Start in science. A fracture in a child is a dangerous pathology that requires immediate medical attention. Closed bone fractures in children.

Almost every child, and therefore his parents, faces the problem of a fracture sooner or later. In order to correctly assess the severity of the situation and seek qualified help in time, you should be aware of the characteristics of fractures in children. Parents often underestimate the severity of the condition because some children are not very sensitive to pain; Some adults consider this almost the norm, explaining it by the child’s mobility. Is it that simple?

Relevance of the issue

As is known from medical statistics, fractures in children account for about 15% of all injuries and injuries for which they seek qualified medical help. The problem is due to the peculiarity of the structure of the human body: the biological mechanics, anatomy and even physiology of a minor are very different from those inherent in an adult, since the body is actively growing and developing. Injuries accompanied by fractures, including violation of the integrity of the epiphysis, are an urgent problem of modern medicine. Updated approaches to refined diagnostics are being developed, and treatment strategies are being formed that would fully satisfy the characteristics of the case.

A key feature of fractures in children is the structure of bone tissue. The musculoskeletal system contains not only a fairly large amount of cartilage tissue, but is also distinguished by the presence of endplates, which an adult does not normally have. Such areas are called growth areas. Children's bones are characterized by increased strength and have a reliable periosteum, which forms callus in a short time. Biomechanical studies have shown the ability to absorb large amounts of energy. Scientists explained this by the porosity of the elements and low mineral density. The abundance of pores in bone tissue is associated with numerous large Haversian canals, due to which the elastic modulus decreases and strength decreases. Growth and maturation are accompanied by a decrease in porosity and thickening of the cortical block, which makes the skeletal system stronger.

Anatomy and injuries

Another feature of fractures in children is due to the attachment of ligamentous blocks to the bone epiphyses. Consequently, trauma to the limb can damage the growth site of the bone. The strength of the elements is ensured by the interweaving of annular blocks and mastoid bodies, but in any case, the growth area is characterized by relatively low strength. This is noticeable if we compare the anatomical features and qualities of the metaphysis, ligamentous fibers, and growth zones. Such areas are relatively resistant to tension, but are subject to the negative influence of torsional force. It is known from statistics that violation of the integrity of the growth plate is most often explained by angular influence or rotation.

Another feature of a fracture in children is the possibility of a displaced format, and the probability directly depends on the quality and parameters of the periosteum. The thicker this block, the lower the risk of closed reduction. After changing the position, it is she who is responsible for maintaining the fragments in the correct and stable state.

Healing process

Fractures in children are accompanied by bone remodeling. The process is ensured by resorption of the periosteum, accompanied by the generation of new bone tissue. Anatomical reduction is only necessary in a limited number of cases. Many traumatized children do not need such an intervention at all. The regeneration process depends on several factors: age, location of the injury relative to the joint, and the presence of obstacles to its activity. Remodeling is determined by the potential ability of the bone to grow, and the lower the age, the greater the potential.

If the injury is localized near the growth block, recovery will require minimal time, especially when the deformity coincides with the articular axis of movement. in which areas have shifted, it overgrows more slowly. Restoration of the diaphysis requires considerable time. Possible rotational injury or leading to deterioration of joint motility. These heal slower than others.

Bones: are they growing in moderation?

One of the features of bone fractures in children is the risk of excessive bone growth. Regarding long bones, this is explained by the effect on growth areas - in this area, blood flow is activated, which is necessary for the restoration of damaged tissue. It is noted that a fracture of the femur in a child under ten years of age is often accompanied by lengthening of the bone by several centimeters in the next couple of years. To minimize the undesirable consequences of rehabilitation, it is necessary to combine bone fragments in a bayonet-like manner. For patients older than this age, excessive development is less dangerous, the process is relatively weakly expressed. If a fracture occurs, it is necessary to provide assistance by simply repositioning the blocks.

About the nuances

A feature of bone fractures in children known to doctors is the progression of deformation. Sometimes the injury is accompanied by damage to the pineal gland. As a result, the site may be closed by a few percent or completely. This leads to angular deformation and can cause shortening of the bone element. There is a possibility of both types of complications. The level of deformation depends on the specifics of the bone and is determined by the ability of the bone tissue to grow.

Studies have shown that fractures in children heal faster than in adult trauma patients. The reason for this is the ability of the child’s skeletal system to quickly grow and increase the thickness of individual blocks. The juvenile periosteum is the area of localization of active metabolic processes. The older the person, the lower the healing rate.

Do you need help?

