Information about necessary tests and examinations. Fracture of the radius in children

Children are very active and inquisitive, sometimes it’s difficult to convince little “whys” to stop running and jumping for one reason or another. Even the most caring parents can get distracted and overlook something - and then the child falls and gets hit hard. Pain may indicate various injuries, and besides this, the baby may simply get scared and cry because of this. No matter what, cases of childhood injuries occur in medical practice Often. Statistics describe the following picture: fractures of the upper limbs in children are twice as common as the lower ones, and the forearm and elbow joint are often affected. In most cases, the injuries are simple, but any injury to a child requires attention and concern from the parents.

The most common fractures in children and their characteristics

Fractures in children are quite specific, as is the speed of their healing - it’s all about the structure of growing bones and joints. Thus, bone tissue at a younger age is more saturated with organic substances, and the bone shell is thicker, with an abundant blood supply. In addition, there are growth zones on children’s bones, which also affects the specific nature of injuries.

So, we can highlight the following features of traumatic injuries to the bones of the hands in children:

• When it comes to children, you can often hear the phrase “green branch fracture.” This name arose by analogy with fresh, young tree branches - they are quite difficult to break off, but can be bent. So is a fracture - the bone looks slightly bent and is broken only on one side, and the thick periosteum keeps the bone fragments from a complete fracture;
• growth zones are located near the joints, and they are responsible for enlarging and strengthening a particular bone. Damage in this area is especially dangerous character– the zone may close prematurely, which in the future can lead to various bone defects;
• pediatric fractures heal faster than those in adults;
• V childhood there is a high probability of a bone outgrowth fracture. In fact, this is not an ordinary fracture, but together with some fragments of bone tissue.

When a child’s arm is broken, it is necessary to take into account this fact - at a young age, residual displacements of bone fragments can self-correct in the process of growth and development of muscle tissue. This does not happen in all cases, but the doctor always pays attention to this possibility, which sometimes eliminates the need for surgical intervention.

The types of fractures in children are similar to those in adults: both open and closed, with and without displacement. Open fractures of the arm in childhood are quite rare; more often they occur less serious injuries– cracks and fractures of incomplete type.

Causes of fractures in children in the photo

Symptoms of a fracture

It is not difficult to suspect or recognize a fracture in a child; the first thing that signals the possibility of a serious injury is a sharp and severe pain. The baby will most likely not be able to fulfill a request to move the injured arm, since in the event of a fracture, any movement of the injured limb aggravates the pain syndrome. Even simply moving your fingers can be an overwhelming task for a baby. With complete bone fractures, the hand may visually have an unnatural deformed appearance. Just as often, swelling and hematoma formation.

No parent can ignore the listed symptoms - they clearly indicate a fracture. But there are also injuries that are more ambiguous to define. So, if the injury is limited to a crack, then there may be no deformation or swelling. In addition, there is a high probability that the baby will even be able to calmly move the injured arm. The only symptom in this case is some pain when pressing on the bone. Cracks are very insidious, because their diagnosis is complicated - the presence of pain alone may indicate a sprain. Such an incorrect conclusion leads to incorrect treatment and can cause complications. That is why, if a fracture is suspected, an X-ray examination is simply necessary.

Features of the symptoms of arm fractures include minor ones - this happens in the presence of a hematoma and manifests itself a few days after the injury.

Separately, it is worth paying attention to another symptom - coldness of the hand. This does not happen often, but there is still a possibility that an artery may rupture due to a fracture and the normal blood supply to the limb will be disrupted.

First aid for a fracture in a child

If yours, and you are sure (or suspect) a bone fracture, then under no circumstances should you lose composure - the baby must be given correct first aid. The algorithm of actions is as follows:

If, no matter what, then before the doctor arrives you need to clamp the wound as tightly as possible with clean available means (towel, gauze, etc.).

Afterwards, you definitely need to go to the hospital - depending on the condition of the baby and the injured arm - either independently or by ambulance. Doctors will do it X-ray, they will accurately determine the scale and severity of the damage, after which they will carry out and prescribe treatment.

What not to do if a child breaks his arm

The first and obvious rule for all parents is that you cannot ignore injuries and remain inactive!

Consulting a doctor is simply necessary if you have pain, and especially in cases where some time after the injury the pain only intensified.

Moving a child to get to the hospital without first securing the injured arm, It’s also not allowed - it can make the situation worse.

If, after a fracture, the arm has taken on an unnatural bend, under no circumstances should you try to straighten it yourself or try to move it to normal position. Such actions will not only harm the child severe pain, but can also cause soft tissue damage and aggravate the severity of bone injury.

In the proximal part radius In children, epiphysiolysis and fractures at the level of the neck are observed mainly. Fractures of the epiphysis are very rare and only in older children. Fractures are a consequence of an indirect mechanism of injury and occur when falling on a straight or slightly bent arm at the elbow. In this case, the forearm is in a position of abduction and supination. Fractures of the upper end of the radius are often combined with fractures of the ulna and dislocations in the humeroradial joint.

