Musculoskeletal Dysfunction Flashcards
What will occur when resistance between a bone and an applied stress yields to the applied stress, resulting in a disruption to the integrity of the bone?
Fracture
What is the most common site of a fracture?
distal forearm (radius, ulna, or both)
What tends to happen faster in children rather than adults?
healing/remodeling of the bone
What factors affect remodeling?
age, location, degree of deformity
What are the six types of fractures?
- plastic deformation (bend)
- buckle (torus)
- greenstick
- complete
- spiral
- growth plate
What will you see in a new fracture?
- generalized swelling
- pain or tenderness
- deformity
- diminished functional use
- ecchymosis
- muscular rigidity
- crepitus
What are the priority actions that you must do with a fracture?
- calm and reassure
- determine the mechanism of injury
- assess the 6 P’s
- move the injured part as little as possible
- cover open wounds with sterile or clean dressing
- immobilize the limb
- reassess neurovascular status
- apply traction if circulatory compromise is present
- elevate the limb if possible
- apply cold to the injured area
- call EMS or transport t to medical facility
What are a few advantages of plaster casts?
- molds close to the body (used better for areas such as pelvis)
- less expensive
- smooth finish (easier to write on)
What are a few disadvantages of plaster casts?
- very heavy
- dry from the inside out
- can take up to 72 hours to dry
- not water resistant
What are a few advantages of synthetic casts?
- lighter weight
- dry quickly
- can be made to be water resistant
- comes in multiple colorsc
What are a few disadvantages of synthetic casts?
- rough texture (harder to write on)
- cannot be molded as close to the body
- more expensive
What is the gold standard to diagnose a fracture?
X-ray
What should you consider when applying a cast to a patient?
- developmental considerations
- cotton liner prior to casting
- pad boney prominences
- mold cast material to limb
- ensure smooth cast edge
- inspect skin integrity
What are a few cast considerations?
- dry from inside out
- no heat lamps or warm hair dryers
- reposition wet cast with palms
- elevate cast/extremity
- apply ice
- assess for s/s of infection
- petal if needed
- assess 6 P’s
- windows
- bivalve
- objects
- moisture
What do you use to remove a cast?
cast cutter/saw
What should you educate regarding cast removal?
- appearance
- skin care
- return to activity
- joint mobility
What is the purpose of traction?
- realign bone
- immobilize
- fatigue muscle to reduce spasms
What are the two different types of traction?
- skin
- skeletal
What is the type of traction ordered dependent on?
- fracture
- child’s age
- associated injuries
What is skin traction applied to?
directly to the skin surface and indirectly to the skeletal sutures
How does skin traction work?
pulling force is applied by weights using tape and straps, weights are attached by a rope to the extremity
What is buck extension useful for?
short term immbolization for issues such as dislocated hips and Legg-Calve-Perthes
How does buck extension work?
- leg is placed in an extended position
- boot appliance is attached to the traction
What is bryant traction useful for?
immobilizes both lower extremities
- fractured femurs
- developmental dysplasia of the hip
How does bryant traction work?
traction applied to the legs, legs flexed at a 90 degree angle at the hips, buttocks raised slightly off bed
What is skeletal traction useful for?
allows for longer traction time and heavier weights
How does skeletal traction work?
applied direclty to the skeletal structure, pin, wire, or tongs inserted into or through the diameter of the bone distal to the fracture
What is 90-90 traction useful for ?
bone realignment, lower portion of leg is supported in cast boot or sling
How does 90-90 traction work?
Steinmann pin or Kirschner wire in distal fragment of femur, results in 90 degree angle at both the hip and knee
What is halo traction useful for?
allows for greater mobility of the body while avoiding cervical spinal motion in displaced or fractured vertebrae
How does halo traction work?
steel halo is attached by four screws inserted into outer skull, rigid bars connect halo to a vest
*scheduled neuro assessments
What should you assess for with all forms of traction?
