Bone and joint injuries in children

Small children often fall during active games, but they rarely have bone fractures. Low body weight and well-developed soft tissue cover weaken the force of the impact when falling. Fractures are also prevented by the structural features of bones and joints in children. A child's bones contain less mineral substances than those of an adult, due to which they are elastic and resilient. The periosteum is located around the bone like a sleeve - in children it is thick and flexible, well supplied with blood. When a bone is fractured, the periosteum often does not rupture completely and prevents greater displacement of the fragments. In the bones of the limbs and spine of children, there are layers of growth cartilage. It is called so because it is thanks to this cartilage that bones grow. The cartilage is flexible, which also prevents fractures.

Sprained ligaments. Such injuries are rare in children under three years of age. The most typical are sprained ligaments of the ankle joint. They occur with an awkward movement, when the foot turns inward. At this point, the child feels a sharp pain, which gradually subsides. However, after some time, swelling appears on the damaged surface of the ankle joint, sometimes bluish in color, painful to the touch. Movement in the joint, although possible, is limited. The child spares the leg and steps on it with difficulty. To provide first aid, a fixing figure-of-eight bandage and an ice pack are applied to the site of the sprained ligament for two to three hours. However, for children of this age group, more typical are not sprained ligaments, but fractures such as a crack in one of the shin bones in its lower third. A crack is diagnosed only by X-ray examination, therefore, after providing first aid, the child must be shown to a traumatologist.

Dislocations. In an accident, the joint capsule may rupture, and then one of the bones slips out of the joint cavity. Joint capsules and ligaments in children are very elastic, and therefore dislocations at an early age are quite rare. You can recognize a dislocation by the following signs: the normal contours of the joint are disrupted, movements in it become sharply limited, pain in the joint increases, the limb shortens or lengthens. In case of a dislocation or suspected dislocation, you need to create maximum rest for the injured leg or arm, apply a splint or fixing bandage and take the child to a traumatologist as quickly as possible. If there is a delay, it will be difficult to put the bone back into the joint due to the rapidly increasing swelling. In addition, a nerve or blood vessel may become pinched between the bones, and this will lead to serious consequences (paralysis or necrosis of the limb).

Subluxation of the radius at the elbow joint. This injury occurs only at the age of 2-3 years and is called "dislocation from extension". The injury is usually caused by a movement in which the child's arm, in an extended position, is subjected to a sharp extension along the longitudinal axis, usually upward, sometimes forward. The child may stumble or slip, and the adult who is leading him holding his hand pulls it to keep the baby from falling. Sometimes such an extension of the arm occurs in a small child during play (adults take him by the hands and spin him around) or while putting on a tight sleeve. In some cases, an adult may hear the arm crunch. Whatever the cause of the injury, the child cries out in pain, after which he immediately stops moving his arm, holds it in a forced position, extended along the body and slightly bent at the elbow. Rotational movements of the forearm at the elbow joint are especially painful. This damage is due to the fact that in such small children the ligament holding the radius bone is still weak. By the age of four or five it becomes stronger, and such complications no longer occur.

After the dislocation has been reduced, you need to be careful: do not lead the child by the sore arm, do not load it by carrying heavy objects. It is better to use "reins" when walking. Traumatic dislocations of large joints (hip, knee, shoulder) in children of the first three years of life are almost never encountered.

Fractures. Fractures may involve various types of damage to the integrity of the bone. Fractures occur when the bone is sharply bent, and it breaks as if a green twig were bent too much (a willow-type fracture). In subperiosteal fractures, the integrity of the periosteum is not damaged, and the bone fragments are hardly displaced. Epiphysiolysis is a fracture in the area of the growth cartilage. Such fractures occur in children whose bones have not yet finished growing, i.e., up to 14 years of age in girls and up to 16 years of age in boys.

Fractures may be incomplete, when the bone parts do not separate across their entire thickness (crack, break), and complete, when the fragments separate along the entire circumference of the bone. The following symptoms are characteristic of a fracture: bone deformation, pain, abnormal mobility at the fracture level, crunching (crepitus), dysfunction, swelling and hemorrhage. Deformation of the limb is associated with the displacement of fragments; in small children, who most often have fractures and subperiosteal fractures, there may be no deformation. In fractures with displacement, the deformation is especially clearly visible in those places where the bone is closely adjacent to the surface of the limb (lower third of the forearm, shin, middle third of the shoulder). Pain accompanies each fracture. At the same time, in case of fractures, small children can use the injured limb - carefully raise their arm or step on their foot. Only an X-ray examination can avoid a diagnostic error. Abnormal bone mobility is observed only in case of a complete fracture. The crunch is caused by friction of uneven fracture surfaces of bone fragments. It is absent in incomplete fractures, as well as if muscles get between the fragments. When examining a child with an arm or leg injury, it is not necessary to look for all the signs of a fracture. Two or three typical signs are often enough to establish the correct diagnosis. In addition, it is not always possible to thoroughly examine small children, since, fearing pain, the child resists examination.

In case of a fracture, the child must be given first aid immediately. First of all, it is necessary to find out the circumstances of the injury. It is necessary to undress the child. Clothes are removed first from the healthy limb, then from the affected limb. In case of severe pain, it is better to cut tight clothes or shoes on the affected limb. During the examination, it is always necessary to compare the affected limb with the healthy one. This will help to immediately notice some symptoms of the injury (forced position, limitation or impossibility of movement, swelling, deformation, shortening of the limb). Then carefully palpate the affected part of the body and find the place of greatest pain.

