Why is a compression fracture of the spine dangerous in children? Compression fracture of the spine in children: causes, symptoms and treatment.

Compression fractures are characteristic, which are serious injuries to the musculoskeletal system. They occupy a relatively modest place in childhood traumatology (1-2%), but without proper treatment can lead to disability (aseptic necrosis of the vertebra, kyphoscoliosis, etc.). This is explained by the anatomical and physiological characteristics of the growing organism. The spine in children has increased flexibility due to higher altitude intervertebral cartilaginous discs, strength ligamentous apparatus and mobility at all levels of the spinal column. Most common cause damage is a fall from a height (a tree, a swing, the roof of a barn, garage or house) or during physical education lessons, training, diving, etc. Damage caused by the action of a force that flexes the spine is observed when falling from a height onto the buttocks, when somersault, falling on the head, etc. A sharp reflex protective contraction of the back flexor muscles creates a significant load on the anterior spine, especially in the area of ​​physiological kyphosis (in the mid-thoracic region). As a result of exceeding the limit of physiological bendability, wedge-shaped compression occurs. With such injuries, injury to the elastic intervertebral cartilage and discs cannot be ruled out.

Compression fractures of the vertebrae in children are characterized by: following symptoms: “post-traumatic apnea” (difficulty breathing at the time of injury), moderate pain in the area of ​​injury, limited mobility in the spine, pain when loaded along the axis of the spinal column, tension in the back muscles at the site of injury, radiating girdle pain in the abdomen. Neurological symptoms with paresis and paralysis of the limbs and dysfunction pelvic organs are rare, they are observed mainly in displaced fractures of the vertebral bodies and spondylolisthesis. For minor compression fractures of the vertebrae clinical symptoms so poor that it is easy to make a diagnostic error. However, with careful palpation and percussion, it is possible to determine the most painful point, which corresponds to the damaged vertebra. When pressing on the shoulder girdle and head (carefully!), the patient feels pain in the area of ​​the injured vertebra. The child performs flexion, extension and rotational movements with some caution. In the damaged area, there is a protective pain tension in the back muscles - a “muscle roller”.

In case of injury to the mid-thoracic spine, a fairly typical complaint from children is difficulty breathing, up to a short-term delay. Damage to the cervical vertebrae is characterized by a forced position of the head, tension of the neck muscles and limitation of rotational movements and tilting of the head. Compression fractures of the vertebrae in a number of patients (26%) are accompanied by post-traumatic radicular syndrome, which is caused by irritation of the roots spinal nerves and meninges. There are observations where compression of several vertebrae simulated symptoms acute abdomen, and errors in diagnosis led to wasted laparotomy.

For compression fracture The vertebral bodies are characterized by the following radiological signs: wedge-shaped deformation of varying degrees, sliding of the end plate with the formation of a wedge-shaped protrusion, stepwise deformation of the anterior surface of the vertebral body, disruption of the topography of the intersegmental groove, increase in intervertebral space, formation of kyphotic curvatures of the spine due to displacement of the posterior part of the vertebral body in spinal canal, subluxation in intervertebral joints. In addition, a spondylogram can reveal compaction of the structure of the damaged vertebra, deepening of the waist, disruption of the integrity of the endplate, as well as a lateral decrease in the height of the vertebral body on a radiograph in anteroposterior projections. To clarify the diagnosis can be used additional methods studies: radiography in later position, tomography of the damaged area of ​​the spine, radioisotope study, electromyography.

The main goal of treating children with compression fractures is to unload the anterior spine as early and completely as possible. This is achieved by traction. If the cervical or upper thoracic spine is damaged, traction is carried out using a Glisson loop, below the XIV thoracic vertebra - using straps for the armpits and a reclinator. Physical therapy is prescribed from the 1st day and is carried out over 5 periods. Wearing a corset is recommended for fractures of three or more vertebrae (especially lower thoracic and lumbar), as well as for complicated fractures of the spine. Restoration of the height of the damaged vertebral body occurs within 1.5-2 years, which determines the period dispensary observation. G. M. Ter-Egiazarov adheres to more active tactics: early corsetry with reclination (polivik corset) and adequate physical therapy, back muscle massage and physiotherapeutic procedures.

Pelvic fractures

Closed fractures of the pelvic bones in children belong to the group of severe injuries. They account for about 4% of all bone fractures and occur mainly between the ages of 8 and 14 years. The severity is closely dependent on complications from the pelvic organs. From early diagnosis These complications and timely and rational surgical intervention determine a favorable outcome.

The cause of pelvic bone fractures in children is most often a car injury - compression of the pelvis by the wheels of a car. In second place in frequency are falls from a height, landslides, and rail injuries. Less common are avulsion fractures resulting from severe muscle strain. This is most often a separation of the outer superior anterior spine with strong traction of this segment by the sartorius muscle during sports games or gymnastic exercises. The same is the mechanism of separation of the anterioinferior spine due to tension of the rectus femoris muscle and separation of the ischial tuberosity (apophysis) when performing the gymnastic element “split”. Thus, to characterize damage to the pelvic bones and its organs in a child, anatomical and physiological characteristics children's pelvis: weakness of the ligamentous apparatus in the pubic and sacroiliac joints; the presence of cartilaginous layers separating all three pelvic bones; elasticity of the pelvic ring due to the flexibility of children's bones. In children, for example, instead of the typical bilateral vertical fracture of the iliac bones observed in adults, the iliosacral joint ruptures and separates mainly on one side.