Sooner or later, bone fractures in children become a problem for almost any family. The more restless the child, the higher the risk of serious injury. Parents must be aware of the manifestations of the problem and know how to provide first aid to the victim. In many ways, the speed and quality of the rehabilitation period depend on it. They determine what kind of help is needed at first, based on the cause of the fracture and factors that determine the specifics of the situation. However, the general tactics are the same for all cases.

From statistical observations it is known that the most common concern is a broken arm in a child; the incidence rate of foot fractures is half as high. If the injury is severe, it is immediately clear what happened, but more often children suffer minor injuries, and only a qualified doctor can diagnose correctly. Some do not pay enough attention to the situation, since the functionality of the affected limb, although impaired, is weak. You can easily confuse a fracture, a bruise, a dislocation. The first in the upper extremities are most often localized in the area of the forearm and elbow joint.

Closed fracture

If a fracture in a child (arm, leg or other part of the body) is observed in this form, it is necessary to give the victim rest and ensure immobility. This step is the first in providing emergency care immediately after an injury. Parents should put the patient to bed, then calm down, since chaotic panic actions will only harm the baby. A cold compress is applied to the affected area. This provides relief and helps reduce internal bleeding. The next stage is immobilization. The term refers to measures to prevent movement of the affected area. The limb must be kept elevated. The patient is then given an analgesic. Doctors recommend using medications containing ibuprofen and paracetamol. Other medications are prohibited until the doctor arrives.

Open fracture

Treatment of open fractures in children should be left to a doctor. The task of those near the victim is to provide first aid. A distinctive feature of the injury is an open wound, which means it needs to be treated as quickly as possible and prevent large-scale blood loss. To stop bleeding, the damaged area is covered with a thick bandage. If the area is dirty, clean it with soapy water. Next, a cold compress is applied, the victim is kept immobile, and an analgesic is given if necessary.

About committing

Taking into account the briefly described above features of bone fractures in children, the importance of providing correct first aid becomes clear, since unsuccessful measures and the lack of suitable treatment can negatively affect a person’s future, lead to skeletal asymmetry and other complications. The key relief measure is immobilization of the affected area. To do this, apply a splint. Any car owner's first aid kit is equipped with such a product. It must be at the disposal of the ambulance team. Parents, when providing first aid to an injured child, should prepare a splint from available materials. Finding something suitable is not difficult - just use a dense material to which the injured part of the body is attached.

As with a displaced fracture in a child, and without such a complication, the task of first aid providers is to find suitable means for immobilization. You can use thick cardboard or plywood. If you have a small board or stick on hand, these items will also work. If a very small baby is injured, it is better to use cardboard and wrap it in cotton wool. A bandage is used to fix the diseased area. It is necessary to stabilize the position of the joints above and below the affected area. There is no need to take off clothes or shoes. It is advisable to take wide objects for applying a splint - they are more reliable than narrow ones. If a limb is injured, it is necessary to fix it in its current position, without adjusting it to a more familiar one or one that seems comfortable or correct from the outside. It is strictly prohibited to adjust the affected block of the support system - this will be done by a doctor.

First aid: nuances

If a displaced fracture occurs in a child, if the injury is not accompanied by displacement, it is necessary to call a doctor as soon as possible. If the situation occurred when the family was in a populated area where it is possible to call an ambulance, the limb may not be immobilized. Parents need to urgently seek medical support, and while waiting for the car with doctors, guarantee the victim peace and immobility. Do not touch the sore area.

There is a situation when a child is injured, but the elders do not have anything suitable for applying a splint at hand. You need to tape the painful area to a healthy part of the body.

Strictly prohibited

One of the features of the treatment of fractures in children is a strict ban on heating and rubbing the diseased area. Parents must monitor the behavior of the victim: he must not move. Under no circumstances should the injured person be forced to move or encouraged to move. It would be dangerous to try to correct the zone on your own. Do not treat the area with gels or ointments.

The rules for providing primary care for both upper and lower extremity injuries are almost the same. If your hand is injured, you should additionally secure it with a scarf. If the injury is localized in the leg, such measures are not required. If damage to the femur or injury involving the pelvic blocks is suspected, four joints are immobilized instead of two.

Subtleties of the question

Doctors, finding out the characteristics of fractures in children and adults, have found that when equal force is applied, an older person is more likely to be injured than a child. The support system in childhood is highly elastic, and its forming elements are flexible. To some extent, a fracture is similar to a broken tree branch. The fragments do not move, which means regeneration requires minimal time. The most difficult case to clarify is if the fracture is localized in the growth area. When examining a part of the body using X-rays, it is impossible to see the cartilage tissue, so identifying the fracture is problematic.

