NCLEX Review Guide: Pediatric Musculoskeletal Fractures

Unique Characteristics of Pediatric Bones

• Children's bones are more flexible and porous due to higher water content and active growth plates, making them prone to incomplete fractures like greenstick fractures.
• Growth plates (physes) are areas of developing cartilage tissue near the ends of long bones that are weaker than surrounding bone and ligaments.
• Pediatric bones heal faster than adult bones due to increased blood supply and metabolic activity, typically requiring shorter immobilization periods.

Specific Fracture Patterns

Physical Assessment Findings

• Pain, swelling, and deformity at fracture site are classic signs, but children may have subtle presentations with incomplete fractures.
• Assess for 5 P's of neurovascular compromise: Pain, Pallor, Paresthesia, Pulselessness, and Paralysis.
• Children may refuse to use affected extremity or demonstrate pseudoparalysis - apparent paralysis due to pain rather than nerve damage.

Immediate Care Priorities

1. Assess and maintain airway, breathing, circulation - always priority in trauma situations
2. Immobilize fracture site above and below the injury to prevent further damage
3. Apply ice wrapped in cloth for 15-20 minutes to reduce swelling and pain
4. Elevate affected extremity above heart level when possible to minimize edema
5. Administer appropriate pain medication based on child's age and weight

Cast Care and Complications

• Teach parents to monitor for signs of compartment syndrome: severe pain, numbness, tingling, or inability to move fingers/toes.
• Keep cast dry and clean - use plastic bags during bathing and avoid getting cast wet.
• Never insert objects into cast to scratch itching skin as this can cause skin breakdown and infection.

• Remember that children's bones heal faster but growth plate injuries have long-term consequences - always prioritize growth plate protection.
• Use the "younger = better healing" rule - infants and toddlers have remarkable remodeling capacity compared to adolescents.
• For NCLEX questions, always choose neurovascular assessment as priority intervention for fracture care.