In children, the following injuries to the pelvic bones are distinguished: 1) isolated fractures of individual bones without violating the integrity of the pelvic ring; 2) fractures with disruption of the integrity of the pelvic ring; a) fractures of the anterior pelvic ring with damage to the ischial and pubic bones on one or both sides, rupture of the symphysis pubis, or a combination of these injuries; b) fractures of the posterior pelvic ring, which include fractures of the sacrum, ilium and rupture of the sacroiliac joint; 16* 483 c) double fractures of the Malgenya type; 3) fractures acetabulum; 4) fracture-dislocations. The presented classification makes it possible, based on clinical and radiological examination data of the victim, to diagnose correct diagnosis, predict in advance the possibility of certain complications and promptly take appropriate measures to eliminate them.

Isolated fractures pelvic bones proceed easily and usually without complications. These include direct fractures of the ischial bones or, less commonly, the pubic bones arising from direct trauma, as well as fractures of the outer anterior superior iliac spine, which can be direct or avulsion. At complete fracture of the anterosuperior spine, the fragment can move a considerable distance as a result of contraction of the sartorius muscle. General state with these injuries it usually remains quite satisfactory. The child complains of more or less pronounced local pain at the fracture site. Bruising and hematoma may appear 12-24 hours after injury. To clarify the diagnosis in all cases where a fracture of the pelvic bones is suspected, an x-ray is required, which, as a rule, captures the entire pelvis as a whole and, if possible, the lumbosacral spine.

It is completely unacceptable to obtain radiographs of individual pelvic bones. Such photographs can cause serious diagnostic errors.

Closed fractures of the pelvic bones with disruption of the integrity of the pelvic ring without damage internal organs may be single or multiple. In case of single fractures, the integrity of the anterior semi-ring in the area of ​​the pubic or ischial bones is most often damaged. With multiple fractures, the anterior part of the ring may fracture on both sides, resulting in the formation of butterfly-shaped bone fragments. The simultaneous fracture of the anterior and posterior semi-rings, first described by Malgenem, is a very severe injuries pelvic bones. In such cases, a typical displacement of fragments occurs - the medial fragment of the pubic bone moves downward, the lateral fragment upwards and outwards.

The general condition of the child is usually severe, symptoms of shock are pronounced. Upon examination, asymmetry of the anterosuperior spines is revealed iliac bones. In the area of ​​the symphysis pubis, crepitus of fragments is sometimes detected. Palpation of the site of bone damage is sharply painful. The patient cannot lift his outstretched leg - positive symptom"sticky heel" The location of the fracture is indicated by the presence of swelling, hematoma and abrasion. Some types of pelvic bone fractures are characterized by a forced position of the patient. For example, when the symphysis pubis is torn, the position is noted on the back with the knee joints bent and the limbs adducted. A fracture of the anterior pelvic ring is characterized by a position with the knee joints bent and legs abducted (frog position, according to Volkovich). The diagnosis is clarified by x-ray examination of the pelvic bones and area hip joints.

In children, pelvic bone fractures can be complicated by concomitant damage urethra or bladder. Most often, damage is observed in fractures located closer to the symphysis of the pubic bones and Malgenya type fractures. Urinary retention and hematuria are often observed with fractures of the pelvic bones without compromising the integrity of the bladder and urethra. These phenomena can be reflexive and caused by spasm of the bladder sphincter or perineal hematoma due to minor damage to the mucous membrane of the bladder and concomitant fracture of the pelvic bones. Bladder rupture is usually a consequence of hydrostatic pressure on the wall, which is damaged at the apex, where the parietal peritoneum meets the bottom of the bladder. Less commonly, the bladder wall is damaged by the sharp edge of a bone fragment. Bladder rupture can be intraperitoneal or extraperitoneal. With an extraperitoneal rupture, urine pours into the peri-vesical tissue, forming urinary streaks in the pelvic cavity, in the retroperitoneal space. The patient's condition is serious. The diagnosis of extraperitoneal bladder rupture is sometimes difficult due to the absence of symptoms of peritoneal irritation. Pain in the lower abdomen and dysuria are noted. The bladder is empty and cannot be detected by palpation or percussion, but there is a continuous urge to urinate without the release of urine or with the release of a small amount of bloody urine. In more late dates a doughy, painful swelling appears in groin areas. Intraperitoneal rupture of the bladder is characterized by peritoneal phenomena. Sometimes it is possible to determine the presence of free fluid in abdominal cavity: percussion reveals dullness in the lateral parts of the abdomen when the patient is positioned on his back, which disappears when turning on his side. A rectal examination reveals overhang and swelling of the vesico-rectal fold of the peritoneum as a result of the accumulation of urine in it. Dysuric phenomena are basically the same in nature as with extraperitoneal injuries.

Damage to the urethra is observed mainly in boys with fractures of the anterior semi-ring of the pelvis or Malgenya type fractures. If there is a complete rupture between the anterior and posterior segments of the urethra, some diastasis may form.

