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Treatment of diaphyseal femoral fractures in children. The most common fractures in children are the femur and radius.

The anatomy and physiology of a child is different from that of an adult, which determines the mechanisms of appearance, clinical picture, treatment methods and possible complications at a fracture femur with displacement in children. For young patients it is necessary to create special conditions recovery so that the injury does not in any way affect the future health of the baby.

Features of childhood trauma with displacement

In preschool children, the bones are thin and contain less minerals, so they are flexible and not brittle. The periosteal layer is thick. Because of this, fractures occur more often, and with full-fledged fractures, the fragments usually do not disperse far.

Children often suffer from greenstick fractures. With such damage, the integrity of the tissues inside the bone is disrupted, but the strong periosteal layer remains intact. Poorly contained debris can move inside the intact case. All this complicates the initial diagnosis of the fracture and requires a thorough hardware examination.

Regeneration in children is more intense and faster than in adults. However, when the fracture of the femoral skeletal structures heals without eliminating the displacement of the fragments, deformation appears in the form of curvature and shortening, which can cause significant disturbances in statics, especially in the pelvic and lumbar zone.

Causes and risk factors

The mechanics of hip injuries in children are the same as in adults. Causes of injury:

  • falling from an elevated position;
  • forced twisting or bending of the leg;
  • road accident.

Due to anatomical and physiological characteristics, the severity of the fracture and the prognosis for recovery in children are not always proportional to the severity of the injury. A minor blow can lead to a complex fracture, and with a serious impact there may not even be a break, or a minor injury with favorable prognosis recovery.

A risk factor for pathological fractures is tumor process V bone structures Oh. Malignant neoplasm has a detrimental effect on tissues, which leads to their fractures even with small impacts or sudden movements.

Classification of fractures

The following types of damage are recognized by location:

  • Fractures of the upper part. Basically, this is an injury to the femoral neck. This area is the most vulnerable in people of any age. This also includes damage to the joints of the pelvis and hip in the baby. In case of a very serious injury, the greater or lesser trochanter is torn off.
  • Diaphyseal, when the bone body is damaged in all three sections.
  • Injuries to the lower part - in the area of ​​​​the connection of the hip bone with the knee joint. If there is a blow to the area above the knee, a crack can form at the joint itself, and rupture of blood vessels can cause hemarthrosis.

Injuries bony body- the most severe and common. They may be accompanied by severe hemorrhage.

Fractures of the femur can be of the spiral, transverse, oblique and comminuted type. This is also taken into account during treatment and rehabilitation measures.

Characteristic symptoms

The main sign of a bone fracture is sharp pain. The hip becomes shortened and deformed, making it impossible to step on the leg. A tumor appears in the damaged area and hematomas occur. Movements become painful, and it is impossible to lift an elongated limb. Pathological mobility is diagnosed, as well as crepitus at the fracture point.

The only group of injuries whose symptoms are very different are subperiosteal and driven fractures of the femur in children under three years of age.

With such injuries, the pain is minor, the leg is not shortened or deformed, and it is possible to maintain support on the limb. Suspicion of a fracture arises due to swelling and pain in the corresponding place.

Diagnostic and treatment methods

The purpose of skeletal traction is to put the sharp ends of a broken bone back in place.

An informative method of hardware diagnostics for such injuries is an x-ray of the hip in two projections. In difficult cases, they are referred for magnetic resonance imaging and computed tomography. Suspected injury nerve fibers or blood vessels - the basis for seeking advice from a neurologist or vascular surgeon.

Treatment of displaced femur fractures in children is usually conservative, in a hospital setting. The doctor chooses one of the methods depending on the characteristics of the injury:

  • Continuous traction until the fracture heals completely.
  • A combination of traction and immobilization using a plastic or plaster bandage. Traction is applied until the callus appears (approximately 21 days) and then replaced with plaster until final fusion.
  • Immobilization using a coxite bandage.

Plaster without previous traction is usually used for subperiosteal and driven-in fractures.

Until the age of five, traction with an adhesive plaster is applied to victims, and skeletal traction is applied to older children. Fusion occurs in 21–56 days. Then the traction is removed, a gentle load is allowed, and a complex is selected therapeutic exercises, ozokerite and paraffin treatments, massage for faster restoration of leg functions.

Surgical intervention such as osteosynthesis with a locking screw is performed if it is impossible to ensure the required quality of traction.

This happens if a child suffers from spastic paralysis And epileptic seizures. Surgery is also indicated if there are a lot of fragments or interposition of soft tissues has occurred. Bony metal structures, as a rule, are not used because they can provoke intensive growth of the periosteum.

