Pediatric Fracture
Introduction
Introduction to pediatric fracture Children's fractures are different from adults. Children's bones are constantly growing and their physiological functions and biomechanical properties are constantly changing. Children's bones are difficult to break completely when fractured due to porous bone and periosteal hypertrophy. Most children do not need surgery for fractures, but they occur near the joints, especially when the growth plate is injured. Unlike the bones of adults, children's bones will correct the deformity after healing, and sometimes it will cause deformities and limb length after the fractures are not healed. Some children are deformed due to damage to the growth structure during surgery. . In fact, most pediatric fractures can be repositioned. Sometimes the fracture reduction is not good and there is a misplacement. The child will correct the deformity by virtue of its strong plastic ability. Of course, it needs to be within a certain range. However, fractures of the epiphysis, intra-articular fractures, etc., if delayed diagnosis and treatment, can cause malformation and disability. basic knowledge The proportion of illness: 0.02% Susceptible people: children Mode of infection: non-infectious Complications: shock, fat embolism syndrome
Cause
Pediatric fracture cause
1. Direct violence
Violence directly affects a part of the bone and causes fractures in the part, which often causes fractures in the injured area, often accompanied by varying degrees of soft tissue destruction. If the wheel hits the calf, a fracture of the humerus shaft occurs at the impact.
2. Indirect violence
Indirect violence causes fractures in the distance through longitudinal conduction, leverage or torsion. When the foot falls from a height, the trunk flexes forward rapidly due to gravity, and the vertebral body at the junction of the thoracolumbar spine is subjected to folding force. The role of compression fracture (conduction).
3. Accumulative strain damage
Long-term, repeated, mild direct or indirect injury can cause a specific part of the limb to fracture, such as long-distance marching to cause the second and third metatarsal and the lower third of the humerus fracture.
Prevention
Pediatric fracture prevention
Some patients can avoid fractures, which requires everyone to be safe first in daily life and work, and always pay attention to reduce fractures.
Children walking unsteadily, easy to fall, especially not to play high, to educate and optimistic about children, to avoid falls. Young people play more, curiosity, parents and teachers should do a good job in education, do not climb the tree. It is best not to ride a bicycle on the street, not to crowded public places.
Complication
Pediatric fracture complications Complications of shock fat embolism syndrome
Early complications
(1) Shock: severe injury, caused by major bleeding or major organ damage.
(2) Fat embolism syndrome: occurs in adults, due to excessive tension in the hemorrhage of the sacral cavity in the fracture, fat drops into the ruptured sinus, can cause lung and brain fat embolism.
(3) Important internal organ damage: 1 liver and spleen rupture. 2 chest and lung injury. 2 bladder and urethral injury. Intestinal damage.
(4) Important surrounding tissue damage:
1 important vascular injury; common such as straight rib exploration fracture, proximal fracture end is easy to cause aortic injury, pre-cavity or posterior luminal artery injury, upper femoral fracture, distal fracture end can cause Take arterial injury.
2 peripheral nerve injury: especially in the area where the nerve is closely adjacent to the bone, such as the fracture at the middle and lower 1/3 of the rib, it is easy to damage the nerve that is close to the skin, and the fracture of the rib is easy to cause total nerve damage.
3 spinal cord injury; a serious complication of spinal fracture and dislocation, more common in the cervical spine and thoracolumbar segment, paraplegia can occur.
(5) Osteofascial compartment syndrome: a series of early syndromes caused by acute ischemia in the muscles and nerves of the fascia formed by bone, interosseous membrane, intramuscular septum and deep fascia. Most commonly found in the volar and calf of the forearm, often caused by hematoma and tissue edema of the fracture to increase the volume of the indoor contents or over-tightening, local pressure forced the volume of the compartment of the fascia to decrease, resulting in increased pressure in the compartment of the fascia .
Symptom
Pediatric fracture symptoms Common symptoms Shoulder joint activity limited bone pain swelling pain after the knee, ... wrist swelling and palm flexion...
Green branch fractures are more common in children with fractures, and often see a constant and continuous situation. Children's bones contain more organic matter, and the outer membrane of the outer bone is particularly thick. Therefore, it has good elasticity and toughness in mechanics. It is not easy to break. When it is subjected to violence, the fracture will appear like the green branches of plants. In the case of constant, the orthopedic surgeon called this special fracture a green branch fracture.
1, the whole body performance:
(1) Shock: for multiple fractures, pelvic fractures, femoral fractures, spinal fractures, and severe open bone. Patients often suffer from shock due to extensive soft tissue damage, massive bleeding, severe pain, or complicated visceral injuries.
(2) Fever: There is a large amount of internal hemorrhage at the fracture site. When the hematoma is absorbed, the body temperature is slightly increased, but it is generally not exceeded. When the open fracture body temperature rises, the possibility of infection should be considered.
2. Local manifestations: Local manifestations of fractures include proprietary signs of fractures and other manifestations.
Second, the signs:
(1) Malformation: the displacement of the fracture segment can change the shape of the affected limb, mainly showing shortening;
(2) Abnormal activity: In normal conditions, the part of the limb cannot move, and abnormal activity occurs after the fracture.
(3) Bone rubbing or bone rubbing: After the fracture, when the two fracture ends rub against each other, a bone squeak or bone rubbing feeling may be generated.
As long as one of the above three signs is found, the diagnosis can be made, but the three signs are not seen, and the possibility of fracture, such as insertion fracture and fracture fracture, cannot be ruled out.
Examine
Pediatric fracture examination
X-ray examination is of great value in the diagnosis and treatment of fractures:
All patients with suspected fractures should be routinely X-ray film examination, which can be found in clinically difficult to find incomplete fractures, deep fractures, intra-articular fractures and small avulsion fractures, even if they have clinically manifested as obvious fractures. X-ray film examination is also necessary to help understand the type and specific conditions of the fracture, and has guiding significance for treatment.
X-ray films should include positive and lateral positions, and the wells must include adjacent joints, and sometimes x-rays of oblique, tangent or corresponding parts of the contralateral side must be added. After reading the x-rays carefully, you should identify the following points:
(1) The fracture is invasive or pathological.
(2) Whether the fracture is displaced and how to shift.
(3) Whether the fracture alignment is satisfactory to the line and whether it needs to be rectified.
(4) Whether the fracture is fresh or old.
(5) Whether there is damage to the joint or bone injury.
Diagnosis
Diagnosis and diagnosis of pediatric fracture According to its clinical manifestations and X-ray examination, the disease can be clearly diagnosed without identification. However, it is necessary to pay attention to the clinical occurrence of fractures, whether it is a simple fracture or a pathological fracture caused by the patient's own disease. In the case of abnormal bone disease caused by the patient's original disease, a slight force can cause a fracture. In this case, it occurs more frequently and needs to be strictly observed and diagnosed.
