Distinction of sprain and fracture

A sprain, also known as distortion, is a condition in which the affected joint is overstressed by external forces. The sprain is usually accompanied by pain and a slight swelling. There are no findings in the X-ray image.

The sprain can be treated by local cold application (cool pack) or with a supporting bandage with diclofenac ointment, known as Voltarengel®, for a few days. The bone fracture (fracture) is caused by the action of external forces that the bone cannot withstand. The uncertain signs of fracture are swelling, pain and functional impairment of the affected body region.

If the arm is broken, for example, it can no longer be played with. Safe fracture signs are the abnormal mobility of the limb, noises from the bone fragments rubbing against each other when the arm is moved and, in the worst case, bone parts protruding from the skin (open fracture). In the case of uncertain fracture signs, only the X-ray image provides information.

Therapy

In the case of humeral shaft fractures, children younger than ten years of age often have the option of conservative treatment, as far as the pain and an axial deviation of no more than 20 degrees allow. A plaster cast is often used for this purpose. The average conservative treatment of a fracture of the arm is 6 weeks, so the cast or splint must be worn for four to six weeks.

This can vary depending on the type of fracture. The cast is used to immobilize the arm and to ensure that the two bone fragments lie exactly on top of each other. Only in this way is it possible to heal the fracture without complications.

In the case of slightly displaced fragments, they are first brought back into their original position. Fractures of the lower end of the upper arm are more common in children. If the fragments are not displaced, a conservative procedure is often sufficient.

An upper arm cast, an upper arm support bandage or a sling is used for immobilization. The arm sling is used to immobilize the upper arm and shoulder. Since the entire arm is immobilised here, it can lead to problems of mobility in the shoulder.

Therefore, early physiotherapy may be desirable, but this should be ordered individually by the doctor. Furthermore, neck pain can occur due to the increased load on the neck. The smaller the child is, the more uncomfortable it is to keep the whole arm still.

A reason for increased crying and whining can also be limited mobility. An example of this would be the Blount sling, which holds the wrist in one position. After an immobilization it is necessary to test the blood circulation and the sensitivity (feeling) of the arm and fingers and the mobility of the fingers the next day.

This is because the nerves and vessels can be damaged by the cast or splint if it is applied incorrectly. If this is overlooked, permanent damage can be the result. During the time in which the cast is worn, regular visits to the doctor are also important in order to check that the cast is correctly fitted and to verify the success of the healing process.

While the arm is in the cast, it should be subjected to as little stress as possible. If the child complains of pressure through the cast or tingling in the fingers, the doctor should be consulted immediately. This may be due to a plaster that is too tight or ill-fitting, through which vessels or nerves of the arm are squeezed.

After a few days, an x-ray check is also carried out, as the fragments may subsequently shift. Again after 4 weeks a new X-ray control is recommended. Even in the case of a broken spoke, simple immobilization with a plaster cast or splint is often sufficient.

If there is too much displacement or kinking in the case of fractures of the upper arm shaft, fractures of the lower end of the upper arm or fractured forearm, or generally in the case of complicated fractures, surgery must be performed to reposition and stabilize the fracture. Vascular and nerve injuries may also occur and therefore surgical reconstruction may be necessary. Depending on the fracture, elastic intramedullary nails can be used for stabilisation.

These nails, which are inserted into the medullary canal of the bone, protect the growth joints. This procedure is also called Elastic Stable Intramedullary Nailing (ESIN). Plate steosynthesis methods may be used.

This means that, among other things, metal plates are used for stabilization. However, this is only done in a few cases. It is also possible to insert two crossed wires (so-called drill-wire osteosynthesis procedure) for direct stabilization of the broken arm.

An external fixator may be necessary for particularly complicated fractures. This is an external holding device which holds the fracture still by means of inserted metal rods. After three to four weeks, another X-ray check is performed.

And further follow-up checks are important until full function is achieved. The metal implants are removed after healing under anaesthesia. 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 malpositions can be left in place as they grow. The extent to which the malposition can be tolerated should always be checked carefully.