The following symptoms are characteristic of urethral rupture: urethrorrhagia - bleeding from the external opening of the urethra; acute complete urinary retention with a full and distended bladder; swelling and hematoma in the perineum and scrotum. For fractures of the pelvic bones in children, except for ordinary ones anti-shock measures, intrapelvic anesthesia is performed according to Shkolnikov-Selivanov (from 60 to 150 ml of 0.25% solution of novo485 caine, depending on age). If urethral injury is suspected, catheterization is contraindicated. It is dangerous due to additional damage in places of tears and ruptures, it is traumatic, painful and uninformative. The best diagnostic method is urethrocystography, which, in the event of a rupture of the urethra or bladder, gives a clear x-ray picture of the damage based on the flow of contrast material into the paraurethral or paravesical tissue.

It must be remembered that one of the severe concomitant injuries in a fracture of the pelvic bones may be a traumatic rupture of the diaphragm (usually on the left) with displacement of part of the abdominal organs into the thoracic cavity. In this regard, in case of fractures of the pelvic bones, fluoroscopy of the chest organs with the study of the contours of the diaphragm is mandatory. Pleural puncture is contraindicated, as there is a risk of injury to the intestinal wall, stomach or parenchymal organ.

For pelvic fractures of various locations in children, the leading method of treatment is conservative. Surgical intervention may be indicated for ruptures of the symphysis with a large discrepancy, with concomitant injuries to the urethra, bladder, diaphragm, etc.

Traumatology and orthopedics
Edited by corresponding member. RAMS
Yu. G. Shaposhnikova

It is impossible to imagine a child who has not fallen at least once in his life. Every parent, sooner or later, has to deal with childhood trauma. Many falls of little pranksters pass without harm to their health. However, some of them lead to serious consequences. Compression fracture of the spine is one of the most serious childhood injuries.

What is a compression fracture?

A vertebral compression fracture is an injury to the spinal column as a result of sudden compression (compression). With simultaneous bending and compression, the vertebrae are damaged, acquire a wedge-shaped shape or are pressed into the spinal canal. With significant destruction of the spinal discs, surrounding tissues may be damaged.

Classification of injury

This article talks about typical ways to solve your issues, but each case is unique! If you want to find out from me how to solve your particular problem, ask your question. It's fast and free!

Children can damage their spine when falling, somersaulting, diving, or jumping. The middle and lower thoracic regions are most often injured, with the lumbar region in third place in popularity, then the upper thoracic region, and least often the cervical region. Compression fractures are divided according to the type of vertebral deformation and the nature of the complications. Descriptions of fractures are presented in the table.

Causes of spinal injury

Spinal fractures are rare in children under 8 years of age. This is due to the fact that their skeleton has not yet completely ossified, the spine remains plastic, and intervertebral discs higher. However, even young children can suffer compression injuries due to overloading of the vertebrae. The main causes of such fractures:

• multiple injuries resulting from a fall or car accident;
• unsuccessful diving;
• sharp landing on the “fifth point”;
• jumping with high altitude on your feet;
• lack of calcium in the body, osteoporosis, osteomyelitis;
• weak back muscles;
• a heavy object falling on the head or shoulder;
• somersaults;
• heavy load on the vertebrae during sports activities;
• sudden lifting of weights;
• damage to the spine by tumor metastases;
• congenital pathologies of the development of the musculoskeletal system;
• birth injuries of newborns.

Signs and symptoms in a child

A compression fracture of the spine in children is characterized by the fact that it does not have pronounced symptoms. With uncomplicated fractures, the discomfort quickly disappears and may not manifest itself for some time. Indirect signs fracture may cause weakness, nausea, dizziness, pressure surges, pale skin, swelling at the site of injury.

In case of neck injury

Displacement of the cervical vertebrae in children often occurs during somersaults, diving, car accidents, or objects falling on the head. The cervical region is the thinnest part of the spinal column, so any sudden movement combined with muscle tension can lead to compression. Symptoms of a compression fracture of the neck:

• pain in the neck area;
• unnatural head turn;
• neck muscle tension;
• limitation of rotational movements;
• pain when trying to tilt your head forward;
• smoothing the back of the neck;
• in severe cases - paralysis of the body.

For thoracic injury

Thoracic injuries are most common in children. This injury occurs due to a fall from a height onto the back, such as from a swing or tree. Children experience difficulty breathing, and may experience delayed breathing immediately after injury. The main symptoms of damage to the thoracic vertebrae include:

• pain in the area of ​​the fracture;
• increased pain when moving or lifting objects, palpating the site of injury;
• back muscle tension;
• stiffness of movements;
• pain in the abdominal area;
• bruises and hemorrhages.

In case of damage to the lumbar region

The lumbar vertebrae can be damaged by a sharp landing on the buttocks, lifting heavy objects, or physical impact on the lower back. After a fall, the child will try to lie on his back or on his stomach on his knees, clasping them with his arms. This situation helps to ease painful sensations.

Symptoms of damage lumbar region:

• the muscles in the lumbar region are tense and the back is bent;
• pain when palpating the injury site;
• being in an upright position, the child gets tired quickly;
• when tapping on the heels, the pain in the lumbar region intensifies;
• girdling and cramping pain in the abdomen;
• tension of the anterior abdominal wall;
• discomfort when bending the body forward.

