Musculoskeletal Peds

Front 1

difference in peds bones

Back 1

More porous and pliable
Growth from epiphyseal plate
Infant fontanel closure by 18 months

Front 2

difference in peds muscles

Back 2

Same number as adult
Length and circumference grow

Front 3

difference in ped ligaments/tendons

Back 3

Stronger than bones until puberty

Front 4

osteomyletis

Back 4

bone infection

Front 5

Acute hematogenous osteomyelitis -

Back 5

blood borne bacterium (s. aureus)

Front 6

Exogenous osteomyelitis -

Back 6

direct inoculation of the bone.

Front 7

symptoms of osteomyelitis

Back 7

severe pain, fever, irritability, tenderness

Front 8

most common sites of peds osteomyletis?

Back 8

Tibia and Femur

Front 9

care/management of osteomyelitis

Back 9

Antibiotics
Surgical Drainage - polyethylene tubes for drainage to suction and instillation of antibiotic solution
casting for immobilization

Front 10

2 sources from acquiring ostemyelitis

Back 10

1.Exogenous – acquired by invasion of bone by direct extension from outside as a result of penetrating would, open fracture, contamination during surgery.

Hematogenous (most common in children) – spread of organisms from preexisting focus, such as furnicles, skin abrasions, impetigo, otitis media, tonsillitis, poor injection technique

Front 11

s&s of osteomyelitis in peds

Back 11

2 yrs old: crying, irritable, not using extremity, fever, increased HR, tenderness, rapid pulse, dehydration, increased warmth and diffuse swelling over affected bones and pains.
These S&S of acute osteomyelitis begin abruptly and commonly accompany a history of trauma to the affected bone.

Front 12

which bones are most effected by osteomyelitis in children?

Back 12

Most cases involve long bones: Femur, tibia.
To a lesser extent: humerus and hip.

Front 13

How long is typical antibiotic therapy for osteomyelitis? By which route should the antibiotics be administered?

Back 13

4-6 weeks
IV- can be switched to PO when they go home

Front 14

Slipped Femoral Capital Epiphysis (coxa vara)
what is it?
s&s?
tx?

Back 14

Spontaneous displacement of the proximal femoral epiphysis.
Occurs before or during accelerated growth and the onset of puberty
Limping. groin, knee, thigh or hip pain. Decreased internal rotation on adduction-loss of abduction and internal rotation.
Treatment - Surgery

Front 15

Legg-Calve’-Perthes Disease
what is it?
s&s?
tx?

Back 15

Aseptic necrosis of
the femoral head
usually boys
peak age 3-12 years
Sx-limp, hip soreness, stiffness
Tx- abduction brace, casts, surgery

Front 16

Osteogenesis Imperfecta (OI)
what is it?
s&s?
tx?

Back 16

Most common osteoporosis syndrome in childhood
bone fragility, deformity, fracture, blue sclera, hearing loss, dental abnormalities
treatment primarily supportive

Front 17

Duchenne Muscular Dystrophy
what is it?
s&s?
tx?

Back 17

Degenerative muscle loss
X-linked recessive or spontaneous
usually presents at age 3-5 years
decrease in development of difficulty with balance or gross motor skills, Gower sign
Dx: biopsy, EMG, serum CPK
Tx: steroids, PT, Bracing

Front 18

Congenital Clubfoot
what is it?
s&s?
tx?

Back 18

Deformities of ankle and foot
Familial tendency
Tx - serial casting, surgery
Teaching - cast care, Neurovascular checks

Front 19

scoliosis
what is it?
s&s?
tx?

Back 19

Lateral curvature of the spine
may be congenital or idiopathic
secondary to some disorders
curves less than 20 degrees usually not treated
braces, exercise and/or surgery

Front 20

Developmental Dysplasia of the Hip (Congenital Hip Dysplasia)
what is it?
s&s?
tx?

Back 20

Spectrum of disorders-abnormality of hip development
Best to diagnose in newborn period for early treatment
Ortolani or Bartlow tests (see text) demonstrate subluxation and the tendency to dislocate
SX – Asymmetric thigh and gluteal folds, difference in leg lengths, broadening of perineum
TX – Pavlik harness, traction, casting and or surgery

Front 21

What are the signs of DDH specific to this age group?
(3mos)

Back 21

Asymmetry of gluteal and thigh folds; limited hip abduction; shortening of femur.
Adduction contractures develop at about 6-10 weeks, and the Ortolani sign disappears. The most sensitive test at this time is limited abduction along with visible signs including shortening of the limb on the affected side, asymmetry of the thigh and gluteal folds, and broadening of the perineum in bilateral dislocation

Front 22

In addition to casting, what other type of reduction devices are utilized in the management of DDH?

