MS 2

Question 1

medical management of DDH

Answer 1

• Treatment varies depending on the severity of the symptoms, the extent of the dysplasia, and the infant’s age.
• Greater chance a normal hip will develop if dislocation is corrected during the first days of life
• During neonatal period, a corrective device is placed to maintain the hip in flexion and abduction

Question 2

most common treatment of DDH

Answer 2

• Traction is used followed by casting/immobilization between the ages 6 to 18 months
• Older child – operative reduction

Question 3

describe scoliosis

Answer 3

• Lateral curvature of the spine of more than 10 degrees
• Can occur anywhere along the spine – thoracic area is the most common
• Most common spinal deformity
• Can be congenital, develop during infancy or childhood, but most commonly seen in early adolescence – called idiopathic scoliosis*

Question 4

scoliosis diagnostics

Answer 4

Forward bending test – screening test

X-ray of the spine – anterioposterior and lateral

Question 5

medical management of scoliosis

Answer 5

• Monitored closely every 3 to 12 months is curve is less than 20 degrees
• If curvature 20 to 40 degrees, bracing is usually considered along with exercise
• Surgery may be considered for severe cases

Question 6

if bone is every disturbed…

Answer 6

(ie/ surgery or compound fracture), at risk for bone infection (ex/ osteomyelitis requires antibiotics)

Question 7

mild and severe treatment of scoliosis

Answer 7

• If curvature is not too bad, just try to attempt good posture to strengthen back muscles to prevent further complications or back discomfort/pain
• May continue to worsen, may need brace or surgery if brace doesn’t work (put rods in bone)

Question 8

describe osteomyelitis

Answer 8

• Infectious process of the bone
• May be acute or chronic
• Can occur at any age. Most commonly between 1 to 12 years
• Most commonly seen in boys – two to three times as often as girls

Question 9

clinical manifestations of osteomyelitis

Answer 9

-Fever
-Abrupt pain – point tenderness above the bone and swelling and warmth over the bone
-Unwillingness to bear weight or to move limb
Irritability
-Possible dehydration/poor appetite

Question 10

medical management of osteomyelitis

Answer 10

• IV antibiotics usually for 4 to 6 weeks
• Bed rest
• Affected limb may be immobilized in a cast or splint
• Surgery may be performed

Question 11

A group of muscle disorders that cause the gradual wasting of symmetrical groups of skeletal muscles.
Most common group of muscle disorders in childhood

Answer 11

Muscular Dystrophies

Question 12

is the most common and serious type of muscular dystrophies

Answer 12

Duchenne’s

Question 13

describe Duchenne’s

Answer 13

This is an X-linked disorder; it is seen only in males
Onset: within first 3-4 years of life
*Sometimes children are perfectly normal in development until ages 3 or 4 and start having muscle wasting

Question 14

describe the development of Duchenne’s

Answer 14

• Muscle weakness begins in the lower extremities in early childhood
• As the disease progresses scoliosis, other musculoskeletal conditions, cardiomyopathy, and respiratory difficulty occur
• *Progressive weakness and muscle deformity leads to chronic disability

Question 15

treatment of muscular dystrophies

Answer 15

• No effective treatment for childhood muscular dystrophy

- Treatment goal is to provide support and prevent complications such as infection or spinal deformities

Question 16

MD diagnostics

Answer 16

Serum enzyme assay, muscle biopsy, and electromyography confirm diagnosis

Question 17

what is a fracture and how are they classified

Answer 17

• Break in bone associated with a fall or other trauma

- Classified according to the type of fracture line & tissue injury (simple-closed or compound-open)

Question 18

greenstick vs complete fracture

Answer 18

• Greenstick most common type in under age 3 year

- Complete – divides bone fragments; Incomplete – fragments remain attached

Question 19

treatment of fractures

Answer 19

casting, traction, surgery

Question 20

common fracture sites

Answer 20

forearm, clavicle, femur, tibia, fibula

Question 21

emergency treatment for fractures

Answer 21

• Immobilize
• Elevate extremity
• Apply cold pack: Generalized swelling from muscles contracting & physiologically splinting the injured area
• Cover open wounds
• Assess neuro vascular (NV) status

Question 22

diagonal or slanting break that occurs between the horizontal and perpendicular planes of the bone

Answer 22

oblique fracture

Question 23

break of fracture line occurs at right angles to the long axis of the bone

Answer 23

transverse fracture

Question 24

bone is splintered into pieces

rare in children

Answer 24

comminuted

Question 25

twisted or circular break that affects the length rather than the width **frequent in child abuse

Answer 25

spiral

Question 26

describe compartment syndrome

Answer 26

* *Most serious complication - Condition of increased pressure in a limited space such as the soft tissue of an extremity, which compromises circulation and nervous innervation

Question 27

s/s of compartment syndrome

Answer 27

``` Paresthesia Pain Pressure Pallor Paralysis Pulselessness **Remember to always monitor neurovascular status of affected area ```

Question 28

why do we call these neuro assessments if unlike normal neural checks

Answer 28

***neurovascular because looking at color and feeling, not cranial

Question 29

process of bone healing

Answer 29

Bone Injury Fibrocartilaginous Callus Formation Bone Remodeling Bony Callus Formation

Question 30

children typically recover ____ from bone injury

Answer 30

*quickly | Can go in and look at potentially child abuse (look at x rays and see it did not form straight)

Question 31

what are the purposes of traction

Answer 31

1) To fatigue the involved muscle & reduce muscle spasm so bones can be realigned 2) To position the distal & proximal bone ends in desired realignment to promote satisfactory bone healing (reduction) 3) To immobilize the fracture site until realignment & healing to permit casting or splinting

Question 32

is produced by attaching weight to the distal bone fragment balanced by the backward force of the muscle pull (counter traction) & force between the patient & bed (friction)

Answer 32

forward force (traction)

Question 33

to adjust counter traction...

Answer 33

increase/decrease foot of bed

Question 34

applied to the body part by hand & placed distally to the fracture site; often performed during cast application **most common type

Answer 34

manual traction

Question 35

pull is applied directly to the skin surface & indirectly to the skeletal structures; pulling mechanism is attached to skin with adhesive material or an elastic bandage

Answer 35

skin traction

Question 36

pull is applied directly to the skeletal structure by a pin, wire, or tongs inserted into or through the diameter of the bone distal to the fracture

Answer 36

skeletal traction

Question 37

is traction still used

Answer 37

yes, but less common (surgery used more)

Question 38

when is traction still used

Answer 38

- typically if very traumatic event (ie/ neck injury) - bones are very compacted * **need weights on one side, hanging freely (not sitting on the floor)

Question 39

complications of traction

Answer 39

``` Decreased muscle strength, tone, & endurance Disuse atrophy Loss of joint mobility Weak back & abdominal muscles Bone demineralization Decreased metabolic rate Venous status & thrombus formation Dependent edema Loss of respiratory muscle strength Anorexia, abdominal distention, & constipation Skin breakdown Urinary retention ```