Treatment and rehabilitation after injury

If a compression fracture is suspected in a child, parents should seek advice from a traumatologist. The specialist makes a diagnosis based on examination and x-ray of the spine. Sometimes, to determine the location and complexity of the injury, the patient undergoes CT and MRI of the spine, electromyography and scintigraphy. Treatment is prescribed depending on the type and degree of deformation.

Duration of the rehabilitation period

The duration of treatment and the duration of the rehabilitation period in children is shorter than in adults. This is due to the characteristics of metabolism. Children's vertebrae are better supplied with blood, which speeds up healing.

However, to eliminate the likelihood of complications, the patient must remain in bed for 1-2 months. The rehabilitation period reaches 2 years. Stages of spinal restoration:

1. Period of acute traumatic compression. The patient is in the hospital for 25-45 days.
2. Stimulation of bone fusion and elimination of damage to the ligamentous apparatus - 1-2 months after injury, carried out in a rehabilitation center.
3. Restoration of the supporting function of the spine (3-10 months after injury).
4. Elimination of residual effects. This is the most long period, which is aimed at preventing the consequences of compression damage. Rehabilitation lasts more than a year.

Conservative therapy: special devices and exercise therapy

Conservative treatment methods are used for uncomplicated spinal injuries. At the initial stage of treatment, the patient must observe complete bed rest. The primary treatment for injury is to relieve the back muscles and stretch the spinal column. The patient is placed on a hard bed, his head should be in an elevated position.

Various devices are used to stretch the spine. In case of damage upper section Glisson loop or Delbe rings are used. The principle of their action is stretching under the patient’s own weight. The lower vertebrae are pulled out using a reclinator and straps. To do this, special cushions are placed under the lumbar region. Sometimes corsets are used during treatment.

From the first days of therapy, physical therapy is used. It is carried out in several stages, the duration of the procedures depends on the severity of the diagnosis. Each stage is aimed at maintaining and restoring certain body functions. The duration of each of them is determined depending on the patient’s condition. Exercise therapy is carried out as follows:

• First period. Over the course of 6-8 days - breathing exercises in a lying position, rotational movements of the feet and hands, flexion and extension of the fingers.
• The second period lasts from 7-9 to 21-25 days after damage. The abdominal and back muscles are involved in the process. The patient moves his arms to the sides, alternately raises his legs, and bends his feet.
• At the third stage, preparations for the transition to vertical position. From days 21-25 to 35-45, the patient bends his limbs, raises his legs at an acute angle, and does exercises on all fours.
• The fourth stage lasts until the child is discharged from the hospital. The exercises consist of gradually moving the patient to a standing position.

Massage

Massage after a fracture helps restore blood circulation. The timing of the procedure depends on the severity of the damage. On initial stage Treatments include rubbing and stroking, then include other elements. The duration of the massage is increased gradually - from 15 to 30 minutes. The procedure should only be carried out by an experienced specialist.

Surgical intervention

Surgical methods for treating compression injuries are used for grades 2 and 3 and for complicated fractures. The recovery process after surgery lasts longer and includes exercise therapy and massage. To strengthen the vertebrae, surgeons inject special solutions into the spinal body (kyphoplasty, vertebroplasty) or fasten it with metal plates and bolts.

Complications and consequences

With timely and correct treatment of spinal injuries, the likelihood of complications and other unpleasant consequences is minimized. The most favorable outcome is for uncomplicated compression fractures. The most severe complications of vertebral injury are neurological disorders(paralysis, loss of sensation in limbs). Possible consequences of spinal injury:

• scoliosis (see also:);
• osteochondrosis;
• spondylitis;
• radiculitis;
• kyphoscoliosis;
• spinal necrosis.

Correct rendering of the first medical care will help avoid many complications of a compression fracture. If a spinal injury is suspected, the patient should be placed on a flat, hard surface and his movements should be limited. If possible, you should put a cotton-gauze collar around his neck. Next, it is necessary to ensure the delivery of the patient to the emergency room.

The bones of small children are in the stage constant growth. This is fraught with frequent injury. The most complex and dangerous fracture is a compression fracture of the spine in children. Children rarely suffer from this type of injury, however, it can have adverse consequences.

Adults must know how to protect a child from such injuries, how to diagnose spinal fractures and what to do to provide first aid. Children's bones heal much faster than adults'. Despite this, treatment of the consequences of such an injury, taking into account the time for rehabilitation, takes approximately two years.

First of all, this is a very severe injury that can be sustained even with a weak but sharp blow. For example, during jumping, diving or falling on the buttocks. Another cause of this disease is considered to be calcium deficiency, which is a companion to osteoporosis.

• Read also: .

Note that a type of compression fracture that is not accompanied by complications is often not diagnosed. This is due to the fact that there are virtually no symptoms. Parents whose children have suffered a spinal injury sometimes believe that the pain will soon subside and everything will get better. But unfortunately, this is not always the case and the consequences can be very serious.

Compression is compression. Hence, this type The fracture is the result of compression of the spinal column. At the same time, the vertebrae change shape and cracks form on them. In most cases, the lower and central part of the thoracic region and lumbar region are damaged.