Clinical and radiological picture

There is moderate swelling of the elbow joint, movements in it are painful, especially supination and pronation of the forearm. Pressure on the head of the radius is also painful. Hemarthrosis is clearly visible. The diagnosis is confirmed x-ray examination elbow joint in two planes. Difficulties in interpreting radiographs may arise with epiphysiolysis of the head of the radial bone without displacement and in young children in whom an ossification nucleus has not yet appeared in the epiphysis. As practice shows, diagnostic errors occur when the epiphysis of the head of the radial bone is completely displaced posteriorly, when its shadow overlaps the ulna. Such injuries occur only in children 13-14 years old. But with careful study of radiographs, this error can be avoided. Most victims experience a characteristic displacement of the head of the radial bone outward and anteriorly. It is also tilted in these directions. Due to the anatomical structure of the elbow joint, under the head of the radial bone, as a rule, compressed bone substance is determined in the form of an intense shadow. With osteoepiphysiolysis, the metaphyseal fragment is displaced. Quite often there is a complete displacement of the head of the radial bone anteriorly, outwardly or posteriorly. Sometimes the head of the radius is identified in subcutaneous tissue elbow joint area.

Treatment

If there is no displacement of the fragments, treatment consists of immobilizing the injured arm with a posterior plaster splint for up to 3 weeks. Experience has shown that displacement up to 60° can usually be corrected using the closed method. With greater displacement, indications for surgical intervention are determined. There are many methods of closed reduction, but they can be divided into two directions. In one case, the reduction is performed in the position of supination of the forearm. In the other case, in a pronated position. The second direction is more reasonable, since it takes into account the mechanism of injury. With open reduction, it is noted that in the pronated position, the distal fragment approaches the wound surface of the radial head.

The reposition technique consists in the fact that with traction and countertraction and full extension in the elbow joint, extreme supination and pronation of the forearm are alternately performed. At the same time, the surgeon, using finger pressure, strives to displace the head of the radial bone until it is completely aligned. This technique is important because the fragments are often interlocked. Make several indicated rotational movements of the forearm and finish with extreme pronation. In this position, a posterior plaster splint is applied from the base of the fingers to the upper third of the shoulder. Immobilization is continued for at least 3 weeks.

If closed reduction fails and large displacements of fragments occur, surgical treatment is indicated. It is generally accepted that for these fractures it gives bad results. However, a detailed study of this issue shows that unsatisfactory results of operations are explained not only by the large displacement of fragments, the severity of the injury, but also by errors made during the interventions. Experience shows that with these fractures, even with significant displacements, the soft tissue connection between the fragments is preserved. Through it, the blood supply to the central fragment continues. Experience also shows that the surgeon often experiences certain difficulties when reducing the head of the radial bone. As a result, it often disrupts the soft tissue connection between fragments, which leads to undesirable consequences.

Open reduction is performed through a posterolateral approach. The joint capsule is opened and blood clots are removed. The position of the radius, the amount of displacement, and the nature of the soft tissue connection between the fragments are assessed. The forearm is deviated inwards, thereby opening the lateral part of the elbow joint. By applying pressure on the head of the radial bone, they try to displace it into the joint space. If the bone substance of the neck of the radial bone is compressed, then the head of the radial bone is not held in the correct position, but tilts towards the deformation of the neck of the radial bone, and it is fixed with a knitting needle. If the head of the radius cannot be lifted and set without damaging the connection between the fragments, then an awl is used as an elevator, which is passed through the bridge between the fragments. If the head of the radial bone is completely free, then it is reduced, while rotation of the head around the longitudinal axis of the neck is not allowed. The wound is sutured in layers. The hand is fixed at an angle of 100-110°, in the middle position of the forearm.

The duration of immobilization depends on the degree of disruption of the blood supply to the radial head. If the soft tissue bridge between the fragments is preserved, immobilization is carried out for 4-5 weeks; if the fragments are completely separated, its duration is increased to 7 weeks. In the first days, a UHF field is used, which has a beneficial effect on the healing process of the fracture and promotes faster resorption of swelling and hemorrhages. After the cessation of immobilization, a gradual development of movements in the elbow joint begins according to accepted rules, paying special attention to the restoration of supination and pronation of the forearm. In most cases they reach full recovery. However, there is also sharp violation functions of the elbow joint with significant or complete disruption of the blood supply to the head of the radial bone. Degenerative-dystrophic processes occur in it. Revascularization of the head occurs and, as a result, ossifications are formed, which naturally negatively affect the function of the elbow joint, especially the rotation of the forearm. This natural process. On radiographs, a characteristic picture is observed: a shadow of ossification appears in the form of a sickle, running between the head and metaphysis of the radius. Contracture in the elbow joint is difficult to treat. Sometimes radioulnar synostosis occurs. This complication usually occurs in children of the older age group.

