Orthopedics Flashcards
DDH
developmental hip dysplasia
- abnormality in development of proximal femur, acetabulum or both
- > females and caucasians
- cause is unknown
DDH risk factors
- family hx
- 1st pregnancy
- oligohydramnios
- breech presentation
- maternal hormones
- twins
- large size
DDH Dx
- physical exam
- ultrasound during PE (2 wks of age)
- x-rays (>4 months)
- ortalomi test in newborns
DDH s/s
- Asymmetry of gluteal or thigh folds
- leg length discrepancy
- hip abduction limitation
- leg with more folds is the affected leg
- Ortolani Sign (click with abduction)
- pain
- abnormal gait - older child
- trendelenberg sign - older child
Trendelenberg Sign
when child stands on affected leg the unaffected hip tilts down
DDH Management
0-6mos
Pavlik Harness
- wear 24/hrs day
- adjust straps with growth
- assess for skin irritation
DDH Management
>6 mos
closed or open reduction w/ hip spica cast application
DDH post op spic cast care
- neurovascular assessments of extremities
- assess cast for drainage and bleeding
- assess resp. system (cast constriction)
- pain management
- skin assessment
- petal cast
Clubfoot Talipes
congenital deformity of the foot and is twisted out of shape or position
Clubfoot Equinius
bent downward
Clubfoot Varus
bent inward, with angulation towards the midline
Clubfoot Dx
Prenatal ultrasound
physical exam
x-ray
Clubfoot Etiology/ risks
- familial hx
- crowding in uterus
- maternal smoking during preg
- Amniocentesis
- > in boys
- > in twins
Clubfoot management
- manipulation and serial casting
- corrective shoes/splints
- surgery
Clubfoot Outcome
-foot may always be slightly smaller and stiffer
Scoliosis
- lateral curve of the spine
- idiopathic scoliosis occurs most commonly in girls 10-15 yrs
Other causes of scoliosis
- neuromuscular dissease
- trauma
- tumors
- vertebrae infections/ diorders
Scoliosis Dx
School screening: middle school
Radiograph to measure curve
MRI
CT
Scoliosis s/s
hips at angle pants/skirt length uneven shoulder heights unequal uneven waist angles respiratory dysfunction (severe curvatures)
Scoliosis Management
-Bracing 25-35 degrees Milwaukee brace wear 23/hrs day wear t-shirt under brace to < skin irritation assess skin under brace frequently -spinal fusion if >40 degrees
Nursing spinal fusion care
- prepare pt for foley, NG tube, chest tubes (rare)
- review pain management (PCA)
- log-roll and avoid twisting trunk
- neuro/ vascular assessments
- assess OR site for blood and CSF
- body jacket used when ambulating
JRA
Juvinile Rheumatoid Arthritis
JIA
Juvenile Idiopathic Arthritis
JRA/ JIA
- group of chronic autoimmune inflammatory diseases affecting joints and other tissues
- chronic inflammation of the synovium of the joints that results in wearing down and damage to articular cartilage
- sxs begin before 16 yrs and last >6 wks
- Peak ages: 2-5 yrs & 9-12 yrs
- > in girls
JRS s/s
- joint swelling, stiffness, redness
- joint pain
- joints warm to touch
- mobility limitations
- fever, rash, malaise
- mild-severe in presentation
JRA types
Pauciariticular
polyarticular
systemic
Pauciarticular JRA
4 or fewer joints
greater risk for iris inflammation (iveitis)
Polyarticular JRA
5 or more joints
Poorest prognosis w/ this and + rheumatoid factor
Systemic JRA
any number of joints involved with high fever, rash, pericarditis, hepatosplenomegaly, lymphadenopathy
JRA Dx
- ESR may be elevated
- Rheumatoid factor > in 10%
- ANA antinuclear antibodies w/ particular only
- Radiographic: may show increased synovial fluid in joint
- R/O other disorders
JRA Management
- NSAIDS (ibu, naproxen)
- Cytotoxic drugs when NSAIDS not effective alone
- Corticosteroids
- Antirheumatic drugs
JRA RN care
- moist heat to joints before exercise
- rest acutely inflamed joints
- splint joints for sleep to decrease pain and prevent flexion deformities
Muscular Dystrophy
- A group of inherited disorders w/ preogressive degeneration of symmetric skeletal muscle groups
- Duchenne muscular dystrophy (DMD) is most common
- Affects > boys
- Inherited from mom to son
DMD s/s
early onset (3-5 yrs)
by 9-11 yrs loss of independent ambulation
progressive muscle weakness
calf muscle hypertrophy
waddling gait
lordosis
winged scapulae
gowers sign (difficulty rising to standing position)
30% have mental delay and learning disabilities
later in diseasse: scoliosis, resp difficulty, cardiac diff
DMD Management
- Maintain muscle function as long as possible
- ROM keep joints flexible
- Splints and braces to prevent contractions
- encourage child to be independent
- respiratory support: intermittent positive pressure ventilation
- support group for DMD
