(NRNP 6541) i Human: Andrew Chen latest update

(NRNP 6541) i Human: Andrew Chen latest update 2023- 2024 2 i Human: Andrew Chen PRIMARY DIAGNOSIS: S89.021A: Salter-Harris type2physeal fractureof 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) 3 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