Professional Documents
Culture Documents
MUSCULOSKELETAL
ALTERATIONS
SOFT TISSUE INJURY
Includes injuries to muscles, ligaments, and tendons
Sports injuries
Mishaps during play
Contusion (bruise) is damage to soft tissue, subcutaneous
tissue, and muscle
Escape of blood into tissues (ecchymosis) causing black
and blue discoloration
Immediate treatment with cold application
Return to participation when strength and range of motion
(ROM) is equal on both side and demonstrated in
activity/sport specific tests
CONTUSION
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DISLOCATIONS
Occur when force of stress on a ligament is sufficient to
displace the normal position of opposing bone ends or bone
ends to socket
Pain is the predominant symptom
Increases with active or passive movement of the affected
extremity
Common injury is nursemaids elbow(pulled elbow)
Subluxation or partial dislocation of the radial head
Hip dislocation: Potential loss of blood supply to the head of the
femur
SPRAINS/STRAINS
Sprains
Trauma to a joint from a ligament partially or completely torn or
stretched by force
May have associated damage to blood vessels, muscles, tendons,
and nerves
Presence of joint laxity as an indicator of severity
Rapid onset of swelling with disability
Strains
Microscopic tears to a musculotendinous unit
Similar to a sprain
Swollen and painful to the touch
Generally incurred over time
NURSING CARE of SOFT TISSUE INJURY
Rest, ice, compression, and elevation (RICE) and ICES
Rest the injured part
Ice immediately (maximum 30 minutes at a time)
Wet elastic bandage for compression
Elevation of the extremity
Immobilization and support (casts or splints as appropriate to
the injury)
Crutches (depending upon injury)
FRACTURES
Common injury in children
Methods of treatment are different in pediatric population than
in the older adult population
Rare in infants (motor vehicle crashes and falls from heights)
Most common fracture is of the distal forearm (radius, ulna, or
both)
Clavicle is also a common fracture in childhood (<10 years old)
In school-age children, playground, bicycle and sports injuries
Clinical manifestations: generalized swelling, pain or
tenderness, deformity, diminished use of limb or digit. Possibly:
bruising, muscular rigidity, crepitus
MOST COMMON FRACTURES IN CHILDREN
Plastic deformation: bone is bent but not broken; most common
in the ulna and fibula and often associated with fractures of the
radius and tibia
Buckle: produced by compression of porous bone; appears as a
raised or protruding projection at the fracture site; more
common in young children
Greenstick: occurs when bone is angulated beyond the limits of
bending; incomplete fracture on the opposite side of the bend
Complete: divides bones into fragments that often remain
attached by a periosteal hinge, which can hinder reduction
GROWTH PLATE INJURIES
FRACTURES
Diagnosed with x-ray
Treatment is usually casting, but can include surgery
Bone healing is typically rapid in children
In neonatal period, 2 to 3 weeks
In early childhood, 4 weeks
In later childhood, 6 to 8 weeks
In adolescence, 8 to 12 weeks
FRACTURED FEMUR
CALLUS FORMATION
EVALUATION OF COMPARTMENT
SYNDROME
Pain
Pulselessness
Pallor
Paresthesia
Paralysis
Pressure
CASTING
Immobilizes to promote healing
Completeness of fracture, type of bone involved, and the
amount of weight bearing influence how much of the extremity
must be included in the cast
Two types of casting material:
Plaster
Synthetic
Cast removal
TYPES OF CASTS
NURSING CARE
Pain management
Evaluate for compartment syndrome
Educate
Nothing put into the cast
Circulation checks
Keeping cast dry
Medication administration
Follow up visits
TRACTION
Traction: Extended pulling force may be used
To provide rest for an extremity
To position for bone healing
To immobilize a fracture until healing is sufficient to permit casting or splinting
To help prevent or improve contracture deformity
To provide immobilization
To reduce muscle spasms (rare in children)
Traction: Forward force produced by attaching weight to a distal
bone fragment
Adjust by adding or subtracting weights
Countertraction: Backward force provided by body weight
Increase by elevating the foot of the bed
Frictional force: Provided by patients contact with the bed
TRACTION
TYPES OF TRACTION
Manual traction is applied to a body part by the hand placed
distally to the fracture site
Skin traction involves pulling mechanisms that are attached to
the skin with adhesive material or an elastic bandage
Skeletal traction is applied directly to the skeletal structure by a
pin, wire, or tongs inserted into or through the diameter of the
bone distal to the fracture
BUCK EXTENSION TRACTION
HALO VEST
ILIZAROV EXTERNAL FIXATOR
NURSING CARE
Assessing the patient in traction
Skin care issues
Pain management and comfort
DEVELOPMENTAL DYSPLASIA OF THE
HIP (DDH)
Formerly called congenital hip dysplasia or congenital
dislocation of the hip
Girls > boys
Family history increases risk
DDH is categorized in two major groups
Idiopathic
Infant neurologically intact
Teratologic (occur in utero and less common)
Neuromuscular defect
DEVELOPMENTAL DYSPLASIA OF THE
HIP (DDH)
3 Types of DDH
Acetabular dysplasia (preluxation)
Mildest form; osseous hypoplasia of the acetabular roof
Femoral head remains in the acetabulum
Subluxation (incomplete dislocation of the hip)
Dislocation (femoral head loses contact with the acetabulum and is
displaced posteriorly and superiorly; ligaments are elongated and
taut)
DEVELOPMENTAL DYSPLASIA OF THE
HIP (DDH)
THERAPEUTIC MANAGEMENT
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NURSING CARE
Pavlik harness
Maintaining reduction
Teaching the parents
Providing skin care
Cast care with older children
CLUB FOOT
Talipes equinus is plantarflexion with the toes lower
than the heel
Boys twice as much as girls
50% of cases are bilateral
Precise cause is unknown
Complex deformity of ankle and foot that includes
forefoot adduction, midfoot supination, hindfoot varus,
and ankle equinus
The foot is pointed downward (plantar flexed) and inward
in varying degrees
BILATERAL CONGENITAL TALIPES
EQUINOVARUS
CLASSIFICATION OF CLUB FOOT
Transitional, mild, or postural
Due to intrauterine crowding
May correct spontaneously or require passive exercise or serial
casting
Syndromic or Teratologic
Associated with other congenital anomalies
Usually requires surgical correction and has a high incidence of
recurrence
Congenital, idiopathic or true clubfoot
Bony abnormality almost always requiring surgical intervention
PONSETI SANDAL
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NURSING CARE
Cast care
Educate parents
Cast care
Brace care
Importance for follow up visits
Post operative care if surgical correction
OSTEOGENSIS IMPERFECTA (OI)
A group of heterogeneous inherited disorders of connective tissue
A rare genetic disorder characterized by bones that fracture easily
Defective periosteal bone formation and reduced cortical thickness
of bone
Classifications based on clinical features and patterns of
inheritance:
Type I (most common and mildest)
Type II (most severe and lethal in infancy)
Type III
Type IV
Type V
Type VI
Type VII and VIII
TYPE I
Type A: Mild bone fragility, blue sclera, normal teeth, hearing
loss
Type B: Same as A except with abnormal dentition
Type C: Same as B but no bone fragility
Two thirds of all cases are type I
TYPE II
Lethal; infant is stillborn or dies in early infancy
Severe bone fragility with multiple fractures at birth
Autosomal recessive inheritance
TYPE III