Fractures in children

83 Fractures in children




Overview/pathophysiology


Fractures are common childhood injuries and usually the result of trauma (falls, motor vehicle accidents, sports injuries, child abuse) or bone disease with abnormally fragile bones (osteogenesis imperfecta). Fractures usually result from increased mobility and immature understanding of potentially dangerous situations. Fractures in infancy are most often caused by trauma or child abuse.




Important variables that affect care of fractures in children as compared with adults:



• Children’s bones heal faster than adults’; the younger the child, the faster the bone heals.

• Children’s bones are softer than adults’; rather than breaking, they bend or buckle.

• Children’s bones have a thicker periosteum and increased amount of immature bone.

• Children’s bones have an open growth plate or epiphysis. Damage to the growth plate can interrupt and alter growth.

• Children usually only complain when something is wrong. Restlessness, extended periods of crying, and calling for the parent more than usual, as well as disuse of affected extremity, or increased use of unaffected extremity after a fall or injury are signals that more investigation of the event is needed.


Most frequent types of fractures in children:



• Bends or plastic deformation: A child’s flexible bone can be bent 45 degrees or more before breaking and remains bent when the force is removed. The ossification of bones begins at birth and continues until the child is 18-21 yr old. The less ossified the bone, the more easily it bends. Thus, this type of injury occurs only in children, most often in the ulna and fibula.

• Buckle or torus fracture: Compression of the porous bone as a result of minimal angular trauma. It causes a bulge at the fracture site and occurs most often in young children, usually in the distal radius or ulna.

• Greenstick: Break occurs through the periosteum on one side of the bone but only bows or buckles the other side. It occurs most often in the forearm.

• Complete fracture: Break divides the bony fragments. The four types include spiral fracture (from rotational force, often associated with child abuse, especially in infants), oblique, transverse, and epiphyseal.


Most common fracture sites in children:


Ulna, clavicle, tibia, and femur.


Most fractures are treated with closed reduction and immobilization of affected area. Developmental age is key to the cause of injury (falls, motor vehicle accidents, sports) and type of fracture.



Health care setting


Emergency department, with possible hospitalization



Assessment


Child’s symptoms, trauma history (should match physical examination), and physical examination are all part of the assessment profile.




Signs and symptoms:


Vary with location, severity, and type of injury. Pain or tenderness at site, decreased range of motion (ROM) or immobility, deformity at fracture site, crepitus, gross motion at injured site, edema, erythema, ecchymosis, muscle spasm, and inability to bear weight may be present.



Physical assessment:


Assess for location of deformity, swelling, ecchymosis, and pain. Check vital signs and perform neurovascular assessment.



Diagnostic tests




X-ray examination:


Most effective tool for determining type and location of a fracture. Much of the skeleton of infants and young children is composed of radiolucent growth cartilage that does not appear on radiographs. Observation of gross deformity and point tenderness may be more reliable in diagnosing extremity fractures than would an x-ray. X-rays of unaffected limb may be obtained for comparison. Radiography of the suspected limb fractures should include joint above and below with a minimum of two views. X-rays are also taken after fracture reduction and often during healing process to assess progress.



Computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, bone scan:


May be needed to evaluate fracture in certain circumstances.





Nursing diagnosis:


Acute pain

related to fracture and other injury


Desired Outcome: Following treatment/intervention, child’s report of pain/pain level is less than 2 on a 5-point scale (e.g., FACES scale), less than 4 on a 10-point scale (e.g., numeric scale), or child exhibits behavior consistent with pain less than 4 on a 10-point scale (e.g., FLACC [face, legs, activity, cry, consolability] scale).




























ASSESSMENT/INTERVENTIONS RATIONALES
Assess pain before and after analgesia administration and at least q4h using appropriate pain scale for child (FLACC, FACES, Oucher, Poker Chip, numeric). This assessment helps determine degree of pain and effectiveness of pain medication.
Administer pain medication around the clock for first 24-48 hr or depending on severity of injury. This decreases or prevents pain more effectively than when given prn. Prolonged stimulation of pain receptors results in increased sensitivity to painful stimuli and will increase the amount of drug required to relieve pain.
Administer analgesia via intravenous (IV) or by mouth (PO) route. Intramuscular (IM) route is rarely used but if it is the only route possible, use topical anesthetic first. These measures facilitate atraumatic care and encourage child to give accurate pain rating. Child may fear a “shot” and deny pain or refuse pain medication.
Position, align, and support affected body part. Appropriate positioning decreases tension on affected area, thereby decreasing pain.
Use nonpharmacologic pain control measures as appropriate for child depending on developmental age. These are adjuncts to pain medication and include rocking, play, toys, music, distraction, relaxation techniques, humor, and massage.
Ice and elevate extremity, especially for the first 48 hr. These measures decrease edema, thereby decreasing pain.
Notify health care provider if relief from pain is not obtained 15 min after IV pain medication, 30 min after IM pain medication (route rarely used), or 1 hr after PO pain medication was given and after using all above measures. Medication may need to be adjusted for optimal pain control. It also may signify a fracture complication.
< div class='tao-gold-member'>

Related posts:

  1. Psychosocial support
  2. Care of the renal transplant recipient
  3. Polycythemia
  4. Bronchiolitis

Stay updated, free articles. Join our Telegram channel
Tags:
Jul 18, 2016 | Posted by in NURSING | Comments Off on Fractures in children

Full access? Get Clinical Tree
Get Clinical Tree app for offline access