Musculoskeletal disorder

Skeletal function
• F - Framework
• L - Lever
• I – it produces RBC
• P - Protection
• S – Stores Calcium & Phosphorus
STRAIN & SPRAIN
 strain

OVERSTRETCHING
SPRAIN

TWISTING
 Assessment:

•PAIN= principal
complains
•+ swollen
 Therapeutic mgt:

• R- Rest
• I - ice (24-48hrs)
• C- Compression
• E - elevate
traction
• Act of pulling and drawing
which is associated with
counter traction
 Purpose:
• P- prevent & correct deformity
• R- reduce pain & muscle spasm
• I- immobility
• S- support affected extremities
• M- maintain body alignment
 Types:
• S- SKELETAL
• M- MANUAL
• S- SKIN
 PRINCIPLES:

• A-Avoid friction
• B-Both have counter &
• C-continuous traction
• D-during pulling; must be align w/ the deformity
 Maintain efficiency of traction:

• A-always be sure that rope is running along the

pulley
• B-bags should be hanging freely
• C-check for the wear & tear
• D- d’ knots must be away from the pulley
 Nursing care:
• WOF: • Hygiene
1. Pneumonia, • comfort\
2. bedsore/ decubitus • Exercise
ulcer • Divert activities
3. Joints contractures/ • Diet
muscle atrophy
4. Constipation
5. infection
RUSSEL’S TRACTION
90-90 TRACTION
BALANCED SUSPENSION
EQUIPTMENTS USED IN BST
 CAST

- Immobilize a bone that has

been injured
• Fiber Glass  Plaster of Paris
• Distraction and comforting
• Cleanliness inside the cast
• X write or put small objects
• Check for compartment
syndrome
• Support with pillow- elevated
• Move gently
• Check for foul odor/itch
• Air dry
• “wet spot” = window
• Palm!! ; x finger to mold
• Electric cast saw
• Encircle the drainage
 Fracture

-break in the continuity of the bone

(trauma, twisting, muscle spasm)
- Not common in pedia (child abuse)
 Assessment:
• Pain
• Loss of fnx
• Deformity
• Erythema
• Edema
• Muscle spasm
• Impaired sensation
 4R’s of tx:
1. Recognition
2. Reduction-restore proper alignment
3. Retention
4. rehabilitation
 Common site:

• Clavicle
• Humerus
• Radius & ulna
• Femur
 Causes:

• Results of trauma
• Motor vehicle accidents
• Falls
• Child abuse
 pathophysio
RESISTANCE OF BONE
AGAINTS STRESS

FRACTURE
FRACTURE common in children:
• Bend fracture= bending bone;
• x straighten w/o intervention

• buckle fracture= result form

compression failure of the bone

• Greenstick fracture= incomplete

fracture
Diagnostic Evaluation
X-ray is most
useful
diagnostic tool
 Assessment of Fractures:
The 5 Ps
Pain and point of tenderness
Pulse–distal to the fracture site
Pallor
Paresthesia–sensation distal to the fracture
site
Paralysis–movement distal to the fracture site
 Stages of bone healing:
I. II. III. Callus IV. V.
Hematoma Cellular formation ossification Consolidati
formation proliferatio on &
n remodeling

Impact- 1st After 24hrs 6-21 days 3-10wks After 9 mos

24hrs to 3 days

Fracture Blood Bridging Callus form Bone

Bleeding supply fracture into bones marrow
Hematom increases ends Union restore
a form & Cell stage Fracture
clots proliferate line is visible
Osteoblast to xray
ic activity
 Bone healing:
• Neonate= 2 to 3wks
• Early childhood= 4wks
• Late childhood= 6-8wks
• Adolescence=8-12wks

Thicken periosteum &

generous blood supply
• Apply cold to injured area
• Limitation of complication
• Control of pain, hemorrhage &
edema
 NSG MGT:

• Immobilize
• cover with sterile gauze
(open)
• Elevate part
 Prevent complications:

• Compartment syndrome,
• Infection,
• Renal calculi,
• And fat embolism (72hrs after
fracture)
Congenital clubfoot
•Congenital
malformation of the
lower extremities
•boys
•Unilateral/ bilateral
• Defect are rigid and cannot
be manipulated into a
neutral position
• Long term follow up is
required until the child
reaches skeletal maturity
 Categories:

1. Positional=stretching, casting,
exercise
2. Teratologic/ syndromic= sx
3. Congenital= sx if (+) bone
involvement
 Common foot malformation:
1. TALIPES VARUS= inversion or bending
inward
2. TALIPES EQUINO-VALGUS = eversion or
bending outward
3. TALIPES EQUINO-VARUS= plantar
flexion, toes are lower than the heel
4. TALIPES CALCANEUS= dorsiflexion, toes
are higher than the heel
 Goal:

Functional foot
 Therapeutic mgt:

• Correction of deformity
• Maintenance of correction
• observation
 TREATMENT:
• Begins soon after birth
• Series of manipulation &
casting are performed
weekly, (2wks)
• & if not corrected in 3
months; surgery is indicated
(postero-medial soft tissue
release)
• Splintage can continued after surgery
with Dennis
• Browne splints
Dennis Brown Shoes
•Dilwyn Evans’ bone
operation- recurrent
clubfoot
•Monitor for pain
• Monitor neurovascular status of
the toes
• Instruct parents in cast care &
signs of neurovascular
impairment
LIMB DEFORMITIES
 Types of Limb Deformities
Amelia: absence of entire
extremity