The high regenerative abilities inherent in the children's body are known. The callus is quickly replaced by the corresponding tissue. Comparing the characteristics of fractures in children and adults, it was found that in the former, areas of scarring appear much less frequently. It was found that in children who have received a fracture, it is possible to maintain an insignificant displacement - it will disappear on its own as the body grows.

Fractures: forms

It is customary to divide all cases into pathological and caused by trauma. The latter are usually observed in everyday life. In a child, fractures of the collarbone, limbs, and other parts of the body are provoked by blows, falls, and jumps. They are not uncommon during games and can be explained by twisting a leg or running for a long time. Pathological cases are provoked by diseases. These are observed in dysplasia, bone tuberculosis, and may indicate improper formation of bone tissue at the embryonic stage of development. A possible reason is a lack of calcium. Sometimes a fracture indicates an inflammatory process localized in the bone tissue.

All cases of injury are divided into open and closed (the general rules of first aid are discussed above). The dangers of the open form should not be underestimated, since damage to the skin is accompanied by the danger of infection of the body. In a child, a fracture of the collarbone, limb, rib or any other block of the support system is accompanied by ruptures, and the dimensions of the damage vary from case to case. Sometimes they are small, in others they are large, leading to the destruction of soft tissue. In addition to introducing dirt, there is a danger of crushing tissue. Cases of open fracture are divided into those accompanied by displacement and those without it. The first involves the movement of bone fragments to the sides, the second option is characterized by a stable position of the fragments in their original location. Fractures with displacement can be incomplete or complete. The connection of the fragments is partially broken, while the bone integrity is preserved - these are features of an incomplete fracture. The second option involves complete separation of the elements.

The main percentage of cases are isolated injuries, in which one segment is damaged. Less common are multiple, combined cases affecting several areas of the body.

How to notice?

The task of parents is to know the symptoms of a fracture in a child in order to call a doctor in time and provide first aid. There are general signs inherent in any injury of this type, regardless of location. All manifestations are divided into probable and reliable. The first category includes skin swelling, hematoma, pain accompanying movement, and palpation. The mobility of the hand, foot, and finger is impaired. Reliable manifestations include deformation of the area and crepitus. The term refers to a crunching sound heard due to the appearance of bone fragments.

This is interesting: trauma and celiac disease

Not long ago, the medical community became interested in the case of a child who often suffered from fractures. In just a couple of years, the seven-year-old child received three fractures of the upper extremities, which were not accompanied by preliminary pressure. Doctors were unable to find any prerequisites for bone fragility; the patient ate well and led an active life. Laboratory studies showed adequate concentrations of trace elements and minerals in the blood. The only questionable result of the study was the level of antibodies, allowing one to suspect celiac disease. The diagnosis was confirmed by gastroenterologists.

As studies have proven, a child is more likely to have fractures of the radius, collarbone and other parts of the body due to celiac disease than in the absence of this disease, since it affects mineral density. An interesting, reliable study was organized in 2011. It turned out that about a quarter of all people diagnosed with celiac disease had recently suffered a fracture.

Why is this happening?

Celiac disease is a pathological condition in which the functioning of the intestinal villi is impaired. The absorption function of the tract is inhibited, the body does not receive the necessary components. This leads to deficiency of iron, vitamin compounds, and folic acid. One of the features of fractures of tubular bones in children (as well as any other elements of the supporting system) is low density, which is caused by a lack of nutrients. Accordingly, celiac disease leads to decreased bone strength. In parallel, the level of inflammation increases, which also negatively affects the health of the supporting system.

Finding out the characteristics of fractures in children's jaws, limbs and other parts of the body against the background of celiac disease, doctors considered: the only reliable method of prevention is proper nutrition. It is necessary to completely eliminate gluten from the patient’s diet. As the researchers of the above-mentioned case noted, this measure applied to the child made it possible to avoid fractures for the next 3.5 years (exactly after the parents brought the child to the clinic for a preventive examination). It is noted that adjustment to a new nutrition system is not easy for children, but the results are worth it.

