fractures

• occur frequently in children and adolescents
• increased vascularity and decreased mineral content make child's bones more flexible, therefore see bowing/buckle fractures rather than complete fracture
• common sites:

  • forearm
  • wrist
  • femur
• trampolines are a big hazard
• bowing deformity: significant bending without breaking of the bone
• buckle: compression injury; the bine bucket rather than breaks, incomplete fracture of the bone, bone breaks into two pieces
• Greenstick fracture: incomplete fracture of the bone
• complete: bone breaks into two pieces
• nursing interventions: immediately after injury; immobilize limb above and below the site of injury
• nursing interventions: cold therapy is useful to reduce swelling the first 48 hours after injury
• nursing interventions: elevate injured extremity above the level of heart
• nursing interventions: preform frequent neuromuscular checks(circulation, nerve damage)
• nursing interventions: assess pain and administer medication as needed
• nursing interventions: administer tetanus vaccine if necessary(compound fracture)
• treatment: casting, splinting, traction
• Duration of immobilization varies from week to months, depending on type of disorder and severity
• Traction: method of slow and gentle immobilization which ma be used to reduce and/or immobilize a fracture, to align an injured extremity, help reduce pain before surgery, and to allow the extremity to be restored to its normal length
• Hardware internal devices: rods, pins, wires
• hardware external devices: pins or wires inserted through the bones and then attached to an external frame, when bone heals, remove device
• External fixation: screws are placed into the bone above and below the fracture, and a device is attached to the screws from outside the skin, where it may be adjusted to realign the bone
• cats or splints may be required for

  • fractured bone
  • weakness
  • paralysis
  • spasticity
  • corrective orthopaedic surgery
• casts can be made of plaster or more commonly a synthetic material such as fibreglass or plastic
• Drying time for cast from 7-48 hours depending on material used

  Weight bearing on the affected part of the body is typically avoided until the material has dried
• teaching- avoid getting cast wet, instruct parent and child to keep spina on as much as possible, do not place anything inside cast, do not apply powder or deodorant, do not trim or break off rough edges of cast, do not pull out the padding from cast, check skin around everyday, avoid excess activities that would compromise the injury, do not walk on non-walking casts, blood cool air to help with itching
• cast removal: when healed, cast removed with cast cutter, skin will look different, exercise regime to help regain muscle strength and function following the injury
• nursing considerations: if closed reduction, pain is likely, assess casted area frequently for first 48 hours, drainage from wound under cast should be noted, monitor for signs of infection, check for crackles j cast, assess for signs of skin breakdown, monitor circulation and swelling
• compartment syndrome: medical emergency, increased pressure in a limited space such as the soft tissue of an extremity which compromises circulation and nerve innervation
• compartment syndrome: clinical manifestation begin 30 minutes after schema starts
• 6 P's

  1. pain
  2. pressure
  3. paresthesia(pins/needles)
  4. paresis(muscle weakening)
  5. pallor
  6. pulselessness
• 3 A's

  1. analgesic requirement increasing
  2. anxiety
  3. agitation
• reducing compartment syndrome: split laser casts and release constrictive bandages, position the limb to promote circulation, surgical decompression or fasciotomy