Rus Articles Journal

Changes at children. First aid and treatment of

None of us are insured from injuries and the more so children who spend the most part of time in the active movement. On what signs it is possible to assume presence of a change at the kid? What first aid needs to be given? How there will take place treatment and how soon the kid will be able fully to play?

the Statistics of children`s traumatism demonstrates that fractures of bones at children arise at not severe injury and banal circumstances - in life, on the street, on the sports ground, for example when falling from big height, during run or walking, etc. Fractures of bones of hands occur at children twice more often than legs. The most frequent place of changes is the elbow joint and bones of a forearm. Fortunately, severe multiple injuries occur at children not often, and make 2,5% - 10% among all damages oporno - the motive device.

of Feature of fractures of bones at children

bones of the child contain bigger amount of organic substances (protein of ossein), than at adults. the cover covering a bone outside (periosteum) thick krovosnabzhatsya well. Also children have zones of growth of a bone tissue (rice). All these factors define specifics of children`s changes.

  1. Quite often fractures of bones at children occur as “a green branch“. Externally it looks as if the bone was cracked and bent. At the same time the shift of bone otlomk happens insignificant, the bone breaks only on one party, and on other party the thick nadkostitsa holds bone fragments.
  2. the Line of a change quite often passes
  3. on a zone of growth of a bone tissue which is located near joints. Damage of a zone of growth can lead to its premature closing and in the subsequent to formation of a curvature, shortening, or a combination of these defects in the course of growth of the child. Than at earlier age there is a damage of a zone of growth, subjects it leads to more serious consequences.
  4. At children more often than adults, have changes of bone outgrowths to which muscles are attached. In essence these changes are separations of sheaves and muscles with bone fragments from a bone.
  5. grow together with
  6. of Tissue of bones at children quicker, than at adults that is caused by good blood supply e periosteums and the accelerated processes of formation of a bone callosity.
  7. At children of younger and average age groups self-correction of residual shifts of bone otlomk after a change is possible
  8. that is connected with I growth of a bone and functioning of muscles. At the same time one shifts are exposed to self-correction, and others are not present. The knowledge of these regularities is important for the solution of a question of surgical treatment of changes.

Types of changes

Depending on a condition of a bone tissue distinguish changes traumatic and pathological. Traumatic changes arise from impact on not changed bone of short-term, considerable size of mechanical force. Pathological changes result from these or those disease processes in a bone breaking its structure, durability, integrity and a continuity. For developing of pathological fractures rather insignificant mechanical influence. Quite often pathological changes call spontaneous.

changes divide

Depending on a condition of integuments on closed and opened. At the closed changes integrity of integuments is not broken, bone otlomk and all area of a change remains isolated from external environment. All closed changes are considered to be aseptic, not infected (not infected). At open changes violation of integrity of integuments takes place. The sizes and nature of damage of integuments differ from a dot wound to huge defect of soft fabrics with their destruction, a razmozzheniye and pollution. A special type of open changes are fire changes. All open changes are initially infected, i.e. having microbic pollution!

Depending on extent of dissociation of bone otlomk are distinguished by changes without shift and with shift. Changes with shift can be full when communication between bone otlomka is broken and there is their full dissociation. Incomplete changes when communication between otlomka is broken not throughout, the integrity of a bone is more kept or bone otlomk are kept by a periosteum.

Depending on the direction of the line of a change T - figurative distinguish longitudinal, cross, slanting, spiral, star-shaped, V - figurative changes with cracking of a bone.

Depending on a type of bones are distinguished by fractures of flat, spongy and tubular bones. Skull bones, a shovel, podvzdoshny bones belong to flat bones (form a basin). Most often at fractures of flat bones of considerable shift of bone fragments does not arise. Vertebras, calcaneal, collision and other bones belong to spongy bones. Fractures of spongy bones are characterized by a compression (compression) of a bone tissue and lead to a bone sdavleniye (reduction of its height). The bones forming a basis of extremities belong to tubular. Fractures of tubular bones are characterized by the expressed shift. Depending on location fractures of tubular bones happen diafizarny (a change of a middle part of a bone - a diaphysis), epifizarny (a change of one of the ends of a bone - an epifiz, as a rule, covered with an articulate cartilage), metafizarny (a change of part of a bone - a metafiz, located between a diaphysis and epifizy).

Depending on quantity of the damaged sites (segments) of 1 extremities or other systems of an organism is distinguished isolated (fractures of bones of one segment), multiple (fractures of bones of two and more segments), combined (fractures of bones in combination with cherepno - a brain trauma, a trauma of abdominal organs or a thorax).
of 1 the Segment of extremities - anatomic and morphological unit of an extremity (for example, a shoulder, an elbow, a shin, a hip).

How to suspect a change?

it is simple to Suspect presence of a change at the child. Most often the child is excited, cries. The main symptoms of a fracture of bones at children are the expressed pain, a swelling, puffiness, deformation of the damaged extremity segment, impossibility of function (for example, impossibility to move a hand, to push around). On skin in a zone of a projection of a change bruise (hematoma) can develop.