Therefore, in cases in which severe contractures in the elbow joint are predicted, last years in older children, removal of the radial head is used with good functional results. In children younger age removal of the head is a mutilating operation leading to significant deformation upper limb, valgus deviation of the forearm. Revascularization of the head is more active in them, and the function of the elbow joint suffers less.

Fractures of the proximal part of the radius in combination with fractures of the ulna

One of the typical combinations of injuries to the elbow joint is a fracture of the head and neck of the radius with a simultaneous fracture of the ulna. This damage is relatively rare. The predominant age of victims is 7-12 years.

Clinical picture and diagnosis

The clinical picture has some features inherent to these lesions. There is uniform swelling of the elbow joint. There is often a valgus deviation of the forearm. Palpation reveals local tenderness in the area of ​​the head of the radius and at one or another level of the proximal part of the ulna. X-ray examination is of decisive diagnostic importance.

A detailed study of the mechanism of injury, clinical and radiological signs convinces of the practical feasibility of distinguishing two main types of these damages:

diverting;

extensor

Abduction fractures occur when falling with emphasis on an extended arm, subject to forced external deviation of the forearm. In this case, a fracture of the neck of the radius or osteoepiphysiolysis of its head occurs, as well as a fracture of the ulna in the proximal part. The displacement of fragments of the radius is usually significant: at an angle of 60-90° and in width more than half the diameter of the bone. However, contact between fragments is usually maintained. Fracture of the ulna occurs at various levels. It is typical that a fracture in the proximal third occurs in young children. Displacement of fragments occurs mainly only at an angle, open outward, and does not exceed 20-30°. Fracture is more common olecranon. There is no significant divergence of the fragments.

Treatment

The reduction technique for an abduction fracture is to simultaneously eliminate the displacement of fragments of the radius and ulna. The assistant fixes the shoulder in the distal part and performs countertraction. The surgeon grabs the distal part of the forearm with one hand, pronates it, fully extends the limb at the elbow joint and carries out traction along the axis of the limb. With his other hand, he grabs the proximal part of the forearm so that the first finger is located on the lateral surface of the elbow joint in the area of ​​the head of the radius and prevents its displacement when performing pressure reduction techniques. At the same time, with his second hand, he deflects the forearm inward, thereby eliminating the angular displacement of the ulna, as well as the displacement of fragments of the radius. This technique does not always lead to the desired result. Therefore, in such cases, the surgeon performs a more significant adduction of the forearm. This is possible due to an existing fracture of the radius. With such a deviation of the forearm, the wound surface of the peripheral fragment of the radius turns out to be directed towards the wound surface of the central fragment, which allows them to be joined. This is done by the surgeon with the first finger. Next, he slightly abducts the forearm and restores the correct relationship in the humeroradial joint and the axis of the ulna. The forearm is flexed to 170° and the arm is immobilized in a plaster splint.

Radial neck fracture

Extension fractures occur from forced hyperextension of the elbow joint or a direct blow to back surface the upper part of the forearm. In all victims, the x-ray picture is almost the same. This is osteoepiphysiolysis of the head of the radius and a fracture of the ulna at the border of the proximal and middle thirds with displacement at an angle, open posteriorly. This radiological picture resembles a Monteggia fracture-dislocation, but with this injury there is no dislocation of the head of the radial bone, but there is osteoepiphysiolysis with anterior displacement of the distal fragment. The described fractures occur only in children 12-14 years old.

The technique for reducing extension fractures is also dictated by the peculiarities of the mechanism of injury and displacement of fragments. Both fractures are repaired simultaneously. The surgeon grabs the distal part of the forearm with one hand and applies traction along the axis with the limb extended at the elbow joint. With the second hand, he grabs the forearm at the elbow joint so that his first finger is located on the front surface of the forearm. With it, he presses on the central end of the peripheral fragment of the radial bone and displaces it posteriorly, bringing it closer to the wound surface of the head of the radial bone. At this moment, the surgeon bends the limb at the elbow joint to an acute angle. A posterior plaster splint is placed in this position.

When determining the optimal period of immobilization, the age of the victim, the level of the ulna fracture, etc. are taken into account. On average, it is 4-5 weeks.

Fractures of the neck of the radius in combination with dislocation of the humeroulnar joint.

Fractures of the neck of the radius with simultaneous dislocation of the glenohumeral joint account for 1.8% of all fractures of the neck of the radius. The typical age range for victims is 9-14 years. Injuries most often occur when falling with emphasis on the hand of an extended arm.

Clinical and radiological characteristics

Based on clinical signs only correct diagnosis difficult to install. There is swelling of the elbow joint, its deformation, distinct springy resistance when trying to move the elbow joint, and sharp pain when pressing on the area of ​​the head of the radial bone. Studying the X-ray picture allows us to distinguish between two types of injuries: with posterior and anterior dislocation in the humeroulnar joint. The latter happens extremely rarely.

