Greenstick fracture (subperiosteal fracture): symptoms, treatment, consequences. Fracture of the radius in a typical location

Last Updated on 06/23/2017 by Perelomanet

Given the fast pace of modern life and the hyperactivity of the younger generation, it is not surprising that traumatologists are never left without work. Childhood injuries can occur under any circumstances:

during the game;
playing sports;
excessive jumping or running;
falling from a height;
strong blow.

The specificity of injuries in children is due to a whole series of characteristics of the child’s skeleton, which is strikingly different from the structure of an adult. Therefore, when diagnosing childhood trauma, specialists must make allowances for the child’s body.

Legs suffer from childhood fractures 2 times less often than arms, which are often broken in the forearm or elbow. Fortunately, severe consequences of injuries in children account for only 10 percent of all injuries.

Peculiarities

A closed greenstick fracture is one of the most common types of injuries among minors. It received such an unusual name due to the significant similarity of the damage to a broken branch of a young tree when it bends, but due to the dense skin, the break point itself is held in place.

It is important to remember that the skeleton of a juvenile is fundamentally different from that of an adult. The bones of children are more elastic and thin, while the periosteum, on the contrary, is very thick. This ensures a good shock absorption effect. A thick layer of cartilage reduces the force on the bone itself.

A greenstick fracture usually occurs along the longitudinal axis of the bone. In this case, the periosteum itself remains intact. The displacement of fragments occurs quite insignificantly, and in some cases it may not exist at all. When such a fracture occurs, the deformation of the bone is minimal, while its fragments are held in one place.

Varieties

In most cases, a greenstick fracture occurs in the lower leg or forearm. Young children should be most wary of such injury. The younger the child, the more serious and dangerous the likely consequences may be. So a greenstick fracture in an infant is an injury that needs to be given close attention.

This is explained by the fact that the location of the fracture often coincides with the intersection of the area of bone tissue growth in the immediate vicinity of the joints. Such damage can cause the bone to become bent or shortened as the child grows up. This is the most dangerous consequence to watch out for with a greenstick fracture in children.

There are several varieties. Epiphysiolysis, apophysiolysis and osteoepiphysiolysis - these are the types of bone fractures of this type that experts distinguish.

During apophysiolysis, a rough area of ossification is torn off, which is called the apophysis. It plays an important role in the growing body of a child, as it is directly involved in strengthening the muscular-ligamentous apparatus. Among the types of bone fractures, osteoepiphysiolysis and epiphysiolysis should be noted. With such injuries, the articular surface called the epiphysis is damaged. It forms the joint along with the adjacent bone.

Causes of green branch failure

The most common fracture is a fall, which is common in children. Injuries in children over the age of several years usually involve a fall on the hand, so a fracture in a child usually affects the bones of the hand or forearm.

Quite often the fracture is accompanied by a bending or twisting motion, and on x-ray the injury looks very much like a long bone fracture in an adult. The main difference is the rupture of the periosteal tissue, which does not allow the bones to separate from each other. Thor fracture, a closed fracture, mainly affects childhood or adolescence.

Symptoms

This type of injury is especially dangerous because it is often practically asymptomatic or the signs of damage are extremely weak. Outwardly, everything may look like a severe bruise.

Here are the main symptoms in which it would be difficult for an ordinary person to suspect a fracture:

the pain experienced by the child is insignificant;
significant discomfort occurs only when direct pressure is applied to the broken limb;
swelling may be completely absent or minimal;
a hematoma forms at the site of injury.

However, in most cases, the limb is not deprived of motor function, which misleads parents. As a result, they may not even realize what kind of injury their child has received and may not realize that it is a “greenstick” bone fracture. To avoid trouble, you should definitely contact a traumatologist, no matter what injury the child receives. Even if you are sure that it is an ordinary bruise.

