Orthopedic Assessment Jan Bazner-Chandler CPNP, CNS, MSN, RN
Dec 31, 2015
Orthopedic Assessment
Jan Bazner-ChandlerCPNP, CNS, MSN, RN
Musculoskeletal Differences in Children Epiphyseal growth plate present Bones are growing / heal faster Bones are more pliable Periosteum thicker and more active Abundant blood supply to the bone The younger the child the faster the healing.
Focused Physical Assessment Inspect child undressed Observe child walking Spinal alignment ROM Muscle strength Reflexes
Assessment Concerns: Pain or tenderness Muscle spasm Masses Soft tissue swelling
CoREminder If an injury has occurred, examine that area
last and be gentle when palpating the injury site.
Nursing Alert A child younger than 1 year who presents with
a fracture should be evaluated for possible physical abuse or an underlying musculoskeletal disorder that would cause spontaneous bone injury.
Neurovascular Assessment Circulation Nerve function
Neurovascular Assessment Sensation
Can the child feel touch on the affected extremity Motion
Can the child move fingers or toes below area of injury / nerve injury
Temperature Is the extremity warm or cool to touch
Neurovascular Assessment Capillary refill
Sluggish capillary refill may signal poor circulation Color
Note color of extremity and compare with unaffected limb
Pulses Assess distal to injury or cast
Neurovascular Impairment Restriction of circulation and nerve function
from injury or immobilizing device.
Clinical Manifestations Increased pain Edema Decreased movement or sensation Diminished or absent pulses distal to injury Patient often described as restless – pain
medication does not work – pain described as deep
Interventions Assess area distal to injury, surgical site, cast,
splint, or traction
Notify physician
Release pressure by splitting the cast or loosening restrictive bandage per physician order.
Compartment Syndrome A painful condition that results when pressure
within the muscles builds to dangerous levels. This prevents nourishment from reaching nerve and muscle cells.
Muscle groups in legs, arms, hands, feet and buttocks can be affected.
Clinical Manifestations The classic sign of acute compartment
syndrome is pain, especially when the muscle is stretched.
There may also be a tingling or burning sensation (paresthesias) in the muscle.
A child may report that the foot / hand is “a sleep”
If the area becomes numb or paralysis sets in, cell death has begun and efforts to lower the pressure in the compartment may not be successful in restoring function.
Physical Assessment• Assess pain and if pain medication is
working.• The muscle may feel tight or full. • Measure the affected muscle group and
compare with the unaffected side.• Check pulses below area of injury
Treatment Prevention!!!! Don’t elevate the affected limb above or
below the level of the heart. Dressings should be removed or loosened if
CS is suspected. Current standards: a split is applied for the
first 48 hours until swelling from injury / surgery has gone down.
Surgical Management
Fasciotomy to relieve pressure. The fascia is divided alongthe length of the compartment to release pressure within.
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Nerve Assessment Important to do on admission from ER or to
the unit and pre and post surgical procedure
Radius and ulna nerve assessment
Ulnar Nerve Injury
Medial Nerve Injury
Radial Nerve Injury
Peroneal Nerve Distribution