Causes and consequences

If we do not touch on the topic of rare congenital and hereditary diseases, we will have to admit: the main percentage of fractures in minors is due to industrial society and the characteristics of social interaction. It is not easy for children to learn to follow household rules and behave correctly in transport, which means that the risk of injury increases. Doctors involved in the diagnosis and treatment of fractures in children note: about 70% of all cases are caused by riding bicycles, skateboards, scooters, and rollerblades. Many children ride where it is prohibited, jump in dangerous places, and fall. Even vehicles do not cause injury to minors as often as occurs due to domestic reasons. On average, the likelihood of injury due to transport is higher for an adult than for a child, but the severity of injury usually dominates in the latter. Studies have shown that on average per thousand children there are 248 people with bruises, 30 with dislocations and about 57 with bone fractures.

To understand how to distinguish these cases, it is necessary to consider their features, at least in general terms.

About terms and situations

A bruise is a closed injury in which organs and tissues suffer, but the structure remains intact. The sections do not come off or rupture, but the integrity of the blood vessels may be damaged. The result is hematomas and bruises. Bruises are visually visible as purple spots, the shade of which gradually transforms to green and yellow. Usually the cause is a collision, fall, blow. The mobility of the diseased part of the body is preserved, but the area responds with pain. To help the victim, apply a cold compress to the area and provide rest.

As studies show, it is possible for an infant to get a fracture, but ligament sprains appear only in people over the age of three. The classic location is the ankle joint. The child makes an awkward movement, the foot turns under. This is possible when a person runs or walks. The risk is especially high when running up stairs. A sprain is indicated by acute pain, followed by possible swelling of the affected area. The skin tone sometimes changes to bluish, and palpation causes pain. Movements in the joint are possible, but the victim tries to spare the affected limb, so he practically does not lean on it.

Parents should apply ice to the affected area, secure it with an elastic bandage, and show the injured person to the doctor for an x-ray examination. There is a high risk of a bone fracture, with symptoms similar to a sprain. X-ray is the only way to clarify the condition.

Dislocation: what is it?

The word refers to an injury in which the articular contour is disrupted. More often the reason is a fall. Movement of the diseased area is limited, pain becomes stronger, and the ability to move is inhibited. The limb injured by the fall becomes longer or shorter than the limb. There is a possibility of deformation.

Parents should provide the patient with rest and secure the affected area with a splint or bandage. It is necessary to seek help from a qualified doctor. You can't fix a dislocation on your own.

Subluxation is very common in practice, with the elbow joint being a typical area. This is most often observed in children aged from one to three years. An adult holds the child's hand tightly, but the child stumbles, suddenly slips or falls, and this leads to injury. The moment is sometimes accompanied by a specific crunch.

With subluxation, the affected area responds with pain, the child does not move the limb, stretches it along the body, sometimes bends it slightly. If you rotate your forearm or elbow, the pain becomes especially severe. Parents should ensure peace in the affected area and take the patient to a pediatric traumatology department.

Crack

When considering the characteristics of bone fractures in newborns, infants, and older children, one cannot ignore cracks. This term refers to partial damage to bone tissue, a fracture that is not completed. It is not easy to identify him, since young children are unable to formulate complaints. From the outside, there is a general concern of the child. The risk of injury is especially high due to the child's light weight. If a child falls, the soft tissue somewhat weakens the aggressive influence, so the likelihood of a crack occurring is greater than a fracture.

An older child can describe the manifestations of the situation. The injured area is bothered by pain, especially severe during movement, palpation, or pressure. If you provide rest to the affected area, the pain dulls, the area pulsates, and in some it tingles. The tissues swell, and the symptom can progress quickly. The swelling will subside a day after the crack occurs or later. Often the area is marked with a hematoma. The victim's limited mobility is noticeable, which is explained by pain and swelling.

The spine suffers

A relatively common diagnosis is a compression fracture. In a child (as well as an adult), this is due to compression of the elements of the spinal column. This is possible when falling, due to a blow to the back, somersault, or gymnastic practice. It is known that in children, muscles are sometimes stronger than the skeletal system. When they contract intensively, a compression effect is formed, affecting individual blocks of the column in the lateral projection. Functionality and sensitivity are not impaired, since there is no spinal injury, but the structure of the column is impaired. The clinical symptoms of the condition are often vague. At the moment of injury, the child catches his breath, the back gives off slight pain, while the child does not even pay attention to the manifestations and continues his games and activities.

Without adequate treatment, a compression fracture leads to complications. These are more common after years. The consequences of the situation include radiculitis, osteochondrosis, vertebral destruction and other similar pathological processes. To prevent the consequences, in case of the slightest back injury, it is necessary to take the victim to the trauma department of the clinic, where an X-ray will be taken, the danger of the condition will be assessed and a therapeutic program will be selected. Inpatient treatment is often indicated. Rehabilitation is accompanied by a special daily routine aimed at unloading the spinal column. This treatment takes quite a long time.

