Bulge break
definition
A bulge break, too Toroidal fracture called, is a colloquially called incomplete fracture of a bone, which occurs especially in childhood. As a rule, this type of fracture occurs on long tubular bones such as the forearm or lower leg bones when they are still growing. Usually it is compression fractures that cause a bulge break.
In the event of a “break”, however, two bone fragments will not be formed. Rather, only the inner layers of the bone are broken, whereas the outer periosteum remains intact and ensures that no separate parts are created. The x-ray shows the bulge fracture with a bulge at the supposedly broken point, which explains the name.
therapy
The treatment of the bulge fracture is usually conservative. In concrete terms, this means that no hernia operation is necessary. The fact that the periosteum is still intact all around ensures good healing results with the conservative approach. If the bone slips slightly, it is moved back into the correct position under the control of an X-ray image and then fixed with a plaster of paris. Immobilization is usually only necessary for about four weeks.
In this case, an operation would only mean a manipulation of the bone growth center, which can ensure that the bone no longer grows. It is generally advisable to treat fractures in children with as little manipulation of the growth centers as possible.
An operation can only help if the ends of the bones are not straight. In this case, there are various ways of stabilizing it, such as wires or plates, which immobilize the break. If the pain is severe, pain treatment with ibuprofen or paracetamol can also be carried out in children.
To restore full movement, physiotherapy can support healing, depending on the fracture site.The affected bone should not be fully loaded directly, as this encourages new fractures at the old fracture site. Unusual breaks, such as the collarbone, cannot be cast in plaster and must therefore be stabilized with special splints.
How long is the cast needed?
The cast is usually worn on the arm for four to six weeks. This period should give the bone the time to properly grow together again. This period is also observed in the event of injuries to the lower leg bones in order to allow the bone to adapt properly.
In the case of fractures of the collarbone, on the other hand, only the shoulder that is affected can be immobilized so that the bone can heal again.
causes
A bulge fracture is a compression fracture. This means that the cause of the break is a collapse of the bone. This compression must take place approximately in the longitudinal direction of the bone, as this creates the characteristic bulge around the bone. Since the break occurs in the growth centers of the bones, the so-called metaphyses, these breaks typically occur in childhood when the bones are somewhat more elastic.
The most common bone affected is the forearm bone, the spoke. These breaks occur when the children fall and catch themselves with their hands. The arms hit the ground vertically and are compressed. The shin is also often affected. This happens when children jump or fall from a great height and land on their feet, causing their legs to be compressed.
The bulge often affects children between the ages of five and ten. The bones are still very flexible at this age and the children are often very active. The breaks therefore mostly arise while romping and climbing. One cause can be, for example, being caught while skating, as the fall happens at a higher speed than when running. Children who move less often and therefore have poorer motor skills are more often affected.
However, bruises, for example in a closing house or car door, can also cause such a break. Overall, the force must not be too great so that the bulge breaks.
Read more on this topic at: Forearm fracture in the child
forecast
The prognosis for a bulge fracture is very good. There are virtually no known cases in which further problems would have arisen from conservative care. Due to the fact that the growth centers of the bones are no longer manipulated, the further longitudinal growth of the bones also works relatively problem-free.
In most cases, a bulge heals within a few weeks without consequences. Only in rare cases do complications arise, such as a new break or a crooked coalescence. This can be treated well with surgery. Fractures affecting the growth plates can cause growth problems in the affected bone in some children.
You can recognize a bulge fracture by these symptoms
For the layman it is very difficult to tell whether the injury has caused a bulge break. However, this is of secondary importance anyway, since the care must be carried out by medical specialists who adapt the therapy accordingly based on the type of fracture.
General signs of a broken bone, such as severe pain when touching the broken area, possible bruising or observation of the course of the injury, can be signs of a broken bone. On closer physical examination, it could be determined that the fracture did not produce two separate bone fragments, but this is usually done by the X-ray procedure, as it is much less painful for the patient. So-called safe break marks are not visible when the bead breaks. These include visible bone ends, deformities and bone rubbing.
As a result of the accident, the children often have other minor injuries. Abrasions and bruises on the hands are typical here, as the children catch themselves with their hands and the forearm is compressed as a result. Ligament damage is also possible in the lower leg due to the accident.
Young children often report abdominal pain and nausea when they are in pain because they project all of the pain onto the stomach. In very thin children, the bulge break can in some cases be felt or even be visible. In rare cases, bulge fractures occur as part of major accidents. Many other symptoms are possible in multiple injuries. This also includes injuries that affect the cardiovascular system or the brain. However, these are not symptoms that are directly related to the bulge breakage.
Read more on this topic at: Broken arm in the child
Pain
Pain is a typical accompanying symptom of every broken bone. These arise on the one hand from the small nerve endings that are also injured when they break and on the other hand from the pressure that occurs in the tissue. The swelling of the forearm - where the torus fracture usually occurs - compresses the nerves, which also contributes to the development of pain. The outermost layer of bone, the periosteum (the periosteum) is particularly sensitive to pain. However, since it was not torn as with other bone fractures, the pain is less compared to a complete fracture.
diagnosis
The reliable diagnosis is made by looking at the X-ray image. Various identifying features can be seen here that make a bulge break very likely. The x-ray shows a round bulge, usually in the middle, on the bone compared to the healthy side. There are also no two separate bone fragments. This means that you cannot see a crack in the X-ray. Furthermore - and giving the injury its name - there is a small bulge on the edge of the bone, which is caused by the fact that the bone material, which is still soft in children, builds up here and has to move there due to space.
The course of the accident also provides an indication of a possible bulge break. The course of the accident can be described by older children themselves, while younger children depend on the statements of observers.
Further information on this: X-ray examination of the child
On which bones is the bulge fracture most common?
Long tubular bones, such as the ulna and radius or the tibia and fibula, are most susceptible to the occurrence of bulbous fractures. But there have also been reports of broken bulges in the collarbone. However, the absolute majority of fractures occur in the portion of the spoke near the hand in the area of the growth center of the bone, where its components are composed a little softer than in the rest of the bone.
Read more on our website Forearm fracture in the child
What is the difference to a greenwood fracture?
In contrast to, the periosteum is still completely intact when the bulge breaks. In the case of a greenwood fracture, the side of the bone that is opposite the actual force of force is completely broken. Conceivable on the basis of a branch that is broken over a small abutment. This also breaks first on the side facing away from the abutment.
Furthermore, in the case of a greenwood fracture, the bone may tear in the middle along the longitudinal direction. However, this risk does not exist in the case of a bead break. Furthermore, the greenwood fracture usually does not occur in the growth centers of the bones, which are more at the end of the bones, but rather in the middle of the bone. Overall, the prognosis for a greenwood fracture is also very good, but not quite as good as for a bulge fracture.
Read more on this topic at: Greenwood fracture