Special group of changes at children are made by compression spinal fractures which arise at an atypical trauma, as a rule, when falling on a back from small height. Insidiousness of these changes is that their diagnostics at children is complicated even at hospitalization in traumatologic offices of children`s hospitals. Pain in a back is insignificant and completely disappears in the first 5 - 7 days. Radiological research not always allows to make the correct diagnosis. Difficulties of diagnostics of this group of changes are connected with the fact that the main radiological sign of injury of a vertebra as a result of a trauma - its wedge-shaped form that at children is normal feature of the growing vertebra. Now in diagnosis of compression fractures of vertebras modern methods of radiodiagnosis - computer 2 and magnitno - resonant get tomographies of 3 from children the increasing value .
of 2 the Computer Tomography (CT) (from Greek tomos - a piece, a layer + Greek grapho - to write, represent) - a method of research at which by means of X-rays receive images of a certain layer (cut) of a human body. Information is processed by the computer. Thus, the smallest changes which are not visible in a usual x-ray picture are fixed. of 3 Magnitno - a resonant tomography (MRT) - one of the most informative methods of diagnostics (is not connected with a x-ray radiation) allowing to receive the layer-by-layer image of bodies in various planes, to construct three-dimensional reconstruction of the studied area. Ability of some nuclear kernels when placing is its cornerstone them in a magnetic field to absorb energy in the radio-frequency range and to radiate it after the termination of influence of a radio-frequency impulse.

Fractures of bones of a basin belong to heavy damages and are shown by the expressed morbidity, impossibility to get on feet, a swelling and deformation in the field of a basin, the krepitation (a crunch, a scratch) of bone otlomk at the movement is sometimes observed by legs.

First aid

First aid at fractures of extremities consists in immobilization, the damaged segment by means of make-shifts (a plate, a stick and other similar objects) which fix by bandage, a scarf, a scarf, a piece of fabric, etc. At the same time it is necessary to immobilize not only the damaged site, but also two adjacent joints. For example: at fractures of bones of a forearm it is necessary to record the damaged extremity segment both luchezapyastny and elbow joints, at fractures of bones of a shin - the damaged extremity segment together with knee and talocrural joints. For removal of a pain syndrome the victim can give anesthetic on the basis of paracetamol or an ibuprofen. It is necessary to try to calm the child, first of all, the quiet behavior. Then to call “ambulance“ (it can be caused even prior to first-aid treatment) or to go independently to the nearest children`s hospital (in a reception), emergency station. As at open changes there is a violation of integrity of skin, the wound is infected and bleeding from the blood vessels damaged by otlomka of a bone can begin, before immobilizing an extremity, it is necessary to try to stop bleeding, to process a wound (if conditions allow) and to apply a sterile bandage.

the Damaged site of skin is exempted from clothes (hands of the one who gives help, have to be washed up or processed by spirit solution). At arterial bleeding (it is bright - red blood follows the pulsing stream) it is necessary to press the bleeding vessel above the place of bleeding - where there are no big muscle bulks where the artery lies not really deeply and it can be pressed down to a bone, for example, for a humeral artery - in an elbow bend. At venous bleeding (blood of dark color flows continuously and evenly, does not pulse) it is necessary to press the bleeding vein below the place of bleeding and to record the injured extremity in the raised situation.

If bleeding does not stop, close a wound a big piece of a gauze, a pure diaper, a towel, hygienic laying (it is necessary to clamp a wound before arrival of the doctor).

If at an open change does not have

of bleeding, then from a surface of skin it is necessary to remove dirt, clothes scraps, the earth. The wound can be washed out under a stream of flowing water or to water with hydrogen peroxide (the formed foam needs to be cleaned from edges of a wound a sterile gauze napkin). Further it is necessary to apply a sterile dry bandage a wound. The open change is the indication for carrying out vaccination against tetanus of 4 (if it was not carried out earlier or term expired from the moment of the last revaccination) that needs to be made in emergency station or hospital.
of 4 Tetanus - the deadly infectious disease caused by Clostridium tetani bacterium. Its disputes can get to an organism through the wound polluted by the earth. Tetanus is characterized by the progressing defeat of nervous system, spasms, paralyzes.

First aid when falling from height consists in immobilization of a backbone and a basin which at the same time are quite often damaged. The victim needs to be laid on a firm plain surface - a board, boards, a rigid stretcher etc. At suspicion on a fracture of bones of a basin the roller keeps within popliteal areas of legs. All this leads to relaxation of muscles and prevents the secondary shift of bone otlomk.

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If at the child injured a hand and it independently to move it can is necessary to address to children`s emergency station which, as a rule, is at each children`s policlinic and hospital.

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If at the child injured a leg, a backbone or bones of a basin, then it cannot independently move. In these cases it is expedient to cause an emergency medical service which will bring the injured child in a reception of children`s hospital.

