What do you know about femoral fractures in children?
What are the symptoms of femoral fractures in children?
What are the symptoms of femoral fractures in infants?
How are femoral trunk fractures treated in children?
How are neonatal femoral fractures treated?
What is the mechanism of injury that leads to femoral fractures in children?
If you want to find the right answer to the above questions, we recommend that you read on.
what you will read next :
Introduction
Generally the main cause of femoral shaft fractures in children is accidents, such as falls from heights or motor vehicle accidents. We may see a baby having a difficult vaginal delivery with a trunk fracture.
We want to talk more about femoral fractures, specifically femoral trunk fractures in children.
What are the symptoms of a femoral shaft fracture in children?
When a child has a broken femoral shaft, he can not walk, can not stand on the injured leg, sometimes the child can not stand on his feet at all. The affected area is swollen and there is a clear deformity of the thigh. It is said that the movements of the involved lower extremities cause severe pain in the affected child. Because of this pain, the child is very restless and cries, and also one of the noteworthy points is that children with hip fractures, abnormal movements of the thighs can be seen and felt in the examination.
What is the mechanism of femoral injury in children?
What are the mechanisms that cause femoral shaft fractures in children? It should be noted that the main cause of trunk fractures in children is accidents, such as falls from heights or accidents with motor vehicles. If a newborn has a broken femoral shaft, he / she is more likely to have had a difficult vaginal delivery with a broken femur.
An important point to note about the causes and mechanisms of femoral shaft fractures in children is that if you or a child under the age of 3 see that the trunk bone is fractured, you should be very suspicious of child abuse by a parent or guardian or so-called child abuse.
treatment
In this section, we want to see what treatment strategies will be available if we encounter a trunk fracture in children?
One thing to note is that there are many different techniques and methods for treating femoral fractures in children. Which of these types of treatments and techniques your doctor should choose depends on different factors that we refer to them below. Your doctor will decide what type of treatment to use depending on the age of the injured child and the extent of the fracture displacement.
First clinical picture
A child who presents with a fracture of the femoral shaft and has a fracture without displacement can only be treated with a cast.
What is the meaning of spica plaster?
The plaster used is called Spica plaster. When it is taken for a child, Spica plaster is broken from the bottom of the chest to the whole lower limb, so that the fingertip should be dipped in the plaster and the lower limb should be plastered from the healthy side to the top of the knee. This plaster will stay for three to six weeks depending on the age of the injured child, then it will be removed.
The second clinical picture
The second clinical picture occurs when the child has a trunk fracture and the fracture is associated with dislocation and the child is under 5 years old. In these cases, the doctor must first reduce the fracture in the operating room and under general anesthesia. After reduction, Spica plaster is taken in the above method.
Now, if the child has a fracture of the femoral shaft with displacement, this time more than five years old, the doctor can choose two treatment methods according to the existing conditions. There are different doctors, each of whom is in favor of one of the following methods.
The first method
Traction and then casting a child who is a candidate for this procedure must be hospitalized. The patient lies on his back in bed while the patient is hospitalized.
The weights are attached to the wide adhesives attached to the skin of the leg (type of skin traction) by means of strings, their weights and ropes are completely standard and cause the tensile force to be transmitted to the lower limb.
In young children, skin stretches and in older children, bone stretches may be used. When bone stretches are used, a metal bar is placed transversely below the patient’s femur above the knee, causing a tensile force to be applied to the entire limb. The lower weights are completely standard and are selected and installed by the orthopedic doctor. With this stretch, the broken parts of the femur are placed next to each other and reach their desired alignment. At this distance, the treating physician must have an X-ray radiograph that can Monitor, control and follow the movements of the parts.
This condition usually lasts for two to three weeks, that means the patient must be hospitalized in the same condition for two or three weeks so that the broken pieces can be placed next to each other and stick together. Then, if there is skin tension, the skin must be glued. The leg should be detached and if there was a bone traction, the rods should be removed from the patient’s foot.