The surgery is performed using general anesthesia. Then the patient’s hip is cast for 42–56 days. In the future, ozokerite and paraffin procedures, massage and a set of therapeutic exercises are determined.

Possible complications

Serious injuries can affect the growth and development of a child’s bone structures.

The consequences of a displaced hip fracture in a child can manifest themselves:

  • in the difference in limb length and lameness;
  • in the curvature of the leg;
  • in joint dysfunctions;
  • in partial and complete immobilization;
  • in constant excruciating pain.

Consequences such as infection and suppuration, as well as fat embolism, should not be excluded. Without medical care the child may become disabled.

Restoration activities

Rehabilitation for a displaced hip fracture in a child is carried out at home according to the recommendations of a pediatrician. It should include:

  • balanced diet;
  • gradual development of the injured leg;
  • complex of physical procedures;
  • massage sessions.

It's worth taking your baby to wellness center for therapeutic gymnastics classes. It is necessary to develop the problem area under the supervision of a specialist.

The prognosis for children's fractures is favorable: fusion of bone structures occurs faster than in adults. But only if the treatment is carried out under strict medical supervision.

The baby's mobility cannot always be controlled. But quality nutrition, reasonable exercise and preventing a lack of vitamin D, calcium and phosphorus will strengthen bones and reduce the risk of fractures.

Femoral shaft fractures occurs frequently and, according to N.G. Damier, accounts for about 10% of all fractures of the extremity bones in children. Fractures of the femoral diaphysis occur from direct violence, flexion when falling on the legs, or twisting when turning the body and having a fixed foot. Most often, fractures occur when falling from a height or during outdoor games: skating, skiing, etc. ice slides. Often a fracture of the femur occurs as a result of a car injury.

Femur fractures are also observed in newborns during difficult childbirth in the breech position. These are the so-called “birth” fractures, which are usually diagnosed and treated in maternity hospitals or in surgical hospitals. With these fractures, consolidation occurs within 2 weeks.

More than half of femoral shaft fractures occur in the middle third, and about 30% occur in the lower third of the femur. According to the plane of the fracture, there are transverse, oblique, helical and comminuted fractures. In 85% of cases, displacement of fragments is observed.

The nature of the displacement depends on the level of the fracture. In case of fractures of the diaphysis of the femur in the upper third, the central fragment, under the action of contraction of the gluteal muscles and the iliopsoas muscle, is displaced outward and anteriorly, and the peripheral fragment is displaced inwardly and posteriorly by the traction of the biarticular and adductor muscles.

For fractures in middle third a displacement of the same nature occurs, however, the deviation of the central fragment outward and anteriorly is less, and the displacement of the peripheral fragment posteriorly is greater.

For fractures in lower third femoral diaphysis the central fragment, under the action of the iliopsoas and adductor muscles, is displaced anteriorly and medially, and the peripheral fragment, under the action of the gastrocnemius and biarticular muscles, is displaced posteriorly and upward.

Clinical picture. Diagnosis is not difficult in the presence of classic signs: pain, dysfunction, changes in the contours of the hip, crepitus of fragments, pathological mobility.

There are no active movements in the hip and knee joints due to severe pain. In case of fractures in the middle third of the diaphysis of the femur with displacement of the fragments, the axis of the limb is deformed according to the “breeches” type, in which the angle is open inwards and the apex is turned outwards. During palpation, one should not try to determine the symptoms of pathological mobility and crepitus of bone fragments in order to avoid additional damage. It should be remembered that fractures of the femoral diaphysis can cause damage to blood vessels and nerves.

Treatment- in the hospital. When providing first aid in an outpatient setting, you should consider the sequence of manipulations before transportation.

The patient is placed on a hard stretcher (bed, dressing table); the surgeon takes the foot injured limb and carries out traction along the length; a 1% pantopon solution is administered in an age-specific dosage; the fracture site is anesthetized, for which a 1 or 2% solution of novocaine or an alcohol-novocaine mixture (2% solution of novocaine and 70° alcohol in equal proportions) is injected into the hematoma at the rate of 1 ml per 1 year of the child’s life. After careful immobilization of the injured limb in a transport splint, the patient is sent to the hospital on a stretcher.

The method of choice in the treatment of femur fractures in children is traction in all its modifications. Due to high plasticity bone tissue and the ability to level the remaining displacement, indications for osteosynthesis are extremely limited, and most often open reduction is performed for fractures in the area proximal part femur.

