Dr. Yavor Pukalski: Children break bones more and more easily

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Dr. Yavor Pukalski: Children break bones more and more easily
Dr. Yavor Pukalski: Children break bones more and more easily
Anonim

The child falls down and starts crying loudly. Pressing down on the arm, leg, or other part of the body that took the brunt of the fall. And we wonder if we should give in to the stress and panic, go straight to the ER, or wait and see if the area swells up and turns blue. Sound familiar? The answer is probably "yes", because every parent has been in this or a similar situation.

When we must seek professional help, how to help the child while waiting for the ambulance, and what not to do in any case, we asked Dr. Yavor Pukalski, orthopedic traumatologist at the Department of Pediatric Orthopedics and Traumatology in University Hospital "N. I. Pirogov".

He specialized in Great Britain, Turkey, and Switzerland. There are quite a few scientific publications in our and foreign medical publications, as well as participation in international symposia and congresses.

What are the most common injuries in children who come to the Clinic for Pediatric Orthopedics and Traumatology in "Pirogov", and what are their causes, Dr. Pukalski?

- We must not forget that in children "typical" fractures change according to age. For example, clavicle fractures are characteristic of the smallest. With the development of fine motor skills and the active involvement of the fingers in games, the percentage of phalangeal injuries increases.

As physical activity increases, especially over the age of 4, we increasingly see fractures around the wrist and elbow, typical of falling from one's own height. And while fractures around the elbow are gradually decreasing in adolescents, fractures at the level of the wrist retain the "leading position" even over 18 years.

When we talk about the lower limb - fractures around the ankle are common. The bones of the thigh and lower leg are thick and strong and therefore rarely break - in high-energy trauma. Of course, the body is not only made of bones. Quite a few patients come to the office with various types of wounds, sprains, sprains.

How is the correct diagnosis made?

- To make a correct diagnosis, an algorithm is followed - a standardized protocol, the basics of which are valid for every speci alty. The examination begins with taking an anamnesis - the patient is asked about when, how he was injured, what complaints he has. The anamnesis often guides us to the correct diagnosis, since certain fractures are characteristic of different mechanisms of trauma.

The examination continues with a view to wounds, edema, deformity, pain. It is important to evaluate the whole patient, not just the affected limb, so that other trauma is not missed. The area of interest is palpated (felt), and according to the patient's complaints and what he feels during the palpation, the doctor draws conclusions about underlying damage.

If a fracture is suspected, the appointment of imaging studies (most often X-ray) and their interpretation is mandatory. In most cases, following these steps is more than enough to make the correct diagnosis.

In which cases is casting resorted to and when is surgery required?

- Each fracture must be considered in the context of the patient himself. Plaster immobilization is the most popular method of treating fractures of the growing skeleton. This is because children's bone has the ability to remodel (self-repair) with growth.

Unlike adults in children this allows us to leave some fractures not perfectly aligned and still have an excellent end result with full recovery. Unstable fractures - those that cannot be held in an acceptable position, as well as intra-articular fractures, are usually indicated for operative treatment.

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If the child suffers a trauma, what should be the first reactions of others to provide adequate help?

- In case of severe trauma - traffic accident, fall from a height, etc., you should contact an "Emergency" team. If we are talking about trauma affecting the limbs, then the initial behavior is the following. Inspect for wounds and active bleeding.

If there is heavy bleeding - apply a tourniquet/inflated blood pressure cuff or clamp with a towel above the bleeding level. Cover the wound with sterile gauze (as long as you have such in the home medicine cabinet) or with a clean cotton cloth. Do not water with alcohol or put cigarette ashes or other folk "remedies" in an attempt to disinfect the place.

If fracture is present or suspected, splint the affected area along with the adjacent two joints. In case of a broken forearm, for example, the splint must cover the elbow and wrist. DIY splints can be crafted from slats, rolled magazines, etc. As soon as first aid is provided, the patient is transported to the appropriate medical facility.

Until the child's condition is clarified, it is extremely important not to give him anything by mouth, in an attempt to calm him down - both for eating and drinking. Giving general anesthesia on a full stomach poses unnecessary risks to the patient.

Is it true that today's children have more brittle bones?

- This is a question we often discuss. It's as if children really break more and more easily. It is difficult to pinpoint a single factor. The quality of the food, on the one hand - colleagues have repeatedly raised the alarm about the increased levels of hormones in the chicken, the reduced nutritional quality of many of the products in the network. On the other hand - the change of diet: migration to "fast foods" instead of home-cooked dishes, as well as desserts with refined sugar instead of fruits. Of course, not least is reduced motor activity. Children spend less and less time playing outside and more and more time in front of the TV, computer or tablet screen.

Bone is a living structure and if it is not "trained", it gradually begins to lose its strength.

What is prevention for he althy bones in children?

- I think it's already clear what my advice will be here. Proper nutrition - with an emphasis on vegetables, fruits, meat. Fewer desserts. More movement. Tips for he althy living haven't changed much in recent decades. Rather, I think the list of unhe althy foods and activities is expanding.

Do you think the playgrounds in the capital are safe?

- It is difficult for me to give a definite answer to this question. I don't think that all the sites in Sofia can be put under a common denominator. I think that in the last 10 years there has been a significant modernization of the children's areas.

Using appropriate materials, assemblies and especially soft surfaces greatly reduces the risks of injury as well as the potential severity of injury during play. I wish someday we can reach infrastructure similar to that of South Korea.

There is constant renovation and maintenance of the playgrounds, running and exercise areas so that they comply with the latest safety and ergonomic norms.

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