1229 Exam 7: Scoliosis, Club Foot, Congenital Hip

Question 1

What are the three types of scoliosis?

Answer 1

Idiopathic
Functional
Structural

Question 2

Definition of Scoliosis

Answer 2

a complex spinal deformity in three planes, usually involving lateral curvaturature, spinal rotation causing rib asymmetry, and thoracic hypokyphosis
Most common spinal deformity
Classified by age of onset
Typically diagnosed in adolescents, usually girls and diagnosed in growth spurt

Question 3

What is idiopathic scoliosis?

Answer 3

Just don’t know what the cause is

Question 4

What is functional scoliosis?

Answer 4

Caused by some other problem, like unequal leg length

Question 5

What is structural scoliosis?

Answer 5

A loss of flexibility, bony changes in the spine, true structural scoliosis the spine will fail to straighten when they bend to the side

Question 6

Degree of spine

Answer 6

Less then 10 degrees are considered postural variations not true scoliosis
Less then 20 degrees if they don’t progress may not require treatment

Question 7

What are the s/s and diagnosis of scoliosis?

Answer 7

Parents reporting that clothes don’t fit right
Positive school screening- Adams test: bend forward with arms hanging loosely, looking for rib asymmetry and for the alignment of the head and gluteal cleft, scapula will be up on one side if a positive Adams test
Observation with screening
X-ray in s standing position, will tell degree of curvature- Kahve technique
Risser scale- how mature skeletal system is so we have an idea how likely the curvature will progress
MRI- scoliosis can occur with other stuff- does not diagnose scoliosis, looks for the other problems that are going along with it

Question 8

Treatment of scoliosis

Answer 8

Decide to treat scoliosis is by the magnitude of the curvature, location of the curvature, type of curvature, age or skeletal maturity of the child, and what underlying disease processes are there

Question 9

How do you treat scoliosis?

Answer 9

Will almost always involve bracing and exercising, they always need to work together, exercise to strength abdominal core muscles and back muscles
Electrical stimulation
Chiropractor
Surgery will be done based on degree of curvature, cause of curvature, curvature of 40 degrees or more will most always have to have surgery, congenital of 30 degrees because of the risk of progression

Question 10

Types of Braces

Answer 10

Boston and Wilmington- under arm prefabricated plastic shell, used mostly for lumbar curvatures
TLSO (thoracolumbosacral orthotic)- individually custom molded plastic shell, it can be molded to fit THAT child’s deformity
Milwaukee- leather and steel contraption, it can be individually adapted, extends from chin cup and neck pads all the way down to pads that rest on the pelvis, used mostly for kyphosis
Charleston- night time bending brace, only used at night b/c it prevents the child from walking, don’t want to keep them inactive during the day

Question 11

What does it mean by surgical correction?

Answer 11

Realignment, fixation or bony fusion, can use donor bone to do graphs.
Using an internal fixation device

Question 12

What is the goal of surgery?

Answer 12

To have a solid, pain free torso that’s well balanced

Looking for maximum mobility in the child

Question 13

Pre op

Answer 13

Talk to parents that this is a major surgery, can be schedule, might want to donate own blood for surgery or can use salvaged blood, parents will have to know how to log roll the child, need to know about chest tubes b/c if anterior repair will have them, foley cath to keep urine away from dressing, based on age need to bring their own things to keep them busy, needs peer counseling

Question 14

Post op

Answer 14

Performing log rolling, use something to relieve pressure on bony prominences, frequent vital signs, circulation checks, neuro vascular checks, giving Pain med IV, PCA if child is old enough to understand, PCA by Proxy is a legal document assign one person, teach specific things and document they were taught, proxy can be a nurse but is only that one nurse can push PCA button,

Question 15

What is club foot?

Answer 15

A skeletal defect of the foot, a term used to describe a common foot deformity, cause is not really known

Question 16

What are the position’s of club foot?