The second method
To treat a femoral shaft fracture in an upper child with displacement is as follows:
Surgery with implanted rod inside the bone:
In this method, the patient should receive general anesthesia in the operating room. The patient’s thigh should be placed in the operating room under general anesthesia and then make two 1 cm incisions on both sides of the knee and insert two long metal rods, usually as thick as a knitting rod, into the femoral canal and guide them to the highest parts of the bone. The purpose of these rods is to immobilize the fracture created in several femurs.
Of the two methods mentioned above, what is most commonly used today is the second technique. This is because in both methods, the patient receives general anesthesia, and if bone traction is used to stretch the patient, the surgical incision will be the same in both skin and bone in both methods. This means that both one-centimeter incisions on both sides of the injured knee above the injured side will be needed to insert the transverse rod to perform the bone extension and to insert the fixing rods into the bone canal.
Now compare the other method. In the second method, the surgical method, in which the rod is inserted into the bone canal; The patient stays in the hospital for only one to two days and then is discharged from the hospital instead of lying motionless on a hospital bed for two or three weeks, it does not need to be plastered and it can be removed sooner.
Keep in mind that in the first method, the cost of long-term hospitalization and the cost of parents staying away from work in order to be with their child in the hospital is much higher than the second method. In the second method, both costs and time are well saved. And the patient will not be away from school for a long time.
Cares
After treating hip fractures in children and infants after fracture treatment, pay attention to the following points:
- If your child has Spica plaster, be very careful that the edges of the plaster on the back of your baby’s back do not injure his skin, and when the patient is lying on his back, you should put a layered blanket under the patient’s legs to avoid skin irritation. In this way, the trunk will be higher and the distance between the back edge of the plaster and the back of the waist will be appropriate
- Another point is that you should leave a space between the edge of the plaster and the baby’s skin with a soft cotton cloth or cotton so that the baby’s skin is not injured.
- Care should be taken not to contaminate the plaster in the groin area with urine or feces.
- An important point that is emphasized is that if you see a part of the plaster cracked, you must see a doctor for repair and correction.
Now let’s see what measures are needed when Spica plaster comes out after six weeks?
Physiotherapy is not needed after the cast has been removed. The patient’s parents, on the other hand, should not constantly encourage the child to walk whenever the child himself feels that he is able to walk and get up.
For a few weeks to a few months, the baby may have a slight lameness while walking. This is normal and should not be a concern. This lameness will improve over time.
Another thing that parents tell their doctor is that when the child is in the cast, they look at the radiograph of their child and notice that the bones are not in place.
Parents should know that there is no need to worry about this. This is normal, that is, the two broken pieces overlap by about 2 cm and even slightly tilted welded broken parts, it is normal to have no problems and will not cause any problems for the child in the future.
Another thing In other words, when a sore thigh develops, it corrects itself after a few months to a few years, that is, the individual’s own body corrects this skew. This property of the bones of the body is called remodeling.
Another point that parents are concerned about is that the child may suffer from short stature in the trunk fracture after treatment. We must say that the shortness that occurs will be repaired by the body itself after a few months to a few years due to the further growth of the fractured femur.
This ability of the body in remodeling also has a limit, and if it is too short or too deviant, the doctor should work to correct it, and the body should no longer be expected to compensate for this deviation with too short, and how much of Acceptable skewness will determine this acceptable limit for the treating physician.
Another thing that happens is about wounds. If the child has undergone surgery, dressing 3 is usually done for up to 7 days. The stitches are usually removed after ten days and the patient will be encouraged to bend and straighten his knees. Another point is that the child may use the axilla for a while to walk, but after one to two weeks, other children can usually walk without a cane. This period is determined by the severity of the fracture and the age of the injured child. Finally, we must point out that the surgical treatment of trunk fractures in children should be entrusted to an experienced surgeon, because despite the many benefits of traction therapy, it will require the knowledge and skill of the surgeon and his experience.