Missed it

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I missed a wrist fracture.

Kid came in, had fallen. We iced. ROM was fine, no swelling or bruising while he was in the clinic, grip strength was good. I sent him along. Never heard anything more, but it was close to the end of the day.

Mom comes in yesterday afternoon upset I didn't contact her. I explain that I didn't see anything to report, he had no signs of a fracture. I offered to contact her every single time he crosses my threshold. He was playing while we talked, and I still didn't see anything out of the norm. Was grasping with both hands, turning and twisting his wrists. Then, the note came this morning it was indeed a fracture.

Part of me feels like crap; I honestly didn't see anything and would have (and have called) if I saw anything to suspect an injury. I hate that I missed it. I keep trying to think of what I didn't check that might have clued me in.

Part of me is a little pissed; mom comes in, mad at me. But, she waited all weekend to take him in to be examined. The office is the same one I use, and is open every day with extended hours. Not to mention all the Urgent Care clinics and two ERs in the area. If she was as concerned as she claims, why wait?

How do you handle joint injuries? What else could I assess?

TIA virtual co-workers!

Also, every single medical professional (me, EMTs, ER doctors) who saw my daughter's displaced broken arm thought is was a dislocated shoulder because the deformity was up so high (just missed her growth plate). The xray proved us all wrong. You can see the xray (and all the support I got!) in this thread: https://allnurses.com/school-nurses/my-daughters-arm-1053406.html

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Specializes in Occupational Health.

Ya'll are simply the BEST! :inlove:

I promise, I'm letting this go as of now!

It does mean a lot to know I'm not the only one who has missed things. This school nursing is a different beast for sure!

Thankfully I have a solid admin team that backs me up too. My principal came by and said she's one of those tough it out moms and has waited days with her kids only to find out it's really something.

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I had a student a couple of weeks ago that hurt her wrist at home. Good range of motion, no swelling. She returned for several days requesting ice for pain, which I reported to the parents. After 1 week they took her in for an xray and of course there was a fracture. The kicker both parents, who were with her when the injury happened, are physicians. NO ONE has xray vision.

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Specializes in school nursing, ortho, trauma.

Didn't you get your pair of School-tec x-ray specs? Helping school nurses assess possible fractures since i don't know when. I keep my pair right next to my crystal ball.

Seriously - You can only assess what you see. If the kiddo had good range of motion, - swelling and wasn't complaining then it would be no cause for concern. You said yourself that mom waited the whole weekend so I see that she was very concerned.

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Don't beat yourself up. I missed a tibia fracture in my 18 month-old several years ago. He tripped and fell on a walkway and got up and kept playing, never cried. Started limping about three days later and I brought him into doctor thinking the worst and they saw nothing on x-ray. Limp got progressively worse and I kept thinking the x-ray was clean so no need to do anything. Finally after a couple more days I brought him back because I was then imagining something terrible like cancer or something...it was a fracture. First x-ray didn't show it because it was small and they only saw it on a repeat x-ray once bone ossification had occurred several days later. He got a thigh-high cast.

My point is he looked fine, barely limping, and it took me a few days to do anything about it. Mom needs someone to be mad at so she doesn't look bad and feel bad about her own lack of follow-up medical care is my guess. I bet your student had a small buckle fracture which is super common and they don't even always cast those. We dealt with one of those as well in my four year-old and there was some back and forth about whether or not to do x-rays and even then, if we should cast it or not...

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Specializes in School Nursing.

This comment thread is amazing.

The kid likely would have behaved the same at home if he was injured the same way. If it was summertime the mom would have no one to blame but herself. You are just conveniently available to project onto.

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Don't beat yourself up, I let my own son walk around with a broken arm for 3 days before I took him to the dr. Same thing, no outward signs, even the doc said he didn't think it was anything, but did an xray and there it was, plain as day.

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When I was a teenager, my karate instructor was demonstrating wrist locks and told me to tap when it hurt...it never hurt...until he let go and then Holy blinding pain, Batman! No swelling, No bruising, but a ton of pain. ER doc insisted that the Xrays were negative. A few days later my PCP called my mom to schedule a cast check...for my broken wrist.

My first year as a school nurse, FF came in said she hit her wrist on her desk and it hurt. Looked fine, gave her an ice pack, school day ended 5 minutes later. The next day, mom is angry AF because I didn't call her about her daughter's broken arm...that she had checked out at 8pm AFTER gymnastics, which the child participated fully in. So I started calling her about everything, between 2-6 visits a day, everyday.

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Specializes in School Nurse, past Med Surge.

I've missed fractures & I've sent kids out for x-rays that turned out to be nothing. It happens. It will happen again. I think you handled it the way any of us would. Now you know, call mom on this kiddo for everything...I think you were right to do that. She'll get sick of it sooner or later and ask you to stop, I bet.

And, tomorrow, don't forget your x-ray glasses. :bugeyes:

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Specializes in Pediatrics Retired.
...And, tomorrow, don't forget your x-ray glasses. :bugeyes:

I've tried these...they don't work; you can't even see through clothing...:bag:

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I've tried these...they don't work; you can't even see through clothing...:bag:

THIS is why I love you, too, ya perv.

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Specializes in ICU/community health/school nursing.

Thankfully I have a solid admin team that backs me up too. My principal came by and said she's one of those tough it out moms and has waited days with her kids only to find out it's really something.

That is awesomesauce. I hope she stays around for you!

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