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Orthopedics Disorders Pediatrics Part II . Jan Bazner-Chandler RN, MSN, CNS, CPNP. Orthopedic Disorders. Congenital Acquired / trauma Infectious. Talipes Equinovarus. Talipes equinovarus or Club foot Obvious deformity noted at birth. Surgical correction. Talipus Equinovarus.

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orthopedics disorders pediatrics part ii

Orthopedics Disorders Pediatrics Part II

Jan Bazner-Chandler

RN, MSN, CNS, CPNP

orthopedic disorders
Orthopedic Disorders
  • Congenital
  • Acquired / trauma
  • Infectious
talipes equinovarus
Talipes Equinovarus

Talipes equinovarus or

Club foot

Obvious deformity noted

at birth.

Surgical correction

talipus equinovarus
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
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
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.
dysplasia of the hip
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
clinical manifestations
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.
interventions13
Interventions
  • Maintain hips in flexed position
  • Traction to stretch muscles
  • Pavlik harness
  • Hip surgery

Bowden & Greenberg

pavlik harness
Pavlik Harness

Bowden & Greenberg

harness
Harness

JB Chandler

osteogenesis imperfecta17
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 imperfecta18
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
3-month-old with OI

Old rib fractures

Old fractures/demineralization

careminder
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
Cerebral Palsy
  • Group of disorders of movement and posture
    • Prenatal causes = 44%
    • Labor and delivery = 19%
    • Perinatal = 8%
    • Childhood = 5%
assessment
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
careminder24
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 manifestations25
Clinical Manifestations
  • Hypotonia or Hypertonia
  • Contractures
  • Scoliosis
  • Seizures
  • Mental Retardation
  • Visual, learning and hearing disorders
  • Osteoporosis – long term due to lack of movement
legg calve perthes
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 manifestations27
Clinical Manifestations
  • Pain – groin, hip or referred pain to knee.
  • Limping
  • Limited hip motion especially internal rotation and abduction is classic sign.
management
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
Osgood-Schlatters

Painful prominence of the

tibial tubercle

Gait.udel.edu

osgood schlatters31
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
assessment32
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.
management33
Management
  • Reduce activity
  • Stretching before activity
  • Anti-inflammatory
  • Avoid activity that cause pain
slipped capital femoral epiphysis
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 manifestations35
Clinical Manifestations
  • Pain in groin, hip or knee
  • Limp (antalgic is limping on affected side)
  • Limited abduction
  • Leg may be shorter
management37
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
Scoliosis

Lateral curvature of spine

Medline.com

mild scoliosis
Mild Scoliosis

Mild forms

Strengthening and

stretching

clinical manifestations40
Clinical Manifestations
  • Pain is not a normal finding

for idiopathic scoliosis

  • Often present with uneven hemline
  • Unequal scapula
  • Unequal hips
assessment41
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.
screening43
Screening

Bowden & Greenberg

scoliosis47
Scoliosis

Spinal Fusion

post operative care
Post-operative Care
  • Pain management
  • Chest tube in many cases
  • Turn, cough, and deep breathe
  • Log-roll
muscular dystrophy
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
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.
assessment51
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
Gowers’ Sign
  • http://www.youtube.com
  • Type in Gowers’ Sign
interdisciplinary interventions
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
Long Term Problems
  • Cardiomyopathy in 90% over 18 years of age
  • Respiratory complications
  • Obesity
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