(NRNP 6541) i Human: Andrew Chen latest update

S89.021A: Salter-Harris type 2 physeal fracture of the right distal 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 testing needed. In addition, a basic understanding of the pediatric anatomy can 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 of cartilage and as the child ages, the cartilage hardens into bone 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) 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 to decrease the incidence of unnecessary x- rays, increase the efficiency of care(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 posterior edge of the medial or lateral malleolus. • Inability to bear weight for 4 steps immediately after injury and at initialmedical evaluation. • Midfoot pain with tenderness over the navicular bone or the base of the 5thmetatarsal. The overall sensitivity of the OAR is 98.3% so it can be a useful clinical decisiontool. (Knipe & Foster, 2016) TREATMENT: 1. Immobilization with short leg splint to stabilize ankle until they see ortho. 2. RICE: Rest, ice (10 minutes, 2 to 3 times a day), compression (ace wrap)and elevate above heart when resting. 3. Use crutches with ambulation. 4. Ibuprofen for pain.