In case of a fracture of the neck of the radius with a posterior dislocation in the humeral-ulnar joint, the peripheral fragment of the radius is displaced posteriorly and upward along with ulna, and also rotated outward. The posterior displacement of this fragment is usually complete. Contact is maintained between the head of the humeral condyle and the head of the radius. But subluxations and even dislocations of the head of the radial bone occur.

Treatment

Guided by the peculiarities of the mechanism of injury and the nature of the displacement of fragments, they strive to straighten the fracture and dislocation simultaneously. In case of posterior dislocation, the reduction method is as follows. The assistant fixes the patient's shoulder, applies countertraction and applies pressure to the olecranon process, thereby promoting its displacement in the distal direction and reduction of the dislocation of the ulna. The surgeon grabs the distal part of the forearm with one hand, pronating it, eliminating the outward rotation of the distal fragment of the radius, and performs traction. With the other hand, he grabs the proximal part of the forearm so that the first finger presses in front on the head of the radius, thereby limiting mobility and preventing it from moving anteriorly at the time of reduction. Next, without stopping the pull on the forearm, bends the limb at the elbow joint. In this case, a click occurs, which indicates reduction of the dislocation. In this case, a comparison of fragments of the radial bone also occurs, since in this case its peripheral fragment is displaced anteriorly and approaches the central one. If the comparison of fragments turns out to be incomplete and a certain displacement remains, then it is eliminated in a way that, with traction on the forearm and pressure on the head of the radial bone, supination and pronation of the forearm are performed alternately. In the pronation position, in which the reduction is completed and the arm is fixed, the wound surface of the distal fragment of the radius approaches the wound

surface of the head of the radial bone and their comparison occurs. The forearm is flexed to 170° and a posterior plaster splint is applied. With this position of the elbow joint, secondary dislocation and displacement of fragments does not occur.

If comparison of fragments of the radius does not lead to success, then resort to surgical treatment. The head of the radius is fixed transarticularly using a pin.

With an anterior dislocation of the ulna, the peripheral fragment of the radius, together with the dislocated ulna, is displaced anteriorly. The head of the radius is located in front of the head of the condyle of the humerus, correctly contacts the latter and is in the position when the limb is flexed at the elbow joint to 90°. In other words, the relationships in the shoulder-elbow joint are not disturbed. There is a separation of the apex of the olecranon process with a large displacement.

In case of anterior dislocation, closed reduction is also performed simultaneously. It consists of traction on the forearm, finger pressure on the head of the condyle of the humerus, followed by flexion of the forearm at the elbow joint to 170°.

The question of determining the optimal timing of immobilization is fundamental. They depend not only on the age of the victim, but also on the degree of adaptation of the fragments and disruption of the blood supply to the head of the radial bone. On average, immobilization lasts 4-5 weeks. When the fragments are completely separated, it is increased to 8 weeks. Experience has shown that with a sufficient period of rest of the elbow joint, the course of the injury is more favorable.

It must be emphasized that with immediate and targeted closed reduction fracture-dislocations, it is often possible to achieve the desired result even with significant displacements of the radial bone fragments.

In case of fractures of the neck of the radius, healed with satisfactory position of the fragments, and the absence of hemodynamic disturbances, restoration of the function of the elbow joint occurs without complications. However, failure to eliminate the displacement and impaired vascularization of the head of the radial bone lead to the organization of blood clots and mineralization of soft tissue in the area of ​​the fracture. X-rays reveal degenerative-dystrophic changes. Revascularization of the head of the radial bone and the formation of ossifications occur. Clinically, this is manifested by impaired flexion and extension in the elbow joint. Rotational movements of the forearm are especially affected, so special attention is paid to their restoration. In such cases, restoring the function of the elbow joint takes a long time, especially in older children, and requires great medical skill and patience. The most good medicine in such cases it is time. Passive, violent movements, movements that cause pain cannot be used, as well as paraffin, ozokerite, and massage of the elbow joint.

The physical therapy technique is simple. The shoulder and forearm are placed on the table. The elbow joint should be fixed, pressed against the plane of the table. In this position, dosed flexion and extension of the elbow joint are performed, as well as simultaneous rotational movements of the forearm in its various positions. Subsequently, electrophoresis of lidase, potassium iodide and other drugs is used.

A broken arm in children is one of the most common injuries. According to statistics, such injuries are more common in the bones of the elbow joint and forearm. Fractures can be different, but most often they are unilateral with or without displacement.

A broken arm may have Negative consequences in the child in the future and may affect the early closure of the bone, the formation of curves, or the limb may become shorter as the child grows. A complication may be the possibility of damage to the outgrowths to which it is attached. muscle, ligaments and muscles can tear from the base of the bone itself. Bones in children grow together faster than in adults, because the periosteum is well supplied with blood and callus forms faster. Thus, the treatment is comparatively faster.

