Anatomical features of children are manifested in special factors that prevent fractures: the developed integuments of soft tissues, the special structure of the periosteum, the presence of elastic germ cartilage, richly supplied with blood. But damage to the skeleton happens even in babies. Some injuries are inherent in children. Thus, a fracture of the capitate of the humerus is characteristic of patients 4–10 years old.
Damage to the capitate of the shoulder bone is always intraarticular. Fracture is often single or in combination with other intra-articular lesions.
The occurrence of injury is associated with indirect force. Most often, an isolated fracture occurs as a result of a support in the fall with the support on the arm of an outstretched hand.
The impact force passes along the radius, as a result of which the head rests against the elevation and breaks off the fragment from the outer side with an offset. Often there is a detachment of the epiphysis with a fragment of the metaphysis. Damage is sometimes limited by the indentation of cartilage on the surface of the joint, the separation of a small cartilage plate.
The tear or rupture of the joint capsule is accompanied by a noticeable hemorrhage. The displacement of the fragment, the possible rotation of the capitate at a height of 60-180 ° around the longitudinal axis depends on the impact force.
Rotation depends to a large extent on the extensor muscles attached to the external epicondyle.
Pain, hematoma due to isolated damage to the capitate, the formation of bone and cartilage fragments are localized in the area of the external condyle. A large fragment with an upward displacement can sometimes be determined by palpation. Elbow movements become painful and restricted.
A slight shift can be identified by the following symptoms:
- traumatic swelling on the lateral side of the joint;
- bruise (hematoma) in the affected area;
- increased pain during palpation.
Crepitus is also a clear symptom of damage, but efforts are being made to avoid manipulation of this symptom in order not to cause suffering to patients.
A child with an intra-articular injury, as a rule, supports the sore limb with a healthy hand. Without additional support, the injured limb hangs along the body.
Significant bias is manifested in increased symptoms. Added pain in the movements of the fingers.
An important role in the diagnosis of damage is assigned to radiographs in various projections. To detect small fragments in the pictures, air is introduced into the elbow joint.
Sometimes the recognition of the defect is difficult if the fragments are of small size. Symptoms of damage are manifested in limited movements of flexion and rotation of the forearm – this is due to the pinching of the fragment, which is between the surface of the joint and the elevation of the bone head. This factor contributes to the recognition of injury.
Cartilage damage is difficult to diagnose in the absence of a capitate elevation fracture. An isolated defect is not recognized early.
Over time, the remaining pain, restrictions in the movement of the forearm indicate the reason – the bruise of the cartilage and the development of dissecting osteochondritis, which can be installed on repeated radiographs.
The nature of treatment is established depending on the complexity of the damage, the timeliness of seeking medical help.
Therapy of injuries without displacement of bone fragments
The absence of displacement of fragments due to a fracture allows immobilization on an outpatient basis for 10–14 days, taking into account the age of the child. As a rule, this is the imposition of a plaster splint in the mid-physiological position of the hand. After removal of the fixing dressing, they proceed to the stage of physiotherapy exercises with physiotherapeutic procedures until the full recovery of all joint functions.
Therapy of injuries with displacement of fragments
In injuries with a slight displacement or rotation of the bone fragments, the surgeon may conduct a conservative reduction in a “manual manner”. In stationary conditions, after anesthesia in the area of the fracture by administering novocaine solution, the doctor grasps the patient’s forearm and stretches the elbow joint. The flexion surface of the patient’s limb should open upwards. The task of the surgeon is to insert fragments with his fingers into his box. To support the patient’s hand is placed on the roller. The elbow is bent to the formation of a right angle and fixed with a plaster cast.
The position of the fragment is checked on a control radiograph, after which they retain immobilization for 3–4 weeks. After removal of the dressing, the recovery period lasts about 2−4 months.
Reduction of fragment even by experienced specialists is not always possible. In such cases, surgery is necessary. For children, the fragment is fixed to the bed with surgical threads (catgut). Preservation, comparison of bone fragments is very important for the rehabilitation of joint functions.
Unsuccessful attempts to reduce the rotation of the fragment by more than 60 °. Manipulations in such cases increase the damage to the articular surfaces, ligaments, and adjacent muscles.
Risks and Forecasts
Untimely access to a doctor, unqualified help, failure to comply with the rules during treatment can lead to complications in remote dates:
- deviation outwards axis of the forearm;
- elbow joint contracture.
The consequences are eliminated much more difficult, with long-term rehabilitation, often after surgery.
It is important to place children with suspected fracture of the capitate of the humerus in hospital conditions, as accurate diagnosis and choice of therapy are crucial for the future physical development of patients.
After completion of treatment and recovery period, children with injuries of the capitate of the humerus are subject to follow-up until about 2 years.