Bone fractures in children occur not only because of pampering; sometimes the fragility of bone tissue is to blame. Why does it occur, how to detect and treat it?

Our expert is pediatrician Anna Mikhailova.

Risk factors

Experts call this condition osteopenia, which means that bone mineral density is below normal. According to various studies, disorders of this kind are found in every third teenager aged 11–17 years.

There are four main risk factors:

Deficiency of calcium, the main “building material” for bone tissue.

Poor nutrition. In addition to calcium, bones need protein, phosphorus, iron, copper, zinc and manganese, vitamins (from autumn to summer it is necessary to take vitamin-mineral complexes). And all these beneficial substances, as a rule, are present in those foods that children like least.

Physical inactivity – to build bone mass, movement is necessary that loads and trains the bones.

“Hormonal storm”: calcium metabolism in the body is under strict control of the hormonal system, and during puberty, disturbances in its functioning are not uncommon.

Many chronic diseases also “interfere” with the normal absorption of calcium: gastrointestinal tract, respiratory tract, liver, kidneys, thyroid gland...

The cunning of the invisible man

Loss of bone density develops slowly and gradually, it is impossible to notice it by eye. But there are five indirect signs that should alert parents.

The child's cases of caries have become more frequent.

“For some reason,” hair splits, nails peel and break.

From time to time there is pain in the legs, especially in the legs.

The schoolchild is slouching more and more, his back gets tired after a long time of sitting at homework or at the computer.

Your child is allergic, because of this he has dietary restrictions; he does not eat dairy products or fish.

Even one such symptom is a signal that the child needs to be examined and find out whether he really does not have enough calcium.

Norm and deviations

First of all, the pediatrician will prescribe biochemical tests of blood and urine, which can be used to determine whether phosphorus-calcium metabolism is impaired. These partner minerals are involved in many vital metabolic processes and work hand in hand: the body cannot absorb calcium if there is not enough phosphorus, but if there is an excess of the latter, calcium is excreted from the body. That's why it's so important to maintain their balance. By comparing the data with the standard indicators for a certain age and detecting deviations, one can suspect the initial stage of osteopenia.

To clarify the diagnosis, densitometry is performed: assessment of bone tissue (ultrasound is often used). Unlike adults, children are analyzed only by the so-called Z-criterion - that is, deviations from the norm in indicators depending on the age and gender of the young patient, which are calculated using a special computer program.

Can we fix everything?

The process of formation of healthy bone tissue can be adjusted as the child grows. For treatment, medications containing calcium are prescribed.

There is a wide choice: for example, for the sake of prevention and in case of a slight deviation from the norm, calcium supplements with vitamin D are prescribed. If a deficiency of not only calcium, but also some microelements is detected, complex preparations are used (they also include manganese, boron, copper, zinc, magnesium ).

Since the absorption of calcium is affected by some chronic diseases, children who have them are selected with special drugs, for example, for gastritis with high acidity, those that “protect” the process of its absorption from the aggression of gastric juice. The course of continued treatment is individual.

But medication alone is not enough. Treatment should be supported by a diet: cottage cheese, cheese, kefir or yoghurt, fish (salmon, sardines), meat, eggs, broccoli, bananas, and legume dishes are recommended.

And of course, you need to make time for sports: at least for regular visits to the pool or fitness room. Precisely regular, not occasionally. And if a child has poor posture or flat feet, it is necessary to undergo treatment under the supervision of a pediatric orthopedic surgeon.

According to statistics, children are more likely to suffer injuries and fractures than adults. The high risk of injury is explained by a mobile lifestyle and anatomical features. These include the presence of tissue growth zones and the special chemical composition of the skeletal system (a large amount of mineral salts and a small amount of organic substances).

Features of childhood fractures

High physical activity and lack of sense of impending danger increases the risk of injury in children. Children suffer fractures of the arms, legs, fingers, ankles, ankles and hips much more often than adults. The injury itself proceeds favorably, and damaged bones are restored in a short period of time. This can be explained by a number of reasons:

• High elasticity of children's bones, their strength and thinness.
• The periosteum in a child, like a case surrounding the bone, is thicker and abundantly supplied with blood vessels, capable of absorbing shock. This feature minimizes the risk of serious injury.
• Preservation from damage is facilitated by germ cartilage, located at the ends of tubular bones, for example, the largest human bone - the femur, which softens the force of impact.