• open, when bone tissue and skin are damaged, they are torn by bone fragments. The area of ​​damage can vary - from a small wound to large defect with tissue destruction soft type, dirt and dust getting there;


• closed, when only bone tissue is damaged, and the skin remains intact. The bone damaged in this way is isolated from external environment. Closed form fractures occur incomplete, complete and single;


• simple, when the damaged bone bends poorly;


• compressive - the presence of a crack in the bone, appears when one bone experiences strong pressure, especially during physical activity;


• with displacement, in which the bones move, the area of ​​tissue damage around it becomes larger. Nerve tissue and large vessels may be affected;


• double form of manifestation - an injury that occurs when falling on a straightened arm (the radius and ulna bones, located in the lower third of the injured arm, break).

One of the main causes of injuries is the fairly active lifestyle of young children. Every child can get a fracture in the following cases:

• when falling on your hand from a height;


• when playing sports;


• playing on the playground, in the house;


• in the event of an accident;


• when a heavy object falls on your hand.

After a child is injured, he will complain of severe pain. The pain, which occurs suddenly, gradually becomes more intense when the child tries to move the injured arm. This is the first sign of a fracture or crack in the bone.

If a fracture of the forearm occurs, the child’s arm is deformed, its function is impaired, as a result of which the child cannot actively move the arm, and in a calm state experiences severe pain. He is scared, crying, looking for protection from his parents.

In a displaced fracture, the arm may shorten due to bone displacement. When palpated, you can hear a crunching sound in the bone (this is bone fragments rubbing against each other). If the fracture is of an open type, then fragments of the damaged bone can be seen from the wound. These are the main signs of a broken arm.

When a fracture of the arm is displaced, the symptoms are the same, only the pain is characterized by its aching manifestation (it constantly intensifies, it can be described by the term “dull”), the arm sags and becomes cold because the blood circulation is impaired. If large arteries rupture, there is a risk of losing large amounts of blood.

If the symptoms described above appear on your face, you should not touch the injured arm or set the bone yourself. The only thing you can do to help your child before visiting a doctor is to fix and immobilize the limb. It is also necessary to fix the joints located nearby so that the bones do not move further. To do this, you can use all the materials at hand - a stick, a ruler, a board, or tie it to your body. Immediately apply a cold compress to relieve the first swelling. You can relieve pain with Baralgin, Analgin, Pentalgin tablets. It is good if the child lies down and moves little.

If children have an open fracture, bleeding from the wound may occur; it must be stopped immediately. The wound is treated with hydrogen peroxide and a bandage of sterile bandage or gauze is applied on top. It is also necessary to free the injured area on the hand from clothing and avoid getting germs into the wound. If your arm is broken, you must promptly seek qualified help from a doctor so that he can conduct a correct examination, establish an accurate diagnosis and prescribe competent treatment.

Only a competent surgeon or a traumatologist at a trauma center or department of a hospital for children can make a correct diagnosis. The doctor interviews the parents and child about all the circumstances that provoked the injury, then examines the patient. This is necessary in order to identify the mechanism of injury and the severity of the injury.

The specialist carefully examines all the symptoms and looks for signs of a fracture, looking for damage to blood vessels and nerve tissue. To make an accurate diagnosis, a picture is taken using an X-ray machine. If the x-ray does not reveal a fracture, they may resort to computed tomography or magnetic resonance imaging. Only after full examination treatment is prescribed.

The presence of a broken arm in a child does not prevent him from walking independently, so in most cases children are sent home after a cast is applied and appropriate treatment is prescribed. A child may be hospitalized if:

• there is an open fracture with displacement and damage to tendons, blood vessels, and nerve tissue;


• there are many bone fragments that need to be removed;


• there is severe blood loss;


• an infection got into the wound and spread further throughout the body;


• a fracture of the arm is combined with a moderate burn;


• there is a fracture that passes through the joint;


• there is a need for surgery for the child.

Treatment can be conservative or surgical. With the conservative method of treatment, a plaster cast or an immobilizing bandage is applied. It should provide good support for the injured arm and nearby joints, and not block blood access to the arm or disrupt the function of nerve tissue. If done correctly, the pain syndrome will gradually decrease. At the same time, the child is given medications that relieve pain and swelling.

IN acute period manifestations of injury for children use plaster casts rather than circular plaster casts. The service life of the splints will depend on the severity of the fracture, its location and the age of the child. This tool Use until the bone heals. The course of therapy must be carried out under the strict supervision of a traumatologist; you must visit him once a week until complete fusion. This procedure it may take a month or two.

For a displaced arm fracture, doctors may resort to using surgical method interventions. This treatment prescribed if:

• it is impossible to set the bone with a splint;


• the bone may not heal properly;


• the nerve will be constantly injured;


• The appearance of pain will be noted with any movement of the hand.

The operation is performed within 2 weeks from the date of injury. If you correctly match the damaged bones, the injury will go away within a month.

