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.