Missed a fracture.

Specialties School

Published

7th grade girl came in, banged her hand in gym. She had no swelling, good movement, good hand grasps and low pain level. I gave her ice since hands tend to bruise and sent her on her way. She came back later in the day holding her hand like a wounded baby bird.

I called her parents immediately, but ugh. They are not easy parents.

I feel like an idiot.

It happens and it will probably happen again. We all feel terribly the 1st time because we assume we should have know. We are in such a unique situation in that a child injures themselves and we see them within 1-2 minutes of the injury. Oftentimes the signs and symptoms that would be major clues have not happened yet. You assessed their injury and gave ice . I always tell the kids if it doesn't get better or it feels any worse to come back and see me.

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Specializes in school nursing, ortho, trauma.

i wouldn't necessarily count that as a miss on YOUR part. YOU called the parents right away. THEY chose to wait on it. As previously stated, you do not have x-ray vision. All we can do is just call the parents. Typically with any type of injury of this nature, I'd do the same - ice it and see. They would do the EXACT same thing at home. It's highly doubtful that they would run right off to the ER at the time of the injury without applying some ice and seeing how it was in the same thing happened on the weekend - that is if they bothered to treat it at all...

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Specializes in Telemetry, Gastroenterology, School Nrs.

Don't feel bad. You have no way to diagnose something like that and were not in the wrong for sending her back to class.

I normally do my initial assessment, and if my findings are similar to yours, I send them back to class with ice, with instruction to come back and see me in 20-30 minutes, so I can see if or how well the ice is helping. Then I call Mom or Dad, that way I can give them any details about changes that might have happened within that time frame.

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Specializes in Pediatrics Retired.

Some years ago I had a kid with a similar incident; fell in the gym, hand hurting, no apparent swelling, yadda yadda run of the mill complaint.....I gave him an ice pack and told him to bring it back when his hand was feeling better. He never brought it back. His dad called me the next day telling me the hand was fractured and the reason the child didn't come back to see me was that he was following my instructions; his hand continued to hurt and never did feel better!!! Talk about feeling like a moron. That compelled me to change my terminology for instructions!!! So, don't consider yourself missing anything. You acted in accordance to how the complaint progressed. Great assessment.

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I went to pick my up kid up from soccer a couple months ago when I noticed she had ice. The ball had bent her finger back so the coach had her sit with some ice. I took a quick look at it but blew it off since it looked fine. The next morning my daughter got up and asked if her finger was supposed to be black and blue and twice it's normal size. Ooopssss.

But the best thing to do is get your x-ray vision repaired. :wacky:

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Specializes in kids.

You cannot miss what you cannot diagnose!!! You did what you could in YOUR scope of practice.

:specs: You don't have XRAY vision!

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Reading this thread has defintely helped me feel better. I had a preschooler come into my office Friday who had fallen on her left wrist. No bruising or swelling, and let me palpate the area with no signs of pain at all when she was distracted by reading a book. She would also say it hurt when I touched other parts of her body such as her right knee, etc. so it seemed to me that she was just reacting that way because she was upset. I sent the student home regardless after 20 minutes and she ended up getting an x-ray but now I have staff coming in telling me they knew it was broken all along and I should have sent her home right away. Ughhh not the way I wanted to start my week

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Specializes in PACU, pre/postoperative, ortho.

No worries. The ER doc missed my son's fracture with the xray in his hands. Wasn't until later when the radiologist viewed it that there was determined to be a fracture.

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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.
Reading this thread has defintely helped me feel better. I had a preschooler come into my office Friday who had fallen on her left wrist. No bruising or swelling, and let me palpate the area with no signs of pain at all when she was distracted by reading a book. She would also say it hurt when I touched other parts of her body such as her right knee, etc. so it seemed to me that she was just reacting that way because she was upset. I sent the student home regardless after 20 minutes and she ended up getting an x-ray but now I have staff coming in telling me they knew it was broken all along and I should have sent her home right away. Ughhh not the way I wanted to start my week

WHAT!!!!! You waited and ENTIRE 20 minutes before you sent her home?! Don't you know she might have DIED!! She was a TRAUMA victim for gosh sakes. What kind of nurse are you? I would have called for a helicopter.;)

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I had a kid last week that fell off playground equipment and came in complaining of pain in her elbow. No outward signs of fracture but continued to complain of pain. Called her mother, she picked her up and took her for an x-ray. The elbow was fine, but they did find a hairline fracture in her hand! Absolutely no complaints of pain in her hand!

Last year I had a kid that did the same thing, complained of elbow pain, and couldn't pronate/supinate. I called mom, encouraged her to have it x-rayed. She didn't. Kid kept coming to office with pain, I kept calling her. She finally took him in and had it x-rayed, and it was indeed fractured. I saw the kid last week for something else and he said, "Remember last year when I hurt my elbow and you said it was just sprained and it was really broke?" GRRRRRRRR.

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I sent the student home regardless after 20 minutes and she ended up getting an x-ray but now I have staff coming in telling me they knew it was broken all along and I should have sent her home right away. Ughhh not the way I wanted to start my week

I'd love to know how they knew it was broken. Give me a break!

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Specializes in school nursing, ortho, trauma.

I just love it, truly do love it when the staff comes in with that smirk on their faces and tells me "they knew all along". Well, pin a rose on your nose! If you happen to know tonight's lotto numbers - fill us all in!

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