The treatment is followed by a recovery period after the bandage is removed. Blood circulation is restored in the injured arm, its muscles need to be strengthened and adjacent joints developed, which is achieved by physical therapy, swimming, massage movements, physiotherapeutic procedures, walks outside. The rehabilitation period is 2-3 months. If a displaced fracture has occurred, then experts recommend:

• Gently bend and straighten your hand with little resistance;


• clench your fingers into a fist (it is recommended to hold a little plasticine or a special ball in your hand);


• progressively rotate the hand to the inner and outer side of the forearm.

A sick child should eat well (the food should contain more vitamins and minerals, especially calcium). These can be nuts, vegetables, fruits, dairy products.

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They are detected less frequently than in adults and are usually subject to outpatient observation. However, such damage should be treated with the utmost seriousness as untimely treatment may cause limited movement and other dysfunction of the hand. Fractures of the bones of the hand are usually the result of direct trauma (blows to the hand). Finger fractures in children can occur due to sports injuries, after a fall, being hit by a heavy object, etc. Clinical symptoms are swelling, pain, limitation of movements. To confirm the diagnosis, an x-ray of the damaged segment of the hand is performed. Treatment is usually conservative - application of a plaster splint followed by physical therapy. If there is displacement, reposition is performed. For open fractures it is necessary surgical intervention.

General information

Treatment consists of applying a plaster cast thumb to the forearm in its upper third. The bones of the wrist are not well supplied with blood, so the fracture heals slowly, and immobilization lasts up to 6 weeks or more. During this period, UHF is prescribed. Then control images are taken. If there is no fusion, fixation is continued for another 4-5 weeks, then the control image is repeated. If signs of decalcification are detected, immobilization is extended for another 1 month.

Metacarpal fractures in children

In children, the fifth and first metacarpal bones are most often broken. The cause is a bruise with a heavy object or a blow with a clenched fist, for example, during a fight.

Fractures of the first metacarpal bone are found in the diaphysis or in the proximal part of the bone. Unlike older patients age groups In children, a typical injury to this area - Bennett's fracture - is almost never detected; instead, osteoepiphysiolysis occurs. With fractures of the diaphysis, displacement is usually absent or slightly expressed, the damaged area is swollen, axial load and palpation are sharply painful. With osteoepiphysiolysis, the distal fragment may shift, while the finger is in an adducted position.

The diagnosis is confirmed by radiography of the bones of the hand; CT and MRI of the hand are rarely required. In case of damage without displacement, the bone is fixed with plaster for 10-14 days. In case of displacement injuries, the metacarpal bone is repositioned under anesthesia: an assistant holds the patient’s hand, and the traumatologist pulls the finger along the axis and moves it to the side, then, without stopping the traction, presses on the protruding fragment and increases the abduction of the finger. Upon completion of reposition, the child is sent for a control x-ray. Immobilization is continued for 2-3 weeks, after removal of the plaster, exercise therapy is prescribed. Treatment is carried out in a trauma center, hospitalization is not required.

Fractures of the fifth metacarpal bone most often occur in the diaphysis, closer to the distal part of the bone. Swelling and dysfunction of the hand are noted; with axial load and palpation, severe pain is detected. The diagnosis is confirmed by X-ray results. For damage without displacement, a plaster cast is applied for 2 weeks. When fragments are displaced, reposition is performed first.

The reposition technique depends on the nature of the displacement. Typically, metacarpal bone fragments are displaced at an angle that is open towards the palm, and the magnitude of the angle can vary significantly. Sometimes there is a displacement along the length or rotation of the distal fragment. To eliminate the displacement, the assistant pulls along the axis of the corresponding finger, and the doctor at this time presses on the fragments from the back, while simultaneously holding them from the palm. Then a control x-ray is performed, the plaster is kept for 2-3 weeks. During the recovery period, exercise therapy is prescribed.

If the fragments are not held in place, it is necessary to perform a closed reduction of the metacarpal bone with percutaneous fixation with a pin. To do this, first reduce the fragments, and then, while continuing to hold the fragments, bend the finger at a right angle. The pin is passed by tilting it slightly obliquely and moving about 1 cm proximally from the joint space between the main phalanx and the metacarpal bone. The cortical layer of the bone is pierced so that the wire is in the medullary canal, and bone fragments are “strung” onto it, holding them in the correct position. The position of the fragments is checked on a control x-ray. Then the protruding end of the knitting needle is bitten off, the tip of the knitting needle is covered with a bandage, and the arm is plastered. After 2-3 weeks, the plaster is removed and the knitting needle is removed.

Finger fractures in children

Fractures usually occur as a result of a direct blow. Displacement is possible, but it is often insignificant. In children under 6-7 years of age, marginal avulsions (open fractures) of the nail phalanx are sometimes observed, accompanied by damage to soft tissues and the formation of a soft tissue defect. Most injuries are treated in an emergency room. For complex multicomminuted closed fractures and open injuries with soft tissue defects, hospitalization in the pediatric trauma department is indicated.

An arm fracture is one of the most common fractures of all bones. human body. In the article you will learn detailed information about this injury.

