1.

Clinical Manifestationss

• The five “Ps” – pain, pulse, pallor, paresthesia, and paralysis are seen with all types of fractures.
• Other characteristic findings include deformity, swelling, bruising, muscle spasms, tenderness, pain,
impaired sensation, loss of function, abnormality, crepitus, shock or refusal to walk (in small
children).

. Provide emergency management when situation warrants, for a new fracture.

• Assess the five “Ps”.

• Determine the mechanism of injury.
• Immobilize the part. Move injured parts as little as possible.
• Cover any open wounds with a sterile, or clean dressing.
• Reassess the five “Ps”.
• Apply traction if circulatory compromise is present.
• Elevate the injured limb, if possible.
• Apply cold to the injured area.
• Call emergency medical services.

2. Assess for circulatory impairment (cyanosis, coldness, mottling, decreased peripheral pulses, positive blanch
sign, edema not relieved by elevation, pain or cramping).

3. Assess for neurologic impairment (lack of sensation or movement, pain, or tenderness, or numbness and
tingling).

4. Administer analgesic medications.

5. Explain fracture management to the child and family. Depending on the type of break and its location, repair
(by realignment or reduction) may be made by closed or open reduction followed by immobilization with a splint,
traction or a cast.

6. Maintain skin integrity and prevent breakdown. Institute appropriate measures for cast and appliance care.

7. Prevent Complications

• Prevent circulatory impairment by assessing pulses, color and temperature, and by reporting changes
immediately.
• Prevent nerve compression syndromes by testing sensation and motor function, including subjective
symptoms of pain, muscular weakness, burning sensation, limited ROM, and altered sensation. Correct
alignment to alleviate pressure if appropriate, and notify the health care provider.
• Prevent compartment syndrome by assessing for muscle weakness and pain out of proportion to injury.
Early detection is critical to prevent tissue damage.
o Causes of compartment syndrome include tight dressings or casts, hemorrhage. trauma, burns and
surgery.
o Treatment entails pressure relief, which sometimes require performing a fasciotomy.

8. Prevent infection, including osteomyelitits, bys using infection control measures.

9. Prevent renal calculi by encouraging fluids, monitoring I&O, and mobilizing the child as much as possible.

10. Prevent pulmonary emboli by carefully monitoring adolescents and children with multiple fractures. Emboli generally occur within the first 24 hours.