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i Human: Andrew Chen
Walden University
NRNP 6541 C8
Dr. Lisa Rinsdale
November 6, 2026
2
i Human: Andrew Chen
PRIMARY DIAGNOSIS:
S89.021A: Salter-Harris type 2 physeal fracture of the right distal tibia.
The Salter-Harris (SH) Classification System is a way to grade fractures that
involve the growth plate (physis). Seventy-five % of lower extremity fractures in
children are SH type 2. (Levine et al., 2026) When a Pt presents with ankle symptoms
a detailed history and physical examination are crucial. Although a nurse
practitioner may provide initial care and refer to a pediatric orthopedic specialist,
obtaining details about the trauma may help narrow down the differentials and
testing needed. In addition, a basic understanding of the pediatric anatomy can lead
to a better understanding of the mechanism of injury. Bone growth is not complete
for a male until somewhere between the ages of 14 to 17 years old. Growth plates
are made of cartilage and as the child ages, the cartilage hardens into bone which is
less flexible and rubbery. (Su & Larson, 2015) AC is 14 years old and because his
growth plates are still primarily cartilage, the risk of SH fracture is high. AC
presented with right ankle pain, swelling and bruising. On exam, his inability to
walk/bear weight and the presence of right ankle bony tenderness make a fracture
much more likely. (Levine et al., 2026)
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