None of us can be immune from various damages and injuries, especially for children who spend most of their time on active movements. By what characteristic clinical signs Is it possible to assume that a child has a fracture? What should first aid be? How should treatment be carried out and how quickly will the child be able to play actively and fully?

According to the statistics of childhood injuries, we can come to the conclusion that fractures of the arm bones in children can occur even with minor injuries and in banal situations - on the street, at home, on a sports ground, for example: a fall from high altitude, while running or even walking. Not counting cases of such pathological processes in which bone tissue suffers. Fractures of the arm bones in children are much more common compared to leg fractures. The most common site of fractures is the radius, elbow joint and bones of the forearm. If we talk about severe multiple injuries in children, they are not observed so often, and account for approximately 2.5% - 10% of cases among all injuries of the musculoskeletal system.

Children's active lifestyle often leads to injuries

First, let's look at anatomical structure. The human hand consists of three parts: the radius, ulna and humerus. Today, these fractures are one of the most common injuries.

Fracture classification information

Next, we will take a closer look at the main types of this type of damage. Depending on the condition of the bone tissue, fractures can be divided into two types - traumatic and pathological. Traumatic fracture is the result of exposure of an unchanged bone to a significant amount of short-term mechanical force. They are much more common. A pathological fracture is the result of disease processes that occur in the bone, thereby compromising its integrity and structure, as well as its continuity and strength. To get such damage, a small force is enough, for example: a blow or a slight push, which is why pathological fractures are called spontaneous.

An arm fracture can be divided into closed and open - this mainly depends on the condition of the skin. Closed fracture is usually called aseptic, that is, one in which there is no infection, since in in this case the integrity of the upper tissues is not compromised, and the area of ​​injury and bone fragments are isolated from the external influence of pathogenic microorganisms. An open fracture of the arm is a fracture that involves and skin. They may look like a small wound, or they may appear as a huge rupture of soft tissue with infection and destruction. Such lesions are considered to be initially infected.

Depending on the degree of separation of bone fragments, it is customary to distinguish between fractures with and without displacement. A displaced fracture can be complete; in such cases, the connection between the fragments is broken and their complete separation is observed. Incomplete fracture - the integrity of the bone is largely intact or the fragments are held by the periosteum.

When talking about the direction of the fracture line, it is customary to distinguish between transverse, longitudinal, oblique, stellate, helical, T-shaped and V-shaped fractures.

Based on the affected area, fractures can be isolated (one part) or multiple (two or more segments). In some cases, combined injuries are observed, for example: damage to the arm is, as it were, “supplemented” with other injuries (craniocerebral, abdomen). Each specific case has characteristic consequences and has its own treatment method.

There are several types of arm fractures

Basic information about a broken arm in a child

An arm fracture is one of the most common fractures among all bones in the human body. A serious fracture is quite easy to detect. But there are also those in which the function of the hand is not significantly impaired, so a slight fracture can be mistaken for a severe bruise. What are they? characteristic features broken arm?

First, let's define a fracture. This is usually called a fracture pathological condition, in which the integrity of the bone connection is disrupted or the bone comes out of the joint altogether. In such conditions, concomitant disturbances of natural processes occur - swelling, hyperemia occurs, soft tissue rupture occurs and pain occurs.

Among the main factors that can provoke a fracture of the arm are:

• blows different strengths and directions;
• falls;
• awkward movements;
• chronic diseases;
• intentional infliction of injury.

Children have a more active lifestyle and therefore injuries in early age quite common.

In most cases, the specificity of arm fractures in children is due to certain factors that are associated with structural features musculoskeletal system body.

The periosteum is a membrane that covers the bone from the outside; in childhood it is thicker and much better supplied with blood, and in the bones it contains a large number of organic matter(zones of bone tissue growth). That is why most often fractures of the limbs in children are of the “green branch” type; such a fracture resembles a broken branch - a broken and bent bone.

A distinctive feature of this type of injury is the predominance of a unilateral fracture with little or no displacement, this is due to the fact that the thick periosteum has the ability to hold bone fragments.

But despite this, it should be noted that a fracture of the arm in childhood can lead to serious consequences in the future, this is due to the fact that the bone growth zone, which is located in close proximity to the joints, can possibly be damaged. . Therefore, injuries near these zones can cause their premature closure, as a result of which a curvature is formed and the bone is shortened as the child grows. Unlike fractures of the arm in the adult half of the population, in children quite often there is damage to the outgrowths to which the muscles are attached, in such cases, and a fracture of the arm is combined with the separation of ligaments and muscles from the base of the bone. But at the same time, bone tissue child's body grows together much faster compared to adults, this is due to increased blood supply to the periosteum, due to which the process of callus formation is faster.

Clinical picture of the fracture

Depending on the specific type of fracture, complaints various patients may vary. But among the pronounced signs the following can be distinguished:

• Availability severe swelling in a joint or periarticular area;
• Acute or Blunt pain varying intensity (with a gradual increase);
• Limitation motor functions limbs;
• Increased pain when trying to move your fingers or hand;
• Pain syndrome on palpation;
• Deformation of the damaged joint.

