ORTHOPEDICS
Overview
Pediatric orthopedic nursing encompasses care of both the trauma and the surgical patient. Patients of all ages are affected by orthopedic issues, from the infant with a congenital club foot to the teenager with a femur fracture from a motor vehicle accident. Surgeries can range from correction of a spinal deformity to acute treatment of a fracture. The predominant focus of the pediatric orthopedic specialty is on fracture care. An increase in physical activity, such as sports and recreational activities, places the pediatric population at high risk for orthopedic injury, specifically upper extremity fractures (Shah, Buzas, & Zinberg, 2014). Many of these patients require surgical nursing care in an inpatient hospital setting. Specialized pediatric orthopedic nursing care and knowledge are essential for the successful treatment and recovery course of these patients.
Background
Fractures in children are an important public health issue and a frequent cause of emergency room visits and inpatient hospital stays. According to the National Electronic Injury Surveillance System (NEISS), nearly one in every five children experiences a fracture sometime during childhood or adolescence (Naranje, Erali, Warner, Sawyer, & Kelly, 2016). The annual incidence of fractures increases with age, with children between 10 and 14 years of age having the highest incidence of fractures. There is no gender difference in younger age groups; however, for older age groups, fractures are more prevalent in males. Children in urban areas or with lower socioeconomic status are also at an increased risk (Shah et al., 2014).
Fractures of the upper extremity in children are much more common than those of the lower extremity. The most common anatomic area for fracture is the distal radius, followed by the elbow and fingers. For lower extremities, the tibia is more commonly fractured than the femur. Supracondylar humerus fractures are the most common in children aged 7 years and younger. Fractures of the femur are most prevalent for ages 0 to 3 years. Falls from playground equipment, trampolines, bicycles, and sports account for a majority of fractures, and there is a higher incidence of these injuries during summer and school holidays (Shah et al., 2014).
Fracture diagnosis is usually made with a plain radiograph. Although a majority of pediatric fractures can be treated nonoperatively, some fractures that are open, displaced, or unstable may require surgical treatment. Surgical treatment depends on the severity of the fracture and ranges from closed reduction to open reduction and internal fixation with hardware. Most orthopedic injuries require a period of immobilization by casting.
85Although most pediatric patients recover completely and return to full function after treatment for a fracture, all fractures are associated with a significant potential for complications. Some serious complications can include vascular injury, peripheral nerve injury, pain, and compartment syndrome. Fortunately, most neuropraxia resolve spontaneously over time with adequate fracture reduction. Compartment syndrome can occur with the initial injury if the swelling is greater than the compartment of the muscle and tissues, or postoperatively if the cast material becomes too tight (Nguyen, McDowell, & Schlechter, 2016). Any of these complications can lead to premature disability and a decreased quality of life. Nursing assessment and clinical knowledge in the care of pediatric fractures can contribute to timely and safe treatment for the patient.
Clinical Aspects
ASSESSMENT
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