Hospitalization is carried out by

to a hospital in cases of fractures of the bones with shift demanding a repozition (comparison of otlomk) or carrying out operation and also with spinal fractures and a basin.

Diagnosis of fractures of bones at children is carried out in emergency stations or receptions of children`s hospitals by traumatologists or surgeons. Survey of the doctor, poll of parents, witnesses or the child about circumstances of getting injured is of great importance for the correct statement of the diagnosis. Surely conduct radiological research. Also quite often (especially at suspicion on spinal fracture) make computer or magnitno - a resonant tomography. In case of the combined trauma for diagnostics of a condition of internals conduct ultrasonic researches (ultrasonography), blood tests, urine, etc.

Treatment

Due to rather fast union of bones at children, especially aged to 7 years, the leading method of treatment of changes is conservative. Changes without the shift of bone otlomk treat by imposing plaster steaks (option of the plaster bandage covering not all circle of an extremity, and only its part). As a rule, fractures of bones without shift are treated on an outpatient basis and do not demand hospitalization. Out-patient treatment is carried out under control of the traumatologist. Frequency of visit of the doctor at a normal current of the period of accretion of a change makes 1 time in 5 - 7 days. Criterion of correctly applied plaster bandage is subsiding of pains, lack of violation of sensitivity and movements in fingers of a brush or foot.“ Disturbing“ symptoms of the fact that the bandage squeezes an extremity are pain, the expressed hypostasis, violation of sensitivity and movements in fingers of a brush or foot. At emergence of these symptoms it is necessary to address the traumatologist urgently. Treatment of changes by imposing of a plaster bandage is a simple, safe and effective method, but, unfortunately, not all changes it is possible treats only thus.

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At changes with shift, at heavy splintered, intra articulate changes performs operation under the general anesthesia - the closed repozition of bone otlomk with the subsequent imposing of a plaster bandage. Duration of surgical manipulation - several minutes. However, carrying out an anesthesia does not allow to allow to go home the child at once. The victim has to be left in a hospital for several days under supervision of the doctor.

At unstable changes quite often apply chreskostny fixing to prevention of secondary shift of bone otlomk metal spokes, i.e. otlomk of bones fix spokes and in addition plaster bandage. As a rule, the doctor defines a technique of a repozition and fixing before carrying out manipulation. When fixing area of a change spokes in the subsequent withdrawal and bandaging of places of an exit of spokes from an extremity is necessary, Such way provides reliable fixing of a change and in 3 - 5 days the child can be written out on out-patient treatment.

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In children`s traumatology widely apply a method of continuous skeletal extension which is most often used at fractures of the lower extremities and consists in carrying out a spoke through a calcaneal bone or a bugristost of a tibial bone (a shin bone) and extension of an extremity freight for the term of a change union. This method is simple and effective, but demands hospitalization and continuous supervision by the doctor to a full union of a change.

the Recovery period

Terms of an union of changes at children depend on age of the patient, location and character of a change. On average fractures of the top extremity grow together in terms from 1 to 1,5 month, fractures of bones of the lower extremity - from 1,5 to 2,5 months from the moment of a trauma, fractures of bones of a basin - from 2 to 3 months. Treatment and rehabilitation of compression spinal fractures depend on age of the child and can will last till 1 year.

the Active recovery period begins

after removal of a plaster immobilization or other types of fixing. Its purpose is development of movements in adjacent joints, strengthening of muscles, restoration of basic ability of the injured extremity and other. To means of recovery treatment physiotherapy exercises (LFK), massage, physical therapy, the pool belong. The physical therapy and massage is carried out by courses 10 - 12 sessions and promotes improvement of microblood circulation and a lymph in the damaged site, restoration of function of muscles and movements in joints.

Special value for a change union at children has a balanced diet. In this regard it is expedient to include in the scheme of treatment vitaminno - the mineral complexes containing everything groups of vitamins and calcium.

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At the heavy open changes complicated by blood circulation violation recommends treatment by oxygen under an elevated pressure in a pressure chamber - a method of hyperbaric oxygenation (it is applied to prevention of infection and promotes activation of exchange processes in an organism).

Recovery treatment (rehabilitation) begins

in a hospital, and then continues in out-patient conditions. At the severe injuries which are followed by the expressed malfunction of the damaged segment treatment in the rehabilitation centers, and also sanatorno - resort treatment is carried out.

of Complication of changes

At difficult changes perhaps expressed dysfunction of the injured extremity, a pain syndrome. Open changes often are followed by blood circulation violation. Consequences of not diagnosed compression spinal fractures at children leads to development of juvenile osteochondrosis - dystrophic (connected with fabric food violation) diseases of a backbone at which intervertebral disks are surprised that is followed by their deformation, change of height, stratification. Also such changes can lead to deformations of a backbone, violation of a bearing and a resistant pain syndrome. Fractures of bones of a basin can be followed by damage of hollow bodies, for example, of a bladder.