Chapter 2520: Understanding Differences
The car accident scene was tragic, the teacher who protected the children sacrificed their life, and Xiao Yu, the younger sister, was fatally injured. How could Shan Shan escape unscathed? Because of this, the doctors must take responsibility for the child and cautiously require her to stay in the hospital for observation.
We often compare children to young saplings. What are the characteristics of these saplings? Their branches break easily, but the skin is intact, making internal fractures hard to discern at first glance.
Children’s bones are like this; because their bones have higher flexibility, lower fragility, and thicker periosteum compared to adults, some children exhibit clinical phenomena like sapling branches breaking. This characteristic in pediatric orthopedics is called greenstick fracture and subperiosteal fracture, different from adult fractures, and unique to pediatrics.
Like Shan Shan, the on-site doctors couldn’t immediately determine if she had hidden fractures. She didn’t complain of pain, and her limbs showed no obvious swelling. Clinical symptoms would only appear as the injury further developed. After being transported from the emergency scene to the hospital, doctors must routinely conduct X-rays on limbs suspected of serious trauma to rule out bone abnormalities. After the X-rays, the report revealed that this child did not just have superficial injuries, but a supracondylar fracture.
Where is the supracondylar area? Simply put, it’s in the patient’s elbow area.
Children’s elbow joint injuries include supracondylar fractures, lateral condyle fractures, radial head fractures, proximal ulnar fractures. The most common is the supracondylar fracture, ranking first.
The characteristic of supracondylar fracture is that it often leads to bone deformities and Volkmann’s ischemic contracture, which is known to be serious and can result in disability.
In clinical fracture treatment, what’s commonly known to the public is manual reduction, where orthopedic doctors, like martial arts experts, appear to manipulate the patient’s limbs magically back into place and fix them with plaster. Sometimes, orthopedic doctors inform patients and their families that manual reduction is insufficient, requiring surgical reduction. Some people may question why the same type of fracture requires surgery for some but not others. Is it because I didn’t give a bribe while others did?
Doctors dare not mess around with bribery in such matters. Such cases go to court, and once the medical records are presented, the doctors won’t be able to walk away unscathed. The reason for significant differences in treatment plans for the same condition usually lies in different classifications. To the general public, it may seem like the same disease, but in the doctor’s eyes, it’s not entirely the same.
Back to the supracondylar fracture, it can be classified according to whether the elbow joint was in extension or flexion at the time of injury, into extension type and flexion type. The former accounts for 90% of pediatric cases. Among them, the extension type is further divided into three types based on the degree of fracture displacement. Like Type I extension type, there’s no displacement, and manual reduction suffices; no surgery is needed. Shan Shan is Type III, with severe displacement, making simple manual reduction unlikely to guarantee non-recurrence, requiring minimally invasive surgery for fixation, only achievable in the operating room.
"The child said she won’t have surgery until she sees her sister," Liu Huaiyu said, "We’ve communicated with her parents multiple times, explaining that the surgery cannot be delayed."
Pediatric orthopedic surgery must be conducted as soon as possible because children are in the growth and development stage, and their fracture sites heal faster compared to adults.