Abnormal mobility and crunching of bone fragments should never be determined, so as not to cause additional suffering to the child and not to cause pain shock. In case of open fractures, fragments should not be immersed into the depth of the wound, as this may subsequently lead to its suppuration and inflammation of the bone (osteomyelitis). If the child's condition is serious, he should be in a lying position during the examination. There is no need to raise his head. In order to prevent vomit from entering the respiratory tract (and vomiting can begin at any time), the child's head is turned to the side.

When providing first aid for both closed and open fractures (after applying a bandage and stopping the bleeding), splinting is mandatory. It is necessary to avoid additional displacement of fragments, relieve or reduce pain, and prevent injury to muscles, blood vessels, and nerves by bone fragments.

Splints or improvised materials are used for this. Standard and improvised splints are used to immobilize (immobilize) the injured limb. Usually, various improvised materials are used for short-term fixation: boards, cardboard, sticks, plywood, etc. For infants and toddlers, a splint made of cardboard, lined with cotton wool and fixed with a bandage is most convenient. In the absence of material from which to make a splint, to fix the arm, it is enough to bandage it to the body, bending it at the elbow joint, and the leg can be bandaged to the healthy leg.

When splinting, two rules must be followed: create immobility in at least two nearby joints (above and below the fracture site); do not allow the bandage to compress large vessels, nerves, and bone protrusions. In the case of closed fractures, the splint can be applied over clothing; in the case of open fractures, after applying a bandage and stopping the bleeding from the wound. Applying a splint should be as painless as possible. It is advisable to have an assistant to support the injured body part when splinting.

Remember: it is better to make a mistake and apply a splint when there is no fracture than not to apply it when the bone is damaged. Splinting is the first means of combating shock. Inconvenient transport and a bumpy road with insufficient fixation of the injured limb can cause this formidable complication, worsening the child's already serious condition.

After first aid has been provided, the child should be taken to the nearest trauma department as soon as possible. It is important to remember that specialized trauma care may require anesthesia, so it is better not to feed small children before this, since vomiting is possible during general anesthesia.

A collarbone fracture occurs when falling on an outstretched arm or on the lateral surface of the shoulder. It is not difficult to determine the fracture, since the collarbone is clearly visible under the skin. Incomplete collarbone fractures are most common in children in the first three years of life. The child is slightly tilted towards the side of the injury, with the healthy hand he supports the injured arm, and shoulder movements are sharply limited due to pain. To provide first aid, the injured arm must be suspended on a sling tied around the neck, or the arm must be bandaged to the body, bent at the elbow and a bolster placed between the inner surface of the shoulder and the chest in the armpit area.

A fracture of the humerus is a serious injury that occurs when falling on the elbow, on an outstretched arm, or when struck on the shoulder. The injured arm hangs along the body like a whip, movements are limited, deformation, abnormal mobility, crunching, swelling and hemorrhage are noted. In case of subperiosteal fractures, not all of the listed symptoms may be observed. For transportation, it is necessary to place a splint in such a way as to immobilize both the shoulder and elbow joints. In case of severe pain, the child should be given analgin.

In case of a fracture of the radius or ulna of the forearm, the most convenient transport splint will be cardboard. The splint can be applied only to the forearm and bandaged so that the hand does not bend.

Spinal fractures are not common in infants. At an early age, they are possible due to falls from a great height (from a house window, from a balcony) or in road accidents. More than a third of a small child's spine consists of cartilage. This makes it more flexible, and in case of injury, it cushions the impact well. In case of injury, the thoracic spine is most often affected, and a compression fracture (compression) of one or two vertebrae occurs. The main symptoms of injury are constant pain in the area of injury, limited mobility of the spine, and at the time of injury, difficulty breathing (the child cannot breathe for several seconds). The victim must be urgently taken to the hospital in a lying position on a hard shield, on his back or on his stomach.

A pelvic bone fracture is one of the most severe injuries, often accompanied by shock and damage to internal organs. The pelvis of small children is very strong and elastic. In order to break it, a very strong blow is needed. That is why such fractures occur mainly during traffic accidents, when falling from a great height. Of the internal organs, the urethra and bladder are most often affected. After the injury, the child is in serious condition, contact with him is difficult. He often takes a forced position, the so-called frog pose - the legs are spread apart and bent at the hip and knee joints. A characteristic symptom is "stuck heel" - the baby is unable to lift his leg out of bed. Pain in the pelvic bones, bruising in the groin area or above the pubis, the inability to urinate on his own are typical signs of a severe pelvic injury. In no case should the victim be turned on his side, sat up or stood on his feet. The best form of transportation is on a shield. A bolster made from a rolled-up blanket is placed under the bent and spread knees. This position provides muscle relaxation, reduces pain in the fracture area and prevents further displacement of the fragments. Analgin can be given to relieve some pain.

A femur fracture most often occurs when falling from a height or during active games (sledding, swinging, cycling). The signs of a femur fracture are the same as with other fractures: pain, impaired limb function, abnormal mobility, crunching, deformation, swelling. First aid requires immobilization of the limb at the hip, knee, and ankle joints. Take two boards and place one on the inside of the thigh and the other on the outside (inner - from the perineum to the heel, outer - from the armpit to the heel). The splints are wrapped in cotton wool and fixed with bandages. Attention! Transportation without immobilization with splints for fractures is unacceptable, since without them the child may develop traumatic shock. In winter and during the cold season, the child also needs to be warmed up, if possible, given hot tea to drink, but should not be fed: the child may need anesthesia, and after eating, he may vomit during and after anesthesia.

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