Breaking a green twig - complications

Fractures Fractures Complications from fractures are rare, but every patient is at risk of some complications. The most common case is a repeated bone fracture in the same place. For this reason, children are advised to limit their activity and avoid situations where falling may occur again. In addition, the dressing or splint may put pressure on the blood vessels and lead to tissue ischemia or necrosis. Abnormal bone fusion is very rare. A childhood fracture itself does not impair bone growth.

Vorobyova Marina

Neurologist of the highest qualification category (work experience 14 years), doctor of neurofunctional diagnostics (work experience 12 years); author of scientific publications on vertebroneurology; participant of scientific conferences on neurology and functional diagnostics of all-Russian and international significance.

Diagnostics

Only a doctor can accurately diagnose a subperiosteal greenstick fracture. Therefore, parents should seek medical help at the slightest suspicion of a fracture. The victim should be promptly taken to a doctor. An appropriate diagnosis can only be made using an x-ray.

It is especially difficult to diagnose such fractures in infants. Difficulties arise due to fatty tissue located under the skin, which significantly complicates palpation. Suspicion of this damage may be caused by swelling and soreness, which are accompanied by high fever. All this can lead to the development of inflammation, in particular osteomyelitis. So it is important to send the patient for an x-ray in a timely manner.

If the victim is small and the displacement due to injury is minimal, then even radiography cannot always give an accurate picture of what kind of damage the patient received. In such situations, it is necessary to clarify the diagnosis. For this purpose, other diagnostic tests may be prescribed. This is an accurate measurement of the relative and absolute length of the limbs, computed magnetic resonance imaging, establishing the range of mobility in the joints and some other methods. In some cases, two x-rays are taken. One is an injured limb, and the other is a healthy limb. They are carefully compared to identify a fracture.

M.A.Abdulkhabirov Department of Traumatology and Orthopedics, RUDN University, Moscow

The author notes the features of the anatomical structure of bones in childhood, the mechanism of their damage and the features of their diagnosis, and also describes the principles of conservative and surgical treatment, taking into account typical complications, as well as ways to prevent them. The article is intended for family doctors, parents, pediatricians, obstetricians, surgeons, physical education teachers, coaches, university and medical college teachers. Key words: fractures, dislocations, children, treatment.

Fractures and dislocations in children (lecture for physicians) MAAbdulkhabirov Department of Traumatology and Orthopedics, PFUR, Moscow

The author lectures about special features of bones in children, mechanism of their injury and diagnosis. The paper also describes operative and non-operative treatment, noticing typical complications and the ways to prevent them. The article is adapted for general physicians, parents, pediatricians, obstetricians, surgeons, teachers of physical training, and teachers in medical schools. Keywords: fractures, dislocations, children, treatment.

Information about the author: M.A.Abdulkhabirov – Ph.D., Associate Professor, Department of Traumatology and Orthopedics, RUDN University, Moscow

Children are not at all immune from injuries, especially since they are very active. There are domestic, street (usually road) and sports injuries, less often criminal ones. Injuries received during obstetrics are also varied: from mild to severe and extremely severe. There is no direct relationship between the severity of the injury and the age of the child. To prevent childhood injuries, not only conversations between parents and teachers and children are useful, but also cartoons and games with them on the topics: “Street”, “Car”, “Fire”, “Swimming” and others. The bones of children have their own anatomical features, and therefore the algorithm for diagnosing and treating children is different depending not only on the location of the damage, but also on the age of the victim.