- 6 P’s
- skin integrity
- body alignment
- pin sites
- position of bandages, frames, splints, boots
- ropes and pulleys
- weights
- bed position
- administer analgesics/muscle relaxants
- developmental and psychosocial needs
Define osteomyelitis.
infection within the bone, usually casued by bacteria introduced by trauma or surgery, by direct extension from a nearby infection or via the bloodstream
What is the most common organism that causes osteomyelitis?
staphylococcus aureus
Where is osteomyelitis most commonly found?
long bones and in children less than 10 years old, and boys more commonly than girls
What will you see in a child with osteomyelitis?
- pain
- fever
- irritability
- erythema
- decreased movement
- edema
- warmth
How is osteomyelitis diagnosed?
- cultures
- labs
- x-ray
- bone scan
- CT scan
- MRI
- bone biopsy
What nursing interventions should we apply to children with osteomyelitis?
- assess 6 P’s
- administer IV antibiotics
- administer analgesics
- promote rest/comfort
- no weight bearing/immobilization
- nutritional considerations
- surgery possibly
- developmental and psychosocial needs
Define Legg-Calve-Perthes Disease.
A condition with unknown etiology that affects the hip where the femur and pelvis meet in the joint;
Who is most susceptible to Legg-Calve-Perthes Disease?
- children 2-12 years old
- boys 4-8 years old
What are the four stages of Legg-Calve-Perthes Disease?
- Necrosis
- Fragmentation
- Reossification
- Remodeling
What is the necrosis stage of Legg-Calve-Perthes Disease?
- Septic necrosis or infarction of the femoral capital epiphysis with degenerative changes which produces flattening of the upper surface of the femoral head
What is the fragmentation stage of Legg-Calve-Perthes Disease?
- Capital bone resorption and revascularization with fragmentation (vascular resorption of the epiphysis
What is the longest stage of Legg-Calve-Perthes Disease?
Stage 3-reossification
What is the reossification stage of Legg-Calve-Perthes Disease?
- New bone formation, seen as calcification and ossification as increased density
What is the remodeling stage of Legg-Calve-Perthes Disease?
- Gradual reformation of the femoral head, hopefully with a spherical form
What clinical manifestations might you see in a patient with Legg-Calve-Perthes Disease?
- slow onset
- limp
- joint stiffness with limited ROM
How would you diagnose Legg-Calve-Perthes Disease?
- H&P
- physical assessment
- x-rays
- MRI
What is the gold standard of diagnosing Legg-Calve-Perthes Disease?
X-ray (definitive diagnosis is made by MRI)
What is Legg-Calve-Perthes Disease classified as?
osteonecrosis
What are the initial nursing interventions for Legg-Calve-Perthes Disease?
- rest/activity restrictions
- reduce inflammation and irritability of the hip (NSAIDS)
- limited or non-weight bearing (crutches, physical therapy, traction)
What are the conservative containment nursing interventions for Legg-Calve-Perthes Disease?
abduction brace, cast, harness sling
What is the key to treating Legg-Calve-Perthes Disease?
keep the ball of the hip in the socket (containment)
Will Legg-Calve-Perthes Disease affect one leg or two?
majority of the time, one
What are the two types of containment of Legg-Calve-Perthes Disease?
- non-surgical (conservative), very slow process
- surgical reconstruction and containment (more serious cases)
What is a benefit of surgical containment?
the child can return to normal activity in 3-4 months
What is the goal of surgical reconstruction of Legg-Calve-Perthes Disease?
avoid prolonged immobility
What is the outcome of Legg-Calve-Perthes Disease affected by?
- early treatment
- child’s age
Define scoliosis.
abnormal lateral curvature of the spine 10 degrees or more
Is there a known cause for scoliosis?
no
Which gender is scoliosis more common in?
females
At what point of development is scoliosis diagnosed?
during the adolescent growth spurt
What two types of curves are in scoliosis?
C-shaped and S-shaped
What are a few clinicial manifestations of scoliosis
-a shoulder that sits higher than the other
How can you screen for scoliosis?
- forward bend test
- scoliometer
