Missed a fractured arm?

[jen42]

I just talked to a girl with her arm in a sling. I saw her on Wednesday after she fell off the monkey bars. She was calm, didn't seem to be in much pain. Said her arm hurt- it wasn't swollen and she could move it. Gave her ice and sent her back to class, telling her if it got worse to come back.

Turns out the next day she was diagnosed with an arm fracture! I feel very oblivious. Just left a long rambling message with the mom apologizing. I feel like there's something I should have noticed... but what? What did I miss?

[Jolie, BSN]

She was diagnosed the NEXT day, which means her parents were not immediately suspicious of a fracture either, and they spend a lot more time with the child than you do!

Kids have a remarkable ability to "hide" fractures. They often do not complain of significant pain, and may continue to "use" the extremity. Without significant swelling or deformity, I don't think your actions were inappropriate.

My old neighbor was an X-ray tech. She often reported seeing kids whose fractures were diagnosed a day or two after the fact, usually based on fever prompted by an inflammatory response to the fracture.

Don't beat yourself up, but thanks for caring so much!

[jax]

I was at school with my 6 year old son when he came up to me crying, saying "mummy, the ball hit me in the arm and it really hurts."

I had a look at his arm, he had full range of motion, no deformity, no super tender spots, so we iced it, let the teacher know and sent him into class.

I went to pick him up 6 hours later, and when I saw him coming down the stairs supporting his arm and with a screwed up little face, my stomach dropped...We went straight to the A@E dept. and sure enought a fracture.

And, I'm an orthopaedic nurse, if only he knew how he could milk this, it pressed all my mummy guilt buttons.

Anyway, yes fractures in kids can be easily missed, and they are not always initially identifed on xray - so dont feel too bad.

[Chilenurse]

In this 4 years as a School Nurse I had this happen at least 2 times.

First time I felt very guilty, but now I know that it is very difficult sometimes by kids to see a fracture right away and even on x-ray sometimes they see it later.

The most important is to ice it, tell him or her to come back if it get worser or even go for a x-ray if necessary. Mostly of the times if I`m unsure I just write a little note for the parents. Up to them if they take them to the doc or not.

Greetings from Germany

[Jeanine]

IF ONLY WE HAD X-RAY VISION!!!!

But then we'd all be billionaires and who would take care of the school children?!

My own daughter got kicked in the shin in PE, in my school, and complained for days. I finally took her for and x-ray which was inconclusive. Finally a bone scan showed a fracture, exactly where she was c/o the point tenderness!

I still get a lot of grief for that one!