Anatomical features of bones in children and types of their fractures To begin with, we note that bone fractures in children, as well as in adults, are divided into diaphyseal, metaphyseal (periarticular) and epiphyseal (intra-articular) fractures, as well as apophyseal injuries, but children have their own features in diagnosis and treatment. Children's bone is more plastic, more elastic and has a higher content of water and organic matter (protein, carbohydrates, fats, etc.) than that of adults. And the amount of inorganic substances (Ca, P, Mg and other trace elements) in the bones of children is less than in adults. In addition, the periosteum in children is thick, flexible, strong and richly supplied with blood. The preservation of bone integrity in children is also facilitated by the presence of epiphyses at the ends of the tubular bones, connected to the metaphyses by wide elastic growth cartilage, which absorbs the force of impact. These anatomical features cause the following skeletal injuries typical for childhood: fractures, subperiosteal fractures, epiphysiolysis, osteoepiphysiolysis and apophysiolysis. More often, cortical fractures occur in children when the opposite cortical bone at this level remains intact. These fractures are also called greenstick or willow fractures. Fractures, fractures and subperiosteal fractures are the most typical and common injuries in childhood. The periosteum remains intact in these fractures. These fractures are more common with fractures of the forearm and tibia. Epiphysiolysis, osteoepiphysiolysis and metaepiphysiolysis are traumatic separation and displacement of the epiphysis from the metaphysis or with part of the metaphysis along the line of the germinal epiphyseal cartilage. They occur only in children and adolescents until the process of ossification of the growth plate is completed. Of particular note is the issue of the mechanism of occurrence, diagnosis and treatment of juvenile epiphysiolysis of the femoral head, because there is also a significant factor in endocrine (hypercortinism) disorders: obesity, stripes on the skin, arterial hypertension and increased urinary excretion of 17-hydroxycorticosteroids and 17-ketosteroids. Apophysiolysis is the separation of the apophysis along the line of the growth cartilage. Apophyses, unlike epiphyses, are located outside the joints, have a rough surface and serve for attachment of muscles and ligaments. An example of this type of injury is displacement of the medial or lateral epicondyle of the humerus.

Diagnosis of fractures in children Displaced bone fractures in children are characterized by classic symptoms: pain and soreness, impaired hand function, deformity and, less commonly, pathological mobility and crepitus. Even low-grade fever is possible. At the same time, with fractures, subperiosteal fractures, epiphysiolysis and osteoepiphysiolysis without displacement, movements can be preserved to a certain extent, pathological mobility is absent, the contours of the injured limb that the child is sparing remain unchanged and only upon palpation is pain determined in a limited area corresponding to the fracture site. Fractures in infants and newborns are the most difficult due to the well-defined subcutaneous tissue, which makes it difficult to palpate the area of a possible fracture. There are difficulties in diagnosing spinal injuries in childhood (especially with slight compression of the vertebral bodies). In all cases, X-ray, CT and MRI studies help make the correct diagnosis. Often, in the presence of a fracture and lack of x-ray control, a diagnosis of bruise is made. As a result of improper treatment in such cases, curvature of the limb and disruption of its function are possible. In some cases, a repeat X-ray examination performed on days 7–10 after injury helps clarify the diagnosis, which becomes possible due to the appearance of initial signs of fracture consolidation. The bones of children have an amazing property: self-removal of displacement of fragments during growth. If it were not for this feature, then the vast majority of people on earth would be crooked and lame. Correction of the remaining bone deformation occurs the better, the younger the patient is. The leveling of displaced bone fragments in newborns is especially pronounced. In children under 7 years of age, displacements for diaphyseal fractures are allowed in the length range from 1 to 2 cm, in width - almost across the diameter of the bone and at an angle of no more than 10°. Therefore, there is no need for mathematical precision when reducing diaphyseal fractures in children! At the same time, rotational displacements cannot be corrected during growth, and therefore they should be eliminated during primary reposition. A slightly different tactic for peri- and intra-articular bone fractures in children. In this case, accurate reposition with the elimination of all types of displacements is mandatory, since unresolved displacement of even a small bone fragment during intra-articular fractures in children leads to joint blockade, varus or valgus deformity of the limb.