Nursery Guide polyclinic surgery.-L.: Medicine. -1986

The child’s body is in a developmental stage, so some pathological processes, which at first glance are identical, do not occur in the same way in small and adult patients.

Hip fractures in children account for about twenty percent of all injuries of this type. Its main cause is destruction of the femur under the influence most often external factors physical impact.

In some cases, it is determined only with appropriate medical examination. Requires high-quality treatment, as it is fraught unpleasant consequences for life.

Possible reasons

Kids are very active and do not see various dangers lurking in their games. Rollerblades and skates are especially dangerous for hip fractures in children - skating on them leads to frequent injuries. Skateboards and bicycles are considered hazardous.

Often the causes of the pathologies in question are falls from a height or certain mechanical effects. In this case, the impact force must significantly exceed the strength of the bone tissue. Femur fractures often occur as a result of road traffic accidents.

Cases are widely known in medicine when a hip fracture in a child occurs as a result of certain pathological processes. Among them is osteoporosis, which is the result of a lack of calcium and other mineral elements in bone tissue. This state of affairs provokes high fragility of the bone, which contributes to its failure even with minimal loads.

This is why nursing similar diagnosis must be professional and very careful, since even changing a diaper can cause injury to the femur.

For those suffering internal damage bones, including oncology skeletal system, bone metastases, osteogenesis and osteomyelitis, even minor mechanical influences are fraught with fractures of the femur. This is due to low threshold strength of bone tissue as a result of ongoing pathologies. To prevent the occurrence of physical damage, even minor injuries must be prevented.

Due to the peculiarities of the anatomical and physiological structure child's body the level of damage is not always proportional to the injury sustained.

Thus, a seemingly insignificant injury can provoke a serious injury. And, conversely, the strongest impact of the mechanical type will not lead to pathology at all, or the damage will be relatively mild with a favorable picture for therapy.

Main symptoms and classification

The injury discussed is quite common. Pathology has certain symptoms. If we consider damage to the femur by location, they are classified as follows:

  • injuries of the upper part - include destruction of the femoral neck, separation of the greater and lesser trochanter;
  • fractures of the diaphyseal or mid-femur in young children;
  • destruction of that part of the thigh that is located near the knee.

Important! The most common is very severe injury to the mid-thigh, diagnosed in sixty percent of patients with this pathology.

Depending on the characteristics, fractures of the upper femur in children can be spiral or oblique. There are transverse injuries and those with multiple fragments. So-called epiphysiolysis affecting the growth zone occurs much less frequently.

The symptoms of the injury in question depend on its location and type and manifest themselves in different ways. If damage occurs to the neck of the bone in question, the child will complain of pain in the area hip joint, and in groin area swelling will appear. Trauma causes the strongest pain syndrome when trying to move. Visually, the affected limb becomes shorter.

In case of destruction of the displacement, the symptoms are unclear, it is possible to lean on the injured leg. Main symptom This pathology is the unnatural position of the foot, turned to the side both when walking and at rest.

Injury associated with the greater trochanter is quite rare and is caused by falling on one side. The signs of this pathology are quite vague. Children most often complain about painful sensations arising during movement. Through certain time hematoma and swelling appear on the upper part.

If the baby complains about severe pain, noticeable shortening of the femur and its deformity, suspected damage to nerve endings and blood vessels, then the symptoms indicate damage to the diaphysis. With this diagnosis, swelling and the development of a hematoma are observed. When examined by palpation, bone fragments can be felt. This pathology can cause painful shock.

Very rarely, but destruction of the lower edge of the bone in question can still occur. In this case, blood accumulates in the joint, as a result of which the main function of the leg is impaired. If a displacement occurs, then the deformation, which is easily determined visually, appears above the knee.

Diagnosis and treatment

The problem of diagnosis is dealt with by orthopedists, surgeons and traumatologists. To install correct diagnosis use:

  • X-ray examination of the hip joint, with direct and lateral projections performed;
  • take an x-ray of the healthy leg;
  • if necessary, study the limb using computed tomography;
  • in some cases an MRI is performed;
  • ultrasound examination.

A puncture is performed knee joint if hemarthrosis is suspected due to damage to the lower part of the femur.

Important! In order for the therapeutic process to proceed quickly with good results and to avoid complications, first qualified assistance to the victim is important.

Most often, it should be provided by the mother or other close relatives. The algorithm of actions consists of the following points:

  1. Bring your child to normal condition, calming the crying.
  2. Give painkillers and, if necessary, sedatives.
  3. If the child is in in a state of shock, and this is revealed by the lack of his reaction to what happened, then take anti-shock therapy.
  4. Fix the leg. To do this, you can wrap any available material that will temporarily act as a tire.
  5. Call an ambulance and arrive at the trauma department.

