Pediatric Orthopedics Flashcards
1
Q
Common threads in pediatric orthopedics
A
- Facilitate normal growth and development
- Consider developmental milestones
- Family education regarding treatment modalities
- Neurovascular assessment
2
Q
Developmental Dysplasia of the Hip
A
- Previously referred to as congenital hip dysplasia
- Reflects a variety of hip abnormalities where there is a shallow acetabulum, subluxation, or dislocation
3
Q
Subluxation
A
An incomplete dislocation of the femur head from the acetabulum. Due to stretch capsule and ligaments
4
Q
Dislocation
A
Occurs when the femur head is displaced out of the acetabulum. due to stretched or enlongated ligament
5
Q
Causes of DDH
A
- 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
6
Q
Common Findings of DDH
A
- 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
7
Q
Treatment of DDH
A
- 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
8
Q
Pavlik Harness
A
- Most common harness used to treat DDH
- Worn continuously until hip stable
- 3-6 months
- If not successful, may need casting
9
Q
Discharge teaching information for a child with DDH
A
- 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
10
Q
Hip Spica Cast
A
- Used to immobilize the hip and knee
- May be used in DDH if Pavlik harness fails
11
Q
Hip Spica Cast Care
A
- 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
12
Q
2 additional Ps
A
puffiness and pressure
13
Q
A
14
Q
Logrolling
A
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
15
Q
Measures to keep cast edges in the perineal area clean and dry for hip spica cast
A
- 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