There are three types of compression fractures and are classified according to the degree of complexity:

• A first-degree injury is diagnosed when the change in vertebral length is no more than one-third of the total size. The second degree is characterized by a change in the shape of half of the vertebral body. The third degree of severity is accompanied by injury to more than half the size of the vertebral body.
• Stage one injuries are considered stable. The rest are unstable; their peculiarity is that the vertebra becomes mobile. The nature of the injury can be single or multiple.

• Read also: .

Distinctive features of the disease

If a minor injury to the vertebrae occurs, then the diagnosis may not yield any results, because there will be no distinctive symptoms. An experienced specialist should perform palpation and tapping, which will help determine the most painful area. Signs of injury can also be detected by pressing on the head and forearm. Children who have broken their spine are careful in their movements.

Symptoms of a compression fracture:

• During injury, breathing problems are observed;
• Unpleasant pain and muscle tension at the site of injury;
• Feeling of pain when putting pressure on the spine.

Often accompanied by pain in the abdominal area. Paralysis of the limbs and problems with the functioning of the pelvic organs are observed infrequently, only in cases where the thoracic region is affected and the vertebrae are displaced.

The most common complaint with a compression fracture is a problem with breathing, in rare cases it is delayed. If injured cervical vertebrae, then you can pay attention to the special position of the head and problems with its movements. In every fourth case of compression fracture, there are symptoms of irritation of the spinal nerve roots.

Treatment

In most cases, parents bring their children to the hospital. But in a number of situations, doctors have to provide emergency assistance on the spot. Regardless of what type of damage is diagnosed, it is important to be extremely careful and careful. It is worth asking the child how he feels and determining the approximate degree of injury. In addition, it is necessary to understand what type of fracture is present and whether there are complications.

• Read also: .

Associated fractures with complications are paralysis and paresis. It follows from this that it is necessary to collect the most comprehensive picture of the disease. If there is even minimal suspicion of a fracture with complications, the child should be transported only in a specially equipped ambulance.

In case of injury cervical region a special splint is applied to the spine.

If other areas are injured during transportation of a child, a rigid stretcher is used. If there is no hard stretcher, then you can take a soft one, but the child must lie on his stomach. A pillow is placed under his head and shoulders.

• Read also: ?

In the hospital, the child is placed on an inclined board. If the doctor diagnoses a fracture without complications, then no special treatment is prescribed. It all comes down to using the corset for some time. If the fracture is accompanied by complications, then surgery. In any situation, it is important to consult a doctor immediately. Treatment of spinal compression fractures in children is supplemented with massage sessions and exercise therapy:

• The first seven days of treatment. Prescribed, which are aimed at improving the functioning of the heart, lungs and stomach. Exercises are carried out to prevent a decrease in muscle strength.
• The next two months of treatment. Exercise therapy classes are prescribed, which are aimed at strengthening muscles. The load on the spine increases.
• The duration of the third period depends on the individual characteristics of the child. At this time, exercise therapy classes are prescribed, which consist of exercises with load and resistance.

In addition, massage is prescribed. It is important that it is done by a qualified specialist. Self-medication in this situation is fraught with serious problems.

The presentation of a compression fracture in children is slightly different from that in adults. This is primarily due to age-related physiological and anatomical characteristics.

The most common fracture is in the thoracic region children's spine due to a fall on their back. From the total quantity various injuries V childhood– 1-2% are compression fractures.

What is a vertebral compression fracture?

A compression fracture of the spine is a fairly common injury that is serious. Compression means compression. Thus, the fracture occurs during compression of the spine. The vertebral body, or even several, suffers at this moment - cracks, deforms, flattens, compresses.

The front of a vertebra is the most common place to become flattened. Its shape takes on a wedge-shaped outline. With a significant fracture, deformed rear end The vertebra can become embedded in the spinal canal, and this, in turn, compresses and damages the spinal cord. The most affected parts of the spine are lumbar And lower thoracic.

The cause of a compression fracture of the spine can be a small but sharp blow, as when jumping, diving or falling and landing on the buttocks or legs.

Stress on physical training, which is performed incorrectly, can also cause a fracture of this kind.

No one is immune from such situations:

Osteoporosis, which is accompanied by loss of calcium, is also one of the causes of this type of vertebral damage.

Fractures in children and their causes

In children, compression fractures of the spine are considered injuries to the musculoskeletal system, which are serious in nature and occupy a modest place in pediatric traumatology.

Nevertheless, disability may occur(kyphoscoliosis, aseptic vertebral necrosis, etc.), if the treatment is not carried out correctly.

The flexibility of the child’s spine is increased, since the height of the cartilaginous intervertebral discs larger, the connected apparatus is stronger and all levels of the spinal column are as mobile as possible.

Fall from a height, for example from a swing, the roof of a garage, a house or barn, a tree, damage during physical education lessons, while diving, training - these are the most common causes of compression fractures in children.

If we consider the mechanism of injury, then the greatest interest is caused by injury received under the influence of a force that bends the spine in an arc. Damage of this kind occurs due to a fall on the buttocks from a height, a fall on the head, or a somersault.

In such cases, a protective contraction of the dorsal flexor muscles occurs, which leads to heavy load on the anterior vertebral section.

