Unit 7 & 8

for congenital defects, degenerative disorders and infections or injuries that impair the integumentary system, the musculoskeletal system or neurologic system

• Bend, Buckle (raised or bulging at fracture site),
• Greenstick (incomplete fractures),
• Spiral (twisting, forms a spiral encircling the bone),
• Transverse (occurs at a 90 degree angle to longitudinal axis of bone),
• Oblique (occurs at 45 degree angle across longitudinal axis of bone),
• Complete (breaka cross entire section of bone),
• Closed (does not break the skin), Compound (open wound through which the bone has protruded),
• Complicated (bone fragments that cause damage to other organs or tissues), Comminuted (more than one fracture line, more than 2 bone fragments either splintered or crushed)

Deformity, muscle spasm, swelling, bruising, crepitus, muscle rigidity

sensation, movement, circulation, cap refill, pulses

• Reduce-manipulation of bone to restore realignment
• Closed-reduction-manual traction to move fracure fragments and restore bone alignment
• ORIF-surgical procedure where fragments are realigned with an internal fixation such as screws, plates, pins
• OREF-surgical procedure to realign bones with an external fixation such as cast or pins

• Pain and point of tenderness
• Pulses-distal to the fracture site
• Pallor-color
• Paresthesia-sensation distal to the fracture site
• Paralysis-movement distal to the fracture site

Regain alignment and length, retain alignment and length, restore function, prevent further injury

Lower extremity, spinal or cervical, spica, plaster, fiberglass

Edema that occurs in response to a fracture that causes pressure in the muscle compartment that reduces cap blood perfusion, therefore unable to meet tissues metabolic need and ischemia begins.

• Traction-application of a pulling force to an injured body part or extremity while countertraction pulls in the opposite direction
• Skin-application of a pulling force directly to the skin through use of skin straps, boots, or foam splints
• Skeletal-uses int to apply force to the bone
• Manual-applied to body part by the hands placed distal to the fracture site

• twist, pull, and/or tear of muscle and/or tendon
• caused by direct or indirect trauma that knocks a joint out of position or overstreches or ruptures

Stretch and/or tear of ligament, may hear a tear or pop of joint, pain bruising, edema

• Shin splints-strain of posterior tibial muscle origin
• Plantar fasciitis-strain to plantar fascia
• Patellar tendinopathy-tennis elbow, tendinitis of hand or wrist
• Osteomyelitis-severe pyogenic infection of the bone and surrounding tissues

Complex deformity of the ankle and foot caused by abnormal positioning and restricted movement in utero, abnormal embryonic development, relationship with other disorders or syndromes

• Talipes varus-inversion or bending inward
• Talipes valgus-eversion or bending outward
• Talipes equinus-plantar flexion, toes lower than heels
• Talipes calcaneus-dorsiflexion, toes higher than heels
• Most common-Talipes equinovarus (TEV)

• Kyphosis-humpback
• Lordosis-swayback

• Infantile (up to 3 years)
• Childhood (juvenile, during childhood)
• Adolescent (during adolescent growth spurt) MOST COMMON

• congenital (caused by vertebral anomalies present at birth)
• idiopathic (cause unknown, subclassified as infantile, juvenile, adolescent, or adult, according to when onset occurred)
• neuromuscular (having developed as a secondary symptom of another condition, such as spina bifida, cerebral palsy, spinal muscular atrophy, or physical trauma)

• Lateral curvature of the spine. 
• Less than 10 degrees is postural deviation
• Less than 20 degrees is mild, no progression, no treatment
• 40-45 degress excessive curvature surgical intervention

Observation, bracing, spinal fusion if severe, and exercise

An idiopathic autoimmune inflammatory disease causing inflammation of joints and other tissues.  It starts before age 16 and has no known cause.

• Between 1-3 years and between 8-10 years of age.
• Twice as many girls than boys get it

There is no treatment, goals are to control pain, preserve joint ROM and function, minimize effects of inflammation such as deformity and promote normal growth and development

Chronic inflammation of the synovium, joint effusion, destruction and fibrosis of articular cartilage, adhesion between joint surfaces, ankylosis of joints

ESR (sed rate), rheumatoid factor, x-ray to show soft-tissue swelling and joint space widening

NSAIDS, methotrexate, corticosteroids (potent immunosuppressives), Slow-acting antirheumatic drugs, splinting as necessary, support

• A bacterial infection in the joint affecting adults under 30 usually caused by N. gonorrhoeae or MRSA.
• Most joints affected, knee, hip, shoulder, wrist, ankle
• Confirmed by blood work, synovial fluid analysis

• IV antibiotic therapy for 2-3 weeks
• Additional oral ABX if needed

• Characterized by excessive fractures and bone deformities
• Also known as brittle bone disease
• Characterized by hearing loss, bone fragility, blue sclerae, fractures, discolored teeth

Careful handling to prevent fractures, careful repositioning to prevent contractures, physical therapy to build strength, surgery to correct deformities, family support, braces and splints to help support limbs and prevent fractures

• Type 1-most common, mild bone fragility, normal teeth, hearing loss, autosomal dominant inheritance
• Type 2-lethal, stillborn or die in early infancy
• Type 3-Severe bone fragility leading to severe progressive deformities, normal sclerae
• Type 4-Mild to moderate bone fragility, normal sclerae, short stature, variable deformity
• Type 5-Clinically similar to Type 4
• Type 6-Sclerae and dentition normal, moderate to severe bone fragility, diagnosed by bone biopsy