To correct a compression fracture, it is necessary to do therapeutic exercises. Swimming is recommended from the age of three. Without adequate support from the body, as you get older and gain weight, the risk of a hernia in the affected area increases.

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

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

What types of fractures are there?

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

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

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

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

Open and closed

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

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

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

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

Without offset and with offset

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

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

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

Features of childhood fractures

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

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

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

Signs of a fracture in a child

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

Fracture of hip bones, femoral neck

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

Localization	Fracture without displacement	Displaced fracture
Upper part of the femur (greater or lesser trochanter)	Mild pain when walking, swelling	Impaired limb function (severe pain when moving)
Femoral neck	The pain is mild; when placing weight on the injured leg, the foot involuntarily turns outward	Severe pain that makes it impossible to lift the limb in a straight position, swelling of the groin, visual shortening of the limb
Mid thigh	Muscle swelling, hematomas, visual shortening of the femur	The same plus abnormal mobility of the femur, accompanied by a characteristic crunch, unbearable pain (up to the development of shock)
Lower thigh	Severe pain, dysfunction of the limb, accumulation of blood in the knee joint	The same, plus visible deformation of the upper part of the knee

Ankle fracture

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

The following symptoms indicate that the ankle bone is damaged:

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

Tibia fracture

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

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

Toe fracture

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

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

Why does a child often break bones?

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

osteoporosis;
osteomyelitis;
new bone formations.

Our expert - pediatrician Anna Mikhailova.

Risk factors

Experts call this condition osteopenia - this 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 the 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, disruptions in its functioning are common.

The normal absorption of calcium is also “interfered” with many chronic diseases: 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” my hair is splitting.
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 minor deviations 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.

Features of bone fractures in children. Types of fractures and treatment of fractures in children. How to suspect a fracture. First aid and treatment. Recovery period. Complications of fractures.

Features of bone fractures in children

A child's bones contain more organic matter (the protein ossein) than those of adults. The shell covering the outside of the bone (periosteum) is thick and well supplied with blood. Children also have areas of bone tissue growth (Fig). All these factors determine the specificity of childhood fractures.

Often bone fractures in children occur as a “green branch”. Outwardly, it looks as if the bone was broken and bent. In this case, the displacement of bone fragments is insignificant, the bone breaks only on one side, and on the other side a thick periosteum holds the bone fragments.
The fracture line often runs along the bone tissue growth zone, which is located near the joints. Damage to the growth plate can lead to its premature closure and subsequently to the formation of curvature, shortening, or a combination of these defects during the child’s growth. The earlier the growth plate is damaged, the more severe the consequences it leads to.
Children are more likely than adults to experience fractures of the bone projections to which the muscles are attached. Essentially, these fractures are separations of ligaments and muscles with bone fragments from the bone.
Bone tissues in children grow together faster than in adults, which is due to good blood supply to the periosteum and accelerated processes of callus formation.
In children of the younger and middle age groups, self-correction of residual displacements of bone fragments after a fracture is possible, which is associated with bone growth and muscle functioning. In this case, some displacements undergo self-correction, while others do not. Knowledge of these patterns is important for deciding the issue of surgical treatment of fractures.

Types of fractures

Depending on the condition of the bone tissue, traumatic and pathological fractures are distinguished. Traumatic fractures arise from the impact of a short-term, significant amount of mechanical force on an unchanged bone. Pathological fractures occur as a result of certain painful processes in the bone that disrupt its structure, strength, integrity and continuity. A minor mechanical impact is sufficient to cause pathological fractures. Pathological fractures are often called spontaneous.

Depending on the condition of the skin, fractures are divided into closed and open. With closed fractures, the integrity of the skin is not compromised, bone fragments and the entire fracture area remain isolated from the external environment. All closed fractures are considered to be aseptic, uninfected (uninfected). With open fractures, there is a violation of the integrity of the skin. The size and nature of damage to the skin varies from a pinpoint wound to a huge defect of soft tissues with their destruction, crushing and contamination. A special type of open fracture is gunshot fracture. All open fractures are primarily infected, i.e. having microbial contamination!

Depending on the degree of separation of bone fragments, fractures are distinguished between non-displaced and displaced. Displaced fractures can be complete when the connection between bone fragments is broken and there is their complete separation. Incomplete fractures, when the connection between the fragments is not broken along the entire length, the integrity of the bone is largely preserved or the bone fragments are held by the periosteum.