Treatment of fractures in children The conservative method has been and remains the leading principle in the treatment of bone fractures in children. In most cases, a fixing bandage is applied. Immobilization is carried out with a plaster splint, usually in the mid-physiological position, covering 2/3 of the circumference of the limb and fixing two adjacent joints. A circular plaster cast is not used for fresh fractures in children, since there is a real danger of circulatory disorders due to increasing edema with all the ensuing consequences, including the development of ischemic Volkmann contracture, bedsores and even necrosis of the limb. As a result of compression by a plaster cast, damage to the nerve plexuses and peripheral nerves is also possible with the development of joint contracture. Consequently, “a plaster cast in pediatric traumatology can and should be a great friend of the doctor and patient if it is skillfully applied and there is control, and an enemy of the patient and the doctor if the bandage was not applied successfully and the patient was not monitored after that.” In case of displaced bone fractures, after local anesthesia of the fragments, a one-stage closed reduction is performed, if possible, as early as possible after the injury. Skeletal or adhesive traction is used in children over 3 years of age, mainly for fractures of the femur. Skeletal traction must be carried out distal to the apophyses to prevent rupture of the growth zones and even lengthening of the injured segment. Thanks to traction, displacement of the fragments is eliminated, gradual reposition is carried out and the bone fragments are held in the reduced position. Anesthesia is carried out by injecting a 0.5–1% novocaine solution into the hematoma at the fracture site (at the rate of 1 ml per one year of the child’s life). Of course, the child will cry and resist, but it is better to let him scream for 5-10 minutes than to experience the effects of short-term anesthesia, which is not safe for children.

Surgical intervention for fractures This is a very important issue, for the solution of which in case of bone fractures in children it must be determined that surgical (surgical) treatment is indicated mainly for intra- and periarticular fractures with displacement and rotation of the bone fragment. This is fundamentally important to prevent deformation and dysfunction of the joints. Surgical treatment (usually with knitting needles) is indicated if a large (not acceptable, not self-correcting) displacement of the diaphyseal fractures persists after two or three attempts at reposition. Open fractures, by definition, require primary surgical treatment of the wound with fixation of fragments with external devices: pins, rods or pins and rods. Incorrectly healed fractures with pronounced deformation require surgical correction. Delayed consolidation, non-union of fractures, pseudarthrosis or bone defects are very rare in children, but if there are such post-traumatic complications after severe open fractures, then their elimination is not possible without surgical interventions. Unfortunately, children are not immune from pathological (due to tumors and diseases) fractures, for which, as a rule, surgical treatment is used depending on the degree of damage and the primary cause of the fracture. Absolute indications for surgical treatment are the presence of concomitant damage to the great vessel and nerve, as well as interfragmental interposition. There are strict principles that must be followed in the surgical treatment of fractures: the most atraumatic approach to soft tissues, the use of gentle methods of osteosynthesis with wires so as not to damage the growth zone. Massive metal implants are used extremely rarely in pediatric traumatology. No one today advocates traditional (as in adults) intramedullary locked osteosynthesis in pediatric practice, however, intraosseous osteosynthesis is possible if the pin is inserted below the level of the growth zone in the proximal bone when introducing flexible pins antegrade or when inserting the pin above the growth zone when inserting it from a distal bone fragment. These features are aimed at protecting growth zones from their iatrogenic damage. It is advisable to use external osteosynthesis with metal plates in older children with diaphyseal oblique and helical fractures of the diaphyses of the femur and tibia, etc. All this makes it possible in some cases to avoid long-term treatment using skeletal traction and does not require additional external fixation in a plaster splint, and also eliminates the development of post-immobilization complications: joint contractures and muscle wasting. In the last 2–3 years, there have been reports of the use of bioabsorbable grafts and plates for the treatment of bone fractures in children. The advantages of these implants are that they are subject to resorption within 1–2 years and there is no need for repeated surgery to remove them.

