x-ray eyes weren't working

[schoolnurse2015]

I know I shouldn't beat myself up, but just had a parent come in this morning to let me know that her son's ankle may be fractured. He came in yesterday with a steady gait. There was no swelling at all, no bruising, and had full ROM. I tried to offer him ice but he didn't want that, he said it felt better by the time I was done my assessment. I didn't even call mom about it because he checked out just fine. I know we don't have x-ray eyes, but just wish I would have caught it.

[schoolnurse61]

Well my x-ray eyes failed me (must be my age). I missed a fracture! Kiddo came in after recess and showed me on the injured hand how his fingers were bent back at recess. Assessment showed not bruising or swelling, he had good ROM and denied pain w that ROM. Gave him ice sent him on his way back to class. his grandmother happens to work in my building so i told her that i saw him and his complaint. guess by the time he got home his hand was quite swollen. ER visit, Peds ortho appt and he is in school the next day with a cast! YIKES. Hate when that happens! gonna have to get to the eye doctor for a checkup!

[MrNurse(x2), ADN]

Had a snowflake c/o bilateral shin pain, no pain with palpation or ankle rotation. My kids present their growing pains like this, but this snowflake has a helicopter mom and I gave the caveat that sometimes fractures are masked. Good way to CYA without being alarmist.

[BeckyESRN]

I'm having the opposite issue- 3 kids so far this year- tons of pain, unable to tolerate even passive ROM, very tender- call home recommend an x-ray and they've all been fine. 2 parents were annoyed with me because "you're the nurse, you should know if something is broken or not". I can only assess what I see and if your kids really appears to be in pain, you can bet I'm going to call you! Sent out another this afternoon, fell off of monkey bars unto arm, we'll see tomorrow if that one was broken.

[RatherBHiking, BSN, RN]

I don't know why we are expected to be able to tell if something is fractured just by assessing. Sure sometimes it's obvious but a lot of times even Dr's can't tell without an xray and even then not always right away. My son had to have 2 x-rays a week apart before they could tell his thumb was fractured. I had one student have 2 x-rays and an MRI before they determined his arm wasn't broken. You did nothing wrong. It's not our job to diagnose anyway.

[kidzcare]

Sign me up for the xray eyes please! I didn't so much miss a fracture this week as I was surprised by one.

I had a student come in from PE after falling and having a hard time lifting his arm. Had him rest with ice. He said he couldn't lift his arm enough to change out of PE clothes. So I called both mom and dad and couldn't get a hold of them. He was in my office about 3 hours before mom could come. He was not complaining AT ALL except when he moved. Then it was all very dramatic. I couldn't get a good read if he was exaggerating or not. Mom called the next day- broken clavicle.

[JenTheSchoolRN, BSN, RN]

Sign me up for the xray eyes please! I didn't so much miss a fracture this week as I was surprised by one.

I had a student come in from PE after falling and having a hard time lifting his arm. Had him rest with ice. He said he couldn't lift his arm enough to change out of PE clothes. So I called both mom and dad and couldn't get a hold of them. He was in my office about 3 hours before mom could come. He was not complaining AT ALL except when he moved. Then it was all very dramatic. I couldn't get a good read if he was exaggerating or not. Mom called the next day- broken clavicle.

I had a kiddo break her ankle without as much as a tear. She could not bear weight and ankle had edema you could see from 20 feet away, so I was definitely calling home and giving an x-ray recommendation. But this kid was actively talking and smiling. I asked her if it hurt and she was like "yeah, but I've had worse." I laughed out loud a little. I have other kids that pull out the drama with a papercut, go figure!

[grammy1]

Has the snowflake shown up in a cast yet?

[DEgalRN]

I missed a broken finger. Kid came with some minor swelling, but no bruising or disfigurement. Full ROM present, said it was very minor pain, but not difficulty. Gave him an ice pack. He came back to drop off the ice pack, and said it felt better. I'm not sure what prompted mom, but she took him for an x-ray and apparently there was a small fracture. I don't feel too bad about missing it, but it's still a sting.

[JenTheSchoolRN, BSN, RN]

I missed a broken finger. Kid came with some minor swelling, but no bruising or disfigurement. Full ROM present, said it was very minor pain, but not difficulty. Gave him an ice pack. He came back to drop off the ice pack, and said it felt better. I'm not sure what prompted mom, but she took him for an x-ray and apparently there was a small fracture. I don't feel too bad about missing it, but it's still a sting.

See, Mom know their kids much better than I could (well, most of the time, but not the thread for that!), so it could have been something small, like him gripping something at home in a different way that he doesn't usually do while doing something at home that we won't have observed him doing at school in a brief time he was our offices.

[kidzcare]

I had a kiddo break her ankle without as much as a tear.

Most of the kids I've seen with bad breaks pretty much look shell shocked. I had a kid with a broken arm come in with an extra bend to his arm. He calmly said "I uh... I hurt my arm" and I said "Well, you broke that arm. Ever been in an ambulance? Today's your day" He had broken the radius and ulna so you can imagine the way his arm bent *shudder*

When my daughter broke her arm she was calm as could be too. Well, until I couldn't ride in the ambulance with her because I had my other two kids with me.

[BeckyESRN]

Possible fx #4 this month, was in fact, fractured. Little one come to me on Monday with an ace bandage in place that the ER gave her and let me know that she is going to see an "Ortho ped doc" on Friday. Next day she comes in with a much better, much more stable looking wrap in place and told me "My mom's vet wrapped me up" Mom is receptionist at a Vet's office

[SchoolNurseTXstyle]

My favorite line that I use "I can see what is happening on the outside, I cannot see what is happening on the inside." With my population of affluent helicopter parents, I tend to over refer for musculoskeletal injuries just to cover myself.

This morning, I was walking a possible wrist fracture down the hall. One of his teachers saw him in the triangular bandage/ sling and yelled "OH MY GOD, is he going to be ok??Poor baby, Poor baby." I ignored her. C'mon now - what am I going to say to that? "No, he is going to die!" Just made the poor kid more anxious than he already was.