Broken arm in the child

introduction

The arm is generally divided into the upper arm, forearm and hand. These are connected to one another by the elbow joint and wrist.

The bone of the upper arm is called the humerus (large tubular bone), the forearm is made of cubit (Ulna) and spoke (radius) built up. The hand is made up of the eight carpal bones followed by the metacarpal and finger bones.

First of all, broken arms behave very differently in children than in adults.
Firstly, the type of fracture is different due to the much more flexible bone being built up. Second, children have a faster and better tendency to self-heal.
If growth plates are affected, particular care must be taken. Because here there is the risk that, with inappropriate treatment, growth will be permanently impaired and malpositions can follow.

root cause

With a broken upper arm one differentiates different types of breaks.

At a Upper arm shaft fracture (humeral shaft fracture) the middle part of the long bone is damaged. This rarely happens, but when it does, it is often done by one Fall or at Traffic accidents.

A fracture of the lower upper arm is also called distal humerus fracture, supra, or epicondylar humerus fracture (the lower end of the humerus is called the condyle) and is usually caused by a fall on the extended arm. As a result, the elbow joint is often affected here.

With a broken one forearm The broken spoke is one of the most common breaks in childhood and occurs in most cases as a result of falls during sports such as Handball, Skating or Snowboarding, which mean a relatively high risk of falling.

Symptoms

The break occurs in every tenth child not obvious recognizable by the parents.

Typical signs of a swelling can be missing and an existing one agility should not automatically lead to the exclusion of a break.

Has a child after a fall or a collision strong pain In any case, a doctor should be consulted in the arm. However, in addition to pain, typical signs are usually listed, such as Feeling numb or cold, Swelling, Restrictions on movement or Misalignments.
The Pain from a broken bone is often very severe. They are conditioned by the Irritation of the periosteum. Use painkillers in children to relieve pain caused by broken bones Ibuprofen and acetaminophen. Here must be on the respective dosage that is based on the child's body weight. Also Distraction of children often helps relieve pain.

diagnosis

It is important to describe the mechanism of the injury to the doctor as precisely as possible. This alone often allows conclusions to be drawn about the location or type of the break.

The doctor will also perform a detailed physical examination, which will check movement restrictions, incorrect or relieved postures, and blood circulation and sensitivity.

The diagnosis is secured by an X-ray. In exceptional cases, for example if the injury was caused by an apparently too weak trauma (a so-called minor trauma) and the bone and tissue structure should be examined more closely, magnetic resonance imaging (MRI) or computed tomography (CT) is indicated for a broken arm .

Read more about this: X-ray examination of the child

Differentiation of sprain and fracture

At a sprain, also called distortion, it happens by external force to a Overuse of the affected joint. The sprain usually goes with pain and a minor one swelling hand in hand. There are no findings in the X-ray image. The sprain can be caused by the application of local cold (Cool pack) or with a supportive bandage with diclofenac ointment known as Voltarengel® for a few days.
The bone fracture (fracture) is caused by the The effect of external forces that the bone cannot withstand. The uncertain fracture signs are swelling, pain and Function restriction the affected body region. If the arm is broken, it can no longer be played with, for example. Safe Fraktur signs are those abnormal mobility the extremity, Sounds of bone fragments rubbing against each other when moving the arm and in the worst case protruding bone parts from the skin (open fracture). With uncertain signs of Fraktur only that applies X-ray exposure.

therapy

Conservative therapy

At Upper arm fractures Children who are younger than ten years often have the option of conservative treatment, if this is the case Pain and one no more than 20 degrees Axial kink allow. A plaster of paris is often used for this.

The average conservative Treatment of a fracture on the arm is 6 weeks, plaster or. rail have to be worn for four to six weeks. This can depend on the type of bone fracture vary. The plaster of paris is used to immobilize the arm and to ensure that the two bone fragments are exactly on top of each other. This is the only way to heal the fracture without complications. With slightly shifted Fragments they are first brought back to their original position.

Fractions of the lower upper arm end are more common in children. If the fragments are not displaced, a conservative procedure is often sufficient here too. One uses one for immobilization Upper arm cast, one Upper arm brace or one loop.

The Arm sling is used to immobilize the upper arm and the shoulder. Since the entire arm is immobilized here, it can lead to problems of mobility in the shoulder. Therefore is possibly early physiotherapy to strive, which should be ordered individually by the doctor. Furthermore, the increased burden on the neck Neck pain occur. The smaller the child, the more uncomfortable it is to hold the entire arm still. Restricted mobility can also be a reason for increased crying and whining. An example of this would be the Blount noosewhich that wrist holds in one position.

After immobilization it is necessary to do the next day Blood circulation and the sensitivity To test the (feeling) of the arm and fingers and the mobility of the fingers. Because the plaster of paris or the splint can damage the nerves and blood vessels if it is incorrectly applied. If this is overlooked, a permanent damage be the consequence. During the period in which the cast is worn are also in the course regular doctor visits important to check the correct fit of the cast and to check the healing success. While the arm is in the cast, it should burdened as little as possible become. If the child complains of pressure from the plaster of paris or tingling in the fingers, an immediate re-visit to the attending physician should take place. This may be a cast that is too tight or badly fitting and squeezes the vessels or nerves of the arm.

After a few days, an X-ray check is also carried out, as the fragments can subsequently shift. Another x-ray check is recommended after 4 weeks.

Even with one Broken spoke is often followed by a simple immobilization plaster or rail sufficient.

Operative therapy

Consists of Upper arm fractures, Fractures of the lower Upper arm end or broken Forearm too great a displacement or kinking or in general with complicated fractures a OP to re-establish and stabilize the fracture.

Vascular and nerve injuries can also occur, which may require surgical repair.

Depending on the break you can elastic intramedullary nails can be used for stabilization. These nails, which are inserted into the medullary canal of the bone, protect the Growth plates. This procedure is also called Elastic-stable intramedullary nailing (ESIN).

Possibly be Plate ststeosynthesis procedure used. This means that, among other things, metal plates are used for stabilization. However, this only happens in a few cases. Two crossed wires (so-called Drill wire osteosynthesis procedure) to directly stabilize the broken arm.

For particularly complicated ones Fractions can a External fixator become necessary. This is an externally attached holding device that holds the breakage steady with metal rods. Another x-ray check is carried out after three to four weeks. And further follow-up checks are important until they are fully functional.

The Metal implants are removed under anesthesia after healing. The Drill wires can be removed after about three to four weeks. The elastic nails (ESIN) can be removed after about six to twelve weeks.

It is important to know that certain Misalignments can be left as these grow out. The extent to which the misalignment can be tolerated should always be carefully checked.

forecast

The prognosis for fractures in childhood is generally to be regarded as good, since childhood injuries are good Self-healing tendency or. Tendency to spontaneous correction demonstrate.

However, this depends, among other things, on the stage of development and on the location, type and extent of the break. Particular attention should be paid to fractures that affect the joints or the Growth plates concern, be directed.

X-rays to check the broken arm are very important in order to detect any malpositions early and correct them in order to ensure normal growth.