A 14-year-old is admitted to the emergency department with a ...

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A 14-year-old is admitted to the emergency department with a fracture of the right humerus epiphyseal plate through the joint surface. What information does the nurse know regarding this type of fracture?
 
  a. It will create difficulty because the child is left handed.
  b. It will heal slowly because this is the weakest part of the bone.
  c. This type of fracture requires different management to prevent bone growth complications.
  d. This type of fracture necessitates complete immobilization of the shoulder for 4 to 6 weeks.

Question 2

What finding is characteristic of fractures in children?
 
  a. Fractures rarely occur at the growth plate site because it absorbs shock well.
  b. Rapidity of healing is inversely related to the child's age.
  c. Pliable bones of growing children are less porous than those of adults.
  d. The periosteum of a child's bone is thinner, is weaker, and has less osteogenic potential compared to that of an adult.

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Answer to Question 1

ANS: C
This type of fracture (Salter type III) can cause problems with growth in the affected limb. Early and complete assessment is essential to prevent angular deformities and longitudinal growth problems. The difficulty for the child does not depend on the location at the epiphyseal plate. Any fracture of the dominant arm presents obstacles for the individual. Healing is usually rapid in the epiphyseal plate area. Complete immobilization is not necessary. Often these injuries are surgically repaired with open reduction and internal fixation.

Answer to Question 2

ANS: B
Healing is more rapid in children. The younger the child, the more rapid the healing process. Nonunion of bone fragments is uncommon except in severe injuries. The epiphyseal plate is the weakest point of long bones and a frequent site of injury during trauma. Children's bones are more pliable and porous than those of adults. This allows them to bend, buckle, and break. The greater porosity increases the flexibility of the bone and dissipates and absorbs a significant amount of the force on impact. The adult periosteum is thinner, is weaker, and has less osteogenic potential than that of a child.

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