Answer 16

Talipes varus- inversion of the foot, turned inward towards the body
Talipes valgus- everted from the body, turned away
Talipes calcaneus- heal lower than toes
Talipes equinovarus- toes lower than toes majority of club feet

Question 17

What are the degrees of club foot?

Answer 17

Positional is the mildest form, no bony involvement, might be utero crowding, tends to resolve on its own
Syndromic is when it’s associated with another problem, deformity of spine, chromosomal abnormality, typically talking about cerebral palsy or spina bifida
Congenital/Idiopathic is the true club foot, has skeletal involvement, rigidity, almost always need surgery to correct

Question 18

How do you diagnose club foot?

Answer 18

Pre natal ultrasound
can detect at birth
usually boys have club foot
half cases are both feet bilateral
addition problems are usually CP or spina bifida

Question 19

Treatment for Club Foot

Answer 19

treatment is begun at birth, as early as the newborn nursery, involves correcting then maintaining, stages of treatment are correction, maintenance and prevention, goal of treatment is for a painless pantegrated foot, because if painless and stable they are able to go through normal development

Question 20

Treatment stages

Answer 20

Correction- start with serial casting, may have to be casted couple times a week at first, move to weekly then bi weekly as growth starts to slow, want to see foot in correct position by 3 months, if isn’t corrected by 4 months start to look at surgery as an option, surgery be done between 6-12 mo, still got to wear cast up to 12 weeks, once out of cast then braces, on continuous bracing 23 hrs/day up to 3 mo before moved to Maintenance by just wearing at night

Question 21

Cast Care

Answer 21

elevate cast 1st day, extremities will swell, do not handle wet cast with fingers, handle with palms of hands, do not put anything in cast, may have infection if fever (hotspot on cast)

Neurovascular assessment
5 P’s for sure- Pain, pulse, pallor, paresthesia, paralysis

Question 22

Dysplasia of hip

Answer 22

abnormal development of the hip, typically includes shallow acetabulum, may be subluxation or dislocation, shallow acetabulum roof, occur in combination will some other problem, 20% are both hips, if in one hip usually the left hip

Question 23

Causes of DDH

Answer 23

intrauterine factors such as crowding, LGA, multiple births, frank breech position, c section baby

Question 24

Cultural factors for DDH

Answer 24

typically Caucasian, how they handle babies, tightly swaddled or strapped to devices with hips open are at great risk for DDH, abducted position on hip or strapped to back have lower incidence of dysplasia

Question 25

Degress of DDH

Answer 25

Preluxation- mildest form, shallow acetabulum roof but femoral head in firm contact, no dislocation or not easily dislocated
Subluxation- most of hip dysplasia, dislocatable not dislocated, demonstrated by Ortoloni and Barlow, frank dislocation
Dislocation- when femoral head comes out of acetabulum

Question 26

Ortoloni and Barlow Test

Answer 26

done by holding babies knees in flex position, placing fingers on hip joints, push forward to see if hip is clicking is the able to dislocate
We will never do test b/c can cause dislocation that’s persistent

Question 27

Assessment of DDH

Answer 27

typically found on well baby visit, shortening of one of the limbs, widening of perineum esp in bilateral, asymmetric leg creases, asymmetric movement, x-ray is to tell about bones and hip joint is cartilage early on, prenatal ultrasound for DDH, x-ray and MRI after 4 months, bilateral dislocation in older child will have strange waddling gait, strange waddling gait=bilateral dislocation, long bones hurt while growing, restless legs and Tylenol for pain

Question 28

Treatment

Answer 28

done has soon as problem recognized, 0-6 mo Palik harness, 6-12 mo skin traction used- weight needs be free hanging to work, hip spika cast opened in center for diapering, maintain position of femoral head into acetabulum for gravity to fix position, closed reduction- pop back in, open reduction-surgical and lock in position, after 6 yrs old tend to not want to fix b/c of damage to joint, FIX EARLY, problems are for child to adapt to the changes