Orthopedics Disorders Pediatrics Part II Jan Bazner-Chandler RN, MSN, CNS, CPNP
Dec 23, 2015
Orthopedics Disorders Pediatrics Part II
Jan Bazner-ChandlerRN, MSN, CNS, CPNP
Orthopedic Disorders Congenital Acquired / trauma Infectious
Talipes Equinovarus
Talipes equinovarus or
Club foot
Obvious deformity notedat birth.
Surgical correction
Talipus Equinovarus Club Foot 1 to 2 per 1000 Males more affected Involves both the bony structures and soft
tissue. The entire foot is pointing downward.
Interventions
Manipulation and serial casting immediately. The more rigid the foot the more likely
surgery will be necessary. Surgery performed between 4 and 12 months.
Metatarsus Adductus Most common foot deformity 2 per 1000 Result of intrauterine positioning Forefoot is adducted and in varus, giving the
foot a kidney bean shape. Most often resolves on own or with simple
exercises.
Metatarsus Adductus
Dysplasia of the Hip Abnormality in the development of the
proximal femur, acetabulum, or both. Girls affected 6:1 Familial history Breech presentation Maternal hormones Other ortho anomalies
Developmental Dysplasia of Hip
Clinical Manifestations
+ Ortolani maneuver Asymmetrical lower extremity skin folds –
soft sign not always seen. In the older infant there would be
decreased ROM in the affected hip especially with abduction.
In the child there might be discrepancy in limb length.
Asymmetry of skin fold
Hip Exam
Interventions Maintain hips in flexed position Traction to stretch muscles Pavlik harness Hip surgery
Bowden & Greenberg
Pavlik Harness
Bowden & Greenberg
Harness
JB Chandler
Osteogenesis Imperfecta
Osteogenesis Imperfecta Genetic disorder Caused by a genetic defect that affects the
body’s production of collagen. Collagen is the major protein of the body’s
connective tissue. Less than normal or poor collagen leads to
weak bones that fracture easily.
Osteogenesis Imperfecta Often called “brittle bone disease” Characteristics
Demineralization, cortical thinning Multiple fractures with pseudoarthrosis Exuberant callus formation at fracture site Blue sclera Wide sutures Pre-senile deafness
3-month-old with OI
Old fractures/demineralization
Old rib fractures
New Born with OI
CaReminder Signs of a fracture, especially in an infant, are
important items to teach caregivers. In a baby, these signs are general symptoms, such as fever, irritability, and refusal to eat.
Cerebral Palsy Group of disorders of movement and posture
Prenatal causes = 44% Labor and delivery = 19% Perinatal = 8% Childhood = 5%
Assessment Developmental surveillance is key Diagnosis often made when child is 6 to 12
months of age Physical exam:
Range of motion Evaluation of muscle strength and tone Presence of abnormal movement or contractures
caReminder Reflexes that persist beyond the expected age
of disappearance (e.g., tonic neck reflex) or absence of expected reflexes are highly suggestive of CP.
Clinical ManifestationsHypotonia or HypertoniaContracturesScoliosisSeizuresMental Retardation Visual, learning and hearing disordersOsteoporosis – long term due to lack of
movement
Legg-Calve-Perthes Vascular disturbance leads to bone death in
hip do to interruption of blood flow. Four times more common in males More common in Asians, Eskimos and
Caucasians. Peak age 6 (2 - 12 years)
Clinical Manifestations Pain – groin, hip or referred pain to knee. Limping Limited hip motion especially internal rotation
and abduction is classic sign.
Right hip - LCP
Management Goal of care is to: Keep femoral head in the
hip joint Traction Anti-inflammatory Physical therapy Surgery if femoral head destroyed
Osgood-Schlatters
Painful prominence of the
tibial tubercle
Gait.udel.edu
Osgood-Schlatters Due to repetitive motion Affects children 10 to 14 years old Males 3:1 Diagnosis is based on clinical signs and
symptoms Pain, heat, tenderness, and local swelling
Assessment Tip: Asking the child to squat or extend his or
her knee against resistance usually elicits pain and is a good indicator of Osgood-Schlatter Disease.
Management
•Reduce activity
•Stretching before activity
•Anti-inflammatory
•Avoid activity that cause pain
Slipped Capital Femoral Epiphysis Top of femur slips through growth plate in
a posterior direction.
Ages 10 to 14 in girls
Ages 10 to 16 in boys
High proportion are obese
Clinical Manifestations Pain in groin, hip or knee Limp (antalgic is limping on affected side) Limited abduction Leg may be shorter
Clinical Manifestations
Management Surgery – fix with a pin Crutch walking Complications
Avascular necrosis of femoral head is compromise of circulation of the femoral head leading to ischemia. This may lead to collapse of the necrotic segment.
Scoliosis
Lateral curvature of spine
Medline.com
Mild Scoliosis
Mild forms
Strengthening and
stretching
Clinical Manifestations• Pain is not a normal finding
for idiopathic scoliosis• Often present with uneven hemline• Unequal scapula• Unequal hips
Assessment Alert: If pain is a reported symptom of the
child’s scoliosis, it should be investigated immediately. Pain is not a normal finding for idiopathic scoliosis, and the presence of this symptom could be signaling an underlying condition such as tumor of the spinal cord.
Screening
Screening
Bowden & Greenberg
Severe Scoliosis
Bracing
Milwaukee Brace
Scoliosis
Spinal Fusion
Post-operative Care Pain management Chest tube in many cases Turn, cough, and deep breathe Log-roll
Muscular Dystrophy Group of genetic diseases characterized by
progressive weakness and degeneration of the skeletal muscles that control movement.
Most common: Duchenne muscular dystrophy (DMD)
Predominately male disease X-linked recessive inherited disease
Pathophysiology DMD is deficiency or absence of the protein
dystrophin. Protein is thought to strengthen the muscle
cell membrane. Laboratory values: Creatinine kinase levels
are high.
Assessment Infant may display mild delay in attaining
milestone. Sitting up, crawling, cruising Toddler (between ages 2 to 3) may have a clumsy
gait and have difficulty climbing stairs. Classic physical finding: Gowers’ sign
Gowers’ Sign http://www.youtube.com Type in Gowers’ Sign
Interdisciplinary Interventions Team of nursing, physicians, specialists Pharmacologic Interventions
Glucocorticosteroids (prednisone and deflazacort): steroids have been found to increase muscle strength and pulmonary function.
Long Term Problems Cardiomyopathy in 90% over 18 years of age Respiratory complications Obesity