Depending on the direction of the fracture line, longitudinal, transverse, oblique, helical, stellate, T-shaped, V-shaped fractures with bone cracking are distinguished.

Depending on the type of bone, fractures of flat, spongy and tubular bones are distinguished. Flat bones include the bones of the skull, scapula, and iliac bones (forming the pelvis). Most often, with fractures of flat bones, significant displacement of bone fragments does not occur. Spongy bones include the vertebrae, calcaneus, talus and other bones. Fractures of cancellous bones are characterized by compression (compression) of bone tissue and lead to compression of the bone (reduction in its height). Tubular bones include the bones that form the basis of the limbs. Fractures of tubular bones are characterized by pronounced displacement. Depending on the location, fractures of tubular bones can be diaphyseal (fracture of the middle part of the bone - the diaphysis), epiphyseal (fracture of one of the ends of the bone - the epiphysis, usually covered with articular cartilage), metaphyseal (fracture of the part of the bone - the metaphysis, located between the diaphysis and the epiphysis) .

Depending on the number of damaged areas (segments) of 1 limbs or other body systems, isolated (bone fractures of one segment), multiple (bone fractures of two or more segments), combined (bone fractures in combination with traumatic brain injury, injury to the abdominal organs) are distinguished. or chest).
1 Limb segment - anatomical and morphological unit of a limb (for example, shoulder, elbow, lower leg, thigh).

How to suspect a fracture?

It is not difficult to suspect a fracture in a child. Most often the child is excited and crying. The main symptoms of bone fractures in children are severe pain, swelling, swelling, deformation of the damaged limb segment, and inability to function (for example, the inability to move an arm or step on a leg). A bruise (hematoma) may develop on the skin in the area where the fracture is projected.

A special group of fractures in children are compression fractures of the spine, which occur as a result of an atypical injury, usually when falling onto the back from a small height. The insidiousness of these fractures lies in the fact that diagnosing them in children is difficult even when hospitalized in the trauma departments of children's hospitals. Pain in the back is minor and completely disappears in the first 5 to 7 days. X-ray examination does not always allow making the correct diagnosis. Difficulties in diagnosing this group of fractures are due to the fact that the main radiological sign of vertebral damage as a result of trauma is its wedge-shaped shape, which in children is a normal feature of a growing vertebra. Currently, modern methods of radiodiagnosis - computer 2 and magnetic resonance imaging 3 - are becoming increasingly important in the diagnosis of vertebral compression fractures in children.
2 Computed tomography (CT) (from Greek tomos - segment, layer + Greek grapho - write, depict) is a research method in which images of a certain layer (section) of the human body are obtained using X-rays. Information is processed by computer. Thus, the smallest changes that are not visible on a regular x-ray are recorded.

3 Magnetic resonance imaging (MRI) is one of the most informative diagnostic methods (not associated with x-rays), which allows obtaining layer-by-layer images of organs in various planes and constructing a three-dimensional reconstruction of the area under study. It is based on the ability of some atomic nuclei, when placed in a magnetic field, to absorb energy in the radio frequency range and emit it after the cessation of exposure to the radio frequency pulse.

Fractures of the pelvic bones are considered severe injuries and are manifested by severe pain, inability to stand up, swelling and deformation in the pelvic area, and sometimes there is crepitus (crunching, creaking) of bone fragments when moving the legs.

First aid for fractures of the limbs consists of immobilizing the damaged segment using improvised means (planks, sticks and other similar objects), which are secured with a bandage, scarf, scarf, piece of fabric, etc. In this case, it is necessary to immobilize not only the damaged area, but also two adjacent joints. For example: for fractures of the forearm bones, it is necessary to fix the damaged segment of the limb and the wrist and elbow joints; for fractures of the shin bones, the damaged segment of the limb along with the knee and ankle joints. To relieve pain, the victim can be given paracetamol or ibuprofen. You should try to calm the child down, first of all, with your calm behavior. Then call an ambulance (it can be called even before first aid begins) or go independently to the nearest children's hospital (emergency department) or trauma center. Since with open fractures there is a violation of the integrity of the skin, the wound is infected and bleeding may begin from blood vessels damaged by bone fragments, before immobilizing the limb, it is necessary to try to stop the bleeding, treat the wound (if conditions allow) and apply a sterile bandage.

The damaged area of skin is freed from clothing (the hands of the person providing assistance should be washed or treated with an alcohol solution). In case of arterial bleeding (bright red blood flows out in a pulsating stream), it is necessary to press the bleeding vessel above the bleeding site - where there are no large muscle masses, where the artery does not lie very deep and can be pressed against the bone, for example, for the brachial artery - in the elbow bend . In case of venous bleeding (dark-colored blood flows continuously and evenly, does not pulsate), it is necessary to press the bleeding vein below the bleeding site and fix the injured limb in an elevated position.