Bone fractures in children occur relatively often due to their carelessness and lack of boundaries of fear.

Types of fractures by location and their symptoms

Experts identify several types of fractures, the most common in children, according to their location, namely: subperiosteal (greenstick type), epiphysiolysis, osteoepiphysiolysis, apophysiolysis and periosteal fracture. Types of fractures and their symptoms:

• A subperiosteal, or so-called greenstick, fracture is characterized by partial damage to the bone. As a rule, this type of injury is typical for tubular (radius, ulna) bones.
• Epiphysiolysis and osteoepiphysiolysis are the most common types of fractures. Osteoblast of the periosteum and epiphysis are responsible for the growth of bone in width and length. If damage to the epiphysis occurs and treatment is not started on time, this can result in different limb lengths.
• Apophysiolysis is a fracture that results in the apophysis being torn off. Periosteal fracture - this type of injury is popularly called a “crack.” The bone remains intact. The danger of this type of injury is that parents often cannot detect damage to a leg, hip, ankle or finger in time, attributing the child’s complaints of pain to a bruise.

Childhood fractures are characterized by a number of common symptoms: acute pain, swelling and poor circulation in the limb, an increase in body temperature up to 38 C.

Bone mobility also occurs, which is uncharacteristic for a healthy person, and the musculoskeletal functions of the injured limb, for example, a leg or finger, are disrupted.

Bone injuries with and without displacement

According to the degree of separation of bone fragments, fractures are divided into two groups: with and without displacement. If, as a result of injury, the periosteum holds bone fragments within two millimeters, then this is a fracture without displacement. If the fragments move by a distance greater than that indicated above, then this type of fracture is called displaced.

Diagnostic methods

Today, to detect and determine the type of injury, radiation diagnostic methods are used, such as X-rays, magnetic resonance imaging, computed tomography, and ultrasound. Sometimes a trauma specialist may order urine and blood tests. Diagnosis of injury in infants is more difficult. At this age, the ossification nuclei in the epiphyses are not formed; in their place there is cartilage, through which X-ray rays pass unhindered, so the specialist must use the image in two projections.

X-ray allows you to diagnose a fracture of the limb; for this purpose, pictures are taken in posterolateral and anterior direct projections

Features of treatment of different types of fractures in children

In case of childhood injuries, it is worth considering the fact that in children under seven years of age, rapid tissue regeneration and bone fusion occur, so preference, as a rule, is given to conservative methods. Surgical intervention is used only in cases of extreme necessity. Features of the treatment of childhood fractures:

• For non-displaced fractures, the patient does not need hospitalization and is treated on an outpatient basis by fixing the injured limb. Typically, a specialist secures the limb with a bandage or splint, placing it on the damaged bone.
• It is necessary to visit a traumatologist once a week to avoid the risk of re-displacement of fragments.
• To avoid secondary displacement of bone fragments, metal knitting needles and an additional plaster bandage are often used, thanks to which the bone is fixed.
• In the treatment of fractures of the femur, humerus, and ankle, traction is often used, which eliminates displacement of the fragments. Reposition occurs, resulting in a comparison of bone fragments.
• For displaced fractures, an operation is performed during which general anesthesia is used. After surgery, a plaster cast is applied and the patient is left in the hospital.

Displaced fractures are more difficult to treat and take longer to treat than non-displaced fractures.

Rehabilitation and recovery

The rehabilitation period directly depends on the age of the child, the nature and location of the fracture. For example, fractures of the pelvic bones, femoral neck and femur heal in two to three months, the upper extremities - a month and a half, and the lower extremities - one and a half to two and a half months. The longest period for rehabilitation of a spinal injury is up to one year.

The recovery period begins when the doctor removes the fixation elements from the patient. At this time, the patient is faced with the task of strengthening muscles, developing joints, and restoring the functions of the damaged limb. For these purposes, physical therapy, massage and physiotherapeutic methods are used. For open fractures, in order to prevent infection, the method of hyperbaric oxygenation is used (a procedure through which cells are actively enriched with oxygen). As a result, the activity of metabolic processes is restored.

