ortho Flashcards
Microcephaly - primary - how many weeks
Intrauterine exposure to toxins (weeks 4 to 20)
Microcephaly - secondary
Third-trimester exposure
Perinatal exposure
Exposure in early infancy
Microcephaly - Effects
(micro is twitchy)
Mild hyperkinesis (twitchy), mild motor impairment
Decerebration (apart from brain stem), complete unresponsiveness
Autistic behavior
CRANIOSTENOSIS - Therapeutic Management
(think crane)
Surgical excision of bone (strip craniectomy)
Along or parallel to suture
Releases fused suture
Directs new growth
PLAGIOCEPHALY
(plagerism is flat)
Skull progressively flattened
Not associated with brain malformation
Treatment
Helmets, bands, time
DEVELOPMENTAL DYSPLASIA of the HIP (DDH)
Formerly called “congenital hip dysplasia” and “congenital dislocation of the hip”
Incidence 1-10/1000 live births
More common in females (60%)
More common in Caucasians than any other group
Etiology of DDH - classifications
(DDH is ASD)
Acetabular (shallow)
Subluxation (partial)
Dislocation
(look at photo in slides)
Clinical Manifestations of DDH - what test?
(dds ortega)
Positive Ortolani test (when laying baby on back and open hips)
Audible click when abducting and externally rotating hip
Therapeutic Management of DDH - deepen what?
Directed toward enlarging and deepening acetabulum
Place head of femur within acetabulum
Congenital Clubfoot
(soft club)
Bone deformity and malposition of foot
Soft tissue contracture
Foot twisted out of alignment
May be misshaped
CLUB FOOT - rigid or flexible?
Deformity apparent at birth
Classification
Rigid or flexible
Physiologic Effects of Immobility - Muscular system
Decreased muscle strength and endurance
Atrophy
Loss of joint mobility
Skeletal system
Bone demineralization
Negative calcium balance
Physiologic Effects of Immobility - Metabolism - what about nitrogen?
Decreased metabolic rate
Negative nitrogen balance
Physiologic Effects of Immobility - Cardiovascular system - what about vasopressor?
Decreased efficiency of orthostatic neurovascular reflexes
Diminished vasopressor mechanism
Altered distribution of blood volume
Venous stasis
Dependent edema
Physiologic Effects of Immobility - Respiratory system
Decreased need for oxygen
Diminished vital capacity
Poor abdominal tone and distention
Mechanical or biochemical secretion retention
Loss of respiratory muscle strength
Physiologic Effects of Immobility - gI - difficulty feeding in what position?
Distention caused by poor abdominal muscle tone
Difficulty feeding in prone position
Gravitation effect on feces
Anorexia
Physiologic Effects of Immobility - Urinary system
Alteration of gravitational force
Difficulty voiding in supine position
Urinary retention
Impaired ureteral peristalsis
Physiologic Effects of Immobility - Loss of innervation
If nerve tissue is damaged by pressure
If circulation to nerve tissue is interrupted
Effects of improper positioning
Sensory and perceptual deprivation
EPIPHYSEAL INJURIES- what is special about it?
Epiphysis
Growth end of long bones
Growing cartilage
Growth plate located in the epiphysis
Weakest point of long bones
Frequent site of damage during trauma
May affect future bone growth
Treatment may include open reduction and internal fixation to prevent growth disturbances
FRACTURES - from what for school age kids?
Common injury in children
Clavicle most frequently broken bone in child, especially younger than age 10
School age—bike, sports injuries
Methods of treatment different in pediatrics than in older adult population
Types of Fractures - compound
(compounded to the outside)
Compound or open
fractured bone protrudes through the skin
Immediate Interventions - fracture
Immobilize
Assess circulation
Apply cool/cold compress
Elevate limb ( keep in alignment)
Sterile/clean dressing over open wound
External Fixation
Ilizarov external fixator
The induction of new bone between bone surfaces that are pulled apart in a gradual, controlled manner
Permits limb lengthening by manual distraction
Stimulates new bone formation
Bone Healing - how long for the 4 different groups?
(heal in 2 - 12 weeks)
Typically rapid healing in children
Neonatal period—2 to 3 weeks
Early childhood—4 weeks
Later childhood—6 to 8 weeks
Adolescence—8 to 12 weeks
THE CHILD in TRACTION
Traction—extended pulling force may be used to
Provide rest for an extremity
Help prevent or improve contracture deformity
Correct a deformity
Treat a dislocation
Allow position and alignment
Provide immobilization
Reduce muscle spasms (rare in children)
Traction- Essential Components
Traction—forward force produced by attaching weight to distal bone fragment
Adjust by adding or subtracting weights
Countertraction—backward force provided by body weight
Increase by elevating foot of bed
Frictional force—provided by patient’s contact with the bed
Types of Traction
Manual traction
applied to the body part by the hand placed distally to the fracture site
Skin traction
pulling mechanisms are attached to the skin with adhesive material or elastic bandage
Skeletal traction
applied directly to skeletal structure by pin, wire, or tongs Inserted into or through the diameter of the bone distal to the fracture
Cervical Traction
Crutchfield or Barton tongs
Inserted through burr holes in skull with weights attached to the hyperextended head
As neck muscles fatigue, vertebral bodies gradually separate so the spinal cord is no longer pinched between vertebrae
Halo traction can be applied in some cases
Therapeutic Management of Soft Tissue Injuries - what type of elastic bandage?
RICE
Rest the injured part
Ice immediately (max 30 minutes at a time)
Compression with wet elastic bandage
Elevation of the extremity
ICES- Ice, Compression, Elevation, Support
Immobilization and support (casts or splints as appropriate to injury)
MUSCULOSKELETAL COMPLICATIONS
Circulatory impairment
Nerve compression syndromes
Compartment syndromes
Volkmann contracture (a deformity of the hand, fingers, and wrist caused by injury to the muscles of the forearm)
Epiphyseal damage
Nonunion/malunion
Infection
Kidney stones
Pulmonary emboli
COMPARTMENT SYNDROME
Pressure within the muscles builds to dangerous levels (from swelling or bleeding)
Decreases blood flow
Prevents nourishment and oxygen from reaching nerve and muscle cells
Causes cell damage and death
Acute or chronic
More painful than would be expected
Not relieved by pain meds
Clinical Manifestations of Osteomyelitis - where is the pain?
Localized Pain - pain will be in a specific spot
Swelling at site
Warm at site
Redness at site
Pain upon weight bearing
Osteomyelitis Diagnosis - is it slow or fast onset?
Signs and symptoms begin abruptly; resemble symptoms of arthritis and leukemia