If the bleeding does not stop, cover the wound with a large piece of gauze, a clean diaper, a towel, or a sanitary pad (clamp the wound until a doctor arrives).

If there is no bleeding with an open fracture, then dirt, scraps of clothing, and soil should be removed from the surface of the skin. The wound can be washed under running water or poured with hydrogen peroxide (the resulting foam should be removed from the edges of the wound with a sterile gauze pad). Next, apply a sterile dry bandage to the wound. An open fracture is an indication for vaccinations against tetanus 4 (if it has not been carried out earlier or the period has passed since the last revaccination), which must be done in an emergency room or hospital.
4 Tetanus is a deadly infectious disease caused by the bacterium Clostridium tetani. Its spores can enter the body through a wound contaminated with soil. Tetanus is characterized by progressive damage to the nervous system, convulsions, and paralysis.

First aid for a fall from a height consists of immobilizing the spine and pelvis, which are often damaged. The victim must be laid on a hard, flat surface - a shield, boards, hard stretcher, etc. If a fracture of the pelvic bones is suspected, a bolster is placed in the popliteal areas of the legs. All this leads to muscle relaxation and prevents secondary displacement of bone fragments.

If a child’s arm is injured and he can move independently, he must go to a children’s trauma center, which, as a rule, is located at every children’s clinic and hospital.

If a child has an injured leg, spine or pelvic bones, he cannot move independently. In these cases, it is advisable to call an ambulance, which will take the injured child to the emergency department of a children's hospital.

Hospitalization to the hospital is carried out in cases of displaced bone fractures requiring reposition (comparison of fragments) or surgery, as well as with fractures of the spine and pelvis.

Diagnosis of bone fractures in children is carried out in emergency rooms or emergency departments of children's hospitals by traumatologists or surgeons. Of great importance for the correct diagnosis is an examination by a doctor, interviewing parents, witnesses or the child about the circumstances of the injury. An X-ray examination is required. Computed or magnetic resonance imaging is also often performed (especially if a spinal fracture is suspected). In case of combined injury, ultrasound examinations (ultrasound), blood tests, urine tests, etc. are performed to diagnose the condition of internal organs.

Treatment

Due to the fairly rapid healing of bones in children, especially under the age of 7 years, the leading method of treating fractures is conservative. Fractures without displacement of bone fragments are treated by applying a plaster splint (a version of a plaster cast that does not cover the entire circumference of the limb, but only part of it). As a rule, non-displaced bone fractures are treated on an outpatient basis and do not require hospitalization. Outpatient treatment is carried out under the supervision of a traumatologist. The frequency of visiting a doctor during the normal course of the fracture healing period is 1 time every 5 - 7 days. The criterion for a correctly applied plaster cast is the subsidence of pain, the absence of impaired sensitivity and movement in the fingers or toes. “Alarming” symptoms that the bandage is compressing the limb are pain, severe swelling, impaired sensitivity and movement in the fingers or toes. If these symptoms appear, you should immediately consult a traumatologist. Treatment of fractures by applying a plaster cast is a simple, safe and effective method, but, unfortunately, not all fractures can be treated only in this way.

In case of displaced fractures, in case of severe comminuted or intra-articular fractures, an operation is performed under general anesthesia - closed reposition of bone fragments, followed by the application of a plaster cast. The duration of the surgical procedure is several minutes. However, anesthesia does not allow the child to go home immediately. The victim should be left in the hospital for several days under the supervision of a doctor.

For unstable fractures, transosseous fixation with metal pins is often used to prevent secondary displacement of bone fragments, i.e. bone fragments are fixed with knitting needles and additionally with a plaster cast. As a rule, the doctor determines the method of reposition and fixation before performing the manipulation. When fixing the fracture area with knitting needles, subsequent care and ligation of the places where the knitting needles exit the limb are necessary. This method ensures reliable fixation of the fracture and after 3 to 5 days the child can be discharged for outpatient treatment.

In pediatric traumatology, the method of permanent skeletal traction is widely used, which is most often used for fractures of the lower extremities and consists of passing a pin through the heel bone or the tibial tuberosity (tibia bone) and traction of the limb with a load until the fracture heals. This method is simple and effective, but requires hospital treatment and constant monitoring by a doctor until the fracture heals completely.

