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Diagnosis of subluxation of head of radius in children and its treatment

Trauma the diagnosis of “subluxation of head of radius in children up to three years - a very common phenomenon. At risk and older children of preschool age, but after six years of such trauma is rare.

problema podvyviha golovki luchevoj kosti u detej

The frequency of doctor visits regarding subluxations of this type connected with anatomical features of the head of the radius in a child, as well as with situations when the child pulls the handle to his hand higher, adult, and any sudden movement (jerk) can cause the dislocation. Therefore, this injury is sometimes called painful Michaud or dislocation from pulling out.

Parents of preschoolers may encounter this problem repeatedly. Consider how to recognize the subluxation, a child and what to do with it.

The features of the head of the radial bone of the child that caused the injuries

In contrast to the anatomical structure of the head of the radial bone of an adult, in children, this bone fragment is a cartilage round shape. Thus, there is a physiological predisposition of the child to the subluxation of the hand, because even with a small sharp movement of the head of the bone is free to slip out of annular ligament. This may even break some of the young fibres of the ligamentous tissues. In addition, the child's muscles are underdeveloped, and joint capsule is very thin.

poluchenie podvyviha golovki luchevoj kosti u detejOften the problem is with the head of the radius occurs when the child's arm is in the extended up position: adult holding his hand, and suddenly the baby falls. Adult while trying to keep him from falling, pulling the handle and thereby provokes a dislocation of the radius. It is not surprising that it is independent, but still bad walking children-two-year-old make up the largest percentage of trauma patients. Injury is possible when lifting the handles of the baby, and mobile games with the older children, and even when dressing the baby in clothes with narrow sleeves.

According to statistics, more girls than boys are prone to dislocations and subluxations (almost two times more cases). The left arm is somehow suffering more often right.

But there is good news: with the release of preschool age, the anatomical shortcomings of the child are being addressed, and the likelihood of such injuries is reduced to zero.

What the child is feeling trauma

So what happens when subluxation of the radius?

The mechanism of this injury is: located in the annular ligament head of the radius as a result of breakthrough or other influencesflies out and clamped to the surrounding tissue. This moment can be heard the characteristic clicking or crunching. The child screams in pain.

vrachebnaya pomosh pri podvyvihe golovki luchevoj kosti u detejSometimes the symptoms of subluxation can be expressed clearly. This leads to the fact that parents are reluctant to visit a doctor, or an appointment to the pediatrician instead of a surgeon and lose valuable time. You need to carefully watch the kids, given the mobility of children and the fragility of their bones.

In most cases, a child with subluxation worried about a sharp pain in the forearm. He holds the injured hand pressed to his stomach, or arm is simply lowered along the body, often extended forward, while slightly bent at the elbow. Child complains of sharp pain and can't (and often can, but afraid) to raise and bend the arm for this reason. However, with the help of a doctor possible careful flexion-extension movement without a change in position of the forearm. On palpation it is sometimes possible to determine the localization of the pain in the head of the radius. Visible external changes, as a rule, no or slight swelling.

Diagnosis of subluxation

Very valuable for the diagnosis in detail to tell the doctor about the situation which led to the injury.

The trauma surgeon must ensure that no such accidents and diseases as:

  • congenital dislocation;
  • fracture of the clavicle, of the neck shoulder;
  • fracture of the wrist or elbow bone;
  • rheumatic and septic arthritis, osteoarthritis;
  • nerve damage;
  • osteomyelitis.

Most often, in addition to exploring and collecting history, no additional diagnostic methods are required.

rentgen pri podvyvihe golovki luchevoj kosti u detejIn some cases, the specialist may schedule you for an exam x-rays (in case of unsuccessful attempts to “right” hand or if there is significant swelling in that area and suspected fracture). For specification of the diagnosis it may be necessary, therefore, should not impede such examination. If the baby does subluxation of the radial bone, a radiograph will not show significant changes in the joint.

If subluxations are repeated regularly in the future possible use of magnetic resonance imaging or an ultrasound test to detect the condition of the annular ligament.

Treatment method of closed reposition

If the diagnosis of “subluxation of head of radius” confirmed, experienced trauma can without delay easy to fix the arm closed method. This procedure does not require anesthesia, parents shouldjust to distract the child from the process of reduction, so as not to irritate it.

The closed method involves the following algorithm.

Initially, the doctor gently removes the forearm, which is fixed by his assistant. Then Flex the elbow of the child at a right angle. One hand specialist covers the brush of the affected hand (as in handshake), well locking your wrist, the other holding the elbow, with the thumb controlling the radial head bone. Then there is the movement of supination (turn the hands). If all goes well, the controlling finger of the doctor “hear” light crunch or click. At this point, certainly there will be pain that is almost immediately gone, and the child will feel relieved. After a while he will forget all about the arm problem and will be easy to use it.

In some cases, the doctor is not immediately possible reduction, it is necessary to repeat the procedure several times.

Skillful reduction of a subluxation depends on the skill of the surgeon and the correctness of the diagnosis.

http://www.youtube.com/watch?v=FSjPp3k_Qsg

After successful reduction the patient hands it is recommended that a couple of days to wear in a fixed position (elbow bent at the same 60-70°) on a soft headband (or scarf tied over the shoulder).

Prevention of recurrence

If your baby is just learning to walk and unsteadily kept on legs, try to help him, not holding his hand, and using special reins for children.

The repeated recurrence of this injury you should observe the action, leading to subluxation, and to identify their mistakes in handling the child. No need to drive the child over the patient's hand, try not to yank his hands and not to raise a child, holding the brush.

zakrytoe vpravlenie zakrytogo podvyviha golovki luchevoj kostiRe-injuries (relapse) may cause deformation of the annular ligament, its inherent weakness.

After repeated cases of subluxation of head of radius after the next reduction, as a rule, place a cardboard or a cast to wear for two weeks. This will allow to give rest for the joint and restore its functionality.

Prevention of relapse is also possible to recommend active or passive gymnastics for joints to strengthen muscles.

Is it possible to remove the subluxation by yourself?

What is required from the parents in case the baby dislocated my pen? First of all, do not panic. Calmly understand the situation, reassure the child and caress him.

The only thing you can do before the visit to the doctor for suspected injury of the hand with the name of “subluxation” isto try to ease the pain your child is attached to the elbow with a cold, wet towel or a bag with ice. To relieve severe pain can be given pain reliever: Ibuprofen or Paracetamol.

But the best option for your child is still rapid qualified medical assistance.

http://www.youtube.com/watch?v=KSHQS1BS-qQ

Remember: self reduction of the hands is unacceptable! This disease requires an experienced traumatologist, to avoid the child the more serious problems with health and mentality. A normal doctor will do this manipulation as gently and competently, and self-medication can be very dangerous for your baby.