Fractures in children


Fig. 6. Fracture of the type of "green branch". Fig. 7. Subperiosteal fractured elbow bone.

Fig. 8. Epiphyseal radial bone offset.

Peculiarities in the structure of the bones in children cause fractures, peculiar only to the children's age. These include cuts or broken bones on the type of "green branch" (Fig. 6), and subperiosteal fractures, when broken bone remains covered by intact periosteum (Fig. 7). Fragments in these cases shifted slightly. Only in children and adolescents there are such kinds of fractures, as epiphyseolysis when there is separation of epiphysis on line germ cartilage, epiphysis when it is separated from the metaphysis, and shifted (Fig. 8). On the mechanism of injury epiphyseolysis such dislocations occur in adults and in those bones, where joint bag is attached to the epiphyseal cartilage (the lower end of the femur, wrist and ankle joints). Clinical signs of fractures in children in General similar to those observed in adults, but in children often marked increase in temperature in the first few days after injury. Diagnosis is difficulty subperiosteal fractures and when epiphyseolysis without bias, as well as due to poor contrast on radiographs cartilage epiphysis in young children. The Union of fractures in children due to good blood supply to the bone, and of periosteum is happening much faster than adults. Treatment is determined by the type of fracture and the age of the child. The majority of fractures treated fixing bandage in the form of a plaster splint, which should cover 2/3 of the circle limbs and two adjacent joints above and below the fracture site. The Paris splint is placed is fixed a gauze bandage. Circular plaster cast in children is not used because of the danger of eating disorders of the limbs. When there is a shift fragments before imposing Longuet need to be mapped. When reposition fragments should do to correct angular displacement. Most often used simultaneously manual reposition under General anesthesia. At fracture of the femur and Shin bones of the significant shift apply traction, which in infants and toddler by using sticky tape or kleola. In older children at fracture of the femur impose skeletal traction spoke conducted through the proximal tibial metaphysis or distal mutatis thigh.
At fracture of leg bones with a significant shift in older children spoke conducted through the heel bone. In newborns and infants at fracture of the femur apply, as a rule, lipoplasties vertical traction. Indications for the surgical treatment of fractures in children is very limited.

Fractures in children differ in a number of peculiarities. This is due to the large amount of ossein in the bones of the child, as well as a thick periosteum, which give the flexibility and elasticity of bones in children. Anatomical features can be explained by a fracture, characteristic only for children (lead cores of ossification, subperiosteal P., fractures and epiphyseolysis), and the rare occurrence of traumatic fractures in the joints. P. cervical hip and P. ankles occur only rarely.
Due to good blood supply and the severity of the periosteum and smaller thickness of the bones in children regeneration processes at fracture expressed better and the accretion of fragments is faster than adults. Approximate terms of accretion P. (in the day) in healthy children, depending on age - see table.

Name bones Age
up to 2 years 3-7 years 8-15 years
Collarbone
Shoulder
Ulnar and radial
Femoral
Tibia
Metacarpal
Metatarsal
7
12
12
14
14
7
7
10-14
14-20
14-20
15-25
15-21
10
10
15-18
20-25
20-25
25-35
25-28
15
15

Conservative treatment of P. in children are leading. When intra-articular P. inaccurate mapping or removal of loose joint ends in the future causes a sharp delay of growth of bones and secondary deformation. Children under 7 years of age at the correct axis of the limb in the process of growth of the child may self-improvement displacement of bone fragments length within 2 a and spans across the bones. In connection with fast development, as well as losing swelling at fracture in children instead of a circular plaster bandage is applied Paris splint is placed.
Operative treatment of P. shown in children older than 5 years in the following cases: if the failed conservative treatment, when the majority of intra-articular P., when correctly fused P., accompanied by a significant violation of the functions with open fractures with significant damage of soft tissues, P. involving injury neurovascular bundle, with some pathological P. In surgical treatment of P. it is necessary to apply new methods of osteosynthesis (simple mapping of fragments, podselenie silk or catgut, fixing pin Kirchner, rod Bogdanov, nail cyto or Sokolova). Tactics in the treatment of pathological P. in children coincides with that of adults.