Wedge-shaped compression occurs when the natural physiological flexibility of the vertebrae is exceeded. In such cases, intervertebral discs and cartilage may be damaged.

Symptoms of a compression fracture

With compression fractures, the clinical picture is mild, sometimes even with symptoms that quickly disappear. This, in turn, greatly complicates the process of diagnosing damage of this kind. Clinical symptoms include:

• Muscle tension in the places where the damage occurred;
• Moderate pain in the area of ​​injury;
• Pain along the spinal axis during exercise;
• Post-traumatic apnea (difficulty breathing);
• Pain in the abdomen that has a radiating encircling nature;
• Limitation of motor activity in the spine.

Morphological changes that occur under the influence of traumatic force sometimes not shown in the clinical picture.

Neurological symptoms such as paresis, dysfunction of the pelvic organs and paralysis of the limbs are rare in children. Such consequences can only occur as a result of fractures of the vertebral bodies, which is accompanied by displacement and spondylolisthesis.

Diagnosis of spinal compression fracture in children

In order not to miss time and prescribe therapy, you should immediately conduct an examination of the child’s spine.

With percussion and palpation, the specialist determines the most painful point, which will indicate a damaged vertebra.

With gentle pressure on the head and forearms, the child will feel pain in the event of a fracture. Flexion, rotation and extension movements are performed with caution.

In the section that is damaged, you can find a “muscle roll” - a painful tension that has a protective function.

In case of injuries in the thoracic spine, children may complain of difficulty breathing, and short-term delays are possible. In case of damage to the vertebrae in the neck area, the following is expressed:

1. Forced position of the head;
2. Limitation of head tilt;
3. Rotational movements are limited;
4. Neck muscles are tense.

In severe compression fractures, which are accompanied by displacement of the vertebrae, a fairly noticeable bulging is observed, which has the character of kyphosis.

If sharp pain is felt upon palpation and the spinous processes of the vertebrae remain in the area of ​​the fracture, then the diagnosis is obvious. Radicular post-traumatic syndrome accompanies 26% of patients with a compression fracture.

The most effective first test that will help diagnose the disease is X-ray. On the spondylogram, the specialist notes characteristic features diseases. To make an accurate diagnosis, the following may be additionally prescribed:

• Tomography of the area of ​​the spine that is damaged;
• X-ray in later position;
• Electromyography;
• Radioisotope research.

Treatment of compression fractures in children

Children whose compression fracture is uncomplicated are subject to inpatient treatment followed by outpatient rehabilitation under the supervision of a pediatric orthopedic traumatologist or surgeon.

If the spinal fracture is complicated, the treatment period is determined individually; recovery therapy is carried out in specialized rehabilitation centers.

It is necessary to transport a child diagnosed with a severe spinal injury only on a stretcher with a hard surface.

The main task at the very beginning of treatment of a fracture is to provide as complete and early treatment as possible. unloading the spine in anterior section . This result is achieved by traction of the spine.

To do this, you need to place the child on a hard surface with his back, while the head should be raised with the help of stands by 25-30 cm. The load is fixed to cotton-gauze straps, which are placed behind the armpits.

In case of damage to the cervical or thoracic spine, traction is performed using Gleason loop. Along with traction, reclination is necessary by placing a bag of sand under the spinous processes that protrude.

From the first day of treatment, gymnastics is prescribed in four periods:

1. First period. Duration – 6-8 days. To reduce negative influence physical inactivity, general tonic exercises are prescribed. Therapeutic gymnastics involves general strengthening and breathing exercises, accompanied by movement of the lower and upper limbs.
2. Second period. Duration – from 7-9 days after injury to 21-25 days. For the formation of a natural muscle corset, this period is considered the most important.

   The exercises that are included in the treatment of the second period are aimed at the abdominal and back muscles, they are accompanied by active movements of the lower and upper extremities, and it is necessary to tear them off the surface of the bed.

   Towards the end of this period, a functional test is carried out to determine how well the extensor muscles of the back are developed. If the child can hold the “swallow” position for a little more than a minute, then the treatment is transferred to the next stage.

3. Third period. Duration – from 21-25 days after the fracture to 35-45 days. The exercises are more complex; exercises are performed on all fours in the starting position, and at the end of the period – on the knees. This stage is considered preparatory to transferring the child to a vertical position.
4. The fourth period. Duration – from the 35th-45th day inclusive until discharge from the hospital. The main point of treatment occurs - the transition from horizontal position to vertical. Every day, the time on your feet is gradually increased by 10-15 minutes.

If more than three vertebrae are fractured, wearing a corset is recommended, especially if it concerns the lumbar or lower thoracic region. The corset is also indicated for complicated compression fractures.

In conclusion, we can add that no matter the severity of the fracture, the process of diagnosing and treating a compression fracture must be carried out under the strict guidance of a specialist.

Even after the end of treatment, the child must be monitored for several years at a dispensary. At the same time, exercise regularly therapeutic exercises under the guidance of adults or methodologists.

Useful in rehabilitation period are: thermal physiotherapy, massage and swimming. Full recovery is possible within 1.2-2 years.

Every parent experiences childhood injuries, but falls in children often resolve without complications. However, there are injuries that lead to serious consequences. These include compression fractures of the spine in children, which, when improper treatment may cause disability for life.

