Musculoskeletal PowerPoint Flashcards
function of musciloskeletal
protecting vital organs, provie support, motion control, stores minerals and ca, source for red blood cell production
why do childrens bones break easier than adults
more porous and pliable
less dense
rapid bone growth facilitates
healing of fractures
growing pains (muscles are pulled)
ossifacation is nearly complete when born but end of long bones continue continues until
20
fractures are caused by
increase stress on the bone
fractures are more common in
children
treatment for closed fracture
castging
treatment for open fractures
surgery and casting
epiphysis
rounded end of a long bone at iste joint with adjacent bones
injuries to the epiphysis is classifed as
salter harris classification
SH fracture type 1
throgh the growth plate
- plate is undisturbed and heals with out disruption in growth
- straight across above growth plate
SH type 2
through the growth plate and metaphysis
- most common
- doseant affect growth plate
- no problem with growth
- stright across above growth plate until half way through then shoots up towards the shaft of the bone
what is mst common SH fracure
type 2
SH type 3
through the growth plate and epipysis
- less common
- serious threat to growth
- straight across the growth plate untl half way through then shoots down towards the end of the bone
SH type 4
crush injury of growth plate
- crush growth plate
- has cell death and growth can be arrested
what types of fractures are associated with abuse
spiral
- twisting
avulsion
- hit
impacted
- thrown
fractures associated wth abuse
postietiot rib fracture
skull fracture
any type of fracture in non ambulant child or a fracture that does not fit the story
5 P’s
pain and point of tenderness
pulse - distal to fracture site
pallor
parashesia - sesaion distal to the racture site
paralysis - movement distal to the fracture site
neurovasular assessment
cap refill
color
warmth
movement
sensation
reduction
realign misplaced bone
immobilization
allowing healing to occur
break the fall break
1 inch above wrist
ulna and radius
neonatla healing peroid
2-3 weeks
ealry childhood healing period
4 weeks
later childhood healing peroid
6-8 weeks
adolescence healing peroid
8-12 weeks
when is a plasd cast done
in ER
why is a plaster cast done in er
because its swollen leave on for 7-14 days to allow for swelling to go down
how long does a plaster cast take to dry and what do we educate about this
2 days
handle with palm of hand
should we have the extremity elevated or dependent
elevated
should you put anything in the cast
no
what to do if cast gets wet
use blow dryer on cool and low to dry ends
dont use heat
try to dry with towel first
complcaiton of casts
compartment syndroe
we shoud compare the injured area with
uninjured area
what is developmental dysplasia of the hip
hip instability after birth
who might have hip dysplasia
breach birth
what dose a hip click mean
hip is weak, bone is present, but not developed
what does a hip clunk mean
displacement
what is the universal screening until wlaking
ortolani and barlow tests
- most common
other s/s of hip dysplasia
limited hip abdution
shorteing of femur
ortolani click less than 4 weeks
gluteal folds
knee height
what determines Pavlik harness or casting
ortho
click or clunk
why must we have careful assessment of babies with hip dysplasia
they grow very quickly
what position does the pavlik harness place them in
abducted
what is metatarsus adductus (intoeing)
convexitey (curvature) of the lateral border of the foot
metatarsus adductus (intoeing) is what type of defect
positional
metatarsus adductus (intoeing) tx
stretching
shoes
cast
metatarsus adductus (intoeing) cause
intrauterine positooning and genetic factors
metatarsus adductus (intoeing) vs clubfoot
club foot cannot return to normal position
clubfoot tx
surgery
serial casting
- start with little bit of stretch and keep going
club foot involves
bone
muscle
ligmanet
tendon
nerve
club foot may be delayed in
walking
in club foot if the tendon is involved may need to stretch
entire leg
scoliosis what is it
lateral S or C shapted
scolisois degree
> 10
what is the msot common spinal deformity
scoliosis
s/s of scolosis
trunk asym
uneven shoulder and hip height
one sided rib hump
promient scapula’
Tshirt may sit on agnle
when does scolosis becomes noticable
preadolsecent growth spurt
3 composents when diagnosing scolosis
lateral curvature
axial rotation
skeletal maturity
lateral curvature
sideways curve
Cobb angle
Cobb angle
hip to spine angle
Axial rotation
spine can rotate
skeletal maturatiy
amount of calcification
what are used to determine degree of curvature
standing radiographs
more calcification =
more surival intervention rather than brace
clues for early detection of scolosis
clothes that fit on angle
mild scolosis (10-20%) treatment
strength
stretch
brace (maybe)
moderate scolosis (20-40) treatment
require bracing
severe scolosis (40-50) treament
necessitate surgery
spinal fusing
bracing
post op scolosis fuse
pain control
prevent complications of immobiltyb
osteomyletis
infection of the bone
most common cause of osteomyletis
staph aureus
s/s of osteomyletis
tenderness at site of infection
erythema
war,
edema
limp/refusal to bear weight
refusal to use extremity
fever
chills
vomiting
osteomyletis tx
IV antibiotics
what is slipped capital femoral epiphysis (SCFE)
head of the femur seperates from the epipysis and slips backwards with potential or complete dislocation
SCFE msot common in
prepuberty boy
overweight or obese
if SCFE is not treated this leads to
calfication
SCFE S/S
acute or chronic hip, thigh, or knee pain, limited internal rotation and obligated external rotation of the hip, out-toe-ing (walking with the toes our)
how will SCFE look like on x ray
ice cream slipping off a cone
SCFE tx
potential traction, brace, surgical, screws or pins
legg-calve-perthes what is it
childhood condition in which the proximal femoral epiphysis has a temporary interruption in blood supply leading to bone necrosis and subsequent repair
legg-calve-perthes is it a self limiting issue
yes
when does legg-calve-perthes get revascularized by
4 years
legg-calve-perthes s/s
pain in hip and on affected side (may radiate to the knee) leg length discrepancy or limp, internal rotation and abduction of the affected limb are limited
legg-calve-perthes tx
maintaining the femoral head and restoring ROM
- may need surgery to clean it out if caught late
- bracing to allow healing
