, half of the cases of injury are due to a broken arm. As for children, according to statistics, they usually get this injury under trivial circumstances, for example, at home or on a playground, when falling from a height, while walking or running, and so on. Children injure the bones of their arms twice as often as their legs. The most “popular” fracture is in the elbow joint, and the second “sore” place in a child is the forearm. Severe multiple injuries, fortunately, are much less common - approximately 2.5% of 10% of all injuries to the musculoskeletal system.
Feature of children's fractures
A child's bones are different from those of adults.the fact 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. These are the factors that determine the specific features of injuries in children, which we will discuss below. Most often, a child can be observed with a "green branch" fracture. It has this name because the bone looks like it was broken and then bent. However, this is not the most severe injury. After all, the displacement of bone fragments may not be strong, since the fracture occurs only on one side. On the other side, the dense periosteum helps to avoid damage, holding the fragments under stress. Sometimes a fracture of the arm that occurred at a young age can have serious consequences in the future. The fact is that the joint line of the bone (radius, ulna or humerus) often passes through the area of connective tissue growth located near the joints. Its damage can lead to premature closure and the formation of shortening, curvature, or a combination of both defects as the child grows up. Therefore, parents should monitor their child and protect him in every possible way from possible falls and injuries. Unlike adults, children most often have injuries to the growths on which the muscles are attached. In fact, such a fracture is a tear of muscles and ligaments from the bone. However, the tissues in a child grow together much faster than in an adult. This is due to the good supply of blood to the periosteum, as well as accelerated callus formation processes. Therefore, any fracture (legs, arms) in a child will heal much faster than in an older person. Another feature of injuries at a young age is the possible self-correction of the consequences of displacement of bone fragments after an injury. This is due to the functioning of muscles and bone growth. However, it should be taken into account that the body will be able to cope with one displacement and “model” it, but not with another. Knowledge of such patterns is important for every parent. Because in the event of injury to the baby, it is you who have the final say in deciding on surgical intervention and further treatment.
Hand fracture: classification
Let's take a closer look at the types of thesedamage. They can be traumatic and pathological. The latter are the result of painful processes occurring in the bone, disrupting its structure, integrity, as well as strength and continuity. To cause such damage, a small force from the outside is enough, for example, a light push or blow, so they are sometimes called spontaneous. Well, a traumatic fracture of the arm is, on the contrary, a consequence of the impact on the bone of a short-term mechanical force of significant magnitude. According to statistics, it occurs much more often than a pathological one. A 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 damaged, and all bone fragments and the area of the injury are isolated from the environment. An open fracture of the arm is characterized by damage to the skin. This can be either a small wound or, conversely, 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 degreetissue separation. A fracture (of the radius or other) with displacement is considered complete if the connection between the fragments is broken. An incomplete fracture is one in which the integrity is practically preserved (or the fragments are supported), that is, the connection is not completely separated. Arm fractures are also classified by the direction of the line of damage to the bone (ulna, radius or humerus). Depending on this, they are divided into transverse, spiral, longitudinal, as well as oblique, stellate, T- and V-shaped. Do not forget that a child can have a fracture of flat (skull, pelvis, scapula), spongy (vertebrae, talus, calcaneus and others) and tubular bones. The problem here is that they form the basis of the limbs. Often, displacement causes injuries to tubular bones, which, depending on their location, are diaphyseal (damage to the middle part), epiphyseal (violation of the integrity of the terminal section), and metaphyseal. Depending on the affected area, there are isolated fractures (of one part) and multiple fractures (of two or more segments). Combined injuries are also possible, when, for example, a hand injury is “supplemented” by others (craniocerebral, abdominal, etc.). Each case differs not only in possible consequences, but also in the treatment method. Therefore, keep an eye on your child, tell him about the rules of conduct on playgrounds. After all, everyone knows that an injury, like a disease, is easier to prevent than to cure!
