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Case studies—primary care
Suspicious Fracture in a Toddler

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Physical Examination

C.R. appears well and in no acute distress. His weight is 12.7 kg (50th percentile), and his height is 83 cm (50th percentile). Vital signs reveal a temperature of 36.2°C, heart rate of 94 beats per minute, blood pressure of 88/56 mmHg, and respirations of 16 breaths per minute. Examination of the head, ears, eyes, nose, and throat show him to be normocephalic with full range of motion, without bruising; his sclerae are clear and his pupils are equal, round, and reactive to light with normal

Case Study Questions

  • 1

    What are the differential diagnoses?

  • 2

    What is the suggested standard of practice for forensic evaluation of suspected child abuse?

  • 3

    Is there a particular type of referral that should be made in a case like this?

  • 4

    What responsibilities, if any, do you have to a child with this type of injury and diagnosis?

Case Study Answers

1. What are the differential diagnoses?

C.R.'s inability to move his arm was suggestive of a fracture, and a nondisplaced supracondylar humeral fracture was confirmed by radiograph. This fracture was noted in the extra-articular aspect of the thin bones between the olecranon fossa of the distal humerus. The fracture line noted was nondisplaced and was visualized from the anterior distal point to the posterior proximal site of the distal humerus. The lack of knowledge regarding the mechanism of

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Clare Cardo McKegney is a Pediatric Nurse Practitioner, The Center for Advanced Pediatrics, Norwalk, Conn.; candidate for the Doctorate of Nursing Practice degree at Columbia University; and Fellow of the National Association of Pediatric Nurse Practitioners.

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