FRACTURES IN CHILDREN POWER POINT IN NURSING

this slide shows more types of fractures common in children, and their medical and nursing management.

1. FRACTURES IN CHILDREN BY VARENCE

2. Fractures is partial or complete break in the continiuty of the bone bone A fracture is the medical term for a broken bone. Fractures can be closed/ simple (where the skin is intact) or open/compound (where there is a wound of the skin). Open fractures may lead to serious bone infection. Suspect an open fracture if there is an associated wound. A child’s bones are different from adults; instead of breaking they often bend like a stick

3. General types of fractures Complete when the fragments are separated Incomplete / when the fragments are attached together Transverse crosswise fracture at the right to the long axis [of the bone Oblique slanting but straight between horizontal and perpendicular direction Spiral slanting and circular twisting around the bone shaft Comminuted when the fragments of the fractured bone lie in the surrounding the tissue (crashed bone) Proximal fragments are closer to the midline Distal fragments are farther to the midline

4. Fig. 61-4

5. Common types of fractures seen in children Plastic deformation occurs when the bone is bent but not broken . A child flexible bone can be bent at 45°or more before b reaking Buckle or torus fracture produced by compression of the porous bone appears as raised of the fracture site. These fracture occur near the metaphysis (portion of bone shaft adjacent to the epiphysis)

6. Contn Green stick occurs when the bone is angulated beyond the limits of bending. The compressed side bends and the tension side fails causing incomplete fracture similar to when a green stick is broken Complete. Divides the fragment. These fragments often remain attached by periosteal hinge which can aid or hinder reduction

7. Causes Fractures happen when more force is applied to the bone can absorb. Bones are weakest when they are twisted Breaks in bones can happen from over use injuries , falls, trauma, or direct hit to the body

8. SALTER-HARISS CLASSIFICATION OF FRACTURES IN CHILDREN Type i: Separation or slip of growth plate without fracture of the bone Type ii: Separation or slip of growth plate breaking off the of the section of metaphysis Type iii: fracture of epiphysis extending through the joint Type iv: fracture of growth plate epiphysis and metaphysis Type v: crushing of epiphysis

9. Investigations History taking & physical Examination X-tray CT scan MRI Bone scan Blood tests CBC, HCT

10. Clinical manifestation Generalized swelling Pain and tender Deformity Diminished functional use of limb Bruising Severe muscular rigidity Crepitus ( granting sensation at fracture site)

11. 5Ps TO R/O COMPATMENT SYNDROME Parasthesia ; tingling and burning sensations Pulselessness ; inability to palpate pulse distal to the fracture/ compartment Pressure; T he limbs feels tense and warm skin is tight and shin. Pressure within the compartment Pain; Elevation of the limb or movement the pain Paralysis; I nability to move the extremity or digits

12. Fracture Healing bone r eparative process of self-healing ( union ) occurs in the following stages: Fracture hematoma ( bleeding, edema) Granulation tissue → osteoid (3 – 14 days post injury) Callus formation (minerals deposited in osteoid) Ossification (3 wks – 6 months ) Consolidation (distance between fragments decreases → closes). Remodeling (union completed; remodels to original shape, strength)

13. Bone Healing Fig. 61-7

14. MANAGEMENT AIMS : To regain alignment and length of the bony fragment (reduction) To retain alignment and bony length ( Immobilization) To restore function to the injured party To prevent further injury or deformity

15. First aid mgt ABCD Determine the mechanism of an injury Move the injured part as little as possible Assess 5 Ps Cover the open wound with clean or sterile dressing Arrest any bleeding Use soft splits when immobilizing the injured part by aiming at securing joint above and below of the fracture In extreme cases particularly lower limbs uninjured part can serve as splint Elevate the injured part Apply the cold compress to injured area Assess neurovascular status

16. HOSPITAL MGT Open reduction like internal fixation Cast application spica cast Calcium tablets Drugs analgesics Closed reduction internal fixatio n

17. Internal fixation Fracture Immobilization Pins , plates, intramedullary wires , and screws Surgically inserted at the time of realignment

18. Application of casts Casts are t emporary circumferential immobilization device commonly used following the closed reduction Spica cast are suitable for age of 6m-6 yrs can be applied covering mid torso (trunk) and continues down to the ankle on the affected side and to the knee on the affected side immobile the hip joint. The is an opening left in perineal area for toileting

19. pavlik harness spica

20. External fixation Metallic device composed of pins that are inserted into the bone and attached to external rods

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