Nutrition, which includes vitamins and large amounts of calcium, plays a special role in the recovery process. For severe injuries, rehabilitation treatment begins in a hospital and then is carried out on an outpatient basis.

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 between the child’s bone tissue and the 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 ​​bone tissue damage 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 an epiphysiolysis 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 sharp 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 find out the mechanism of damage from the parents. 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.

Although low bone density (called osteoporosis or osteopenia in early and mild forms) is much more common in older women, it also occurs in children, especially with certain genetic diseases, hormonal disorders, poor diet and/or very little sun exposure. In children, low bone density is diagnosed in much the same way as in adults and requires bone imaging techniques. Low bone density in growing children can be treated through a combination of lifestyle changes, better nutrition and medication.

Steps

Part 1

Diagnosing low bone density

Identify signs that may indicate low bone density. Although you won't be able to diagnose low bone density in your child with certainty (that's what doctors are for), there are certain secondary signs and symptoms that can point out this problem. A common sign is a history of frequent bone fractures, although sometimes stress fractures and bone cracks are difficult to identify without x-rays.

• Signs that a child may have one or more stress fractures include: deep aching pain that lasts longer than one week, excessive tenderness of the bones to touch, local swelling or puffiness, local redness and/or bruising.
• Risk factors for low bone density include various medical conditions (see below) and certain medications, including corticosteroids, anticonvulsants, and immunosuppressants.

1. Contact your family doctor or pediatrician. Parents are usually unaware of low bone density in their children until they experience fractures, especially for no particular reason. In this case, a child may have several consecutive bone fractures in different places despite the fact that he is not actively involved in sports. If this happens, consult your doctor to check if your child's bone density is low.

   Take a series of x-rays of the bone. In most cases, low bone density in children is discovered when visiting a doctor due to a broken leg, arm, or spine. Thus, if a child is given an X-ray of a broken arm or leg, there is a fairly high probability that the doctor will notice increased fragility or porosity of the bones; however, standard X-rays taken for fractures are not accurate enough to determine bone quality and density.

   • X-ray examination is only the first stage of analysis, which allows us to conclude about low bone density. Other tests are also needed for an accurate diagnosis.
   • On X-rays, healthy bones appear almost white, especially their outer borders, called the cortex. With osteoporosis, bones appear grainier and darker because they contain less minerals such as calcium, phosphorus and magnesium.
   • In children, mild thinning of bone tissue without any fractures is usually called osteopenia rather than osteoporosis.

2. Get blood and urine tests. If past fractures and X-rays indicate your child has low bone density, the doctor will order blood and urine tests to confirm (or rule out) the possible diagnosis. These tests are designed primarily to measure levels of calcium, alkaline phosphatase, vitamin D, and thyroid and parathyroid hormones, which can detect low bone density in both children and adults.

   • The absorption of calcium plays an important role, since this chemical element is the main component of bone tissue. High levels of calcium in the blood may indicate that the child's body is not using it properly. However, low blood calcium levels may mean that the child is not getting enough calcium from food or is losing it too quickly.
   • Vitamin D acts much like a hormone and is essential for the absorption of calcium in the intestines. Vitamin D is produced in the skin under the influence of sunlight.
   • Thyroid and parathyroid hormones play an important role in regulating and restructuring bone growth. Diseases (or injuries) to these glands can cause low bone density in both children and adults.

3. Get dual-energy X-ray absorptiometry (DXA). If blood and urine tests also indicate low bone density or osteoporosis, DXA can more accurately determine the mineral density of various bones. DXA uses two x-ray beams of different energies to produce an image of the area of ​​interest, and then compares the image to a “standard” for the child's specific age and gender. The data is then compared to the bone density (BDT) of children of the same age with healthy bones.

   • In children, low bone density is most often found in the spine and pelvis, which is considered the most reliable and clear sign of abnormal bone density.
   • Bone density values ​​determined by DXA are not considered completely reliable because children's bones are less dense and more variable than those of adults.
   • PCT values ​​determined by DXA may underestimate the decrease in bone density in children. In other words, this method can show “normal” bone density in cases where it is low.