Features of spinal fractures in children The cervical vertebrae are most often damaged. If spinal fractures are not accompanied by damage to the spinal cord, then treating these fractures is not difficult. It is important to immediately establish or exclude damage to the cervical (especially the first and second) vertebrae by x-ray examination, taking into account the fact that a direct view of these vertebrae is possible only in photographs with the mouth open. And, nevertheless, in case of any injury, it is better to immediately fix the head with a head holder and remove it only if damage to the bone structures and vertebral ligaments is completely excluded. For fractures (usually compression fractures of the bodies) of the vertebrae, there is no need for heavy plaster corsets, but it is better to undergo bed rest with physical therapy to strengthen the spinal muscles and maintain correct posture. All this can also be combined with walking in a corset made of polymer field grass, in which you can even swim, which is highly recommended for children during the recovery period of treatment for injuries to the thoracic and lumbar spine. If a child falls from a height (catatrauma) or in a car accident, combined injuries (bone fractures and damage to internal organs) are possible. For pelvic fractures, it is important to clarify or exclude damage to the urethra, bladder and kidneys through a thorough clinical examination, ultrasound, radiography, laparocentesis and laparoscopy.

Dislocations in children Dislocations and dislocations-fractures of bones in children occur in all locations. There are also fractures of one bone and dislocation of the other bone of the forearm (Galleazi and Monteggia). Diagnostic and treatment principles for children are the same as for adults: radiography in two projections with the capture of two joints, complete anesthesia and urgent removal of dislocation. Plaster splint immobilization for 10–14 days is mandatory for dislocation of the humerus to prevent the development of habitual shoulder dislocation. Children with intra-articular fractures and fracture-dislocations in the area of the elbow joint, which accounts for about a third of all injuries in childhood, require especially careful attention. This joint is very complex and is formed by the humerus, ulna and radius bones. Here there are dislocations of the forearm bones in different variations, isolated dislocation (subluxation) of the head of the radius, fracture of the olecranon, head and neck of the radius, separation of the head of the condyle and fracture of the trochlea, coronoid process, condyles and (medial and lateral) epicondyles of the humerus, and also supracondylar and transcondylar fractures. The external epicondyle of the shoulder may end up in the elbow joint, and if it is promptly fixed to its parent bed with a spongy (preferably connulated) screw in time, the function of the elbow joint will not suffer. Usually, to fix bone fractures in the elbow joint, osteosynthesis with wires, cancellous screws, and Weber-Mühler wires is used (Fig. 1, 2). Bone fractures in children heal 3–4 times faster than in adults. Consolidation of fractures occurs from 2 weeks to 1–1.5–2 months, depending on the nature of the fracture and the general condition of the victim (vitaminosis, rickets and other concomitant diseases). With insufficient duration of fixation and early loading, secondary displacement of bone fragments and even repeated fractures (refractures) are possible. Physical therapy should be moderate, gentle and painless. Massage near the fracture site, especially with intra- and periarticular injuries, is contraindicated, as this leads to the formation of excess callus (myositis ossificans and periarticular ossification). Children who have suffered injuries near the epimetaphyseal zone require long-term follow-up.

Other types of injuries Birth (obstetric) injuries (paralysis) occur due to damage to the brachial plexus during childbirth. Their frequency averages 0.1–0.2% of cases among newborns. Depending on the severity and anatomy, injuries to the brachial plexus vary, as do functional impairments. Their treatment is usually conservative. There are also surgical methods: brachial plexus neurolysis, myoplasty, etc. With the advent of new diagnostic (arthroscopy, CT and MRI) capabilities, transchondral fractures began to be diagnosed, that is, cartilage damage with the detection of small cartilaginous and osteochondral bodies, which are removed during diagnostic and treatment arthroscopy.

Treatment

This type of fracture is treated in two ways. It can be surgical or conservative. If the doctor is inclined towards conservative therapy, then the patient is given local or general anesthesia, and then parallel reposition of the bone fragments begins. Thus, the doctor eliminates the resulting deflection. As soon as the bone damaged as a result of the fracture acquires an anatomically correct position, a plaster cast is applied to the limb.

