Pediatrics, part 46: Musculoskeletal Disorders - Fractures


Cathy discusses fractures. She first explains the different classifications of fractures (closed/simple fracture, open/compound fracture, transverse fracture, impacted fracture, comminuted fracture, oblique fracture, spiral fracture, greenstick fracture). Cathy then covers the signs/symptoms and diagnosis of fracture, as well as medications used in the treatment of a fracture. She also discusses procedures used to set or reduce a broken bone, including closed reduction and immobilization, external fixation, and open reduction and internal fixation (ORIF). Cathy discusses emergency care of fracture and key components of a neurovascular assessment. She then explains the signs/symptoms and treatment of compartment syndrome, which is a serious complication of a fracture. Finally, Cathy provides you with a quiz to test your understanding of some of the key points she covered in the video.

  • 00:00 Introduction
  • 00:21 Fractures
  • 3:34 Compartment Syndrome
  • 4:26 Quiz Time!

Full Transcript: Pediatrics, part 46: Musculoskeletal Disorders - Fractures

Hi, I'm Cathy with Level Up RN. In this video, I will be discussing fractures. So if you have our Level Up RN pediatric nursing flashcards, go ahead and pull them out so you can follow along with me. And at the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key points I'll be covering. So definitely stay tuned for that.

Let's start off by talking about the different types of fractures. So a closed or simple fracture does not break the skin surface as opposed to an open or compound fracture that does break the skin surface, which increases the risk for infection. With a transverse fracture, the fracture line runs perpendicular to the long axis of the bone. With an impacted or compression fracture, two or more bones are crushed together due to a loading force. A comminuted fracture results in two or more pieces. An oblique fracture is a fracture that occurs at an angle. A spiral fracture occurs due to a twisting motion and is very often a sign of abuse. So if a child presents with a spiral fracture in their arm, then you definitely need to assess for a possible abuse situation. And then finally, a greenstick fracture is a partial fracture where only one side of the bone is broken.

Signs and symptoms of a fracture include pain, edema, ecchymosis, crepitus, and deformity in the affected extremity. In most cases, an X-ray can be used to diagnose a fracture, but a CT or MRI may be necessary in some cases. In terms of medications used in the treatment of a fracture, analgesics can be used to help control pain, and then prophylactic antibiotics would be prescribed when the patient's risk of infection is higher, such as with an open fracture. There are several different options for setting or reducing a broken bone. A closed reduction with immobilization is where we set the broken bone without cutting the skin open. Examples of closed reduction include a splint, cast, or traction. External fixation is where screws or pins are inserted into the bone and then attached to an external frame. And then open reduction with internal fixation, which is ORIF, is where pins, plates, screws, and/or rods are used internally to set the bone.

In terms of nursing care, emergency care of a fracture would involve cutting the clothing away, removing jewelry, controlling bleeding, and immobilizing the fracture through splinting. When we're caring for a patient with a fracture, we're definitely going to be performing neurovascular checks. So we'll be assessing our patient's pain level. We'll be assessing their sensation in the affected area. So we need to find out do they have numbness, tingling, or lack of sensation? We also need to assess their skin temperature and color, their capillary refill time, their pulse strength, and their ability to move the affected extremity. We also need to monitor for a complication called compartment syndrome. This is where we have increased pressure within a muscle compartment of an extremity that impairs circulation. Signs and symptoms of compartment syndrome include a hard and swollen muscle as well as intense pain that is unrelieved by medication. To remember many of the signs and symptoms of compartment syndrome, you can remember the five Ps. This includes intense pain, paresthesia, which is a pins and needles type sensation, paralysis, pallor, and pulselessness. The treatment for compartment syndrome is a fasciotomy. This is a surgery where we cut into the fascia in order to relieve pressure within the muscle compartment.

All right. It's quiz time, and I've got three questions for you.

Question number one, what type of fracture is often a sign of abuse? The answer is a spiral fracture.

Question number two, what fracture complication may cause intense pain, paralysis, and pulselessness? The answer is compartment syndrome.

Question number three, what is the treatment for compartment syndrome? The answer is a fasciotomy.

All right. That's it for this video. I hope you found it to be helpful. Take care, and thank you so much for watching.

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