Back 22

Pavlik Harness
The Pavlik harness is the most widely used abduction device. It is worn continuously until the hip is clinically and radiographically stable, usually 3-6 months

Front 23

List specific home care instructions directed toward maintaining Carey’s skin integrity with a hip spica cast. (full pelvic/leg cast on both sides)

Back 23

Petal cast edges by applying waterproof tape around all edges ; waterproof cast openings; keep skin clean and dry with mild soap and water
Petalling cast edges is done to provide a continuous waterproof bridge between the perineum and the cast to prevent leakage. Making the cast openings waterproof and keeping the skin clean and dry will minimize the risk of skin breakdown.

Front 24

Discuss the long-term consequences in the event Carey was not treated until she reached 2 years of age.

Back 24

Stretched ligaments can lead to bone deformities. Often require traction for reduction; pinning; and casting over a long period of time. Possible limb shortening on the affected side.

When treatment is delayed, the treatment becomes more difficult, the deformity more severe, and the prognosis less favorable.

Front 25

Fractures facts

Back 25

Active mobility and limited gross motor coordination put children at risk
rare in infants
clavicle, femur, forearm are common sites
growing bones more porous than adult-greenstick, bends and buckle fractures are common

spiral fractures: most common in child abuse situations

Front 26

five “P’s” of ischemia from a vascular injury

Back 26

Pain and point of tenderness; Decreased Pulse distal to Fx; Pallor; Paresthesia distal; and Paralysis

Front 27

Which of the diagnostic studies is most useful for assessing skeletal trauma?

Back 27

Radiography-The calcium deposits in bone make the entire structure radiopague making visualization and diagnosis of injury possible.
Blood studies-Severe Soft tissue, muscle, and bone injury often results in the destruction of red blood cells with a rise in bilirubin and a fall in the hemoglobin or hematocrit reading.

Front 28

What clinical manifestations would alert you to the possibility of compartment syndrome?

Back 28

Deficit of neuromuscular status/weakness and pain; tenseness.
The compartment syndrome occurs when increased pressure within a closed space (such as the muscles and nerves of the upper and lower extremities) rises and compromises circulation to the muscles and nerves within this space. The symptoms reflect a deficit or deterioration of neuromuscular status in the anatomic area surrounding the involved structures.

Front 29

Randy’s mother has indicated that her son is “always on the go” and “never sits still.” Recommend 3 activities that would meet Randy’s developmental needs while in traction.

Back 29

Activities to promote Industry and Concrete Operations such as:
Nerf Basketball
Walkie Talkies
Punching Bag

Front 30

cast facts / teachings

Back 30

Use palms of hands with wet cast
elevate extremity
observe five p’s of ischemia
check for hot spots
specialized car seats


use of fingers can cause skin indentations= skin trauma

Front 31

Traction

Back 31

Skin traction - Buck extension, Bryant traction, Russell Traction, Cervical

Front 32

skeletal traction

Back 32

Crutchfield Tongs, Balanced Suspension, 90/90, Dunlop
Maintain traction, maintain alignment, prevent skin breakdown, care for pins, prevent complications

Front 33

traction

Back 33

traction refers to the set of mechanisms for straightening broken bones or relieving pressure on the spine and skeletal system. There are two types of traction: skin traction and skeletal traction.

Front 34

bucks extension

Back 34

Buck's extension a temporary type of lightweight traction applied to the distal end of a fractured lower limb; the foot of the bed is raised so that the body makes counterextension; often used to reduce muscle spasm.

Front 35

bryant traction

Back 35

mainly used in young children who have fractures of the femur or congenital abnormalities of the hip.[1] Both the patient's limbs are suspended in the air vertically at a ninety degree angle from the hips and knees slightly flexed. Over a period of days, the hips are gradually moved outward from the body using a pulley system. The patient's body provides the countertraction

Front 36

russells traction

Back 36

a unilateral or a bilateral orthopedic mechanism that combines suspension and traction to immobilize, position, and align the lower extremities in the treatment of fractured femurs, hip and knee contractures, and disease processes of the hip and knee. Russell's traction is applied as adhesive or nonadhesive skin traction and uses a sling to relieve the weight of the lower extremities subjected to traction pull. A jacket restraint is often incorporated to help immobilize the patient.