Surgery is required in certain cases. Here are the most common ones:

intra-articular damage accompanied by displacement of the epiphysis;
injury to the fingers, femoral neck or end of the humerus;
a fracture that is complicated by burns, rupture of blood vessels and nerves.

In such situations, surgery should be prescribed. After it is performed, a plaster cast is applied to the injured limb. For some time after this, the patient should be given anti-inflammatory and painkillers.

Features of rehabilitation during the period of immobilization

This period begins from the moment the operation is completed and continues until the fracture is consolidated or a scar is formed. During this time, it is necessary to create optimal conditions that will help the recovery process proceed correctly. One of the main methods of rehabilitation during the period of immobilization is physical therapy, which involves the use of the following exercises:

Ideomotor exercises. Their essence lies in the mental representation of movements in the area of the damaged limb;
Exercises for those muscle groups that are not involved in immobilization;
Static exercises of an immobilized limb.

Therapeutic exercise helps reduce the risk of developing secondary disorders, maintain muscle tone and strength, achieve correct positioning, and improve tissue nutrition.

Recovery process

It is worth noting that the recovery period in children proceeds quite quickly, bone tissue is restored well. Several factors contribute to this. This is the preservation of nutrition of soft tissues in the area of the bone and itself, without interrupting the blood circulation process. In general, regeneration processes of all types of tissue occur in an accelerated manner in a child’s body.

In addition, collagen production begins, and a bone callus quickly forms on the damaged area. Finally, this is facilitated by the complete absence or small number of fragments.

In most cases, the plaster cast from the damaged area is removed after four weeks. After this, you cannot do without a course of full rehabilitation.

Age differences

If you compare the bones of a child and an adult, you can identify a number of differences, due to which the same injuries manifest themselves differently in them.

A child's bones are much thinner due to lack of minerals, but they are also more porous.
Adult bone tissue is less elastic due to a lack of collagen.
The high density of children's bones is ensured by a large number of Haversian canals.
In children, the epiphysis and metaphyseal region are separated by large elastic cartilage, which softens any blow.
Flexibility and shock absorption are given to children's bones by the increased thickness of the periosteum, which is generously supplied with blood vessels, thanks to which, if necessary, accelerated growth of callus occurs.
Children's bones contain cartilage tissue.

Almost all childhood fractures take the form of a “green twig” that has been bent or broken. In very young children, after an injury in the bone growth zone, adverse consequences occur with curvature or shortening of the bone. Therefore, it is especially necessary to protect children from serious injury.

Removing plaster

The doctor removes the cast from the limb as soon as it has healed. All necessary procedures are prescribed immediately. With their help, it is possible to develop joints and strengthen muscles, and restore motor functions. Among such procedures, physical therapy, massage, physiotherapy, classes in the pool, and treatment in a sanatorium should be highlighted.

At this time, it is of great importance to provide the child with adequate nutrition, which should include a variety of foods rich in microelements and vitamins. First of all, calcium. The child should be provided with comprehensive care and no stress. All this will allow you to get better as quickly as possible.

To prevent such injuries, you should explain to your child from the first years of life the importance of following basic safety rules when playing sports and outdoor games.

Damage to the radius

Another common type of injury is a fracture of the radius in a typical location. This definition refers to a fracture of the distal metaepiphysis of the radius.

This injury is very common because this bone is considered the thinnest in the human body. In addition, it has a characteristic structure - the cortical layer is very thin, and the spongy inner part is characterized by reduced strength.

Women during menopause are most susceptible to such damage. This happens due to the characteristics of the hormonal system. During this period, the fairer sex develops osteoporosis, and the amount of calcium in the bones decreases significantly. All this significantly increases the risk of fractures.

