Chapter 29 & 30: Musculoskeletal and Neuromuscular Dysfunction Flashcards
What are some pediatric differences when compared to adults regarding musculoskeletal system?
4 differences
- epiphyseal plate still elongating
- ligaments and tendons are stronger than bones until puberty
- bones are more porous and pliable – “bounce” rather than break
- infant skull fontanels in process of closing
What are fractures?
4 aspects
- break in a bone
- common injury in children, but rare in infants except with MVA
- most common broken bone in childhood (< 10 y.o.) = clavicle
- may be caused by bicycle or sports injuries
What are the 4 types of fractures?
- compound/open: fractured bone protrudes through skin
- complicated: bone fragments have damaged other organs/tissues
- comminuted: small fragments of bone are broken from fractured shaft and lie in surrounding tissue
- greenstick: compressed side of bone bends but the tension side of the bone breaks, causing an incomplete fracture
What is a growth plate (epiphyseal/physeal) injury?
4 aspects
- injury to the cartilage growth plate (epiphyseal plate), weakest point of long bones
- frequent site of damage
- may affect future bone growth
- treatment:
– ORIF – open reduction, internal fixation – prevents growth disturbances
What are some s/s of fractures?
7 s/s
- swelling
- pain or tenderness
- deformity
- diminished functional use
- bruising
- muscular rigidity
- crepitus
What are general bone healing times for each stage of childhood?
- neonatal = 2 - 3 weeks
- early childhood = 4 weeks
- later childhood = 6 - 8 weeks
- adolescence = 8 - 12 weeks
– younger children have more osteoblasts –> faster healing times for fractures
How are fractures diagnosed? What are some interventions for fractures?
- confirmed diagnosis with X-rays
- treatments:
– pain meds
– PT & OT
– skin assessments
– neurovascular checks – CMS checks (circulation, movement, sensation)
– pulses in extremities distal to fracture
What are the 5 P’s for fracture assessment?
- pain
- pulse – distal to fracture
- pallor
- paresthesia – sensation distal to fracture
- paralysis – movement distal to fracture
What might be indicated by pain unrelieved by pain medication?
compartment syndrome
What are some education topics for families of casted pts?
5 education topics
- don’t get it wet
– use blow dryer on COOL setting if it gets wet
– if too wet, will need to have it changed - don’t stick anything down cast
– can cause skin breakdown or infection - supervise casted children to ensure nothing is stuck down cast
- parents can perform home CMS checks
- cast removal
– child can touch saw to see that it won’t hurt
– limb will look different when cast comes off (pale, smelly, smaller than other limb)
What is traction? What is it used for?
5 uses
- an extended pulling force using weights for injured extremities
- used to:
– rest an extremity
– position bones for healing
– immobilize a fracture until healing is sufficient for casting
– prevent contracture
– reduce muscle spasms
What is developmental dysplasia of the hip (DDH)?
3 aspects
- congenital hip dysplasia
- abnormality in the development of the proximal femoral head and acetabulum where they are improperly aligned – femur head lies outside acetabulum
- 2 types:
– idiopathic – infant is neurologically intact
– teratologic – neuromuscular defect
How is DDH diagnosed?
US or X-ray
What are some s/s of DDH?
5 s/s
- asymmetrical gluteal and thigh folds – most common s/s
- shortening of femur
- Ortolani click
- limited hip abduction
- positive Trendelendburg sign with lordosis
What are some interventions for DDH?
2 interventions
- swaddling
- Pavlik harness – skin assessments