Recovery period

The timing of fracture healing in children depends on the patient’s age, location and nature of the fracture. On average, fractures of the upper limb heal within 1 to 1.5 months, fractures of the lower limb - from 1.5 to 2.5 months from the moment of injury, fractures of the pelvic bones - from 2 to 3 months. Treatment and rehabilitation of spinal compression fractures depend on the age of the child and can last up to 1 year.

The active recovery period begins after removal of plaster immobilization or other types of fixation. Its goal is to develop movements in adjacent joints, strengthen muscles, restore the supporting ability of an injured limb, etc. The means of rehabilitation treatment include physical therapy (physical therapy), massage, physiotherapy, and a swimming pool. Physiotherapy and massage are carried out in courses of 10 - 12 sessions and help improve microcirculation of blood and lymph in the damaged area, restore muscle function and joint movements.

A balanced diet is of particular importance for fracture healing in children. In this regard, it is advisable to include vitamin-mineral complexes containing all groups of vitamins and calcium in the treatment regimen.

For severe open fractures complicated by circulatory disorders, treatment with oxygen under high pressure in a pressure chamber is recommended - the method of hyperbaric oxygenation (used to prevent infection and helps activate metabolic processes in the body).

Rehabilitation treatment begins in a hospital setting and then continues on an outpatient basis. In case of severe injuries accompanied by severe dysfunction of the damaged segment, treatment is carried out in rehabilitation centers, as well as sanatorium-resort treatment.

Complications of fractures

With complex fractures, severe dysfunction of the injured limb and pain syndrome are possible. Open fractures are often accompanied by poor circulation. The consequences of undiagnosed compression fractures of the spine in children lead to the development of juvenile osteochondrosis - a dystrophic (associated with tissue malnutrition) disease of the spine, which affects the intervertebral discs, which is accompanied by their deformation, changes in height, and dissection. Also, such fractures can lead to spinal deformities and poor posture.

Discussion

Hello! I read the article and my excitement increases!
My baby broke her arm. She is 4 months old. Non-displaced fracture of the humerus (hit the side). They put a plaster on, scheduled for a week. A week later, the x-ray showed an increase in the distance and bending of the bone. The plaster was transferred. Another week, the x-ray showed that the process had begun, the doctor says that everything is fine. But I saw in the picture that the bone was curved and fused at an angle!!! They promised to remove the cast in 14 days. Total 1 month! I have a suspicion that the doctor is waiting for the bone to grow back to the broken part on its own. After all, everyone says that in children it heals quickly! Won't you have to break it later!? And will the arm be able to develop correctly? Was it a medical error when the plaster was first applied?

I just came in for a consultation - an 11th grader hit a child in the chin with a soccer ball in the school yard... he says it was very hard.
I found out when he came home from school - he said his mouth did not close, but in the evening everything was fine, so the child did not give in to persuasion to go to the doctor.
My chin is swollen, quite a lot... now a bruise has appeared. But he doesn’t complain about anything and it doesn’t bother him, because he seems to have even forgotten about it.
Actually, 2 days haven't passed yet...
Is it worth going to the doctor? what is the probability of fracture? after all, the face... I wouldn’t want anything to become deformed;)
My son is 10 years old.

20.09.2006 09:15:35, ......

From my own experience, if a small child has a fracture, it is better to call an ambulance rather than drag yourself to the emergency room!!! In children, repositioning is actually carried out under anesthesia, so in case of displacement, they will be sent to the hospital in any way. Secondly, hospitals definitely have an X-ray, but in emergency rooms it may not work (it’s broken, the hours are unacceptable). So the emergency room is often just a waste of time :(
Also for mothers - even after anesthesia, it is possible to pick up the baby the next day with a signature. And one more thing - if you end up in the emergency room and your child is injected with a “painkiller”, make sure that the doctor indicates in the extract what exactly was injected!!! We managed to screw up and later in the hospital we lamented for a long time that it was unclear what the child had already received...
Also, even at the emergency room they ask, if not the insurance policy, then its number - while you are driving, at least call home so that the policy can be found and the number dictated. In general, it would be nice to have it with you in the hospital. If they are hospitalized for repositioning, they will ask when the child last ate and drank - before anesthesia, it seems that you should not drink or eat for at least 2 hours, so on the way to the hospital if there is obvious displacement, it is probably better not to give anything to drink.. .

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.

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.
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 your 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.
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.
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.
2. 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. 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 promotes the production of vitamin D in the skin (at least in the clear summer months).
3. 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. Insufficient 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.