Fracture mechanism

In most cases, this injury occurs when a person extends their arm forward during a fall. There are two types of fracture of the radius in a typical location, depending on the position in which the hand was. A fracture can be flexion, in which case the bone moves inward. If it is extensor, in this situation the fragment moves outward.

An extension fracture is considered more common, since people often straighten their wrist when they fall.

First aid

At the first suspicion of this type of fracture, you should immediately call an ambulance. If it is not possible to quickly get to the hospital, the hand needs to be immobilized using any available means. It could be a board, a stick, a branch. Cold should also be applied.

The diagnosis is made after an X-ray examination in an emergency room or hospital. Typically, with this diagnosis, the patient is hospitalized. Treatment tactics are determined individually in each case.

When the cast is removed, it is important to follow the rules on how to develop an arm after a fracture. If the radius is damaged, an Elizarov apparatus is installed. This will help prevent the fragments from moving. After removal of the device, wounds may remain in the soft tissue, so vigorous movements should be avoided to prevent bleeding. Only after all wounds have healed does full recovery begin.

Tibia fracture

A tibia fracture is a significant injury to the fibula and tibia due to excessive load that they could not withstand. This is a common injury, including among children and adolescents.

In ICD 10, a fracture of the tibia is coded S82. The injury can be closed or open. The method of treatment depends on its complexity and nature.

Fracture of the green branch (subperiosteal) - what is it, what are the symptoms and treatment?

A green branch fracture is also called a subperiosteal fracture. This injury is common in children. In case of a fracture, the periosteum protects the injured bone from complete separation of its surfaces. The structure resembles the breaking of a fresh twig. A green branch fracture causes symptoms similar to those of other uncomplicated fractures. Treatment of a fracture does not require adjustments. Placement in a cast or splint is effective in promoting proper bone healing. After the cast is removed, rehabilitation and exercise are recommended.

Fotolia

Closed fracture

A closed fracture is considered a very significant injury. In this situation, the condyles of the tibia and ankle bones are often affected.

With such a fracture, the patient's limb mobility is severely limited. The patient is unable to lift his leg up. When trying to lift the lower leg, the end of the tibia under the skin begins to protrude. Also, when you feel it, you hear a characteristic crunch.

During the treatment process, the extension method is used, that is, stretching the damaged bone. It can be adhesive or skeletal.

Among other methods of therapy, the surgical method is distinguished. It involves intraosseous fixation using metal pins, rods or plates. A fixation method is also used by applying a plaster cast.

If a minor is injured, he cannot do without children's crutches.

How to recognize a broken green branch in a child?

The most common test to confirm a bone fracture in a child is an x-ray. If your child complains of arm or wrist pain after a fall and swelling occurs, call your doctor right away. If there are no visible signs of a fracture, but the child feels pain for a long time after a fall, you should consult a doctor to rule out a possible fracture (it could be a bruise itself).

During the interview, the doctor checks the painful areas and orders an x-ray, which clearly shows whether the bone is broken or not. The doctor usually prescribes an examination in two projections. In the case of a green branch fracture, the fracture gap is not visible on the radiograph. However, you can see detachment of the periosteum - this is a consequence of the hematoma. In rare cases, additional tests such as magnetic resonance imaging or computed tomography are performed.

With each fracture in a child, the doctor assesses by touch the condition of the bone, the degree of its possible deformation and the presence of a pulse. This eliminates possible complications after a green branch fracture.

Open fracture

With an open fracture, bleeding occurs. The patient experiences traumatic shock, he has a gaping wound with bones coming out, which have broken through the soft tissue and skin. Such damage is accompanied by severe pain, limited mobility, dizziness and weakness.

If the fracture is primary, one reduction is sufficient. If the nature of the damage is helical or oblique, sutures are applied with fixation to the wire. When treating open fractures of the tibia, metal rods are usually inserted into the victim. They have holes on the sides through which special substances, such as antibiotics, are supplied into the bone marrow canal. After this, a plaster cast is applied.