Pediatric Fractures, Soft Tissue Injuries, and Traction Management in Orthopedics

Soft Tissue Injury

Types include Contusion, Sprain, and Strain.

Soft Tissue Injury Treatment

Includes REST, ICE, alternating every 30 minutes, COMPRESSION, and ELEVATION.

Fractures

A break in the bone.

Fractures in Children

Fractures heal much faster in children.

Greenstick Fracture

Most common type of fracture in children due to incomplete calcification; softer, more flexible bones.

Incomplete Fracture

One side of the bone is broken and the other side is bent.

Compound Fracture

Bone breaks through the tissue.

Spiral Fracture

Caused by forceful twisting of the bone; suspicious for child abuse.

Simple Fracture

A fracture that does not break the skin.

Complete Fracture

A fracture that completely separates the bone.

Buckle Fracture

A fracture that causes a bulge in the bone.

Comminuted Fracture

A fracture that results in multiple pieces of bone.

Longitudinal Fracture

A fracture that runs along the length of the bone.

Oblique Fracture

A fracture that occurs at an angle across the bone.

Transverse Fracture

A fracture that occurs straight across the bone.

Fracture Manifestations

Symptoms can include swelling/edema, pain and guarding, deformity, bruising, and crepitus.

Fracture Diagnosis

X-ray is the only definitive diagnosis.

Initial Care for Fractures

Includes pressure for bleeding and immobilization in the position found.

Fracture Treatment

Includes reduce and immobilize; broken edges can damage vessels/nerves.

ORIF

Open Reduction and Internal Fixation; allows for earlier mobility.

Growth Disturbances from Fractures

Fracture at the epiphyseal plate can cause bone shortening or overgrowth.

Traction Purpose

To reduce and immobilize; used when casts do not work.

Types of Traction

Includes Manual, Skin (Bryant's traction, Buck's skin traction, Russell traction), and Skeletal (Steinmann pin, Kirschner wire).

Manual (Closed) Reduction

Accomplished by bringing the bone fragments into apposition through manipulation and manual traction.

Child's alignment

The position and posture of a child, ensuring proper alignment.

Skin care

The practice of maintaining healthy skin, particularly in patients with casts or traction.

Check heels and coccyx

Inspect these areas for pressure sores using a mirror.

Monitor pin sites for infection

Regularly check areas where pins are inserted for signs of infection.

Neurovascular checks q 1-2 hours (7 P's)

Assessments including Paralysis, Paresthesia, Pain, Pulse, Polar, Pallor, and Puffiness.

Traction

A method of treatment that involves the use of weights to align bones.

HOB up

Head of bed elevated; allowed during traction with suspension.

NEVER lift or remove weights during patient care

A critical guideline to follow while managing patients in traction.

Concerns Related to Immobility

Issues that may arise from immobility including Constipation, Urinary retention, Growth and development, Nutrition, Pneumonia, Skin integrity, and Compartment syndrome.

Pre-casting

The process of checking for abrasions, cuts, and swelling before applying a cast.

Post-casting

The phase involving early identification of complications and correct drying of the cast.

Plaster Casts Drying

Takes 10-72 hours to dry; should be uncovered and turned every 1-2 hours.

Casts

Devices used to immobilize broken bones or injuries.

Fiberglass Casts

Casts that dry quickly, are easily applied, and can be waterproof.

Types of Casts

Includes Long Arm, Short Arm, Long Leg, and Short Leg casts.

Neurovascular checks

Assessments performed every 1-2 hours to monitor movement, sensation, circulation, temperature, color, and swelling.

COMPARTMENT SYNDROME

A condition indicated by sudden increase in pain unrelieved with narcotics.

Cast Care Teaching

Instructions including not putting anything down the cast, keeping it dry, and monitoring for complications.

Crutches

Assistive devices requiring upper body strength and proper height adjustment.

Crutch paralysis

A condition that may occur due to improper use of crutches.

Thrombosis

A potential complication related to immobility and improper use of crutches.

Review Crutch Walking

An important skill to teach for proper use of crutches.

Concussion

temporary disturbance of the brain that may be followed by a period of unconsciousness

Manifestations of Concussion

Amnesia, Headache, Nausea/Vomiting, Lethargy

Long-term Complications of Concussion

post concussion syndrome

Nursing Considerations for Head Trauma

Wake them up to assess neuro status! Neuro Checks: Grips and movement, Pupils and eye movement, Pain sensation, LOC, Symmetry, Fontanels

Signs of Increased ICP

Worsening Headache, Vomiting more than twice

CT Scan of the Head

Physician may or may not order CT scan of the head

Post-Concussion

The first few days following a concussion, when the brain is still healing, a child may be too symptomatic to attend school

Return to School After Concussion

It is NOT necessary for a child to be 100% symptom-free before returning to school

Contusion

Bleeding/bruising in an area of the brain

Manifestations of Contusion

Loss of consciousness to coma, Focal seizures, Speech disturbances, Mild hemiparesis

Epidural Hematoma

Bleeding that occurs outside of the brain tissue; accumulation of blood between the dura mater and the skull

Manifestations of Epidural Hematoma

Rapid deterioration, Leads to increased ICP, Contralateral Hemiparesis, Headache that worsens, Vomiting, Seizures, Ipsilateral pupil dilation

Subdural Hematoma

An accumulation of blood between the dura mater and arachnoid mater

Manifestations of Subdural Hematoma

Altered LOC, Headache, Seizures, Gait difficulties

Basilar Skull Fracture

Fracture of the anterior and/or posterior base of the skull; causes tearing of the meninges resulting in leaking of CSF and/or blood

Manifestations of Basilar Skull Fracture

Vertigo, Battle's Sign, Raccoon eyes, Cranial nerve deficits, CSF/blood leaking from the nose or ears, Patient will report a salty taste

Shaken Baby Syndrome

Non-accidental brain injury that causes the brain to strike the inside of the skull; causes tearing of the nerve fibers within the brain

Consequences of Shaken Baby Syndrome

Results in retinal, subarachnoid and subdural hemorrhage, Bilateral hematomas, Blood present in CSF, Cervical spine injuries, Permanent disability or death

Assessment for Head Trauma

Pediatric Coma Scale to assess LOC and neuro function; Headache - exhibited by fussiness; N/V or poor feeding; Bulging fontanels - ↑ ICP; Increased temperature; Damage to hypothalamus; Negative Doll's Eyes Reflex (CN III); Fundoscopic eye exam; Retinal hemorrhage; Papilledema; Pale or blue skin

Severe Cases of Head Trauma

Decerebrate or decorticate posturing

Treatment for Head Trauma

Respiratory, Ventilator - acutely hyperventilate child to decrease ICP, Vitals, Respiratory status, Rising systolic pressure, Widening pulse pressure, Bradycardia, HOB UP, Seizure precautions, Barbiturate coma, Diuretics, Mannitol, Steroids, I and O

Prognosis of Head Trauma

20-25% mortality, 80% permanent neurological injury, Developmental delays, Motor deficits, Visual deficits, Epilepsy, Speech and language deficits, Behavioral disorders