11.2 Spinal Abnormalities, Osteogenesis Imperfecta (OI) and Osteomyelitis

Question 1

Legg-Calve-Perthes Disease (Calve Disease)

Answer 1

• Avascular necrosis of femoral head
• Temporary disturbance to circulation/vascular supply of head of femur which produces ischemia and avascular necrosis
• It is self limiting but can last several years
• 4 stages from necrosis to reforming
• Happens more often in males than females and peaks at 4-8 y/o
• The younger the child the better the outcome

S/S
- Presents with intermittent limp that worsens with activity

Treatment
- Rest
- Limited Weight Bearing
- NSAIDs

Question 2

Scoliosis

Answer 2

• Lateral S or C shaped curve to the spine
• Commonly found during pre-adolescent growth spurt

S/S
- Truncal asymmetry
- Uneven hips, shoulders
- One sided “rib hump”
- Prominent scapula
- NO PAIN

Treatment
- Bracing
- Surgery

Question 3

Bracing for Scoliosis

Answer 3

• Used for moderate curves (25-45 degrees)
• Anything higher requires surgery

TLSO Brace
- Progressively fixes curvature of spine

Question 4

Other Spinal Issues

Answer 4

Torticollis (Wry Neck)
- Head tilt caused by a rotation in the spine and tightening of sternocleidomastoid muscle.
- Treatment is to stretch the muscle progressively through physical therapy

Kyphosis (Hunchback)
- Upper portion of spine is abnormally curved

Lordosis (Swayback)
- Abnormal curvature of the lower spine
- (looking upward at the lord)

Question 5

Osteomyelitis

Answer 5

• Commonly seen in the summer when children are outside playing and get scrapes/cuts
• Infection of the bone. Usually happens when skin gets cut and bacteria travels to the bone forming an abscess in the bone.
• Typically seen in 10 and younger years old
• Most commonly caused by Staph Aureus

S/S
- Pain, tenderness, swelling, warmth or redness around a certain bone
- Elevated ESR and WBC

Treatment
- Culture of the bone or drain the abscess
- Targeted Antibiotics via IV
- If antibiotics do not work, then surgery is done

Question 6

Osteogenesis Imperfecta (OI)

Answer 6

• Also known as brittle bone disease
• Genetic condition that is characterized by easily fractured bones. Collagen (connective tissue) is affected.
• HIGH RISK FOR FRACTURE AND DEFORMITIES (can even fracture from changing a diaper)

S/S
- Easily fractured bones
- Blue sclera
- Early hearing loss
- Discolored, small teeth

Treatment
- NO CURE
- Bisphosphonate Therapy (to restore strength to bones)
- Handle these children with extreme care