Musculoskeletal Conditions (5-7 questions)

Question 1

healing time for bones?

Answer 1

• takes 1 week for every year of age up to 10 yo

Question 2

cast care

Answer 2

• assess cirulcation

- anti-histamines for itch; nothing inside cast!

Question 3

compartment syndrome

Answer 3

• complication of fracture
• swells
• can lead to tissue death and perm disability
• surgical emergency

Neurovascular 5 P's
Pallor - shows lack of perfusion
Pain - more intense?
Pulse - weak or absent?
Paralysis 
Paresthesia - tingling or numbness?

Question 4

Traction - skeletal

Answer 4

• assess skin around pins
• neurovascular assess
• assure weights hang freely
• developmental stim - what toys would be good?

Question 5

Bryant’s traction

Answer 5

• for kids <2
• both legs straight at 90 degrees
• buttocks slightly off bed

Question 6

Hip-spica cast

Answer 6

• mid chest to legs w/bar between legs to abduct
• place disposable diaper under edges to prevent soiling cast
• elevate head of bed so urine and stool drain downward
• skin check - reposition frequently

Question 7

Developmental Dysplasia of the Hip - how ID?

Answer 7

• ID’d in little babies (breech del, fetal pos in womb)
• Otolani/Barlow Sign (“click”)
• shortened limb on affected side
• ASYMMETRICAL SKIN FOLDS IN GLUTEUS AND THIGHS

Older children:

• Limp when walk
• toe walking

Question 8

Developmental Dysplasia of the Hip - interventions

Answer 8

• Pavlik Harness - 6-12 weeks for < 6mo

- Surgical reduction w/Hip Spica Casting (if not responsive to Pavlik Harness)

Question 9

Osteogenesis Imperfecta

Answer 9

• genetic disorder
• bones fracture easily
• sclera is blue tint
• small stature
• spinal curvature
• think skin, brittle teeth

No cure - maximize bone mass thru exercise (swimming, walking)

Question 10

Osteomyelitis

Answer 10

• infection in a bone
• more common in long bones
• fever, pain, swelling, redness in affected area
• 4-6 weeks of antibiotics
• may need surgical removal of necrotic tissue

Question 11

Scoliosis - non-structural

Answer 11

• unequal leg lengths
• C shaped curve of spine - it disappears when child bends over at waist
• treat w/shoe lifts; postural exercises

Question 12

Scoliosis - structural

Answer 12

• an S shaped curvature of spine
• does not disappear when child bends at waist
• dx w/xray

< 40 degrees - prolonged bracing, tight shirt under brace; wear 16-23 hours/day; psych support; traction; electrical stim

> 40 degrees - surgical rods to realign and fuse spine (Harrington Rods); physical therapy; decreased mobility due to surgery