Fractures in children. First aid and treatment

Content

  • Features of bone fractures in children
  • Types of fractures
  • As suspected fracture?
  • First aid
  • Treatment
  • The recovery period
  • Complications of fractures

  • child injury statistics indicatethat bone fractures in children occur in non-severe injury and mundane circumstances - at home, on the street, on the playground, such as a fall from a great height, while running or walking, etc. Fractures of the bones of the hands of children are found in 2 times more often than the legs. The most common fracture site is the elbow and forearm. Fortunately, severe multiple injuries in children are uncommon and comprise 2.5% - 10% of all injuries of the musculoskeletal system.

    Features of bone fractures in children

    The child's bones contain a greater number oforganic substances (protein ossein) than in adults. skin covering the bone on the outside (the periosteum) thick, well supplied with blood. Also for children there are growth areas of bone tissue. All these factors determine the specificity of children's fractures.

    • Fractures in children. First aid and treatment Often, bone fractures in children occur attype of "green branches". Outwardly, it looks as if the bone broke down and bent. 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.
    • the fracture line often passes for the growth zonebone, which is located near the joints. Damage to the growth zone can result in premature closure and subsequent to forming the curvature, truncations, or a combination of these defects during the growth of the child. The earlier in life there is a damage zone of growth, the more detrimental effects it causes.
    • Children more often than adults, there are outgrowths of bone fractures, which are attached to the muscles. Essentially, data are broken detachments of ligaments and muscles to bone fragments of bone.
    • bone tissue in children grow together more quickly than adults, due to good blood supply is, the periosteum and accelerate the formation of callus.
    • In children younger and middle age groupspossible self-correction of residual displacement of bone fragments after a fracture, which is associated with bone growth and I am functioning of muscles. While some displacements undergo self-correction, while others do not. Knowledge of these laws is essential to solve the problem of surgical treatment of fractures.


    Types of fractures

    Depending on the status of bone tissuedistinguish pathological fractures and traumatic. Traumatic fractures occur from exposure to the 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 rather insignificant mechanical action. Often referred to as spontaneous pathological fractures.

    Depending on the condition of the skinfractures 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 are considered to be aseptic, non-infected (uninfected). In open fractures has been a violation of skin integrity. The size and nature of skin lesions differ from the point to the huge wound of soft tissue defect to their destruction, crush and pollution. A special type of open fractures are fractures of the gunshot. All open fractures are initially infected, ie, having microbial contamination!

    Depending on the degree of dissociation of bonefragments distinguish fractures without displacement and with displacement. Fractures with displacement can be full when the connection between the bone fragments and has broken their complete separation. Incomplete fractures, when the connection between the fragments is not compromised throughout, bone integrity largely maintained or bone fragments are held periosteum.

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

    Depending on the type of bone fractures distinguishflat, spongy and cortical bones. By the flat bones include the skull, scapula, ilium (pelvis form). Most often in fractures of flat bones significant displacement of the bone fragments nevoznikaet. By spongy bones are the vertebrae, heel, collision and other bones. Spongy bone fractures are characterized by compression (compression) and bone leads to compression of the bones (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 diaphysis and epiphysis) .

    Depending on the number of damaged areas(Segments) of extremities 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 or chest).


    As suspected fracture?

    To suspect that a child has a fracture difficult. Most often, the child is excited, crying. The main symptoms of bone fractures in children are severe pain, swelling, swelling, deformation of the damaged segment of the limbs, inability to function (for example, the inability to move his hand, stepping on the foot). The skin in the area of ​​the projection of a bruise may develop fractures (hematoma).

    A special group of fractures in children areCompression fractures of the spine, which occur at unusual injury, usually a fall on the back with a small height. The insidiousness of these fractures is that their diagnosis in children is difficult even with hospitalization in the casualty 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. Difficulties of diagnosis in this group of fractures related to the fact that the basic radiological signs of vertebral damage due to trauma - its wedge shape, which in children 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.

    Fractures of the pelvic bones are heavydamage and soreness occur, the inability to get to his feet, swelling and deformity in the pelvic area, sometimes there is crepitus (crunching, creaking) of bone fragments at the feet movement.


    First aid

    First aid for fractures of limbsimmobilization is damaged segment with the help of available tools (boards, sticks and other similar items), which are secured with a bandage, handkerchief, scarf, cloth, etc. It is necessary not only immobilize the affected area, but also the two adjacent joint .. For example: for fractures of the forearm bones is necessary to fix the damaged segment of a limb and wrist and elbow joints, with fractures of the tibia - the damaged segment of the limb with the knee and ankle joints.

    For pain relief can be affectedgive based analgesic paracetamol or ibuprofen. It is necessary to try to calm the child, above all, his calm demeanor. Then call

    "ambulance" (It can be called before the commencement of the firstassistance) alone or head to the nearest children's hospital (the emergency room), emergency station. Since the open fractures there is 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.

    Damaged skin free from clothes(Hand of the one who assists, should be washed or treated with an alcoholic solution). When arterial bleeding (bright red blood flows pulsating jet) need to press the bleeding vessel above the bleeding place - where there is a large muscle mass, where the artery is not very deep and can be pressed down to the bone, such as the brachial artery - in elbow . When venous bleeding (dark blood pouring continuously and evenly, not pulsing), you must press the bleeding vein below the bleeding site and locked in the raised position the injured limb.

