A two-year-old child has sustained an injury to the leg and refuses to walk. The nurse in the emergency department documents swelling of the lower affected leg. Which of the following does the nurse suspect is the cause of the child’s symptoms?
A. Possible fracture of the tibia.
B. Bruising of the gastrocnemius muscle.
C. Possible fracture of the radius.
D. No anatomic injury, the child wants his mother to carry him.
Correct Answer: A. Possible fracture of the tibia.
The child’s refusal to walk, combined with swelling of the limb is suspicious for fracture. The severity of a fracture usually depends on the force that caused the break. If the bone’s breaking point has been exceeded only slightly, then the bone may crack rather than break all the way through. If the force is extreme, such as in an automobile crash or a gunshot, the bone may shatter.
Option B: Toddlers will often continue to walk on a muscle that is bruised or strained. If the bone breaks in such a way that bone fragments stick out through the skin, or a wound penetrates down to the broken bone, the fracture is called an “open” fracture. This type of fracture is particularly serious because once the skin is broken, infection in both the wound and the bone can occur.
Option C: The radius is found in the lower arm and is not relevant to this question. If possible, do not move a person with a broken bone until a healthcare professional is present and can assess the situation and, if required, apply a splint. If the patient is in a dangerous place, such as in the middle of a busy road, one sometimes has to act before the emergency services arrive.
Option D: Toddlers rarely feign injury to be carried, and swelling indicates a physical injury. The signs and symptoms of a fracture vary according to which bone is affected, the patient’s age and general health, as well as the severity of the injury.