Mecromelia: partial
absence of extremity

Phocomelia: deficiency of
long bones with relatively
good development of hands
and feet attached at or near
shoulder or hip (“seal
limbs”)
Developmental Dysplasia of the Hip
(DDH)
• Condition in which the head of
the femur is seated improperly
in the acetabulum, or hip
socket of the pelvis
• females
• Range from mild to
severely dislocated
• Can be congenital or can be
develop after birth
 Cause:
• Unknown,
• Family hx,
• Intrauterine position,
• Delivery type,
• Joint laxity,
• Post natal positioning
 Degree:
1. Dysplasia – mildest form, delay acetabular
development

2. Subluxation – largest percentage,

incomplete dislocation;
**femoral head remains partially in
contact with the acetabulum

3. Dislocation –severe form; femoral head

losses contact with the acetabulum
 Clinical manifestations:
a. Asymmetry of thigh
b. Unequal knee height
c. Limitation of hip
abduction
d. (+) trendelenburg sign
e. “Clunk” sound
•Treatment initiated
before 2 months
•By 6 mos – Ortolani (-)
 Goal:

•Maintain hip joint so

that femoral head and
acetabulum can develop
properly
 Intervention:
: <6 mos
=splinting the hip w/ PAVLIK
HARNESS to maintain flexion
& abduction & external
rotation;
x curative;
6mos to 2yo:
Close reduction- spica cast
12 weeks
2yo>:
Open surgical reduction
• FOLLOWING SURGERY:
=position & immobilization in spica cast
until healing is achieved, then abduction
splint

• X double or triple diaper

• Put undershirt
• Diaper under straps
• Feed football/supine (when in
cast)
• Look for location of marking in
harness when adjusting
• Place baby on back when
sleep= supine
scoliosis
•Lateral curvature of
the spine
•Sx & non- sx
intervention are used
• Tx depends on age, degree
of curvature, & amount of
growth that is anticipated
• Long term monitoring
 Causes:

1. Congenital infantile
2. Paralytic
3. Idiopathic / adolescent
 assessment
• Visible curve fail to strengthen when
child bends forward & hang arms
toward feet

• Asymmetry – hips, shoulder, ribs

• Leg length discrepancy
 4 common types of curves:

1. Thoracic- 90% on R side

2. Lumbar – 70% on L side
3. Thoracolumbar –80% on R side
4. Double major –curve that occur left to
right side
 Not all curvature of spine is
scoliosis:

1.<10 degrees = postural

variation
2.20-50 deg= bracing
3.45>deg= sx
 Intervention:

• Monitor curvature
• Prepare use of braces/
surgery
• physiotherapy
 Physiotherapy:
• Gives more emphasis on
posture,
• Strengthening the
muscles
• Correction of muscle in
balance
 Braces:
• Worn 16-23 hours a day
• Inspect skin breakdown
• Keep skin clean, & dry
• Inconvenient
• 15-16yo cessation of
bracing
• X curative
• compliance
 Surgery:for severe curves
•In thoracic scoliosis, metal
rods can be inserted along
the spine (COTREL –
DUBOUSSET
INSTRUMENTATION)
•Rods are left in spine
throughout life
•Harrington system
• May return to school after 1
month
• 5-7 day = discharge
• After 2 days= ROM, log roll,
elevate head
• DIET
• LUMBAR SCOLIOSIS
• =tx: fusion & underarm brace for
6months after sx
• proper alignment, x twisting movt
 Goal: post op

•Avoid
complications
• Encourage coughing & deep
breathing
• Activity restriction
• Log roll- side lying- sitting -
ambulation
• Administer prophylactic IV
antibiotics
 SEPTIC
ARTHRITIS
•Condition in which
bacteria invade the
joint space (hip)
•<10 yo (3-7yo)
 Bacteria access:
1.Direct puncture/wound infection
2.Seeding from distal infection site
3.Compression of joint capsule
from adjacent osteomyelitis
 Causative agents:

•S. aureus
•H. influenza type B
•Streptococci (most
common)
 sepsis
Avascular necrosis

Permanent deformity,
decrease ROM,
disability
 Goal:

•Prevent destruction of
the joint cartilage and
maintain function,
motion and strength
 Treatment:

•Joint aspiration or
orthrotomy followed by
IV antibiotics then oral
antibiotics
 Assessment:
• Fever to moderate severe pain
• Refusal to bear weight
• Limited range of motion
• Affected joint is warm and
swelling
 Management:
• Assess signs of infection
• Resolution of fever
• Analgesics
• Codeine or morphine
• Antibiotics
• Assistive devices
JUVENILE IDIOPATHIC
ARTHRITIS
(juvenile rheumatoid arthritis)
•Autoimmune disorder in
which autoantibodies
mainly target the joints.
•Pain, redness, swelling,
warmth, and stiffness after
inactivity.
 Therapeutic management
• Inflammation control
• Pain relief
• Promotion of remission
• Maintenance of mobility
 Meds:

• Corticosteroids
• NSAIDS
• Anti-rheumatic drugs=
methotrexate and etanercept
 Assessment:
• Note irritability
• Limited ROM
• Fever
• Redness
• Nonpuritic rash
• Observe gait
• Increase sedimentation rate
 Nursing management:
• Manage pain
• Maintain mobility
• Consult pediatric rheumatologist
• Eye exam
• Control inflammation
• SWIMMING