(NRNP 6541) i Human: Andrew Chen latest update 2023-
2024
2
i Human: Andrew Chen
PRIMARY DIAGNOSIS:
S89.021A: Salter-Harris type2physeal fractureof
... [Show More] therightdistal tibia.
The Salter-Harris (SH) Classification System is a way to grade fractures that involve the growth plate
(physis). Seventy-five % of lower extremity fractures in children are SH type 2. (Levine et al., 2022) When a
Pt presents with ankle symptomsa detailed history and physical examination are crucial. Although a nurse
practitioner may provide initial care and refer to a pediatric orthopedic specialist, obtaining details about
the trauma may help narrow down the differentials and testingneeded. In addition,abasic understanding
of the pediatric anatomycan leadto a better understanding of the mechanism of injury. Bone growth is
not completefor a male until somewhere between the ages of 14 to 17 years old. Growth plates are made
ofcartilage andas the child ages, the cartilage hardens intobone which isless flexible and rubbery. (Su &
Larson, 2015) AC is 14 years old and because his growth plates are still primarily cartilage, the risk of SH
fracture is high. AC presented with right ankle pain, swelling and bruising. On exam, his inability to
walk/bear weight and the presence of right ankle bony tenderness make a fracture much more likely.
(Levine et al., 2022)
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The Ottawa Ankle Rules (OAR) were initially developed for adult Pts but have been shown to be useful in
pediatric Pts over 5 years old. The goal of the OAR’s are todecreasethe incidence of unnecessary xrays, increase the efficiencyofcare(waiting time) and keep the cost of medical care down. According to
OAR, imaging is necessary if there is pain in the malleolar zone and at least one of the following:
• Bone tenderness along the distal 6 centimeters (cm)of the posterioredge of
the medialor lateral malleolus.
• Inability to bear weight for4steps immediatelyafter injuryandat initialmedical evaluation.
• Midfootpain with tenderness over the navicularbone or thebase of the 5
thmetatarsal.
The overall sensitivity of the OAR is 98.3% soit canbe a usefulclinicaldecisiontool. (Knipe & Foster, 2016)
TREATMENT:
1. Immobilization withshort legsplint tostabilize ankle until theyseeortho.
2. RICE: Rest, ice (10 minutes,2to 3 times aday),compression (ace wrap)andelevate above
heart when resting.
3. Usecrutches withambulation.
4. Ibuprofenforpain. [Show Less]