Among the many manifestations of fractures, the position of the limb can be distinguished. It can be natural, passive or forced. Eg:

If the hand hangs unnaturally or passively, this may indicate possible damage radial nerve. This position can be explained by a dislocation or a feeling of soreness. When the neck of the humerus is fractured, the axillary nerve is damaged, and therefore the person’s position is constrained.

It is necessary to pay attention to the position of the arm during a fracture

Particular attention should be paid to such a symptom as cold hand. This primarily indicates that blood circulation in the limb is impaired. Explicit and open ruptures of large main arteries, when the diagnosis is obvious, are not often observed. Much more often you can find thrombosis, which is caused by a rupture of the intima of the artery.

Another symptom of a fracture is fat embolism(impaired blood metabolism in tissues during shock). This condition accompanied by sharp deterioration the patient's condition, even before loss of consciousness.

First aid for a fracture

It should be understood that at the pre-medical stage, first aid in order to prevent possible complications is fixation and immobilization of the limb; an effective and adequate pain reliever is important. Fixation of the hand should affect not only the injured area, but also the neighboring joints; this can be done by applying a special splint using available materials, for example, a ruler, a stick, a straight branch, this reduces the risk of further displacement of the bones and reduces pain. In cases where the hand has an unnatural position, it is prohibited to straighten it.

If there is an open fracture of the arm, bleeding from the injured limb can often be observed. In such situations, it is necessary to immediately stop the bleeding,, if possible, carry out aseptic measures and apply a sterile dressing.

Information about necessary analyzes and examinations

The initial medical examination should begin with a physical examination of the patient and a history. Taking into account the details of the accident, a specialist can easily determine the type traumatic injury, taking the mechanism of injury as a basis.

The specialist will examine the fracture site and the arm for deformation and swelling, and will also examine whether there is any damage blood vessels and nerve endings.

X-ray examination is necessary to view fractures and detect displacement. Some types of fractures may not be noticeable on x-rays; in such cases, a CT or MRI should be prescribed.

Taking an X-ray is the main procedure for a fracture

What type of treatment is needed for a fracture?

Bone tissue in children grows together quite quickly, especially for younger children. school age(up to 7 years), therefore the most common method of restoration is conservative. If the fracture was not accompanied by displacement of the fragments, treatment consists of applying a so-called plaster splint. This overlay does not cover the entire circumference of the injured limb, but only part of it. Ordinary non-displaced fractures are treated exclusively on an outpatient basis; the patient does not require hospitalization.

At normal course fracture, the fusion of the radius and other bones in the injured arm occurs quite quickly; it takes approximately five to seven days to visit a traumatologist during the rehabilitation period. If gypsum bandage If applied correctly, the child’s pain quickly subsides and then disappears altogether.

During normal healing, there should be no impairment of the sensitivity of the fingers and movements of the fingers. If the plaster was applied unprofessionally, a side effect occurs such as compression of the limb, and the following may be observed: alarming symptoms, for example, swelling, It's a dull pain, exacerbation or loss of sensitivity. If at least one of the listed symptoms occurs, you should immediately seek help from a specialist.

In the presence of severe displaced fractures (for example, intra-articular fractures of the radius), surgical intervention may be indicated - closed reposition of the fragments followed by the application of a plaster cast under full anesthesia. This surgery only takes a few minutes, but after this operation, hospital observation is required.

To prevent repeated displacements in unstable fractures, fixation with metal pins is used. Initially, bone fragments (ulna, radius or forearm) are fixed with knitting needles, and only then a plaster cast is applied. This type of patient management requires special care and dressings in a hospital.

Recovery period

For the period of restoration of the integrity of the radial, ulnar and humerus may affect whole line factors:

• Nature of damage;
• Age;
• Location of the fracture.

In most cases recovery period lasts approximately 1-1.5 months. Complex cases with displacement take longer.

Active rehabilitation period - time after removal of plaster or other types of fixation (wires)

During this period, it is necessary to carry out measures to develop movements in adjacent joints, restore the abilities of the injured limb, and prescribe procedures to increase muscle tone. For these purposes, exercise therapy, special massage, swimming and physiotherapy are prescribed. All of the above procedures must be carried out throughout the entire recovery course, without interruptions.

Prognosis in the treatment of fractures

Most fractures heal well, and normal arm movement is usually restored.

Many factors that are based on medical history and individual physical features can determine the final result after a fracture:

• Purpose timely treatment usually improves results.
• Fractures in young children and adolescents heal much faster.
• Joint fractures and open fractures can lead to the development of complications.
• Chronic and systemic diseases may slow down the healing and recovery processes.

In conclusion, it should be recalled that all parents need to understand that only timely access to qualified medical care and conducting comprehensive examination child helps prevent serious complications in the future. Correctly prescribed fracture treatment is the key get well soon child.