Damage to bones and joints in children

Little children often fall during mobile games, but they rarely have bone fractures. A small body weight and well-developed cover of soft tissues weaken the impact force when falling. Prevent fractures are also features of the structure of bones and joints in children. The baby's bones contain less mineral substances than the adult's, which makes them elastic and resilient. A periosteum is located around the bone, like a sleeve, in children it is thick and flexible, well supplied with blood. When a bone fracture, the periosteum is often not completely ruptured and prevents a larger displacement of the debris. In the bones of the limbs and the spine, the children have layers of germ cartilage. It is called so because the bones grow with this cartilage. The cartilage is flexible, which also prevents fractures.

Sprain. In children of the first three years of life, such traumas are rare. The sprains of the ankle joints are most typical. They arise with awkward movement, when the foot is turned inward. At this moment, the baby feels a sharp pain, which gradually subsides. However, after a while on the broken surface of the ankle joint appears swelling, sometimes cyanotic color, painful to the touch. Movement in the joint, although possible, but limited. The child spares his leg and struggles with it. To provide first aid, a fixative eight-band bandage and an ice pack for two to three hours are applied to the ligament site. However, for children of this age group, the sprains are not more typical than the sprains, and fractures are similar to the fracture of one of the shin bones in its lower third. The fracture is only diagnosed with an X-ray examination, so after the first aid the child should be shown to the trauma doctor.

Dislocations. In case of an accident, the articular bag may break, and then one of the bones slips out of the joint cavity. Articular bags and ligaments in children are very elastic, and therefore dislocations at an early age are quite rare. You can recognize the dislocation by such signs: the usual contours of the joint are violated, the movements in it become sharply limited, the pain in the joint increases, the limb shortens or lengthens. If a dislocation or suspicion of it is necessary to create a maximum rest for the injured leg or arm, apply a tire or a fixing bandage and deliver the child to the traumatologist as soon as possible. If delayed because of the rapidly increasing edema, it will be difficult to tilt the bone into the joint. In addition, between the bones, a nerve or vessel can be injured, and this will lead to severe consequences (paralysis or necrosis of the limb).

Subluxation of radius in elbow joint. This trauma occurs only at the age of 2-3 years and is called "dislocation from stretching." Trauma is usually caused by a movement in which the child's arm, which is in the extended position, undergoes a sharp extension along the longitudinal axis, often upwards, sometimes forward. The child may stumble or slip, and the adult who leads him by the hand, pulls for it to keep the baby from falling. Sometimes a small child has such a stretching of the hand during the game (adults, taking his hands, twisting around him) or putting on a narrow sleeve. In some cases, an adult can hear the hand crunching. Whatever the cause that caused the damage, the child cries out in pain, then immediately stops moving his hand, holds it in a forced position, stretching along the trunk and slightly bending at the elbow. Particularly painful rotational movements of the forearm in the elbow joint. This damage is due to the fact that in such small children the ligament that holds the radial bone is still weak. By the age of four or five, she is getting stronger, and such complications are no longer found.

After correcting the dislocation, you must be careful: do not drive the child for a sore hand, do not load it with heavy objects. On a walk it is better to use the "reins". Traumatic dislocations of large joints (hip, knee, shoulder) in children of the first three years of life are practically not found.

Fractures. In fractures, various violations of bone integrity are possible. Fractures occur with a sharp bending of the bone, and it breaks as it happens when the green twig is strongly bent (a break in the type of the willow twig). With subperiosteal fractures, the integrity of the periosteum is not disturbed, and bone fragments are almost not displaced. Epiphyseolysis - a break in the field of germ cell cartilage. Such fractures occur in children who have not yet completed the growth of bones, that is, up to 14 years in girls and up to 16 in boys.

Fractures can be incomplete, when parts of the bone are disjointed not along the entire thickness (crack, base) and full, at which the debris is disconnected along the entire circumference of the bone. For the fracture, the following symptoms are typical: bone deformation, pain, abnormal mobility at the fracture level, crunch (crepitation), impaired function, edema and hemorrhage. Deformity of the limb is related to the displacement of debris; in young children, who often have fractures and subperitoneal fractures, there may not be a deformation. In fractures with displacement, the deformation is particularly well seen in places where the bone is close to the surface of the limb (lower third of the forearm, lower leg, middle third of the shoulder). The pain accompanies each fracture. At the same time, in the case of fractures, small children can use an injured limb - gently raise their arm or step on the leg. Only X-ray study allows to avoid a diagnostic error. Abnormal bone mobility is observed only with a complete fracture. The crunch is caused by the friction of uneven surfaces of fracture of bone fragments. It is absent with incomplete fractures, and also if muscles fall between the fragments. When examining a child with a damaged arm or leg, it is not necessary to look for all signs of a fracture. To establish the correct diagnosis, two or three typical symptoms are sufficient. In addition, small children can not always be examined carefully, because, fearing pain, the child resists examination.

In case of a fracture, the child should immediately provide first aid. First of all, you need to find out the circumstances of the injury. It is necessary to undress the baby. Clothing is removed first with a healthy, and then with a sick limb. With severe pain, narrow clothes or shoes on a sick limb are best cut. During the examination, one always has to compare a sick limb with a healthy one. This will help to immediately notice some symptoms of damage (forced position, limitation or inability to move, swelling, deformity, limb shortening). Then gently feel the affected part of the body and find the place of greatest soreness.

