The transitional fracture is a fracture at the growth plate of a bone, which begins to close in children as young as ten years of age. When the bone is subjected to high stress, it breaks into two (two-plane fracture) or three parts (triplane fracture) along this weak point.
What is a transitional fracture?
A transition fracture is a broken bone. In the phase between adolescence and adulthood, the skeleton is exposed to particular stress: the bones in the fetus begin as soft tissue that only gradually hardens. For what is the definition of hoffa-kastert syndrome, please visit healthknowing.com.
After birth, this process continues; so that tubular bones such as the tibia can grow properly, they have so-called growth plates, which consist of cartilage. Bone cells gradually move into the tissue and stabilize the framework, following a genetically predetermined pattern. Weak spots along the joints are particularly prone to breakage.
Physiology distinguishes between two-plane fractures with two fragments and triplane fractures with three fragments. Among the triplane fractures, a type I and a type II can be distinguished, which differ from each other in the course of the fracture.
Causes
The fracture occurs when the bone is subjected to excessive stress, such as in a fall or collision. The cause of the transition fracture at the ankle, in which the end of the tibia bone jumps off, is often a fall on the legs that the affected person is unable to cushion.
It is characteristic that the fracture follows developmental weak points in the bone. Tissues in the growth plate that are not yet fully ossified are more prone to fracture. The fracture therefore follows the path of the growth plate and takes the path of least resistance.
As soon as the joint begins to close from the age of 10, fragments of firmer bone form: they lie like islands in the softer tissue of the joint cartilage, in which ossification has not progressed so far. Ossification begins in children from the age of 12 at the ankle. Eleven percent of injuries at this joint are transitional fractures. Because the growth plate begins to close from the center here, the end of the bone is particularly prone to transitional fractures.
Symptoms, Ailments & Signs
The transition fracture is immediately expressed in severe pain in the corresponding region, which can also swell. In some cases, the affected child or young person’s vision goes black for a short time due to the combination of shock and pain. In the case of a transitional fracture of the ankle, those affected cannot put weight on the leg.
The fracture may be visible externally if the bone is visibly displaced, protrudes unnaturally, or has abnormal mobility; this can result in rubbing or scraping noises. However, if a fracture is suspected, those affected should immobilize the bone immediately if possible.
The area around the fracture swells when blood seeps into the tissue from injured vessels – the swelling can also turn bluish in this context and lead to additional uncomfortable pressure sensations.
Diagnosis & course of disease
An X-ray confirms the fracture and shows its exact course. Computed tomography (CT) is also rarely necessary, which, in contrast to the X-ray image, depicts several cutting planes and thus gives a three-dimensional impression. Doctors also examine the surrounding tissue and the rest of the bone during the examination to rule out additional fractures and other lesions.
This also applies to other parts of the body if they are affected. To a certain extent, the human body can repair broken bones itself. Without proper treatment, however, the healing process is suboptimal, eventually leaving crooked bone that is generally susceptible to new injury. In addition, a gap between bone and joint – for example at the ankle – increases the risk of early arthrosis.
Complications
First and foremost, patients with a transition fracture suffer from very severe pain. As a rule, the pain also spreads to the neighboring regions, so that there is also pain there and thus severe restrictions in the patient’s movement. Most of those affected also suffer from sleeping problems and irritability, since the pain often occurs at night.
Likewise, the transitional fracture can lead to a loss of consciousness and thus possibly to another injury in the event of a fall. The patient’s quality of life is significantly restricted and reduced due to the transitional fracture. If the fracture is left untreated, the bone can grow together incorrectly, which can continue to lead to pain and limitations in everyday life. A permanent feeling of pressure often occurs with this complaint.
Usually, this fracture can be treated without complications. Immobilizing the affected region allows the bone to grow back together. There are no further complaints. Surgical interventions are only rarely necessary. In most cases, the life expectancy of the patient is not negatively affected by the transitional fracture.
When should you go to the doctor?
If children and adolescents experience pain and impairments of the skeletal system during the transition to adult life, a check-up visit with a doctor should take place. If the pain persists for a long time or increases in intensity, the health irregularities should be examined and treated. There is also cause for concern if there is swelling or problems with general movement. A doctor should be consulted to obtain a clarification of the symptoms. If physical resilience decreases, if sporting activities are no longer carried out as usual or if movement is no longer possible without symptoms, a doctor is needed.
If you feel ill, change your behavior or feel generally unwell, the observations should be discussed with a doctor. Discolorations of the skin are to be understood as a warning signal from the organism. There is a medical condition that needs to be treated. The occurrence of a very strong pain experience is characteristic of the transition fracture. To avoid complications, painkillers should not be taken until the doctor has been consulted. Secondary diseases are possible, which could lead to irreparable damage. Until the cause has been clarified, it is advisable to relieve the body. The footwear worn should also be checked and, if necessary, optimized.
Treatment & Therapy
Immediately after the fracture, the bone should be at rest as much as possible. In the case of a transition fracture, the type of treatment actually depends on the type of fracture. If, in the case of a transitional fracture of the tibia, the fragments jump off the end of the bone in such a way that there is a gap of more than two millimeters between the bone and the joint, there are two possibilities:
In closed reduction, the practitioner straightens the bone without invasive intervention, while in open reduction, they perform surgery on the joint. In both cases, the patient is under anesthesia, otherwise the procedure would be extremely painful. In addition, the joint must be completely still during reduction.
A bone screw then fixes the fragment so that it can grow correctly on the bone. The twoplane fracture typically requires one horizontal screw, while two screws hold the fragments in the triplane fracture. Reduction is not required for transition fractures that cause a gap of less than two millimeters at the joint.
The patient receives a lower leg cast that stabilizes the broken bone for four to six weeks. During this time, the body repairs the tissue by strengthening the bone until it is fully resilient again. Medicine also refers to this process as consolidation.
Prevention
The growth plate represents a natural weak point for fractures in the critical transition phase. Preventive measures therefore consist primarily of avoiding falls, accidents and other heavy loads on the bones. Motor dexterity, coordination, alertness and the child’s ability to detect potential dangers in good time can help prevent such incidents.
You can do that yourself
Adolescents who have sustained a transitional fracture must follow the usual procedures recommended for fractures. After the medical treatment, the affected part of the body must be rested so that the fracture can heal.
The patient can cool the fracture periodically to relieve any pain. If a plaster cast is applied, good personal hygiene must also be observed at the affected area. In order to avoid inflammation and infection, it is important to carefully clean the affected joint without getting water under the cast. The doctor can prescribe suitable ointments that reduce the pain and contribute to rapid healing. Alternatively, there are various natural remedies such as aloe vera or agaveon. In consultation with the doctor, physical exercise can be resumed after a few weeks. Depending on the location of the fracture, regular stretching exercises can contribute to healing and also alleviate accompanying symptoms.
With early treatment, supported by the patient through self-help measures mentioned, the transitional fracture should heal without complications. If severe pain or other problems occur, the doctor must be informed.