In case open injury to the above actions you need to add a tourniquet to stop bleeding and primary processing wounds using hydrogen peroxide. But any other actions to straighten the leg and the like are strictly prohibited.

Specialists at the trauma department where the patient is admitted provide treatment, usually conservative, depending on many factors.

So, if no displacement of femoral bone fragments is detected, then traction is performed using the Charest method. IN mandatory UHF procedures are shown, physical therapy, massages and some physiotherapy are used.

In cases of injury greater trochanter or small, skeletal traction is indicated, which involves the application of a cast of a certain configuration, starting from the waist line and ending with the lower leg.

Therapy for diaphyseal fractures consists of constant traction until a callus forms. Next, the complex includes a plaster cast until complete healing.

An open fracture requires surgical intervention, in which fragments are collected using specially provided surgical means they are fixed. The use of the Elizarov apparatus is also allowed. Wearing a plaster cast lasts up to three weeks.

Using drug therapy, produce pain relief and increase the amount of calcium in the child’s body. With its help, the process of bone fusion and regeneration is accelerated. By performing a combination of all the necessary manipulations, the fastest recovery is achieved.

Fractures of the femoral neck (femoral neck) account for half a percent of all fractures that occur in the younger generation. Statistics show that there is no gender division in this matter: this disease equally often affects both young representatives of the fair sex and boys. The most risky age is from five to fourteen years. It is extremely rare for such a fracture to occur in children from two to four years old and in teenagers from fifteen to seventeen years old.

The reason why a small patient may experience a fracture of the spinal joint is a severe injury, which can be obtained as follows:

road traffic accident, fall from a height of more than two and a half meters, fall from a height of half a meter to one and a half meters (the percentage of such fractures is 16%), doing the splits, falling during the game.

Symptoms

Symptoms of the disease may differ from each other special case. It all depends on which part of the cervix was injured and affected. If we are talking about fractures that are accompanied by displacement, then the signs will be as follows:

the baby’s hip joint will begin to hurt very much, swollen tissue will appear in the groin, the child will not be able to lift or move his leg, any movement made by the affected limb will provoke severe pain, the affected limb visually becomes shorter than the other.

If a fracture has occurred, but there has been no displacement, the symptoms will be less painful and severe:

the baby will be able to lean on the injured leg, the pain in the leg, and specifically in the hip joint, will not be unbearable, but moderate, visually the injured leg will be slightly turned away from itself - exactly as it happens during walking.

Diagnosis of femoral neck fracture

The doctor, being an experienced diagnostician, will easily make a diagnosis and after visual inspection. However, in order to be one hundred percent sure of his assumption, the doctor will send the little patient to radiographic examination hip joint. The most informative in in this case is considered a direct shot. In some cases, when no displacement is observed, to announce final diagnosis The doctor needs to compare the x-ray of the affected joint with the x-ray of the healthy one.

Extremely in rare cases Your doctor may need the results of one of the following diagnostic tests:

MRI, computed tomography.

Complications

The main complication that the discussed pathological condition is fraught with is nonunion of the fracture. As a result, the child may become bedridden. But, as a rule, such a complication threatens elderly patients much more than children. Modern surgery and the treatment methods available today make it possible to qualitatively heal a fracture of this part of the leg in children, without leaving noticeable marks.

Treatment

Treatment of the disease under discussion occurs exclusively in clinical settings. The pediatric traumatology hospital is designed for this purpose. Sometimes treatment can be done at home, but this is the exception rather than the rule.

What can you do

Parents who suspect a hip fracture in their child need to do everything they can to get their child to the hospital as soon as possible children's department at medical institution. It's pretty serious defeat bone tissue, the treatment of which should be carried out exclusively by a specialist with medical education. No plantains, cabbage compresses and herbal decoctions will not help in treating this fracture. The first and only thing that mom and dad should do if they suspect something is wrong is to organize the delivery of a small patient to a doctor or the delivery of a doctor to a small patient. This will be the end of their healing mission.

What can a doctor do?

A femoral neck fracture in a child occurs according to exactly the same algorithm as in adult patients:

reduction, immobilization of the affected limb in order to fix it qualitatively and correctly, restoration of the functioning of the leg.

The most popular method of treating the disease under discussion is traction. Thanks to this method, the doctor can reinsure himself and his patient against the displacement of fragments. If the baby is less than three years, then in his case the vertical extension method will be used. A couple of weeks after use this method After treatment, the functioning of the limb will be restored. The limb will not remain shortened, but will regain its original length.