4. Ask your doctor about peripheral quantitative computed tomography (QCT). Typically, PCCT is more accurate than DXA because it can differentiate between the inner cancellous (intramedullary) bone tissue and the denser, harder outer cortex. Additionally, a PCCT scan takes little time and is usually performed in the wrist or tibia (tibia). This method is considered to be better for detecting low bone density, although it is less common than DXA.

   • If in doubt, it is best to do both DXA and PCCT to determine if your child has low bone density.
   • Currently, PCCT is done primarily for research purposes, so this method may not be available in your area. Ask your doctor about the possibility of performing PCCT.

   Part 2

   Preventing Low Bone Density in Children

   1. Keep in mind that in most cases, low bone density in children cannot be prevented, although sometimes it can be avoided. For example, giving birth prematurely increases the risk of developing weaker, more fragile bones. Low bone density can also be caused by diseases such as cortical paralysis, Crohn's disease, osteogenesis incomplete, intestinal malabsorption syndrome, metabolic problems (homocystinuria and lysosomal disease), liver and kidney diseases, type 1 diabetes, and some types of cancer. and hyperparathyroidism.

      • It is necessary to identify the child's disease and determine possible side effects, including low bone density, to understand possible problems in the future.
      • Stress fractures and bone cracks can be difficult to detect. However, careful consideration should be given to a child's complaint of deep, aching pain that lasts longer than a few days, especially in the absence of other obvious signs of superficial trauma.

   2. Encourage your child to play sports, especially outdoors. Although low bone mineral density in children often cannot be prevented, there is an increasing number of cases where it is associated with a sedentary lifestyle, especially in children living in large cities. Unlike past generations, today's children lead a much less active lifestyle, which negatively affects their bones and muscles.

      • Determine the maximum permissible time that a child is allowed to spend at the computer and watching TV.
      • Encourage your child to play outdoors with friends, as well as cycling, swimming and gardening.
      • Indoor physical activity is also good, but it is better to exercise outdoors, as sunlight helps the skin produce vitamin D (at least in the clear summer months).
      • If a child requires bed rest due to illness, this significantly increases the risk of osteoporosis, so with the permission of the doctor, try to keep the child at least a little active.

   3. Make sure your child eats normally. Inadequate or poor nutrition can also lead to low bone density in children and adults. Calcium and vitamin D are most important for normal bone density. In addition, a lack of magnesium or boron can also cause insufficient bone density. Make sure your child eats less at fast food establishments and avoid giving him processed foods with lots of preservatives. Prepare homemade meals using fresh ingredients.

      If your child smokes, help him quit this bad habit. Research shows that tobacco use increases the risk of low bone density. If your teen smokes cigarettes or uses tobacco in any other way (such as chewing it), encourage him to quit.

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 abundantly 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. Epiphysiolysis 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 site of 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 mid-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 reposition, 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 incorrectly 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 prolonged, 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. Non-union 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.).

Which doctors should you contact if you have bone fractures in children:

• Traumatologist
• Surgeon
• Orthopedist

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Other diseases from the group Trauma, poisoning and some other consequences of external causes:

Arrhythmias and heart block in cardiotropic poisonings

Depressed skull fractures

Intra- and periarticular fractures of the femur and tibia

Congenital muscular torticollis

Congenital malformations of the skeleton. Dysplasia

Lunate dislocation

Dislocation of the lunate and proximal half of the scaphoid (de Quervain's fracture dislocation)