Never determine the abnormal mobility and crunch of bone debris, so as not to cause additional pain to the child and not cause painful shock. With open fractures, it is impossible to immerse fragments in the depth of the wound, since in the future it can lead to suppuration and inflammation of the bone (osteomyelitis). If the child's condition is severe, during the examination it should be in a prone position. It is not necessary to lift his head. In order to prevent the ingress of vomit into the respiratory tract (and vomiting can begin at any time), the child's head turns sideways.

When providing the first pre-medical care, both in the case of a closed and in the case of an open fracture (after bandaging and stopping bleeding), shinning is mandatory. It is necessary in order to avoid additional displacement of debris, to relieve or reduce pain, to prevent injury of muscles, vessels and nerves with bone fragments.

Used for this tire or materials. For immobilization (immobilization) of a damaged limb, standard and improvised tires are used. Usually for a short-term fixation use various auxiliary material: planks, cardboard, sticks, plywood, etc. For infants and toddlers, the most convenient is a tire made of cardboard, covered with cotton and fixed with a bandage. In the absence of material from which it would be possible to make a tire, to fix a hand it is enough to pribintovat it to the trunk, bending at the elbow joint, and the leg can be bandaged to a healthy leg.

When splicing, you must follow two rules: to create immobility in at least the two nearest joints (above and below the fracture site); Do not let squeeze the bandage of large vessels, nerves and protrusions of bones. With closed fractures, the tire can be applied over clothing, when open - after applying bandage and stop bleeding from the wound. The application of the tire should be as painful as possible. For splinting it is desirable to have an assistant who would support the damaged part of the body.

Remember: it's better to make a mistake and apply a tire when there is no fracture than not to apply it when the bone is damaged. Shinning is the first way to combat shock. Inconvenient transportation and jolting along with insufficient fixation of the damaged limb can cause this terrible complication, worsen the already serious condition of the child.

After first aid, the child should be delivered as soon as possible to the nearest trauma unit. It must be remembered that for the provision of specialized trauma care, anesthesia may be needed, so it is better not to feed young children, since vomiting is possible during general anesthesia.

Fracture of the clavicle occurs when falling on an elongated arm or on the lateral surface of the shoulder. Determine the fracture is not difficult, since the clavicle is clearly visible under the skin. In children of the first three years of life most often there are incomplete fractures of the clavicle. The child is tilted slightly in the direction of damage, with a healthy hand, he supports the injured arm, movements in the shoulder are severely limited due to pain. To provide first aid, the injured arm must be suspended on a kerchief tied over the neck, or the arm should be tied to the trunk, bending it at the elbow and placing a roller between the inner surface of the shoulder and the thorax in the armpit area.

Fracture of the humerus - a serious injury that occurs when falling on the elbow, on the outstretched hand or when it strikes the shoulder. The injured hand hangs along the trunk like a whip, movements are limited, deformation, abnormal mobility, crunching, swelling and hemorrhage are noted. With subperiosteal fractures, not all of the listed symptoms can be observed. For transportation it is necessary to put the tire in such a way as to fix both the shoulder and elbow joints. If severe pain should be given to the child analgin.

In the case of a fracture of the radial or ulnar bone of the forearm, the most convenient transport tire is the cardboard. The tire can be applied only on the forearm and bandaged so that the brush does not bend.

Fractures of the spine in infants are not found. At an early age, they are possible when falling from a high altitude (from the window of the house, from the balcony) or in road accidents. The backbone of a small child is more than a third of cartilage. This gives it greater flexibility, and with a trauma it damages the shock well. In injuries, the thoracic spine is more likely to suffer, with a compression fracture (contraction) of one or two vertebrae. The main symptoms of the injury are permanent pain in the area of damage, limitation of the mobility of the spine, and at the time of injury, difficulty in breathing (within a few seconds the child can not breathe). The victim must be urgently transported to the hospital while lying on a solid shield, on his back or on his stomach.

Fracture of the pelvic bones is one of the most serious injuries, often accompanied by shock and damage to the internal organs. The pelvis in young children is very durable and elastic. In order to break it, a very strong blow is needed. That is why such fractures occur mainly during road accidents, when falling from a high altitude. Of the internal organs most often suffer from the urethra and bladder. The child after the injury is in serious condition, contact with it is difficult. He often takes a forced position, the so-called frog posture - legs are divorced and bent in the hip and knee joints. A symptom of the "stitched heel" is characteristic - the baby is unable to lift his foot from the bed. Pain in the pelvic bones, bruising in the groin or above the pubis, the inability to self-urinate are typical signs of severe pelvic trauma. The victim is in no case to be turned on his side, planted and put on his feet. The best type of transportation is on the shield. Under the bent and divorced knees, put a roller made of a folded blanket. This position provides relaxation of muscles, reduces pain in the fracture region and prevents further displacement of debris. For some easing of pain, analgin can be given.

Fracture of the femur often occurs when falling from a height or during outdoor games (sledding, swings, bicycles). The signs of a hip fracture are the same as in other fractures: pain, limb function, pathological mobility, crunch, deformity, edema. At the first aid immobilization of a limb in a hip, knee, ankle joint is necessary. Take two boards and put one of them from the inside of the thigh and the other from the outside (inner - from the crotch to the heel, external from the axilla to the heel). The tires are wrapped with cotton and fixed with bandages. Attention! Transportation without immobilization by tires during fractures is unacceptable, since without them a traumatic shock can develop in a child. In winter and in the cold season, the child should also be warmed, if possible, with hot tea, but should not be fed: the baby may need anesthesia, and after eating, he may have vomiting during and after anesthesia.

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