Bone fracture is one of the most common diseases found in children after infection case. Children, in their stages of development, do a lot of activities which give a higher chance of them getting injured. When children fall, they instinctively brace for the impact by leaning on the palm of their hands, causing them to fall with their arms stretched out. The condition often causes fractures around the elbow and wrist. Occasionally, the injury in those particular areas is more than just a long bone fracture, but also damaged the joint. In the children’s stages of development, the joint area is close to the growth plate, making it difficult to interpret the X-rays when an injury occurs. The growth plate can be confused with a fracture line (overdiagnosis) and vice versa. The fracture line can be blurred, missed, and presumed there is no fracture (underdiagnosis). However, with good quality X-rays and a radiologist who carefully reads, analyzes, and compares the angles of both sides of the arm and hand, both injured and uninjured, a fracture can be suspected.
In most growing tissue cases, a good treatment of bone fracture in children will properly heal with no internal fixation (a surgical procedure that treats an unstable bone fracture by surgically implanting plates, screws, or pins to hold the bone fragments in place) surgery required. However, in the case of a joint or impaired growth plate, proper treatment by an orthopedic doctor is needed to prevent permanent disability such as a bent arm, especially at the elbow. Although these defects are more cosmetic lesions and not functional for daily activities, these cosmetic lesions will significantly interfere with the quality of life of children into adulthood. The quality of life of children often escapes the ultimate goal of medical treatment. It is high time healing is more than just being able to function again, but totally healed, and the bone looks normal.
Providing better understanding to the parents about the right diagnosis and proper treatment according to standards might not be an easy task. However, it is highly important and must be done through various media. Health promotion provided by teachers and health staff in schools regarding the symptoms of fractures, first aid, and how to take the patient to the hospital is the starting point for adequate treatment to prevent disabilities. Conversely, overdiagnosis and overtreatment are also dangerous, psychologically and financially detrimental.
Delayed treatment of joint injuries caused by mistreatment of regular bone fracture (by “sangkal putung” or bonesetter conservative treatment) resulted in neglected fracture instead of a simple procedure of repositioning and using the cast as a stabilizer. The procedure for neglected fracture includes surgery to open up the injured area to be repositioned and implants internally set to stabilize the bone during treatment. Diagnostic errors such as false positives and false negatives have detrimental influences on the patient and the family. Advanced education for all medical specialists is highly important.
Corresponding Author: Dr. Komang Agung Irianto dr., Sp.OT(K)
Journal title: Lateral versus posterior surgical approach for the treatment of supracondylar humeral fractures in children: a systematic review and meta-analysis.
Authors: Komang Agung Irianto, I Putu Gede Pradnyadewa Pradana, Brigita De Vega
Published in F1000Research (2022)
