Transdermal fracture of the humerus with and without displacement in children

Transdermal fracture of the humerus occurs during the fall and is often accompanied by displacement of fragments. Mostly children who suffer from such trauma are those whose bone tissue is not yet mature enough. If you suspect a fracture, you need to contact a traumatologist. He will prescribe a diagnostic examination and the necessary treatment.

Causes and features of the injury

The main cause of pericondylar fractures of the humerus in children is a fall on the outstretched arm, hand (in this case, the fracture will be extensor) or elbow with a bent arm (flexion fracture).

Thinning of the tissue around the condyles often results in injury, which makes them vulnerable to damage.

The fracture is open and closed, but the second option is more common. Transdermal fracture of the humerus with displacement in children is dangerous because complications can occur – trauma to nerves, blood vessels and muscle rupture.

Transdermal fracture of the humerus without displacement of the closed type in the child is rare. This can only be observed with an underdeveloped muscle system.

6-10 years – the age of children at which they often have similar injuries (due to fights, falls, etc.). Boys are more likely to suffer such damage than girls. It is also interesting that a closed transcondylar fracture of the left humerus with a displacement makes up more than half of all injuries.

Main symptoms

  • Severe pain in the elbow area, which intensifies even with the slightest pressure;
  • A crunch of bones was heard during the fall;
  • Severe edema with an extracondylar fracture, the hand becomes hot;
  • Violation of the configuration in the elbow;
  • The movements are constrained and painful, a crisp sound of bone fragments is heard;
  • Cyanosis of the damaged part;
  • With the open type of damage, bleeding appears, since the bones that come out, injure the blood vessels;
  • Unnatural position of the arm below the elbow;
  • With a flexion fracture, the damaged arm looks elongated, with an extension – shortened;
  • If the broken portion of the bone is directed upward and rotated due to the natural traction of the muscles, then an intercondylar fracture of the humerus is formed with a shift. In this case, the position of the shoulder is in discrepancy with the position of the forearm.

What first aid can be given for an extracondylar fracture?

If there was a closed fracture, it is necessary to immobilize the arm and, if possible, give pain medications to the patient.

Diagnostics

The main diagnostic test method is x-ray. It will make it possible to detect a bone fracture and its features – with or without displacement. It is also important to diagnose a rotational change in bone position – a turn. X-ray study is carried out in 2 projections. There are situations when you may need a shot of a healthy hand for comparison.

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If necessary, computed tomography is possible, in some cases it will give a more accurate picture of the damage. A general analysis of blood and urine is given in order to identify concomitant diseases or traumatic shock.

Treatment

Patients with similar fractures can be divided into three main groups. In accordance with the correlation to a specific group, therapeutic measures are carried out.

  1. Affected without displacement or with a slight displacement of bone fragments, which does not require reposition (matching fragments of bone after a fracture). Treatment is carried out in the form of immobilization of the arm with a splint, while the arm is suspended in a bent state, for about 14-21 days. If the bone fracture was beveled and without displacement, then by the end of the first week, radiography should be done to exclude displacement after removal of the edema. If a bias is detected, the child is hospitalized, where traction therapy occurs. If there is no bias on the X-ray, then after the end of the tire wearing period the physiotherapeutic and functional stage of treatment begins and the tire can be removed for a while.
  2. Patients with strong displacement of fragments. The fracture plane is in a transverse or toothed position. The therapy is carried out using closed manual reposition with further immobilization of the arm with a gypsum splint. In any case, the rotational displacement is first excluded, after which the lateral and longitudinal displacements, and in the last place, the front, rear and angular displacements, are excluded. It is important enough to follow the sequence when eliminating types of displacements. If rotation is not eliminated with a closed transcondylar fracture of the humerus with a displacement, then the formation of the sharp end of the protrusion into the bend of the elbow is possible, which will lead to trauma to the soft tissues, vessels and nerves. And if we allow the fusion of bone fragments in this position, then the elbow joint will not be able to bend-unbend. Reposition takes place under general anesthesia.
  3. Patients with a fairly serious displacement and a sloping plane of damage, severe bleeding or after a large number of unsuccessful manual adjustments, with comminuted fractures, neurological pathologies. Such victims are treated stationary with constant traction, which allows you to slowly and painlessly eliminate the displacement. If the damage is beveled, the gypsum tire will not be able to fix and hold correctly placed fragments or prevent secondary rotation. And with bleeding and neurological pathologies, the use of manual reduction can be dangerous. Traction occurs with the help of Marx staples or Kirchner spokes, which are sent to the base of the elbow. At the same time, cargo from 2 kg gradually reaches 5 kg. Approximately on the third day from the beginning of the traction, a control x-ray should be taken. Over time, the load decreases to avo >

The success of any treatment depends on the characteristics of each fracture. All manipulations should be reasonable and gentle for the child.

Rehabilitation

Rehabilitation with an extra-conditial fracture of the humerus with displacement in children begins even before discharge from the hospital.

All activities are focused on the prevention of post-traumatic complications and the restoration of motor function:

  • Taking medication. This includes anti-inflammatory drugs to relieve swelling and pain, chondoprotectors, B vitamins (help restore muscle tissue and ligaments), preparations containing calcium are taken for any damage to the bones, since they are the main element of bone tissue.
  • Physiotherapy according to indications: electrophoresis with medicine, magnetotherapy, currents and applications with paraffin. Physiotherapeutic procedures improve blood microcirculation in a damaged place, relieve pain and relieve swelling.
  • Proper nutrition with a predominance of foods containing large amounts of phosphorus, calcium and protein.
  • Therapeutic exercises should focus on the dosage of exercises. Do not do warm-ups and violent movements. Start the load with moderate movements, gradually increasing from the moment the callus is formed.
Shishkevich Vladimir
Shishkevich Vladimir
Orthopedic doctor, traumatologist
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Vladimir Shishkevich

Orthopedic surgeon, traumatologist, vertebrologist. It specializes in the treatment of diseases in orthopedic, traumatological, vertebrological profiles. Diagnoses diseases of the musculoskeletal system, conducts treatment, monitors the healing process, recovery from injuries and operations, the application of immobilizing dressings, closed correction of dislocations and fractures.

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