Tooth luxation

Dislocation of the scaphoid

Dislocations of the upper limb

Dislocations of the upper limb

Dislocations and subluxations of the radial head

Dislocations of the hand

Dislocations of the foot bones

Shoulder dislocations

Vertebral dislocations

Forearm dislocations

Metacarpal dislocations

Foot dislocations at the Chopart joint

Dislocations of the phalanges of the toes

Diaphyseal fractures of the leg bones

Diaphyseal fractures of the leg bones

Old dislocations and subluxations of the forearm

Isolated fracture of the ulnar shaft

Deviated nasal septum

Tick ​​paralysis

Combined damage

Bone forms of torticollis

Posture disorders

Knee instability

Gunshot fractures in combination with soft tissue defects of the limb

Gunshot injuries to bones and joints

Gunshot injuries to the pelvis

Gunshot injuries to the pelvis

Gunshot wounds of the upper limb

Gunshot wounds of the lower limb

Gunshot wounds to joints

Gunshot wounds

Burns from contact with Portuguese man-of-war and jellyfish

Complicated fractures of the thoracic and lumbar spine

Open injuries to the diaphysis of the leg

Open injuries to the diaphysis of the leg

Open injuries to the bones of the hand and fingers

Open injuries to the bones of the hand and fingers

Open injuries of the elbow joint

Open foot injuries

Open foot injuries

Frostbite

Wolfsbane poisoning

Aniline poisoning

Antihistamine poisoning

Antimuscarinic drug poisoning

Acetaminophen poisoning

Acetone poisoning

Poisoning with benzene, toluene

Toadstool poisoning

Poisoning with poisonous wech (hemlock)

Halogenated hydrocarbon poisoning

Glycol poisoning

Mushroom poisoning

Dichloroethane poisoning

Smoke poisoning

Iron poisoning

Isopropyl alcohol poisoning

Insecticide poisoning

Iodine poisoning

Cadmium poisoning

Acid poisoning

Cocaine poisoning

Poisoning with belladonna, henbane, datura, cross, mandrake

Magnesium poisoning

Methanol poisoning

Methyl alcohol poisoning

Arsenic poisoning

Indian hemp drug poisoning

Poisoning with hellebore tincture

Nicotine poisoning

Carbon monoxide poisoning

Paraquat poisoning

Poisoning by smoke vapors from concentrated acids and alkalis

Poisoning by oil distillation products

Poisoning with anti-depressant drugs

Salicylate poisoning

Lead poisoning

Hydrogen sulfide poisoning

Carbon disulfide poisoning

Poisoning with sleeping pills (barbiturates)

Poisoning with fluoride salts

Poisoning by central nervous system stimulants

Strychnine poisoning

Tobacco smoke poisoning

Thallium poisoning

Tranquilizer poisoning

Acetic acid poisoning

Phenol poisoning

Phenothiazine poisoning

Phosphorus poisoning

Poisoning with chlorine-containing insecticides

Poisoning with chlorine-containing insecticides

Cyanide poisoning

Ethylene glycol poisoning

Ethylene glycol ether poisoning

Poisoning with calcium ion antagonists

Barbiturate poisoning

Poisoning with beta-blockers

Poisoning with methemoglobin formers

Poisoning with opiates and narcotic analgesics

Poisoning with quinidine drugs

Pathological fractures

Maxillary fracture

Fracture of the distal radius

Tooth fracture

Fracture of the nasal bones

Scaphoid fracture

Fracture of the radius in the lower third and dislocation in the distal radial-ulnar joint (Galeazzi injury)

Fracture of the lower jaw

Fracture of the base of the skull

Proximal femur fracture

Calvarial fracture

Jaw fracture

Fracture of the jaw in the area of ​​the alveolar process

Skull fracture

Fracture-dislocations in the Lisfranc joint

Fractures and dislocations of the talus

Fractures and dislocations of the cervical vertebrae

Fractures of the II-V metacarpal bones

Fractures of the femur in the area of ​​the knee joint

Femur fractures

Fractures in the trochanteric region

Fractures of the coronoid process of the ulna

Acetabular fractures

Acetabular fractures

Fractures of the head and neck of the radius

Sternum fractures

Femoral shaft fractures

Humeral shaft fractures

Fractures of the diaphysis of both bones of the forearm

Fractures of the diaphysis of both bones of the forearm

Fractures of the distal humerus

Clavicle fractures

Bone fractures

Fractures of the shin bones

Hindfoot fractures

Fractures of the bones of the hand

Fractures of the bones of the forefoot

Fractures of the forearm bones

Midfoot fractures

Midfoot fractures

Fractures of the bones of the foot and fingers

Pelvic fractures

Fractures of the olecranon process of the ulna

Scapula fractures

Fractures of the humeral condyle

Patella fractures

Fractures of the base of the first metacarpal bone

Humerus fractures

Metatarsal fractures

Spinal fractures

Fractures of the proximal end of the tibia