MS 1

Question 1

when do the sutures of the cranium close fully

Answer 1

Sutures of the cranium do not fuse completely until age 18 months

Question 2

how long does growth at the epiphyseal plate occur

Answer 2

Growth occurs at the epiphyseal plate until adult height is reached (stimulated by pituitary GH)

Question 3

what is important to know about the bones and muscles of children compared to adults

Answer 3

• Bones are more pliable & porous in children resulting in bend or buckle (esp infants)
• Soft tissues are more resilient & bone healing is more rapid in children than in adults

Question 4

when should you investigate for child abuse

Answer 4

if infant/young child has a broken bone, possibly investigate for child abuse (should not be very easy to break) have bendy bones

Question 5

why do children recover from bone injuries quickly

Answer 5

d/t very vascular bones and children tend to have a lot of calcium in their diet

Question 6

what diagnostic tests can be used for evaluating MS

Answer 6

X-ray
Ultrasound
Arthrography (local anesthesia)
Bone scan (sedation)
CT (sedation)
MRI (sedation)
Arthroscopy (local or general anesthesia)
Joint aspiration (local anesthesia)

Question 7

what is imperative to assess for in MS physical exam

Answer 7

Five P’s of vascular impairment

1) Pain & joint tenderness
2) Pallor
3) Pulselessness distal to the fracture site
4) Paresthesia distal to the fracture site
5) Paralysis

Question 8

why are we so concerned about the pt having one of the 5 Ps

Answer 8

Very concerned about 5 Ps because can lead to possible paralysis, permanent injury to the nerves, and compartment syndrome

Question 9

what is the purpose of casting

Answer 9

to immobilize the fracture site & involve joints above & below the fracture

Question 10

what are the types of casting

Answer 10

Plaster of paris (drying takes 24-48 hours)

Synthetic

Question 11

cast care

Answer 11

• A wet cast should be handled by the palms of the hands to prevent indenting the cast & creating pressure areas
• No hot spots should be felt; nothing inside cast
• Check for swelling in first 6-8 hours; Elevate; protect from water & urine

Question 12

why do you not IMMEDIATELY put a cast on after injury

Answer 12

• d/t initial swelling and tissue damage (have swelling under control BEFORE cast is put on)
• still have risk once cast is on, that some swelling may occur (educate to ensure elevated extremity above heart for 72 hrs after casted)

Question 13

10 yr old complaining about toes or fingers feel odd (tingly, feels like they are asleep) what should mom do?

Answer 13

• mom goes ahead and calls provider, talks to nurse who triages with mom and tells her to ELEVATE it and get swelling decreased)
• eventually will need to come in and see provider to prevent compartment syndrome
• IF has one of the 5 Ps??, (cannot extend fingers ex) is an EMERGENCY d/t potential for nerve damage

Question 14

which type of cast is used more often now

Answer 14

synthetic

Question 15

describe clubfoot

Answer 15

• A common deformity in which the foot is twisted out of its normal shape or position
• Unilateral clubfoot is more common than bilateral
• May occur as an isolated defect or more be in association with other disorders or syndromes
• Cause is unknown(familial, more common in boys)

Question 16

an inversion or bending inward

Answer 16

Talipes varus (clubfoot)

Question 17

an eversion or bending outward

Answer 17

Talipes Valgus (clubfoot)

Question 18

*most common – plantar flexion in which the toes are lower than the heel

Answer 18

Talipes equinus (clubfoot)

Question 19

dorsiflexion, in which the toes are higher than the heel

Answer 19

Talipes calcaneus (clubfoot)

Question 20

treatment of clubfoot

Answer 20

• Correction of the deformity (if not, may affect gait eventually)
• Maintenance of the correction until normal muscle balance is regained
• Follow-up observation to avert possible recurrence of the deformity
• Casting is begun immediately after birth
• Surgery is usually performed between ages 4 months to 1 year

Question 21

with surgery or casting what is always a potential risk

Answer 21

-With surgery or casting always risk you will impact extremity involved: may end up with one leg that is shorter or muscle that is smaller

Question 22

describe Developmental Dysplasia of the Hip (DDH)

Answer 22

• Occurs in 1 – 3% of newborns
• Left hip affected more often than right hip
• Increased incidence with breech presentation and among siblings of affected children
• More commonly seen in females – four times as often as boys

Question 23

three degrees of DDH

Answer 23

Acetabular dysplasia
Dislocation
Subluxation

Question 24

mildest form, no subluxation or dislocation

Answer 24

Acetabular dysplasia

Question 25

incomplete dislocation of the hip

Answer 25

subluxation

Question 26

femoral head loses contact with the acetabulum, hip rests in a dislocated position

Answer 26

dislocation

Question 27

DDH assessment

Answer 27

• Diagnosis should be made during the neonatal period, treatment initiated before 2 months of age is most successful
• Hip examination needs to be included as part of the health examination until the child begins to walk (until 24 mos)

Question 28

DDH clinical manifestations of infants

Answer 28

Shortening of the limb on the affected side
Unequal gluteal folds (prone position)
Restricted abduction of hip on affected side
Positive Ortolani test
Positive Barlow test

Question 29

DDH clinical manifestations of toddlers/older children

Answer 29

Waddling gait
Marked lordosis when standing
Affected leg shorter than other leg
Presence of Trendelenburg sign

Question 30

diagnostics of DDH

Answer 30

• *Ultrasound is the BEST way to determine DDH, identify before 3 months as it is easier to identify earlier and implement measures ASAP
• As a provider*** do it before 3 months ultrasound, can pick it up better when younger (according to dr. Comeaux)
• Radiographic examination – infants older than 4 months