Distal fracture of the shoulder
One of the most common fractures is the distal fracture of the shoulder. This fracture can be epiphyseal, supracondylar or overcross. Epiphyseal and epicondylar fractures can be caused by a fall on the outstretched arm, and an extra-muscle fracture is the result of child abuse.
Diagnosis is established using the x-ray of the limb in the posterolateral and anterior direct projections. Violation of the connection of the shoulder with the ulna and radial bones or with the appearance of an edema on the back surface of the elbow indicates the presence of an overexploitation or radiologically non-rectifiable fracture. With such fractures, an attempt to move the hand causes pain and swelling. Neurological disorders may also appear: if the injury is localized next to the medial, radial or ulnar nerves.
Reparation of fragments is important for the treatment of distal fracture of the shoulder. Only careful repositioning can prevent deformation of the humerus and ensure its normal growth. Repositioning is carried out in a closed way or with the help of internal fixation of fragments, in the extreme case, an open reposition is made.
Distal fracture of the radial and ulnar bones
Often in children met and compression fracture metaphysis of the radius. It is caused by falling on a hand with the straightened brush. Sometimes such a fracture can be mistaken for a bruise, so the hospital with such fractures are treated only 1-2 days after receiving the injury.
The diagnosis is made using the x-ray of the brush in the lateral and anteroposterior projections. For treatment, plaster is applied to the wrist and forearm. He grows up in 3-4 weeks.
Fracture of the phalanges of the fingers
The cause of the fracture of the phalanx of the fingers in children is most often the pinching of the fingers with the door. Under the nails with this fracture, hematomas may be formed that require drainage. When opening the bleeding from under the nail bed or with partial detachment of the nail, an open fracture can be diagnosed. In this case, it is necessary to prevent tetanus and apply antibiotics.
Diagnosis is made using the x-ray of the finger in the lateral and anterior direct projections. In the treatment, a gypsum dressing is applied. Closed repositioning of fragments is only needed if the phalanx is rotated or bent.
Fractures in children beginning to walk
A screw-shaped fracture of the tibia (distal third) occurs in children 2 -4 years. Such a fracture can occur when stumbling over something or falling during a game. As a result, there is swelling of the soft tissues, the child feels pain and turns to walk.
The diagnosis is based on the x-ray in the lateral and forward direct projections. In some cases it is additionally necessary to do an x-ray in an oblique projection or a scintigraphy of bones. Treatment consists in imposing a high plaster boot. After 1 to 2 weeks, Podnostic bone formation takes place, and bone adhesion occurs after 3 weeks.
Lateral fracture of the ankle
The separation of the epiphysis of the fibula has stretch symptoms: in lateral area of the ankle appears pain and swelling. The diagnosis is confirmed by radiography under load (normal radiography of the fracture does not reveal).
Treatment of the lateral fracture of the ankle is made by immobilization of the fibula with a plaster sapozhkom. Treatment lasts 4-6 weeks.
A fracture of the metatarsal
A fracture of the metatarsal can be caused by a trauma to the rear of the foot. In this case, the child swollen soft tissue and a bruise. Diagnosis is established by the x-ray of the foot in the lateral and anteroposterior projection.
As a treatment, a gypsum dressing is used, which looks like a gypsum boot. With a fracture of the diaphysis V metatarsal bone fracture may not grow together. In this case, one can rely on the leg only after radiologic confirmation of the presence of signs of bone fusion. Fracture of the phalanges of the toes
Such a fracture in the child may occur as a result of trauma when walking barefoot. At the same time, bruises appear on the fingers, they swell and become painful. The diagnosis is made using an X-ray. The presence of bleeding indicates an open fracture.
In the absence of a strong bias, a closed reposition of the fragments is not performed. Treatment consists in tying a sick finger to a healthy one for a few days: until the edema recedes.
Surgical treatment of fractures in children
Surgical treatment of fractures in children is performed in 2-5% of cases. Stabilization is performed surgically with an unstable fracture, with multiple or open fractures, with intraarticular fracture or fracture of the epiphyses with displacement of fragments.
In the treatment of fractures in children, three basic surgical methods:
open reposition with internal fixation
closed reposition with internal fixation
/ The open reposition with internal fixation is used intra-articular fractures, with biased fractures of the epiphyses, with unstable fractures, with damage to blood vessels and nerves, as well as with an open fracture of the shin or thigh.
Closed reposition with internal fixation is used metaphyseal or diaphyseal fractures, with intraarticular fracture e / or fracture of the epiphysis, as well as with fracture of the femoral neck, finger phalanges or distal part of the shoulder.
External fixation (complete immobilization of the fracture site) is done with fractures accompanied by a severe burn with unstable fracture of the pelvis, with an open fracture 2 nd or 3 rd degree, with a fracture accompanied by damage to the nerves and blood vessels.