Muskuloskeletal Flashcards
Developmental considerations for kids
- reach skeletal maturity (ossification) by 17Y in males, 2Y after menarche in F
- epiphysis/epiphyseal plate fine unless fracture occurs on plate–may not grow to normal length
- porous bone–incomplete bone break may occur in kids
- thicker periosteum
Casts
Rigid device that immobilizes the affected body part while allowing other body parts to move
- made of plaster, fiberglass often, polyester-cotton
- used for arm, leg, brace, body
NC for patient in cast
- handle cast with palms if wet
- turn cast every 2 hours until dry; can take 24-48h if plaster, fiberglass w/i minutes; don’t use heat or dryers
- don’t give ibuprofen bc can impede bone healing but may need other pain meds incl narcotics and NSAIDs
- ice over cast can help with itch and dec swelling
- elevate extremity
- infx in cast will be warm to touch–can drill a small hole and look
- watch for skin b/d—edges can get pokey—may need to put moleskin there
- don’t stick things down to itch besides fingers to test tightness
- good assessment—5 Ps—pain, pallor, pulse, paralysis, paresthesia
- exercise non-affected side
- isometric exercises for affected side—prevent foot drop by keeping foot at 90 degree angle and having them lay on stomach
- good diet, lots of fluids
- assess tightness of cast
Potential complications of cast
- keep heel off mattress
- feel for hot spots, tingling of skin by pt (cast might be too tight)
- notify MD at once of wound drainage
- skin b/d—petal edges
- watch pressure areas esp (elbow, knee, ankle)
NC for cast removal
- loud noise of cutter may be scary
- cast cutter works by vibration so it won’t cut the child
- explain procedures, demonstrate on yourself, provide distraction, provide headphones, restrain child as needed, reward child after
Traction
Application of a pulling force to the body to provide reduction, alignment, and rest at that site
- includes skin, skeletal, and manual traction
- used to get bones back in place
NC for traction
- maintain correct balance btwn traction pull and counter traction force
- care of weights–make sure correct ones are not ordered
- make sure feet are not at end of bed
- skin inspection
- pin care
- assessment of neurovascular status
Assessment for traction
Temperature—extremity and infection
Ropes hang freely
Alignment
Circulation check (5 Ps)
Type and location of fracture
Inc fluid intake
Overhead trapeze
No weights on bed or floor
5 Ps of circulatory check
Pain, pulse–use cap refill if cast covers pulse, paresthesia, paralysis, pallor
Developmental dysplasia of the Hip (DDH)
- spectrum of disorders related to abnormal development of the hip
- caused by lag in development or the way the baby lays in utero
Risk factors for DDH
- breech birth
- big baby
- female
- C/S
- twin
- swaddled with legs out
- positive FH
Dysplasia
Ball is slightly out of socket; least severe
Dislocated DDH
Ball is completely out of the socket at rest
Subluxation DDH
In resting position, the ball is not located normally in the socket; rests partway out of socket
CM for DDH (infant and older child)
- Infant—asymmetry of gluteal or thigh fold, limited abduction, affected leg looks longer, Galleazzi sign (short femur), ortolani test (hip click during rotation)
- Walking child—Positive Trendelenburg sign (when standing on one leg, hip drop occurs in the leg that you are standing on), waddling gait or limp
DDH tx by age
- early identification and tx (before 6M)
- positioning the hip in flex, abducted positions to deepen the hip socket
- 0-6M—Pavlik harness (not thick diapering)
- 6-18M—preop skin traction (3W)—Buck or Russell, closed or open reduction under general anesthesia, hip spica cast (2-4M until hip stable)
- Older child—surgical reduction—osteotomy of acetabulum
DDH NC
- always put undershirt on child under chest straps and put knee socks under feet and leg straps
- check skin for redness 2-3x/day
- gently massage skin under straps daily to increase circulation
- avoid lotions and powder
- teach how to hold child with harness on
Congenital clubfoot
Talipes equinovarus; true bone deformity and malposition with soft tissue contracture (can’t be manipulated straight unlike many newborns)
Positional clubfoot
Occurs from intrauterine crowding and responds to simple stretching and casting
Syndromic clubfoot
Assoc with other congenital abnormalities and often resistant to treatment
Congenital clubfoot tx
true/idiopathic clubfoot which usually required surgical correction
Therapeutic management of congenital clubfoot
- serial casting–gradual manipulation where a new cast is put on every 1-1.5 weeks for 8-12W and feet are gradually stretched; surgical, outpatient, can leave when pt wakes up and eats
- Surgery with pins and lasts 2-3M if serial casting doesn’t work
- child will wear splint or brace to maintain correction