If the small patient is more than five years old, then the doctor can use a special medical device for traction. It is a very thin rod made of metal. This rod was invented by a German surgeon named Krischner. Since its invention, the device began to bear the name of its creator - the Krishner knitting needle.

The period of immobilization for the disease under discussion in representatives of the younger generation can last up to one hundred and twenty days. It is extremely rare, but still sometimes doctors resort to surgical methods treatment pathological condition. In other words, to operations. Operations are carried out if:

originally applied conservative treatment turned out to be ineffective or ineffective, a fracture of the femoral neck resulting from injury turned out to be open, near a child together with open fracture a significant amount of soft tissue was affected.

It is difficult to say how quickly the patient will recover. The fact is that the timing of treatment is even more individual than the treatment methods. The speed of the healing process depends on the following factors:

the age of the baby, the general condition of the little patient’s body, the severity of the fracture.

Healing of a fracture with a ten percent displacement is considered acceptable. A shortening of the leg by no more than one centimeter is considered normal.

Prevention

It is impossible to prevent a fracture of the spinal cord. You can try to limit the child’s activity, but even such a radical measure cannot bring desired results. It is necessary to warn the child to take precautions when playing sports and during active games.

It is important that the nutrition of the younger generation is of high quality and balanced. There should be enough vitamins and microelements for the full development of the child’s body.

Anatomical and physiological features childhood determine the characteristics of the occurrence and course of hip fractures in children.

Features of hip fractures in children

Up to 6 years of age, children’s bones are relatively thin and contain less minerals, so they are flexible and less fragile than those of adults; the periosteum is thick, as a result of which incomplete fractures are not uncommon, and in cases complete fractures the displacement of fragments is less pronounced than in adults. Greenstick fractures are common in children.

The regeneration process for fractures in children is more intense and faster than in adults. However, when a hip fracture heals without eliminating the displacement of the fragments, deformation occurs in the form of curvature and shortening, which can lead to significant static disturbances, especially pronounced in the pelvis and spine. Therefore, the principles of treating hip fractures in children are the same as in adults, although there are differences in treatment techniques.

The main causes of fractures in children are falls from heights, being hit by moving vehicles and unorganized sports activities.

Diaphyseal fractures of the femur in children produce the same characteristic displacements of fragments that lead to deformation of the limb - curvature and shortening.

Treatment of hip fractures in children

Treatment of diaphyseal fractures in children under 5 years of age is carried out by suspending the injured limb in vertical position according to Sheda.

Anesthesia is performed by injecting 5-10 ml of 2% novocaine into the hematoma. Then a zinc gelatin extract is applied to the entire lower limb from the hip joint to the foot. A plywood board is inserted into the gauze loop, and a cord is used to pull it.

The child is placed on the bed (placed under the mattress wooden shield). Traction is carried out in a vertical position of the limb, the cord is thrown over a block mounted above the bed or using a metal frame. The size of the load depends on the age of the child (2-5 kg, for a newborn - 300-500 g).

The criterion for correctly applied traction is the elevated position of the pelvis on the side of the injured hip.

After applying traction, you should continuously monitor it and promptly strengthen the traction with bandaging. If you pay less attention to traction, then very quickly, following the reduction of the limb, the zinc gelatin bandage may slip and secondary displacement of the fragments will occur. If observation and control over the state of traction are organized correctly, then by the end of the 3rd week, clearly expressed consolidation occurs, and traction can be stopped.

Treatment of femoral shaft fractures by traction in children over 5 years of age is carried out according to the rules of adults.

After anesthetizing the fracture site (10 ml of 2% novocaine), skeletal traction is applied to the upper metaphysis tibia. The leg is placed on a Wehler, Chaklin, Bogdanov splint in an abduction position, which depends on the degree of outward deviation of the central fragment. Comparison of fragments is carried out using the same techniques as in adults, and a load of 4-6 kg is left (depending on age and muscle tone).

From the first days after traction is applied, the child begins classes under the guidance of the duty nurse or instructor. therapeutic exercises- active movements of the foot, movements of the patella. Clinically pronounced consolidation is observed already in the 2nd week, which is confirmed x-rays. The traction stops after the child independently lifts the extended leg. Strong consolidation occurs after 3 weeks (depending on age). A few days after the traction is removed (monitoring the strength of the formed fusion), the patient is put on his feet, and he begins to walk, first with crutches, and then, as he feels stability and the strength of the injured limb returns, with a stick.