These 3 trauma injuries are easy for you to miss
Young gymnasts may be more stoic than other kids you treat. "So you really have to use all your clinical tools: History, physical exam and X-rays to determine whether it's something more significant or not," says Robert Frederick, MD, sports medicine specialist at the Rothman Institute at Thomas Jefferson University Hospital in Philadelphia. Here are three injuries that could be overlooked by ED nurses:
- Growth plate injury.
"Frequently, it's difficult for emergency room personnel to properly interpret X-rays from skeletally immature patients, says Frederick. "You should always obtain comparison view of the opposite extremity and maintain a low threshold for referral to a specialist, even if the X-rays appear normal."
- Stress fractures.
If a child reports low back pain or pain tingling down one leg, suspect a stress fracture, says Valerie Elliott, RN, an ED nurse at The Children's Hospital in Denver. "This is not something that happens overnight. It occurs over a period of time," Elliott notes.
This fracture easily can be missed because it won't be seen on CT or MRI scans. It can be diagnosed only with a bone scan outside of the ED, says Elliott. "If the patient comes in complaining of lower back pain, you cannot consider it negative unless they have a bone scan," Elliott cautions. "And if a stress fracture isn't taken care of, it can cause some chronic problems."
- Additional fractures.
Because the child might have fallen by as far as 12 feet, there could be multiple fractures involved. "Sometimes we see the obvious fracture, but we might miss another fracture," says Elliott. "Always check the joints above and below the injury."
Young gymnasts may be more stoic than other kids you treat. "So you really have to use all your clinical tools: History, physical exam and X-rays to determine whether it's something more significant or not," says Robert Frederick, MD, sports medicine specialist at the Rothman Institute at Thomas Jefferson University Hospital in Philadelphia.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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