    If the bleeding does not stop, close the wound with a large piece of gauze, a clean diaper, towel, sanitary napkin (to clamp the wound should be until medical help arrives).

    Fractures in children. First aid and treatment If there is no open fracture bleeding, thenskin, remove dirt, bits of clothing, ground. The wound can be rinsed under running water or pour hydrogen peroxide (formed foam must be removed from the edges of the wound with sterile gauze). Further, the wound should be dry apply a sterile bandage. An open fracture is an indication for vaccination against tetanus (if the period since the last revaccination has not been carried out previously or has expired), that needs to be done in the emergency room or hospital.

    First aid for falls from a height isimmobilization of the spine and the pelvis, which then often damaged. The victim must be put on a firm, flat surface - a board, boards, rigid stretcher, etc. If you suspect a fracture of the pelvis in the popliteal the legs fit cushion. All this leads to the relaxation of the muscles and prevents secondary displacement of the bone fragments.

    If a child is damaged hand and can move independently should contact the Children's emergency station, who, as a rule, there is every children's clinic and hospital.

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

    Hospitalization performed in cases of bone fracture with displacement requiring repositioning (matching fragments) or surgery, and fractures of the spine and pelvis.

    Diagnosis of bone fractures in childrenIt performed in the emergency room or emergency rooms or children's hospitals traumatology surgeons. Of great importance for the correct diagnosis has 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) produce computer or magnetic resonance imaging. In the case of associated trauma to diagnose the state of internal organs carried ultrasound (ultrasound), blood tests, urine, etc.


    Treatment

    Due to the rather rapid coalescence of bone inChildren, especially those younger than 7 years, the leading treatment for fractures is conservative. Fractures without displacement of bone fragments are treated by applying a plaster splint (option plaster bandage covering not the entire circumference of limbs, 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 doctor visits in the normal course of healing of fractures period is 1 in every 5 - 7 days. The criterion for the correct casting of a pain subsided, no violation of sensitivity and movement in his fingers the hand or foot.

    "alarming" symptoms that bandage compresseslimb pain are expressed edema, disturbance of sensitivity and movement in his fingers the hand or foot. When these symptoms should immediately seek traumatologist. Treatment of fractures by applying a plaster cast is a simple, safe and effective method, but unfortunately, not all fractures can heal is the only way.

    In fractures with displacement, with heavycomminuted, intra-articular fractures of the surgery is performed under general anesthesia - closed reposition of bone fragments, followed by casting of. The duration of surgical procedure - a few minutes. However, the conduct of anesthesia did not let go of the child's home immediately. The victim must be retained in the hospital for a few days under the supervision of a physician.

    In unstable fractures for preventionsecondary displacement of bone fragments often used Transosseous fixation of metal spokes, ie, bone fragments are fixed with needles and an additional plaster cast. As a rule, reduction and fixation technique doctor determines prior to the manipulation. When fixing the fracture area spoke in the subsequent ligation of the necessary care and places the output of the spokes of course, this method provides a reliable fixation of the fracture, and 3 - 5 days a child can be discharged to outpatient treatment.

    In pediatric traumatology widely used methodcontinuous skeletal traction, which is most often used for fractures of the lower limbs and is to hold the spokes through the calcaneus or the tuberosity of the tibia (shin bone), and limb extension load for a period of fracture healing. This method is simple and effective, but it requires in-patient treatment and constant supervision of a physician to complete fracture healing.


    The recovery period

    Dates seam fractures in children depend onage 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, lower limb bone fractures - from 1.5 to 2.5 months from the date of injury, fractures of the pelvis - from 2 to 3 months. Treatment and rehabilitation of spinal compression fractures depends on the age of the child and can last for up to 1 year.

    Fractures in children. First aid and treatment Active recovery period beginsafter removing the plaster immobilisation or other fixation. Its purpose is the development of movements in adjacent joints, strengthening muscles, restoring the ability to support the injured limb, and so on. By means of rehabilitation treatment includes physiotherapy (physical therapy), massage, physiotherapy, pool. Physiotherapy and massage courses held 10 - 12 sessions and helps to improve blood and lymph microcirculation in the damaged area, restoration of muscle function and movement in the joints.

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

    In severe open fractures, complicatedblood circulation, it is recommended treatment with oxygen under high pressure in the chamber - a method of hyperbaric oxygenation (used to prevent infection and helps activate the metabolic processes in the body).

    Reducing treatment (rehabilitation)It begins in the hospital and then continued on an outpatient basis. In severe injuries, accompanied by a pronounced violation of the functions of the damaged segment being treated in rehabilitation centers, as well as spa treatment.


    Complications of fractures

    For complex fractures may expressviolation of the injured limb function, pain. Open fractures are often accompanied by blood circulation disorders. The consequences of undiagnosed spinal compression fractures in children leads to the development of juvenile osteochondrosis - degenerative (associated with malnutrition tissue) diseases of the spine, which affects intervertebral discs, accompanied by their deformation, changes in height, stratification. Also, these fractures can cause spinal deformities, incorrect posture and persistent pain syndrome. Fractures of the pelvis may be accompanied by damage to the hollow organs such as the bladder.

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