Peds Musculoskeletal Dysfunction

• Skin: involves tapes, boots, etc, but no machinery.
• – Buck’s Extension
• – Russell Traction
• – Cervical Traction 

• Skeletal: this is the heavy machinery type with pins and rods and screws etc. 
• – Halo
• – Balanced suspension
• – Femoral traction 

• The 5 P's:
• 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 

• • Skin care issues
• • Pain management/comfort 
• (See Guidelines on p. 1762)

• Diminished environmental stimuli
• Altered perception of self and environment
• ncreased feelings of frustration, helplessness, anxiety
• Depression, anger, aggressive behavior
• Developmental regression. The older the child, the more severe the psychological impact. 

• • Clubfoot
• • Developmental Dysplasia of the Hip
• • Legg-Calve’-Perthes Disease
• • Slipped Capital Femoral Epiphysis 

• shortly after birth cast will be admin'd and changed 1-2 weeks to remodel foot/calf. 
• after cast, will move to brace.

• • Unstable hip: Mildest form-hip ligaments are lax, allowing displacement
•  • Sublaxated hip: Head of femur is under lip of acetabulum, but not well seated
• • Dislocated hip:Femoral head loses contact with acetabulum 

• – Shortened limb on affected side
• – Restricted abduction of the hip on affected side
• – Unequal gluteal folds when infant prone
• – Positive ortolani test
• • Click heard when hips pulled up to flex. 
• --Positive barlow test
• • Click heard when hips abducted

• • Affected leg shorter than the other
• • Trendelenburg Sign
• – Hips should remain level when weight is shifted from one leg to the other
• • Greater trochanter is prominent
• • Waddling gait if bilateral dislocations 

• • Osteochondritis deformans juvenilis or coxa plana
• Self-limited, idiopathic, occurs in juveniles ages 2 to 12, more common in males ages 4 to 9
• Avascular necrosis of the femoral head (avascular because head of femur does not articulate with acetabulum.)
• 10%-15% have bilateral hip involvement
• After resolving may have normal femoral head or may have alteration

• – Insidious (slow) onset, may have history of limp, soreness or stiffness, limited ROM, vague history or trauma
• –  Pain and limp most evident on arising and at end of activity
• –  Diagnosed by x-ray

• – Goal: keep of femur in acetabulum
• – Containment with various devices
• – Rest, no weight bearing initially
• – Surgery, in some cases
• – Home traction, in some cases

• Affects the upper (capital) femoral growth plate/slips backwards in the acetabulum
• Hip disorder related to times of growth, especially during adolescence
• Cause is unknown, but 
• Connection to stress on the epiphyseal plate just prior to closure, ie usually occures in obesce clients during puberty b/c structure cannot support the child's weight plus growth. 
• Majority of patients exceed 95th percentile for weight and 90th percentile for height

• • Weakest point of long bones is the cartilage growth plate (epiphyseal plate)
• • Frequent site of damage during trauma
• • May affect future bone growth
• • Treatment may include open reduction and internal fixation to prevent growth disturbance 

• Compound or open: Fractured bone protrudes through the skin
• Complicated: bone fragments have damaged other organs or tissues
• Comminuted: small fragments of bone are broken from fractured shaft and lie in surrounding tissues
• Greenstick: compressed side of bone bends, but tension side of bone breaks causing incomplete fracture

Fat embolism: remember the yellow marrow (usually femur fxr)? Fat from yellow marrow leeches into vasculature and embolizes in heart, lung, ect. 

Compartment syndrome: Area is crushed/constricted. Cuts off vasculature/nerve function. Will turn necrotic. Can occur with casting.

• • A group of autosomal recessive inherited disorders of connective tissue
• • Involves a gene deficiency that leads to deficiency in collagen
• • Characterized by excessive fragility and bone defects
• • Multiple classifications ranging from stillborn/early death to mild bone fragility

• Sprains
• Strains
• Contusions

• • Trauma to a joint from ligament partially or completely torn or stretched due to force
• • May have associated damage to blood vessels muscles, tendons and nerves
• • Presence of joint laxity as indicator of severity
• • Rapid onset of swelling with disability 

• • A microscopic tear to musculotendinous unit
• • Similar to sprain
• • Swollen, painful to touch
• • Generally incurred over time 

• • Damage to soft tissue, subQ tissue, and muscle
• • Escape of blood into tissues-ecchymosis-black and blue discoloration
• • Swelling, pain, disability
• • ie Crush injuries 

• RICE & ICES
• R = rest
• I = ice (max 30 min at a time)
• C = compression
• E = elevation

• I = ice (max 30 min)
• C = compression
• E = elevation
• S= support

• • Disease is usually self-limiting
• • Treatment is conservative
• • Avoidance of activities that cause knee pain
• • Wrapping with elastic bandages
• • PT
• • Ice, heat, and NSAIDs
• • Knee brace 

• • Inflammation and infection of bone by bacteria
• May be caused by exogenous or hematogenous sources
• Exogenous
• – Infectious agent invades following penetrating wound, surgery (orthopedic pinning most common in children), etc.
• Hematogenous
• – Preexisting infection spreads to bone from skin, URI, abscessed tooth, phyelonephritis, etc.

• • Any organism can cause, but most common is staph aureus
• • Signs and symptoms begin abruptly, resemble those of arthritis and leukemia
• – Erythema, limited ROM, fever, lethargy, pain
• • Treatment:
• – IV antibiotics for extended time 

• Autoimmune inflammatory disease
• No known cause
• Peak ages: 1-3 years and 8 to 10 years
• Often undiagnosed
• 90% have negative Rheumatic Factor
• Symptoms may burn out and become inactive
• Chronic inflammation of synovium with joint effusion, destruction of cartilage 

• Stiffness, swelling, loss of mobility in affected joints (worse in the am)
• Warm to touch, usually without erythema
• Symptoms increase with stressors
• Growth retardation
• Treatment: NSAIDs, corticosteroids 

Can result from TB, arthritis, osteodystrophy or compression fracture

• • Accentulation of the cervical or lumbar curvature beyond physiologic limits
•  • May be idiopathic or secondary due to complication of trauma
•  • May occur with flexion contractures of hip, CHD
• • In obese children, abdominal fat alters center of gravity, causing lordosis