Nursing Care for Pediatric Musculoskeletal Trauma

Falls and minor accidents are common in childhood and sometimes result in musculoskeletal trauma, like fractures. Since a child’s musculoskeletal system isn't yet fully developed, fractures can lead to permanent disability or premature death, if left untreated.

As the nurse, you'll provide care for your pediatric patients with fractures by monitoring for complications, providing supportive measures, and reinforcing education.

Now, a fracture is defined as a complete or partial break in a bone, which occurs when the physical force applied to the bone is stronger than the bone itself.

The most common type of fracture is a closed, or simple, fracture, which occurs when the bone breaks, but the overlying skin remains intact.

Other types of fractures include comminuted fractures where the bone breaks into multiple fragments and open, or compound, fractures, which occur when the fractured ends of bone pierce through the overlying skin.

Most often, fractures are caused by trauma, associated with a fall, sports injuries, or not wearing proper safety equipment, like a helmet or seatbelt.

However, in some cases, fractures result from child abuse. Usually these become apparent when a child presents with injuries that have implausible or inconsistent explanations, like femoral and humeral fractures in patients who can't walk yet, or repeated injuries, shown on imaging as multiple fractures at different stages of healing.

Okay, so, patients with fractures typically experience pain, swelling, and tenderness to the area of injury. You may also notice discoloration or bruising to the area, decreased range of motion, and numbness or tingling distal to the site of injury.

Since clinical manifestations of fractures can look similar to other musculoskeletal injuries, diagnosis is confirmed using imaging, such as an X-ray, CT scan, or MRI.

Most fractures are treated with rest and immobilization to promote proper healing and alignment, typically with application of a cast or splint.

If a fracture is displaced, meaning the bones aren’t in their original position or misaligned, your patient will require a closed reduction procedure, where the bones are realigned without surgical intervention, like with a cast, or an open reduction, where surgery is performed.

Once aligned, bones can be held in place using internal fixation devices, like nails, pins, screws, and plates within the skin, or external fixation where pins, screws, and wires are inserted into the fractured bone and held in place by a bar or ring outside of the skin.

Less often, traction is used to immobilize fractures prior to surgery, which refers to a system of weights and pulleys that hold tension on a bone to keep it in place.

Alright, when caring for your pediatric patient with a fracture, you’ll collaborate with the registered nurse, or RN, to monitor for complications, provide supportive measures, and reinforce education.

Begin by performing neurovascular checks on areas distal to the injury by inspecting skin color, and checking temperature, pulses, and capillary refill.

You’ll also monitor sensation, as well as movement by having the child wiggle their toes or fingers depending on the injury location.

Immediately report if your patient has cold, pale, or discolored skin, absent or faint pulses, weakness, numbness, tingling, or severe pain, since these can indicate compartment syndrome, which is a serious complication caused by excessive pressure on the tissues from edema or a cast that’s too tight, leading to hypoxia, ischemia, and tissue damage.

Now, when caring for a child in traction, observe the traction ropes and wheels to ensure no knots or kinks are present and that alignment and tension are continuously maintained.

Be sure the weights are hanging freely, meaning they never touch the floor or bed, and that they’re out of reach of the child.

Because patients with traction must remain on bedrest, assist them with frequent position changes and monitor for signs of skin breakdown.

Also remember to check your patient’s pain level before repositioning, bathing, or other activities, and administer pain medications, as ordered.

For children who are unable to verbalize pain, look for nonverbal cues such as grimacing, abnormal posturing, or irritability and quantify their pain using an age-appropriate scale, like the Wong-Baker Faces Scale or the Face, Legs, Activity, Cry, Consolability Scale, known as the FLACC scale.

As needed, provide distractions to reduce pain, such as coloring, reading, playing games, or encouraging caregiver involvement.

Finally, reinforce education about fracture care with your patient and their caregivers. Remind them to follow prescribed cast and splint care measures and stress the importance of attending all follow-up appointments.

Also, be sure to review injury prevention measures, like wearing a helmet and other protective gear when riding a bicycle or playing sports, as well as wearing seatbelts in the car.

Alright, as a quick recap… Falls and minor accidents in childhood can result in musculoskeletal trauma, like fractures. Diagnosis of fractures is made using imaging, such as an X-ray, CT scan, or MRI.

Treatment of fractures can involve rest and immobilization, casts or splints, as well as traction or surgery. As the nurse, you'll provide care for your pediatric patients with fractures by monitoring for complications, providing supportive measures, and reinforcing