How to identify this trauma in children
How to recognize if your arm is brokena child, is not difficult at all. In this case, the clinical manifestations of complete bone damage (radius, ulna and others) with displacement of their fragments are practically no different from those in adults. A child in an unhealthy state is usually excited, crying and capricious. An obvious symptom of a fracture is pain in the injured area, swelling and puffiness, deformation of the arm and the inability to act, for example, to move the damaged segment, may be observed. A hematoma often forms on the skin in the projection area. In the first few days after the injury, the child's temperature rises to 37-38 degrees, which is associated with the absorption of the contents of the bruise. However, errors in diagnosis are far from uncommon, especially with injuries in small children. So, in the case of a fracture, epiphysiolysis, osteoepiphysiolysis and subperiosteal fractures, which are not characterized by displacement, the mobility of the limb may be preserved, its contours remain unchanged. Only when palpated is there pain in a limited area. Therefore, such a fracture is often diagnosed as a bruise, which is fundamentally wrong. Other factors also make recognition difficult: insufficient anamnesis, well-defined subcutaneous tissue, which significantly complicates palpation, fragments that are not characterized by displacement, as a result - the impossibility of identifying an injury under the periosteum. The danger of such unqualified conclusions is incorrect treatment, which can subsequently lead to curvature of the limb and disruption of hand function. Therefore, in order to make a 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 has injured his hand in this way,the very first thing that needs to be done 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 the fracture occurred in the forearm, then the damaged segment of the arm, as well as the radius and elbow joints, should be immobilized. This will reduce pain and reduce the risk of further displacement. And this can happen with any bone: radius, humerus, ulna - it all depends on where the blow fell. Then you need to apply a splint to the limb from improvised materials (use a ruler, stick, etc.) and hang it on a bandage made of a scarf or shawl thrown over the neck. If the arm looks unnatural, do not try to bring it back to its original appearance and straighten it. This will only cause unnecessary pain to the victim. In addition, if the bones have shifted, your actions can increase 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, then the wound is infected. In this case, bleeding may begin from the vessels damaged by bone fragments (radius, ulna or humerus, depending on the injury). Therefore, before immobilizing the limb, you need to stop the blood loss, treat the wound and apply a bandage (necessarily sterile)! To do this, first wash your hands (or the person who will provide first aid) and free the damaged area from clothing. A sign of arterial bleeding is a bright scarlet color of blood flowing in a pulsating stream. In this case, press the vessel slightly above the site of injury - where there are no dense muscle masses, where the artery lies close to the surface. If bleeding from a vein, press it below the place from which the blood flows (dark and not pulsating) and fix the arm in a slightly raised position. If bleeding does not stop, apply pressure to the wound with a clean towel, piece of cloth, gauze or other available means until the doctor arrives. If the child has an open fracture but there is no bleeding, simply remove any clothing scraps, dirt or other external irritants from the skin surface. Rinse the wound under running water, or ideally with hydrogen peroxide. In the latter case, foam may form, remove it from the edges of the injured area with a clean piece of cloth and apply a dry sterile bandage. An open fracture (of the radius and others) is an indication for tetanus vaccination. Keep this in mind if the vaccination has not been administered or has expired. Give the child a painkiller (usually ibuprofen or paracetamol-based medications), but do not feed or give water, as anesthesia may be needed in the hospital. What happens next depends on the correct diagnosis and prescribed treatment, so take the child to the nearest clinic as soon as possible. Children are examined in emergency rooms, in some cities in hospital admissions departments, by surgeons and traumatologists. In this case, an X-ray examination is mandatory!
What treatment is shown for fracture
Children's bones heal quite quickly,especially at primary school age (up to 7 years), therefore the most common method of recovery is conservative. If the fracture is not accompanied by displacement of fragments, it is enough to simply apply the so-called plaster splint. It does not cover the entire circumference of the injured limb, but only part of it. Normal fractures without displacement do not require hospitalization and are treated on an outpatient basis. With normal fusion of the radius and other bones of the injured arm, you will have to visit a traumatologist during the rehabilitation period every five to seven days. With the correct application of the bandage, the child's pain gradually decreases, and later it disappears completely. There should be no movement or sensitivity disorders in the fingers. If the bandage was applied unprofessionally and the limb is squeezed, such "alarming" symptoms as aching pain, swelling, loss or exacerbation of sensitivity may be observed. If at least one of them occurs, consult a doctor! Unfortunately, simple plaster casting does not always help. In case of severe fractures with displacement (for example, intra-articular radius bone), surgery under general anesthesia may be required – closed reposition of fragments with subsequent plaster casting. Such surgical intervention lasts only a few minutes, but due to anesthesia, the child is left in the hospital under the supervision of a doctor. To prevent repeated displacement in unstable fractures, fixation with metal pins can be used. Initially, bone fragments (radius or ulna, forearm, depending on the injury) are fixed with them, and then a plaster cast is applied. This method requires special care and dressing, so children are hospitalized for three to five days, and then outpatient treatment is prescribed.
Recovery period
On the timing of fusion of the radius, elbow and humerusThe condition of the bones is influenced by several factors: age, nature and location of the fracture. On average, it takes 1-1.5 months to restore the arm. A complex case with displacement will take a little longer. The active period of rehabilitation begins after the removal of the plaster cast or other types of fixation (for example, pins for a severe fracture of the radius). At this time, the child should be forced to develop movements in adjacent joints, increase muscle tone, and restore the supporting capabilities of the injured limb. For this, therapeutic exercise, special massage, swimming and physiotherapy are indicated. All these procedures must be carried out 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 movements in the joints. Particular attention during treatment should be paid to the nutrition of children. Include in the child's diet supplements containing the necessary groups of minerals and vitamins. In case of open fractures complicated by circulatory disorders, oxygen treatment is recommended - hyperbaric oxygenation. This method is used to prevent infection and helps to activate metabolic processes in the child's body. Initially, treatment begins in a hospital, and then continues in an outpatient setting. Sometimes after a complex fracture, there may be a dysfunction of the injured arm and pain syndrome. In such cases, treatment can be carried out in special rehabilitation centers. We recommend reading:
