Bone fractures in children. How to Diagnose Low Bone Density in Children Anatomy and Injury

I will give a brief summary of the main points on diagnosis from the mentioned article.

The evaluation of children with fractures is often challenging because there are no clear guidelines for differentiating traumatic fractures from fractures caused by bone pathology. Although most fractures in children are not serious, recurrent fractures can be associated with a wide range of both primary bone diseases and secondary causes, necessitating a thorough history and physical examination.
Currently, there is no “gold standard” for the examination and treatment of children with fractures and low BMD, so the diagnosis of osteoporosis in pediatric practice should be established based on a combination of clinical and radiological signs.
Interpretation of densitometry data in growing patients is difficult because actual BMD measured by DXA depends on many factors that change over time. Interpretation of BMD results should be based on the Z-score (SD relative to age, gender, ethnicity-matched controls) using databases specific to the densitometer model and patient population.

Clock fractures in the pediatric population (frequency up to 50% in boys and up to 40% in girls), this especially applies to fractures of the distal radius. The peak incidence of fractures occurs between the ages of 11 and 15 years, which corresponds to the period of maximum growth rate and lag in bone mass accumulation.

Rare vertebral compression fractures in children and vertebral and hip fractures without significant trauma (eg, car accident) are considered clearly pathological.

The list of conditions associated with reduced bone strength in children is extensive (Table 1), but most of them can be excluded with a careful history, physical examination, and the use of specific diagnostic tests.
Primary skeletal diseases leading to juvenile osteoporosis are relatively rare, the most common of which is osteogenesis imperfecta: type I may be accompanied by blue staining of the sclera, dentin pathology, and the development of hearing impairment; heredity can be traced, genetic markers are available. In the absence of these signs, the presence of idiopathic juvenile osteoporosis, a rare disease characterized by multiple pathological fractures in school-age children and spontaneous stabilization after puberty, may be suspected.

Secondary osteoporosis is a complication of a significant number of chronic diseases (Table 1), and a decrease in BMD may be a consequence of the underlying disease, a complication of therapy, or a combination of these factors. Vitamin D deficiency and reduced dietary calcium intake also lead to decreased BMD along with the development of rickets. A decrease in BMD was noted in children with idiopathic hypercalciuria.

Any child with a pathological fracture needs BMD determination. Densitometry is indicated for clinically significant fractures, such as long bone fractures of the lower extremities, vertebral compression fractures, and 2 or more long bone fractures of the upper extremities.
In the case of multiple traumatic fractures, the decision to screen is made individually, taking into account the number and severity of fractures.
Typically, DXA is performed on the lumbar spine, proximal femur, distal radius, or whole body.

Taking into account the large number of causes of fractures against the background of decreased BMD, the examination plan should be based on anamnesis and physical data. We recommend, at a minimum, obtaining routine hematological and biochemical parameters, ESR, intact parathyroid hormone, blood calcium and phosphorus, 24-hour urine calcium, and screening for celiac disease. Determination of 25-OH-D is also necessary.

Bone marrow biopsy, endoscopy/colonoscopy, liver biopsy, and genetic testing may be performed as indicated.
Markers of bone remodeling can be useful in the selection of therapy, but require very careful interpretation in children.
I hope my colleagues will complement me.

• Which doctors should you contact if you have bone fractures in children?

What are bone fractures in children

The anatomical features of the structure of the skeletal system of children and its physiological properties determine the occurrence of certain types of fractures that are characteristic only of this age.

It is known that young children often fall during outdoor play, but they rarely experience bone fractures. This is explained by the child’s lower body weight and well-developed soft tissue cover, and therefore by a weakening of the impact force during a fall. Children's bones are thinner and less strong, but they are more elastic than adult bones. Elasticity and flexibility depend on the smaller amount of mineral salts in the child’s bones, as well as on the structure of the periosteum, which in children is thicker and richly supplied with blood. The periosteum forms a kind of sheath around the bone, which gives it greater flexibility and protects it from injury. The preservation of bone integrity is facilitated by the presence of epiphyses at the ends of the tubular bones, connected to the metaphyses by wide elastic growth cartilage, which weakens the force of impact. These anatomical features, on the one hand, prevent the occurrence of a bone fracture, on the other hand, in addition to the usual fractures observed in adults, they cause the following skeletal injuries typical of childhood: fractures, subperiosteal fractures, epiphysiolysis, osteoepiphysiolysis and apophysiolysis.

Breaks and fractures like a green branch or a willow twig are explained by the flexibility of bones in children. This type of fracture is observed especially often when the diaphysis of the forearm is damaged. In this case, the bone is slightly bent, on the convex side the outer layers are subject to fracture, and on the concave side they retain their normal structure.

Pathogenesis (what happens?) during bone fractures in children

Subperiosteal fractures characterized by the fact that the broken bone remains covered with periosteum, the integrity of which is preserved. These injuries occur when force is applied along the longitudinal axis of the bone. Most often, subperiosteal fractures are observed on the forearm and lower leg; In such cases, bone displacement is absent or very insignificant.

Epiphysiolysis and osteoepiphysiolysis- traumatic separation and displacement of the epiphysis from the metaphysis or with part of the metaphysis along the line of the germinal epiphyseal cartilage. They occur only in children and adolescents until the ossification process is complete.

Epiphysiolysis occurs more often as a result of the direct action of force on the epiphysis and, according to the mechanism of injury, is similar to dislocations in adults, which are rarely observed in children. This is explained by the anatomical features of the bones and ligamentous apparatus of the joints, and the place of attachment of the articular capsule to the articular ends of the bone is of significant importance. Epiphyseolysis and osteoepiphysiolysis are observed where the joint capsule is attached to the epiphyseal cartilage of the bone: for example, the wrist and ankle joints, the distal epiphysis of the femur. In places where the bursa is attached to the metaphysis so that the growth cartilage is covered by it and does not serve as a place for its attachment (for example, the hip joint), epiphysiolysis does not occur. This position is confirmed by the example of the knee joint. Here, during injury, epiphysiolysis of the femur occurs, but there is no displacement of the proximal epiphysis of the tibia along the epiphyseal cartilage.

Apophysiolysis is the separation of the apophysis along the line of the growth cartilage. Apophyses, unlike epiphyses, are located outside the joints, have a rough surface and serve for attachment of muscles and ligaments. An example of this type of injury is displacement of the medial or lateral epicondyle of the humeral csti.

Symptoms of Bone Fracture in Children

With complete fractures of the bones of the extremities with displacement of bone fragments, the clinical manifestations are practically no different from those in adults. At the same time, with fractures, subperiosteal fractures, epiphysiolysis and osteoepiphysiolysis without displacement, movements can be preserved to a certain extent, pathological mobility is absent, the contours of the injured limb that the child is sparing remain unchanged and only upon palpation is pain determined in a limited area corresponding to the fracture site. In such cases, only x-ray examination helps to make the correct diagnosis.

A feature of bone fractures in a child is an increase in body temperature in the first days after injury from 37 to 38°C, which is associated with absorption of the contents of the hematoma.

Diagnosis of bone fractures in children

In children, it is difficult to diagnose subperiosteal fractures, epiphysiolysis and osteoepiphysiolysis without displacement. Difficulty in establishing a diagnosis also arises with epiphysiolysis in newborns and infants, since even radiography does not always provide clarity due to the absence of ossification nuclei in the epiphyses. In young children, most of the epiphysis consists of cartilage and is passable for x-rays, and the ossification nucleus gives a shadow in the form of a small dot. Only when compared with a healthy limb on radiographs in two projections is it possible to establish the displacement of the ossification nucleus in relation to the diaphysis of the bone. Similar difficulties arise during birth epiphysiolysis of the heads of the humerus and femur, the distal epiphysis of the humerus, etc. At the same time, in older children, osteoepiphysiolysis without displacement is easier to diagnose, since radiographs show a separation of the bone fragment of the metaphysis of the tubular bone.

Errors in diagnosis are more often observed with fractures in young children. Insufficient medical history, well-defined subcutaneous tissue making palpation difficult, and the absence of displacement of fragments in subperiosteal fractures make recognition difficult. Often, in the presence of a fracture, a bruise is diagnosed. As a result of improper treatment in such cases, curvature of the limb and impairment of its function are observed. In some cases, repeated X-ray examination, performed on the 7-10th day after injury, helps to clarify the diagnosis, which becomes possible due to the appearance of initial signs of fracture consolidation.

Treatment of bone fractures in children

The leading principle is the conservative method of treatment (94%). In most cases, a fixing bandage is applied. Immobilization is carried out with a plaster splint, usually in the average physiological position, covering 2/3 of the circumference of the limb and fixing two adjacent joints. A circular plaster cast is not used for fresh fractures in children, since there is a risk of circulatory disorders due to increasing edema with all the ensuing consequences (Volkmann's ischemic contracture, bedsores and even necrosis of the limb).

During treatment, periodic x-ray monitoring (once a week) of the position of bone fragments is necessary, since secondary displacement of bone fragments is possible.

Traction is used for fractures of the humerus, shin bones and mainly for fractures of the femur. Depending on the age, location and nature of the fracture, adhesive plaster or skeletal traction is used. The latter is used in children over 3 years of age. Thanks to traction, displacement of the fragments is eliminated, gradual reposition is carried out and the bone fragments are held in the reduced position.

For bone fractures with displacement of fragments, one-stage closed reduction is recommended as early as possible after the injury. In particularly difficult cases, reposition is performed under periodic X-ray control with radiation protection for the patient and medical personnel. Maximum shielding and minimal exposure allows for repositioning under visual control.

The choice of pain relief method is of no small importance. Good anesthesia creates favorable conditions for repositioning, since the comparison of fragments should be done in a gentle way with minimal tissue trauma. These requirements are met by anesthesia, which is widely used in hospital settings. In outpatient practice, reposition is performed under local or regional anesthesia. Anesthesia is carried out by injecting a 1% or 2% novocaine solution into the hematoma at the fracture site (at the rate of 1 ml per one year of the child’s life).

When choosing a treatment method for children and establishing indications for repeated closed or open reduction, the possibility of self-correction of some types of remaining displacements during growth is taken into account. The degree of correction of the damaged limb segment depends both on the age of the child and on the location of the fracture, the degree and type of displacement of the fragments. At the same time, if the growth zone is damaged (during epiphysiolysis), as the child grows, a deformation may appear that was not there during the treatment period, which should always be remembered when assessing the prognosis.

Spontaneous correction of the remaining deformity occurs the better, the younger the patient is. The leveling of displaced bone fragments in newborns is especially pronounced. In children under 7 years of age, displacements for diaphyseal fractures are allowed in the length range from 1 to 2 cm, in width - almost the diameter of the bone and at an angle of no more than 10°. At the same time, rotational displacements cannot be corrected during growth and should be eliminated. In children of the older age group, more accurate adaptation of bone fragments is necessary and it is necessary to eliminate deflections and rotational displacements. For intra-articular and periarticular fractures of the bones of the extremities, accurate reduction is required with the elimination of all types of displacement, since unresolved displacement of even a small bone fragment during an intra-articular fracture can lead to blockade of the joint or cause varus or valgus deviation of the limb axis.

Surgical intervention for bone fractures in children is indicated in the following cases:

• with intra- and periarticular fractures with displacement and rotation of the bone fragment;
• with two or three attempts at closed reduction, if the remaining displacement is classified as unacceptable;
• with interposition of soft tissues between fragments;
• with open fractures with significant damage to soft tissues;
• in case of improperly healed fractures, if the remaining displacement threatens permanent deformation, curvature or stiffness of the joint;
• for pathological fractures.

Open reduction is performed with special care, gentle surgical access, with minimal trauma to soft tissues and bone fragments and is completed mainly by simple methods of osteosynthesis. Complex metal structures are rarely used in pediatric traumatology. Most often, a Kirschner wire is used for osteosynthesis, which, even when carried out transepiphyseally, does not have a significant effect on bone growth in length. The Bogdanov rod, CITO, Sokolov nails can damage the epiphyseal growth cartilage and are therefore used for osteosynthesis for diaphyseal fractures of large bones. For improperly fused and improperly fused bone fractures, false joints of post-traumatic etiology, compression-distraction devices of Ilizarov, Volkov-Oganesyan, Kalnberz, etc. are widely used.

The time frame for consolidation of fractures in healthy children is shorter than in adults. In weakened children suffering from rickets, hypovitaminosis, tuberculosis, as well as with open injuries, the periods of immobilization are extended, since the reparative processes in these cases are slowed down.

With insufficient duration of fixation and early loading, secondary displacement of bone fragments and re-fracture are possible. Ununited fractures and pseudarthrosis in childhood are an exception and, with proper treatment, usually do not occur. Delayed consolidation of the fracture area can be observed with insufficient contact between fragments, interposition of soft tissues, and with repeated fractures at the same level.

After the onset of consolidation and removal of the plaster splint, functional and physiotherapeutic treatment is indicated mainly for children with intra- and periarticular fractures, especially when movement in the elbow joint is limited. Physical therapy should be moderate, gentle and painless. Massage near the fracture site, especially with intra- and periarticular injuries, is contraindicated, since this procedure promotes the formation of excess callus and can lead to myositis ossificans and partial ossification of the joint capsule.

Children who have suffered injury near the epimetaphyseal zone require long-term follow-up (up to 1.5-2 years), since injury does not exclude the possibility of damage to the growth zone, which can subsequently lead to limb deformity (post-traumatic deformity of the Madelung type, varus or valgus deviation of the limb axis, segment shortening, etc.).

For the full development of a child’s body, a sufficient supply of not only vitamins, but also other minerals is necessary, the lack of which affects health. Increasingly, hypocalcemia is detected in children under one year of age, a lack of calcium in the body. Calcium for children under 1-1.5 years old is one of the important minerals, the norm of which should be supplied to the body daily. It is necessary for the health of bones, teeth, heart, as well as the general formation of the body.

Calcium helps in the absorption of many substances, including iron, and is also responsible for the functioning of the nervous system. Calcium, together with magnesium, ensures the functioning of the cardiovascular system, and in combination with phosphorus, it takes care of the formation of teeth and bones. In order for calcium to be absorbed, it is important that the body receives a sufficient amount of vitamin D. What is the best drug to choose? After the examination, the doctor will prescribe the necessary medications.

Importance of calcium for children

Already from birth, calcium plays a role in the formation of bones and teeth, and is responsible for processes such as the contraction of muscle fibers and the functioning of the nervous system. Calcium ions directly affect blood clotting and improve the functioning of the endocrine system. Sufficient calcium intake protects children from allergic reactions and also protects against inflammatory processes.

If a child does not receive enough calcium from birth, this can lead to the following problems:

• rickets;
• osteoporosis;
• deformation of the lower extremities (O- and X-shaped type);
• the edges of the crown may soften;
• the appearance of bumps on the crown and forehead;
• the back of the head may become flat and the skull may become asymmetrical;
• brittle and bad teeth;
• weak bones, which leads to frequent fractures.

This is not a complete list of calcium deficiency problems.

The occurrence of rickets is associated not only with a lack of calcium in the blood, but also with vitamin D and phosphorus, which help it to be absorbed. It is very important for a small, immature body to have all the necessary vitamins. Also, a lack of calcium in the body of children under 1-2 years of age leads to osteoporosis, which may not manifest itself for a long time, but when it becomes more severe, it provokes frequent bone fractures.

Causes of insufficient calcium intake in children's bodies

Normally, a child should receive 500-1000 mg of calcium every day. Since babies under 1-2 years of age most often feed on breast milk, the mother needs to eat properly and also take calcium gluconate (Calcium D3 Nycomed) and other vitamins to compensate for the deficiency during the feeding period. It is worth remembering: if the level of calcium in the blood of a nursing mother is underestimated, this has a detrimental effect on the child’s health.

There are cases when a sufficient amount of calcium enters the body, but it is not absorbed due to a lack of vitamin D. The right foods cannot completely compensate for the deficiency in children under 2 years of age, so doctors recommend, in addition to changing the diet, taking calcium gluconate preparations (Complivit, Calcium D3 Nycomed), which most often comes in addition to other vitamins. It is worth knowing that in the summer, vitamins are synthesized in sufficient quantities in the child’s body, including vitamin D, so at this time of year it is not worth taking additional vitamins, because Exceeding the norm can lead to hypervitaminosis. Vitamins whose norm is too high can cause colitis and other intestinal diseases in a child.

The child’s body should receive the daily calcium intake in the following dosage:

• 400-500 mg is the norm for ages from 0 to six months;
• 500-700 mg is the norm for ages from six months to a year.
• 700 mg and above should enter the body of a child from 1 year of age.

Unlike other vitamins, an excess amount of calcium in the blood does not affect the baby’s health in any way; up to 1-2 years of age, the excess is excreted through urine and feces. If we talk about excess calcium in the blood, which comes through drugs along with other microelements (Complivit, calcium D3 Nycomed), for example, vitamins B and D, then this can lead to salt deposits in the kidneys. You can find out about side effects of the drugs in the instructions for use.

Symptoms and signs of substance deficiency in a child

Determining the lack of calcium in the blood of a child under one year old is problematic, since he does not walk yet, and only a specialist can identify hypocalcemia. The main symptoms when the level of calcium gluconate in the blood is underestimated are as follows:

• when crying, you may notice a trembling of the chin;
• increased sweating in the back of the head;
• in the areas of the head where the child most often comes into contact with the pillow, hair abrasion is noticeable;
• Loud noises make the child flinch.

Also, a lack of calcium in the body of a child under 2 years old can be determined by cracked corners of the mouth, anemia, cramps and poor condition of nails. Products and vitamins in preparations (Calcium D3 Nycomed) help compensate for the lack of microelements in the body, after which the symptoms and signs gradually disappear and the child feels better.

Treatment of hypocalcemia

Since the absorption of calcium in the blood of an infant directly depends on the mother, she should first review the food and take medications (for example, Aufbaukalk, Complivit D3 Nycomed). The instructions for use of the drugs indicate which vitamins are included in the supplement.

• cottage cheese;
• cheeses;
• chicken eggs;
• liver;
• butter;
• dairy and fermented milk products;
• chocolate.

Also, when the child can be introduced to complementary foods, these products should be present in his diet. Reviews from many mothers who changed their diet and food products indicate that some symptoms went away immediately, the child stopped frequently being capricious and crying.

If food does not help compensate for calcium deficiency in children under 2 years of age, the doctor may prescribe medications. Which drug is best suited for use in children and adults? Medicines that have proven themselves and have positive reviews:

• Complivit Calcium D3 Nycomed.

Complivit calcium D3 Nycomed is designed specifically for children under 1-2 years of age. Complivit also includes vitamin D for better absorption. Suspension Complivit D3 Nycomed has a sweetish taste, which will not cause problems for the mother while taking the medicine. Instructions for use: dilute the powder in ½ glass of water, shake before giving. Complivit calcium D3 Nycomed has contraindications.

Aufbaukalk. A natural preparation containing calcium gluconate, which can be used from a six-month-old child. Aufbaukalk comes in 2 jars, from which you need to give the drug in the morning and evening. Aufbaukalk should be taken as directed.

Calcium gluconate. A very cheap drug, produced in its pure form. Calcium gluconate is prescribed to the mother during lactation. Calcium gluconate in combination with Aquadetrim should be given to children up to one year old; in this combination, the symptoms disappear after 2 days. Instructions for use: take 2 g 3 times a day.

The doctor must decide which drug is best to give to the child, depending on how low the level of calcium in the body is. How to take the drug can be found in the instructions for use.

The difference between childhood injuries and adults is explained by the peculiarities of the child’s skeleton. Mostly children injure their arms, legs, and collarbone. Severe fractures, among all injuries in children, account for only 10% of cases. It is important for all parents to know how dangerous a fracture is in a child, the symptoms and features of the recovery period.

More often, the child injures his arms and collarbone; his legs are broken half as often. Fractures of the feet, pelvis and other parts of the skeleton occur in only 1 out of 1 thousand children. This is due to serious differences in the bone tissue of a child from an adult skeleton.

Among the reasons why the same injury in an adult and a child will have a different nature are:

1. The child’s bone tissue is just forming, so it is more porous;
2. There is more collagen in children's bones and the skeleton is more flexible; with age, the amount of this substance decreases significantly;
3. The increased number of Haversian canals provides strength to the child’s bones;
4. The periosteum of a child's bones is thicker, and many blood vessels pass through it. This tissue acts as a natural shock absorber and gives flexibility to the skeleton. And in case of a fracture, due to the increased amount of nutrients, callus forms faster;
5. The metaphyseal part of the skeleton and the epiphysis are separated by cartilage tissue, which softens any mechanical impact.

There is more cartilage tissue in the children's skeleton, since the bones have not had time to gain calcium. Due to this, children are less likely to suffer fractures, and in case of injury, healing requires only 2–4 weeks.

Most fractures in children are of the Greenstick type. The bone breaks or bends. After a fracture, children under 10 years of age may develop pathologies:

• Subsequently, the bone becomes bent;
• One limb becomes shorter than the other;
• Bone tissue is not formed correctly.

Pathologies after injury appear in adolescence, when bone tissue grows rapidly and the body undergoes hormonal changes.

Classification of pediatric bone injuries

Depending on the area of ​​damage to bone tissue and the characteristics of the child’s skeleton, fractures in a child are divided into several types.

With this type of injury, the apophysis, which is located under the joints, is damaged. The structure of the process is rough. Its main role is to attach muscles and ligaments to bone tissue. When the epiphysis is fractured, the damage occurs at the border of cartilage growth, and the atrophied part suffers.

The cells that form the bone are not damaged and blood circulation in the tissues is not impaired. Impaired growth and bone formation from such a fracture occurs in one in a hundred cases. Among all fractures in children, apophyseolysis damage accounts for 80% of cases.

Osteoepiphysiolysis and epiphysiolysis

These two types of injury are similar, differing only in location on the arm or leg. The fracture occurs at the site of cartilage attachment to the ankle or wrist joint. A fracture in the elbow or ankle is caused by a fall on an outstretched arm or straight legs.

With osteoepiphysiolysis and epiphysiolysis, the distal parts of the bones shift and form an angle, the sides of which are open to the part opposite to the bend of the joint.

The soft upper structure of the bone is not as fragile and strong as in an adult, and when bent, an incomplete fracture is formed. The bone becomes covered with cracks, but remains in place and does not divide into several fragments. The injury is called a “greenstick fracture.” This variety occurs only in childhood.

The child does not lose the ability to move his arm or leg, and swelling does not form on the soft tissues. The main symptom is pain. The injury is often confused with soft tissue contusion or joint dislocation.

All types of fractures in a child are divided depending on the nature of the injury and the condition of the tissues:

• Traumatic. The bone was subject to some influence from outside the body. Traumatic fractures can be accompanied by damage to nerve endings, muscles, tendons and blood vessels. Based on the condition of the soft tissues above the fracture zone, traumatic injuries are divided into two types: open and closed. With a closed fracture, the soft tissues are not injured, while an open injury is accompanied by rupture of the skin and blood vessels, and a wound is formed at the site of the injury. With an open fracture, the child may die from blood loss;
• Spontaneous or occurring due to a pathological phenomenon in the body. A fracture occurs due to a chronic disease associated with the destruction of bone tissue, under the influence of inflammatory processes or against the background of vitamin deficiency.

Based on the location of the bone fragments, fractures are divided into two types: with and without displacement.

All types of fractures with an unresolved upper part - the periosteum - belong to the subperiosteal group. Depending on the type of damaged bone, injuries are divided into three types: tubular, cancellous and flat.

Fractures are also divided into groups according to the specific line of damage:

• Longitudinal;
• T-shaped;
• Helical;
• Brokenness;
• Vertical straight and oblique;
• In the form of the Latin letter V.

The simplest are considered to be vertical ones without debris or displacement. According to complexity, all injuries are divided into groups: multiple and isolated. With multiple trauma, several bones, soft tissues and blood vessels are damaged at once.

Symptoms of early trauma

Complex trauma with multiple fragments and displacement in a child and an adult has common symptoms:

1. The functionality of the limb is completely or partially lost;
2. A state of shock or stress in a child is accompanied by loud crying;
3. Swelling and redness develop on the injured limb;
4. The limb is deformed;
5. The temperature rises to 37.8 degrees;
6. Hematomas form on the skin;
7. An open fracture is accompanied by bleeding;
8. The child experiences severe pain. When you try to move the injured limb, the pain intensifies.

Symptoms can be pronounced or vague, appear all together or one at a time. The symptoms of a “green twig” injury are minimized, but specialists can easily diagnose the injury.

With pronounced symptoms, the child cannot move a limb and cries constantly. A subperiosteal fracture causes vague symptoms:

• Slight redness in the area of ​​injury;
• A dull ache that some children can easily tolerate;
• No deformation.

An undiagnosed greenstick fracture can trigger the development of bone tissue pathology in older age. A fracture occurs from any strong mechanical impact, since the child’s bones are more porous and do not contain enough calcium.

The specificity is in the intact periosteal membrane, which connects the bone fragments, even after displacement. Such an injury heals quickly, since the intact membrane nourishes the tissues and blood circulation in them is not impaired. And if the displacement is not diagnosed in time, then the child develops bone curvature.

Diagnosis of childhood injuries

A fracture in a young child is accompanied by loud crying; children over 4–5 years old can describe the pain and show where it is located. It is important for parents not to panic and not to scare the baby.

A splint is applied to the injured limb, and the child is given an anesthetic drug: Ibuklin, Nurofen. A cold compress is applied to the damaged area as local anesthesia. A sick child should immediately consult a doctor.

If the fracture is open and the child is bleeding, then first of all it is necessary to stop the bleeding and disinfect the wound. To do this, a compressive bandage is applied higher up the limb; damaged large vessels can be pinched with your fingers. An ambulance is called.

You should not try to set protruding bone fragments on your own. The doctor will do this with sterile instruments in the operating room. The protruding bone is covered with sterile gauze or a napkin until the doctors arrive.

At the clinic, the child is sent for examinations:

• Visual examination by a pediatric traumatologist;
• X-ray image in two projections.

During a visual examination, the doctor will try to determine the presence of a fracture by palpation and will find out from the parents the mechanism of injury. An x-ray will help make a diagnosis and provide a clearer picture of the nature of the fracture line.

If the X-ray examination does not produce results, then the child is prescribed magnetic resonance imaging. The study will help clearly identify damaged bones, blood vessels, and nerve endings.

The injury could cause various pathologies in the child’s body, and the child is additionally prescribed examinations by a cardiologist or neurologist. Electrocardiography is performed, blood is donated for antinuclear antibodies.

A greenstick fracture can only be diagnosed using an x-ray.

Therapy for a young patient

Based on the child’s diagnosis and general history, the doctor selects individual treatment. A childhood fracture is treated in two ways:

1. Conservative;
2. Surgical.

Conservative therapy

Conservative therapy: closed reposition of bones, if the fracture is displaced, and application of plaster. Non-surgical reduction is performed in simple cases and is performed without anesthesia. Conservative therapy is suitable for simple injuries or for the “greenstick” type of fracture: foot, ankle, ankle, fingers, forearm.

To relieve pain, the child is prescribed analgesics. The pain symptom goes away on the second or third day after fixation. Anti-inflammatory drugs will help prevent complications.

And to speed up the fusion process, the child is prescribed vitamins with a high calcium content.

Surgical intervention for a child is prescribed in the most severe cases. Reposition of bone fragments by surgical intervention is divided into types:

• Closed operation. Mainly prescribed for intra-articular injury. The bones are fixed using metal pins that are inserted into drilled holes. The ends of the spokes remain outside, and the fasteners are removed after fusion of the bone tissue;
• Open surgery. Prescribed in case of a fracture with multiple fragments and displacement in the area of ​​the epiphysis, inside the joints. The soft tissues are dissected, the vessels are moved to the side. The bone is fixed using metal plates. The soft tissues are sutured, the limb is fixed with plaster.

There is also external bone fixation, which is used if soft tissue is damaged. This is due to burns and damage to the vascular system.

All operations on the child are performed under gentle anesthesia. The plaster cast lasts for at least 1 month. Bone tissue restoration is monitored by x-rays, which are taken every 1.5 to 2 weeks.

A child’s tissues grow together quickly, this is due to the following factors:

• The child's body intensively produces collagen, which is necessary for the formation of callus;
• With a greenstick fracture, blood circulation and nutrition of the bone tissue are preserved.

A fracture is dangerous in children aged 10–11 years. At this time, bones grow rapidly and a fracture can provoke different growth of fragments of one link. Variation in bone size is prevented using a bayonet-shaped connection, which is performed through open surgery.

Any, even the most minor childhood fracture, needs treatment. Improper fusion leads to recurrent fractures and the subsequent development of bone tissue pathologies.

Recovery and rehabilitation

Healing of children's bones takes less time than with an adult injury. If an arm is broken, the child will remain in a cast for no more than one and a half months; the legs will have to be kept in a bandage for up to two and a half months. It will take the longest time to restore the hip joint; the baby will have to lie in a special cast for up to three months.

The most difficult fracture is considered to be a compression fracture. It will take up to 1 year for a child to recover from such an injury. Recovery time depends on the age of the baby and his individual health characteristics. Bones heal faster in children under 5 years of age. The recovery stage is more difficult in children aged 10–11 years, when bones are growing rapidly and a large amount of calcium is required.

Immediately after the cast is removed, the child is prescribed the following procedures:

• Massage;
• Physiotherapy.

These procedures will help to quickly develop the damaged joint, normalize blood circulation and tone the muscles. Sanatorium-resort treatment will help speed up rehabilitation.

Throughout the entire recovery period, the child’s diet includes foods rich in calcium and vitamin D3: cottage cheese, lentils, corn, pomegranates, jellied meat, milk, fermented baked milk, kefir.

After a fracture, the child recovers quickly; the main thing is to surround him with attention and take care of the peace of the injured limb. Children quickly get used to the plaster and stop noticing it by the end of the first week. And proper nutrition and vitamins will help the baby recover in the shortest possible time.

The human body in the growth stage is able to accumulate calcium in its tissues. Thanks to this feature, a child's bones are much stronger than those of an adult, but this does not mean that children are less at risk of getting a fracture. Due to the increased physical activity characteristic of most children, their skeleton is constantly exposed to excessive loads. A small blow is enough for the bones to give way.

This often happens while a child is learning to walk. Lack of coordination and the ability to stand firmly on your feet makes it difficult to group the lower limbs when falling, which sooner or later leads to a predictable result - their damage.

What types of fractures are there?

Any injuries are classified, first of all, by their location. When talking about a broken leg in a child, we can mean damage to:

• hips;
• shins;
• ankles;
• feet (including fingers).

At the same time, one cannot ignore the specifics of the injury. Fractures are classified according to the following criteria:

1. maintaining the integrity of soft tissues;
2. nature of damage;
3. final position of the bone.

Open and closed

In medical parlance, a fracture is a violation of the integrity of bone fragments, but such an injury can also damage soft tissues. In this case, a laceration forms at the site of injury. Such fractures are called open. They have a number of characteristic differences from closed-type injuries, in which the integrity of the skin is not compromised:

Complete and incomplete (cracks, subperiosteal and “green sprig”)

Another important classification feature is the degree of bone tissue damage. Depending on the severity of the damage, fractures are divided into complete and incomplete (partial). The latter include:

1. Cracks. Injuries of this type can be single or multiple. Depending on the severity of the injuries sustained by the limb, the crack passes through the bone or along its surface (periosteum). Fractures of this type are usually classified according to shape and direction. Depending on the position relative to the axis of the bone, cracks are longitudinal, oblique, transverse and spiral.
2. Subperiosteal greenstick fractures. Such injuries are more common in young children due to the age-related characteristics of their skeletal structure. Due to the high concentration of beneficial microelements in some tissues, their strength increases, and when a bone is broken, the periosteum remains unharmed. A similar effect can be observed if you bend a green willow branch: the wood will crack, but the bark covering it will retain its integrity.

Without offset and with offset

With a partial fracture - fissure or subperiosteal - the structure of the bone as such is not disturbed. Thanks to this, its fragments remain motionless. Such injuries are called non-displaced fractures. They are difficult to diagnose, but they are more treatable.

With complete fractures, there is a risk that the fragments of the damaged bone will take a position that is physiologically inappropriate for them (displacement will occur). Injuries of this type are fraught with complications.

The bone at the site of the chip is sharpened, which threatens soft tissue damage (open fracture). In addition, the displacement of fragments prevents the restoration of the entire structure. Without their return to the proper position, there is no talk of injury healing.

Features of childhood fractures

The younger the child, the more flexible his bones are. For this reason, fractures in preschool children are relatively rare and are almost never complete. Most children, after an unsuccessful fall on their leg, end up with a crack or a subperiosteal “twig” without displacement of the chips.

Recovery from injuries in children is much more intense than in adults, due to the accelerated process of tissue regeneration. Of course, this does not mean that a child with a fracture does not need urgent medical attention. Moreover, the younger the child, the more dangerous it is to delay treatment of a damaged leg.

Without medical intervention, a broken bone may not heal properly. At the stage of active development of the body, this threatens irreparable deformation of skeletal fragments (for example, in the hip area) and disruption of musculoskeletal function. This is why it is so important to diagnose the problem in time.

Signs of a fracture in a child

To detect bone damage, it is not necessary to take your baby for an x-ray (although this procedure has been and remains the best method for diagnosing injuries). The fact that a child has suffered a fracture can be judged by its characteristic symptoms. Depending on the location of the damage, the clinical picture of the traumatic condition may vary.

Fracture of hip bones, femoral neck

Hip fractures present in different ways in children. The symptoms of injury directly depend on which bone was damaged. In addition, the clinical picture of a fracture of the neck and any other part of the femur with and without displacement varies greatly. Comparative characteristics of such injuries are presented in the table:

Ankle fracture

An ankle fracture is the most common injury in active children. Its wide distribution is associated with the anatomical features of the structure of the human legs - during any movement, most of the load falls on this area.

The following symptoms indicate that the ankle bone is damaged:

• pain in the ankle area;
• swelling of local soft tissues;
• extensive hematomas and hemorrhages;
• dysfunction of the joint (limited mobility of the foot).

Tibia fracture

In the human body, the lower leg is represented by two bones - the tibia and fibula. Both of them are thick and massive, it is difficult to damage them. For this reason, a tibia fracture is considered a specific injury, the symptomatic picture of which will directly depend on the source and nature of the damage received. Nevertheless, all such injuries have common signs:

• pain in the knee joint, making it difficult to move;
• edema;
• small local hemorrhages.

Fractured toe

A broken toe is the most difficult to identify. Conventionally, the symptoms that help to do this are divided into 2 groups:

1. Probable. These include pain, redness and swelling of the soft tissues, an unnatural position of the finger and difficulties that arise when trying to move it.
2. Reliable. 100% signs of a finger fracture are pronounced bone defects identified by palpation - pathological mobility, deformation, shortening, etc.

Why does a child often break bones?

If any fall or blow results in injury for the baby, he probably has a pathological predisposition to fractures. This is the name for a condition in which the integrity of the bone structure is disrupted due to internal changes occurring in the body. Pathological fractures are often caused by the following diseases:

• osteoporosis;
• osteomyelitis;
• new bone formations.