What is a compression fracture?

What is a vertebral compression fracture? The structure of the spinal column consists of vertebrae, muscles and ligaments, and its main function- protects the spinal cord. A compression fracture of the main part of the musculoskeletal system is caused by contraction, compression, deformation and cracking of the vertebrae. In this regard, they become wedge-shaped, and the apex, moving beyond its limits, can put pressure on the lower vertebra or stick into the spinal cord.

Vertebral body fractures in children of this type They are rare and, for the most part, respond well to treatment. But this is only possible if the injury was detected in time and treatment was carried out competently. In the absence of therapy or its ineffectiveness, the consequences will be severe.

Treatment of compression fractures of the thoracic spine and its other areas must be carried out comprehensively and include, as traditional conservative methods, as well as exercise therapy, special massage for compression fractures of the spine and other rehabilitation methods.

Factors causing injury

Children under 8 years of age rarely suffer a spinal fracture. This is due to the fact that the child’s skeleton has not yet completely ossified - the spine is plastic, the intervertebral discs are higher. But despite this, even children can get this injury due to overload of the vertebrae.

The main factors of compression fracture:

• as a result of a fall or accident;
• during an unsuccessful dive;
• sudden fall on the pelvis;
• landing on your feet from a great height;
• low amount of calcium in the body;
• osteoporosis, osteomyelitis;
• weakened back muscles;
• falling of a heavy object on the head or shoulders;
• increased load during sports activities, somersaults;
• sudden lifting of weight;
• tumor metastasis to the vertebrae;
• congenital pathology of the musculoskeletal system;
• birth injuries of the baby.

Quite often, a compression fracture is accompanied by injuries such as fractures of the pelvis, limbs, concussion of the brain or spinal cord, and other traumatic brain injuries.

Classification of injury

The first two places are occupied by injuries of the spine of the middle and lower thoracic region, the third place in popularity is assigned to the lumbar zone, followed by the upper thoracic and cervical. In addition, compression fractures of the spine in children are divided according to the type of vertebral deformation and the nature of complications.

The international classification distinguishes three degrees of damage:

• I or stable – the damaged vertebra has sank by 1/3;
• II or unstable – reduction in the height of the vertebral body by half;
• III - the vertebra is deformed by more than 50%.

A fracture also occurs:

• uncomplicated - pain only at the site of the injury;
• complicated – there is a disruption of the spinal cord.

Severe injury with multiple injuries and the formation of bone fragments can cause disability. The consequences of a fracture of the cervical vertebrae are very severe, including death.

Symptoms

A compression fracture of the spine in a child is different in that it does not have pronounced symptoms. If the fracture is uncomplicated, then the discomfort quickly passes and may not manifest itself for some time. Secondary signs of injury are nausea, dizziness, pressure changes, pale skin, swelling in the area of ​​injury.

Neck injury

Somersaults, diving, road accidents and objects falling on the head often provoke displacement of the cervical vertebrae in children. This department the spinal column is the thinnest, so the slightest sudden movement in combination with tense muscles can cause compression.

Symptoms of a neck fracture:

• neck pain;
• turning the head is unnatural;
• neck muscle tension;
• rotational mobility is limited;
• when bending the head forward there is a sharp pain;
• the back of the neck is smoothed;
• in rare cases - paralysis of the body.

Thoracic injury

The most common injuries are to the thoracic region, which occur due to a fall on the back from a height. For the first time, children experience difficulty breathing.

The main signs of damage to the thoracic vertebrae:

• pain;
• pain during movement and palpation intensifies;
• back muscles are tense;
• movements are constrained;
• abdominal pain;
• hematomas.

Lumbar injury

The lumbar vertebrae can be damaged by sharp drop on the buttocks, lifting weights, physical impact on the lower back. After an injury, the baby will try to lie on his back or on his stomach on his knees, clasping them with his arms. This position relieves pain.

Symptoms of injury:

• the muscles in the lumbar area are tense, the back is bent;
• pain on palpation;
• vertical position tires the child;
• lower back pain increases when you tap your heels;
• girdle pain in the abdomen of a spasmodic nature;
• tension in the anterior walls of the peritoneum;
• when bending the body forward there is an unpleasant sensation.

Important! Any back injury is dangerous.

If a child has a spinal injury, then before the medical team arrives, he should be given assistance to prevent the displacement of the vertebrae, as well as their additional deformation.

First aid for a spinal fracture or other injury involves immobilizing the victim and transporting him to the emergency room as quickly as possible.

Until the medical team arrives, adults can take a number of necessary measures:

1. If there is a blow to the lumbar region, the baby must be laid on his stomach, and a soft pillow or rolled-up cloth or jacket placed under his head.
2. In case of a blow to the chest area, on the contrary, the victim should be laid on his back and preferably on a surface that is as hard as possible.
3. If the cervical spine is damaged, you must be very careful in your actions, since any careless movement can cause damage to the spinal cord. With this injury, it is better not to touch the child until the ambulance arrives.

Important! You cannot try to straighten your child’s spine on your own!

The best action is to cover the child's body with soft objects that will help prevent unnecessary movements. If a minor injury to the tailbone or back occurs, then it is not advisable for the patient to sit, stand, or move for some time.

