Among the different types of disorders that occur in the integrity of parts of the skeleton, the most common in children is a subperiosteal fracture. This is pretty serious damage. With such an injury, tissue damage and preservation of the integrity of the periosteum located around the bone are noted. Often, a fracture is not accompanied by displacement of fragments, which makes therapy and recovery faster and easier. This injury is also defined as a green twig injury.
What should you know about this injury?
It should be noted that in children, a subperiosteal fracture occurs very often, since the structure of their tissues differs significantly from that of adults. At a young age, they are more elastic and thin, as they consist of morecollagen and minerals.
The periosteal tissue in children is better supplied with blood, thanks to which the elasticity of the cartilage located between the epiphysis and the metaphysis makes it possible to reduce the force of action and the intensity of pressure directly on the base itself. This injury leads to a violation of the integrity of the element responsible for shock mitigation and good cushioning.
Mechanism of occurrence
The main mechanism for the occurrence of a subperiosteal fracture in children is the presence of strong pressure, localized in the region of the longitudinal axis of the bone. It is worth, first of all, to pay attention to the fact that in the period of adulthood, such a force turns out to be the cause of a fracture of the limbs. In children, at this time, it is only a violation of the integrity of the periosteum.
Is there a subperiosteal fracture on the forehead? Epiphyseolysis and osteoepiphysiolysis occur at the point of attachment of the articular capsule to the cartilage of the bone, that is, in the ankle and wrist joints. This violation does not occur in the hip part of the skeleton and other places where the articular bag covers the growth cartilage, which, in turn, does not serve as a place for its attachment.
In most cases, such damage can affect the lower leg, and, in addition, the forearm. The leading position among childhood injuries is occupied by violations in the integral structure of the radius. On x-rays, the lesions may look like a bent green twig cracking under the skin.
What is the danger?
Despite the fact that the subperiosteal fracture is considered simple in the field of current traumatology, it still turns out to be very dangerous for the he alth of the child. It is characteristic that in young patients there are significantly more complications after such an injury. Now let's try to figure out what causes are the key factors that provoke the occurrence of such an injury.
Reasons
Among the main causes that can lead to a subperiosteal fracture, attention should be paid to the following:
- Active games. Most often, the periosteum can be injured due to human activity. These are ordinary street games or sports. A very common reason is cycling, skateboarding, rollerblading, skating, and in addition, dancing. Thus, any active activity during which you can inadvertently fall provokes such a fracture.
- The result of the fall. Due to the fragility of the bone tissue, any fall can cause injury to the periosteum.
- Being struck with even slight force against a hard object results in a subperiosteal fracture of the radius.
- Being involved in a traffic accident is rarely the cause of such an injury. But, according to statistics, in these cases there is a complete fracture of bone tissue with the appearance of displaced fragments.
Next, let's talk about the symptoms that accompany the occurrence of such a fracture, regardless of age.
Fracture symptoms
Symptomatic manifestation of a complete fractureand closed subperiosteal fracture of the radius are fundamentally different from each other. It is necessary to be able to distinguish between an absolute violation of bone integrity and a minor injury that can occur without the presence of displaced fragments of the injured part of the skeleton. In an adult, as well as in a child's body, the following patient complaints will indicate the presence of a complete fracture:
- Presence of limited movement.
- The occurrence of pathological mobility in the area of the received blow.
- Presence of soft tissue swelling around the injury site.
- The presence of a visually deformed injured limb.
- Presence of general hyperemia in the patient.
- Formation of subcutaneous hematoma and hemorrhage due to impact or pressure.
- Crunching of bone fragments may be observed during an attempt to move.
It should be emphasized that a subperiosteal fracture of the radius in children does not have similar symptoms, which is a common reason that adults mistake such an injury for a severe bruise. In most situations, this injury results in minor pain.
Despite the fact that children will be able to lean on the injured limb, this may be accompanied by a strong painful sensation. Unlike an absolute fracture, a subperiosteal fracture may occur with little or no swelling.
Diagnosis
As a diagnostic tool to determine the type of fracture that has occurredthe doctor will not be able to perform only palpation of the damaged area, since the child's body is characterized by well-developed subcutaneous fatty tissue.
After an external examination of the patient, the specialist will need to prescribe an X-ray examination, thanks to which it is possible to diagnose the presence of an incomplete violation of bone integrity or periosteal injury. Cases that are particularly difficult to diagnose require a comparison of images of a he althy limb with an injured one in order to determine the broken integrity.
Treatment
Today, the treatment of a subperiosteal fracture is either conservative or operative. A conservative method of treating the diagnosis in question is to perform general or local anesthesia, under which one-stage closure of the reposition of fragments is performed.
Thus, the resulting deflection of injured bone tissue is eliminated. After the doctor restores the damaged bone in its normal anatomical position, it is required to apply a plaster cast for fixation. With regard to surgical methods of treatment, their cost due to complexity, as a rule, is relatively higher than conservative repositions. Surgical intervention for such a fracture can be of the following types:
- Performing a closed reposition with fixation of the bone fragment in a closed form (this is done if the fracture occurred inside the joint capsule, the femoral neck was injured, or a subperiosteal fracture of the clavicle occurred).
- Execution of openreposition with fixation of a fragment of an injured bone. This method of therapy is used in the event that the epiphysis has been displaced, and at the same time, intra-articular damage, an unstable fracture, or an open subperiosteal injury are ascertained.
- Performing external fixation. This is considered necessary for the treatment of complicated injuries, accompanied by ruptures of nerve endings and blood vessels, and in addition, burns of varying severity. Also, such a measure is required in the presence of violations of the integrity of bone tissues in an unstable form.
After the doctors perform the operation, they apply a cast to fix the injured area. In addition, the doctor prescribes the intake of special medications that have anti-inflammatory and analgesic effects ("Ibufen", "Nalgezin", "Ketorol").
With the use of crutches, patients are allowed to move already on the second day after the start of therapy. Despite this, given the difficulty of mastering crutches, patients often need to lie down for extended periods in order to restore the integrity of the periosteum. In such situations, it is mandatory to take expectorant medications that prevent pneumonia due to prolonged immobility of the patient after the injury.
Duration of treatment
The duration of therapy in the presence of a subperiosteal injury directly depends on how old the victim is, andalso from the location of the fault line. It is characteristic that young patients do not have to be so long in a state of immobility for the fusion of the periosteum in comparison with older children.
Recovery period
There are probably no specific figures on the healing time of a closed subperiosteal fracture, since the recovery period is different for everyone, it largely depends on the location, and in addition, on the nature of the damage. On average, a fracture of the upper extremities grows together from one to one and a half months. The recovery of the lower extremities takes, as a rule, from one and a half to two months, and the bones of the pelvis need up to three months. In the event that a compression fracture of the spine occurs, the patient will need up to one year for therapy and rehabilitation.
After removing the cast
A full-fledged rehabilitation process starts from the moment when the patient is completely removed from the cast along with other types of fixations. The rehabilitation period usually includes a set of movements that are able to strengthen the muscles, restoring the supporting ability of the limbs.
Such procedures include visits to special physical education sessions, massages, physiotherapy. You also need to visit the pool. As a rule, twelve sessions are prescribed for visiting massages and physiotherapy. In particular, attention should be paid to proper nutrition, it is important to include only those products that are equipped withvitamins and minerals. Special preference is given to products with calcium. As a rule, patients begin the recovery period directly in the hospital, and then gradually move to an outpatient setting.
