A school-age child sustained a contusion on the front of one thigh while playing football and reports some difficulty flexing his foot on the affected side. What will the primary care pediatric nurse practitioner do to treat this injury?

• A. Place the child on crutches and limit weight-bearing until symptoms subside.
• B. Refer the child to an orthopedic specialist for immediate evaluation and treatment.
• C. Recommend rest, ice packs, compression, and elevation of the extremity.
• D. Prescribe acetaminophen with hydrocodone along with NSAIDs.

Answer: (B)

A thigh contusion with difficulty flexing the foot signals potential injury beyond a simple bruise—such as occult fracture, significant soft-tissue injury, or nerve/vascular involvement. In a school-age child, these signs raise concern for problems that can worsen if not promptly evaluated, so an orthopedic assessment is appropriate to rule out fractures, assess for compartment syndrome, and determine the need for immobilization, imaging, or further treatment.

While resting, icing, compression, elevation, and basic analgesia are appropriate for minor contusions, the new limitation in moving the foot indicates a higher risk injury that benefits from specialized evaluation. Delay or relying solely on over-the-counter analgesics could miss a fracture or nerve injury, leading to complications. Therefore, urgent referral to orthopedics for prompt imaging and management is the best course.