● Children have stronger self-healing ability after fracture than adults
"Never operate with a knife if it can be closed reduction" is a concept actively advocated and practiced by Professor Meng Jimao, founder of orthopaedics in China, to treat children's fractures. The treatment of closed reduction has less injury and pain, and the charge is only 1/10 of the surgical treatment. It only requires doctors to have higher medical skills. They need to feel the alignment and alignment of the fracture with two hands, and often need more than two doctors to work together.
Sometimes, after the reduction, the parents saw the film but thought that the fracture end was not "tight", and were dissatisfied with the treatment. In fact, as long as the "hook" is on and the "hook" is tight, it will automatically fit perfectly.
This is because children's fractures have the following characteristics:
1. Children's bone has strong strain shaping ability and thick periosteum. One side of periosteum often keeps continuity after fracture, and there are fewer comminuted fractures and open fractures than adults.
2. Children's bones have strong ability of natural repair and healing, and fracture nonunion rarely occurs. Bone nonunion after fracture in children mostly occurs in the improper application of open reduction and internal fixation, and most of them are iatrogenic complications.
3. Children's bones have good shaping ability. Even if they cannot be completely restored after fracture, they can be recovered through growth and development adjustment within a certain range, without affecting the function.
● Surgical reduction may cause children to grow short legs
The growth plate of children's epiphysis is a weak area in bone mechanics, and its strength is significantly lower than that of joint capsule and ligament. Therefore, the injury of epiphysis in children is more than that of joint capsule ligament. Epiphyseal injury is a special problem in children fracture. Therefore, open reduction should be avoided as far as possible without affecting fracture healing and bone function. Only fractures involving joints and epiphyseal growth plates require more accurate reduction; Or in the case of failure of closed reduction of fracture and difficulty in stabilizing the position after reduction, it is necessary to perform surgical open reduction.
Children are in the process of continuous growth and development. The reason why they grow is that the growth plate - epiphysis exists between the bones. If the epiphysis of children is also nailed with steel plates, or easily cut and reset by surgery, as in the treatment of adult patients, the children's bones will never grow again, which will cause limb shortening, for example, one leg is longer than the other, Or cause angular deformity of bone and joint, that is, as the saying goes, the bone is connected askew.
● Fracture "shaping" determines functional recovery
Children's fracture repair takes a long time. Fracture healing in children can be divided into three stages: inflammation stage, repair stage and shaping stage. The inflammatory phase and repair phase are completed within 3 months, while the shaping phase takes 3 to 6 months or even longer to complete.
The shaping of fracture is of great significance for the recovery of bone function. The factors influencing the fracture shaping include the age of the patient, the location of the fracture, and the angular direction of the fracture. The younger the age, the closer the fracture is to the joint (metaphysis of bone), and the stronger the shaping ability. For some children with fractures, even if there is a large displacement, as long as good shaping is maintained, bone function can eventually recover.