It should be remembered that any load on the spine after an injury may cause complications.

Diagnostics

Diagnosis of injury is carried out only by a traumatologist. With minor compression, it is not easy to identify damage - the symptoms are mild. Therefore, they first carry out thorough palpation and tapping in the area of ​​the bruise. This will help identify the most painful area. Gentle pressure on the head and shoulder girdle will also help identify a spinal injury.

To take out accurate diagnosis A traumatologist conducts various research activities:

• X-ray – it is carried out in two projections, lateral and direct, which allows you to accurately identify existing damage and the degree of severity.
• Magnetic resonance imaging - the procedure is prescribed in cases where a specialist suspects damage to the nerve endings in the spine.
• Computed tomography - this must be performed after receiving x-rays for a more thorough study of the spine and existing injuries. Myelography is often prescribed simultaneously with CT scanning. With its help, you can study the condition of the child’s spinal cord in the area of ​​the injury.
• Densimetry helps identify the presence of osteoporosis.

When examining a patient instrumental methods, he is also prescribed a neurological examination, which allows him to assess the functioning of the spinal cord, the condition of the peripheral nerves and roots.

Treatment

If you suspect this injury in a child, parents should seek advice from a traumatologist, who, after making a diagnosis, will prescribe necessary treatment. The treatment method will depend on the degree of damage and the location of the injury - surgical or conservative.

Conservative treatment

• traction;
• wearing a corset.

This therapy is used to treat grade I compression fractures. Its main goal is complete liberation spinal column from load. This can be achieved using traction.

1. For injuries to the neck and upper thoracic region, a Glisson loop is used.
2. If the thoracic region is injured below the 14th vertebra, the patient needs traction by the armpits.
3. In case of injury to the lower back, lower thoracic region, or a fracture of three vertebrae is diagnosed, wearing a corset is prescribed for a period of more than three months.

Conservative treatment can be divided into three stages:

• I - pain relief, traction. The child is prescribed painkillers to reduce discomfort. During treatment, it is necessary to observe strict bed rest at a 300 incline on a hard surface for a period of five days.
• II - restoration of normal blood supply in the damaged area. This stage lasts up to two weeks. The patient undergoes courses of magnetic therapy and electrophoresis.
• III - formation of a muscle corset. In addition to physiotherapy, bed rest with traction, a back massage is prescribed.

Exercise therapy is performed at all stages of therapy.

Surgical intervention is performed for complex injuries, when the installation of a special solution is necessary to correct the height of the damaged vertebrae. Surgery is also necessary if there are bone fragments or damage to the child’s spinal cord. In these cases, special metal fixing structures are installed.

Recovery time after surgery lasts longer and also includes exercise therapy and massage.

Rehabilitation

The rehabilitation course after a compression fracture is divided into several levels:

• The first month after the injury, the child should be in the hospital under the full supervision of medical staff. He is prescribed bed rest without movement using vertebral traction on a special device - the Glisson apparatus and the Delbe device. The bed should be tilted. This helps the patient reduce tension in the back muscles and straighten the vertebrae along their entire length.
• The second month of rehabilitation is aimed at restoring the muscles and ligaments of the back. During this period, the child is allowed to get out of bed and move for a limited period of time.
• For a year after the injury, the child should sleep on a hard surface without a pillow. He must also attend a physical therapy room and perform regular exercises. special exercises to restore all functions and flexibility of the spine. also in mandatory physiotherapeutic procedures should be carried out.

To fully recover from a compression fracture of the spine and strengthen its functions, the minimum period that may be needed is two years.

After being stationary long time the victim's bones and muscles do not receive proper tone, and therefore they need prolonged recovery process to return to your previous healthy state.

You can begin physical activity no earlier than two months after receiving the injury. However, this period may be reduced or increased. It all depends on the nature of the damage.

The child is prescribed to wear a special neck and back brace, and is completely prohibited from sitting on a chair or armchair for a long period of time. It is only allowed to lie on your back or walk in a corset.

The rehabilitation period is aimed at restoring blood circulation in spinal muscles. Congestion that appears after wearing a rigid corset can be eliminated with special movements. A set of exercises is selected individually for each patient.

A course of physical therapy must be carried out for at least one year after stopping wearing a corset. Combining physical pumping of the back and abdominal muscles with massage is the most effective complex rehabilitation.

The objective of this course is not only to strengthen the muscular skeleton, but also to regulate the functioning of internal organs that have been compressed by the corset for a long time.

The most effective physiotherapeutic measures are visiting electrophoresis to dilate blood vessels and capillaries, magnet therapy, paraffin treatment, water procedures and massage. Exercising in the pool is good for restoring the spine. Therefore, his visit should become regular for the child.

Complications and consequences

To the very severe complications Damage to the vertebrae includes neurological disorders - paralysis, loss of sensation in the limbs. Common consequences of spinal injury are vertebral necrosis, kyphoscoliosis, radiculitis, osteochondrosis, spondylitis and scoliosis.

With timely and competent treatment of a compression fracture of the spine, the risk of complications and other negative consequences is reduced to a minimum.

Do not delay diagnosis and treatment of the disease!

Make an appointment with a doctor!