Pediatric Orthopedics Flashcards
Common threads in pediatric orthopedics
- Facilitate normal growth and development
- Consider developmental milestones
- Family education regarding treatment modalities
- Neurovascular assessment
Developmental Dysplasia of the Hip
- Previously referred to as congenital hip dysplasia
- Reflects a variety of hip abnormalities where there is a shallow acetabulum, subluxation, or dislocation
Subluxation
An incomplete dislocation of the femur head from the acetabulum. Due to stretch capsule and ligaments
Dislocation
Occurs when the femur head is displaced out of the acetabulum. due to stretched or enlongated ligament
Causes of DDH
- Maternal hormone secretion (estogen) causes laxity of pelvic joints in both the mother and fetus
- Intrauterine position, higher incisdence occurs with breech presentation and cesarean sections
- Size of infant - large infants or twins being more susceptible
- First born - uterus not fully stretched
Common Findings of DDH
- Apparent shortening of femur - noted by level of knees in flexion
- Limited hip abduction
- Asymmetrical appearance to gluteal and thigh folds - due to subluxation or dislocation
- Femoral head easily palpable when it slips out of the acetabulum
Treatment of DDH
- Diagnosis before age 2 months - earlier diagnosis the more postive the prognosis
- Goal- restoroe normal architecture and function of the hip
- Harness or splints
- Casting
- Surgery
Pavlik Harness
- Most common harness used to treat DDH
- Worn continuously until hip stable
- 3-6 months
- If not successful, may need casting
Discharge teaching information for a child with DDH
- Information about treatment modality
- Importance of regular appointments
- Role of serial ultrasound or x-rays
- Facilitating normal growth and development of child
- Monitoring for developmental milestones
Hip Spica Cast
- Used to immobilize the hip and knee
- May be used in DDH if Pavlik harness fails
Hip Spica Cast Care
- Neurovascular assessment - 6 Ps +2
- Frequent neuro checks due to cast acting as a tourniquet if extremity swells
- Avoid denting the plaster cast with fingertips while it is still wet- drying can take up to 48 hours
- Do not put anything into the cast
- Logroll the client when turning (2-3 staff)
- Special measures to keep cast clean
- Precautions with feeding
- Petaling edge of cast with moleskin will protect skin against rough edges
2 additional Ps
puffiness and pressure
Logrolling
When the body is in alignment and is turned as one unit. Usually require 2-3 extra members. Do not use the crossbar to turn patient as this will weaken or dislodge the cast
Measures to keep cast edges in the perineal area clean and dry for hip spica cast
- Cover the cast edges with waterproof material such as plastic wrap or small disposable diapers
- Larger diaper can then be applied over the waterproof material and the cast
- Do not cover the entire cast with plastic
Feeding a child in a spica cast
- Careful positioning
- Elevate infant’s head and still support hips and legs
- Older children may find the prone position easier for self feeding
Congenital Clubfoot
A common deformity of the foot that occurs in 1 per 1000 live births. Males are affected twice as often as females. The foot is twisted inward and flexed in a downward position with bone deformity and soft tissue contracture
Treatment of clubfoot
- Correction of deformity
- Maintenance of the correction
- Follow-up observation
Clubfoot Serial Casting
- Begun shortly after diagnosis/birth
- Casts changed frequently every 2-3 weeks to accomodate rapid growth
- Maximum correction is usually achieved within 8-12 weeks
- Failure to achieve normal alignment indicates the need for surgical intervention
- Optimum time for surgery is between 4 and 12 months of age
TNI Serial Casting
- Education of parents/caregivers
- Observation of skin and circulation
- Overall treatment plan
- Cast Care
- Methods to facilitate normal development
