Which of the following types of fractures is most likely to impact growth in a child?
a greenstick fracture
a fracture of the bone shaft
a fracture of the epiphysis of the bone
a compound fracture
The Correct Answer is C
Pediatric skeletal development depends on active epiphyseal growth plates where longitudinal bone growth occurs through endochondral ossification. Physeal cartilage, osteogenic activity, vascular supply, and chondrocyte proliferation determine growth integrity. Injury to this region disrupts alignment, growth potential, and may lead to limb length discrepancy or angular deformity depending on severity and timing.
Rationale:
A. Greenstick fractures occur in immature bone due to increased collagen content and reduced mineralization, producing incomplete cortical disruption. Although common in children, the periosteum remains intact, preserving growth plate function and typically not interfering with longitudinal bone development or epiphyseal activity.
B. Shaft fractures involve the diaphysis, which is primarily cortical bone responsible for structural support. These fractures heal through callus formation and remodeling without affecting the epiphyseal plate, therefore they rarely alter future bone growth or cause permanent growth disturbances.
C. Epiphyseal fractures directly involve the growth plate, which contains actively dividing chondrocytes essential for longitudinal growth. Damage can cause premature physeal closure, growth arrest, or asymmetric development leading to limb shortening or angular deformities, making it the most critical injury affecting pediatric skeletal growth.
D. Compound fractures involve bone penetrating through the skin barrier, increasing infection risk and soft tissue injury. However, unless the growth plate is involved, they do not inherently disrupt bone elongation or epiphyseal cartilage function and therefore have limited direct impact on skeletal growth potential
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Hydrocephalus is characterized by excess cerebrospinal fluid accumulation within the ventricular system due to impaired absorption, obstruction, or overproduction. In infants, open cranial sutures allow increased intracranial pressure to manifest as progressive head enlargement, bulging fontanelles, and ocular displacement known as “sunset eyes.”
Rationale:
A. Spina bifida is a neural tube defect involving incomplete closure of the spinal column and may coexist with hydrocephalus but is not itself an expected clinical finding associated with increased intracranial pressure in this presentation.
B. Low weight for age reflects failure to thrive or chronic malnutrition. It is not a defining feature of hydrocephalus, which primarily affects cranial volume and neurological status rather than systemic growth parameters.
C. Enlarged head circumference is a classic sign of progressive hydrocephalus in infants due to open sutures allowing skull expansion. This compensatory growth occurs as intracranial pressure increases from cerebrospinal fluid accumulation.
D. Poor skin turgor indicates dehydration, which is unrelated to cerebrospinal fluid accumulation or intracranial pressure changes. It reflects fluid loss rather than intracranial pathology.
Correct Answer is D
Explanation
A Milwaukee brace is a cervicothoracolumbosacral orthosis used in the management of adolescent scoliosis to halt curve progression during skeletal growth. It applies corrective pressure to the trunk while allowing growth modulation, requiring prolonged daily wear with proper skin protection to prevent breakdown and ensure alignment correction.
Rationale:
A. Wearing the brace only during sleep is incorrect because therapeutic effectiveness depends on prolonged daily wear, typically 18–23 hours per day. Limiting use to sleep provides insufficient corrective pressure, allowing continued spinal curvature progression during active growth phases.
B. Using the brace only as needed for back pain is inappropriate because the Milwaukee brace is not an analgesic device but a structural correction orthosis. Intermittent use fails to maintain continuous spinal alignment forces required to prevent worsening of scoliosis.
C. Wearing the brace directly against the skin increases risk of skin irritation and pressure injury, especially over bony prominences. Continuous friction and moisture accumulation can lead to breakdown, discomfort, and reduced compliance with long-term brace therapy.
D. The brace should be worn over a fitted t-shirt to protect the skin from direct contact with rigid plastic components, reducing friction and pressure injury risk. A snug cotton layer also improves comfort, enhances adherence, and allows early detection of skin breakdown during routine inspection.
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