Fractures in kids?
Childrens bones are immature tend to bend or buckle
Young bones heal quickly due to thick periosteum that provides abundant blood supply
Callus helps fracture site to remodel.
What causes fractures?
•MVA (hip and femur)
•Child abuse (especially in infants)
•Bone diseases (osteogenesis imperfecta)
What are S/S of fractures?
Pain or tenderness at site
•Immobility or decreased ROM
- •Deformity of extremity; abnormal
- •Inability to bear weight, limp or
- abnormal gait
What are treatments for fractures?
•Reduction—closed or open
•Retention—casts or traction
how do you take care of a cast?
- •Applied with waterproof tape around
- groin or perineum
•Cool blow dryer to decrease itching
•Report foul smell or drainage
- •Assess sensation, color and
Why do you immobilize a broken bone?
Helps achieve and maintain a more functional position or rests and protects an affected area during bone healing.
Why are splints used?
To stablilize and protect or rest an affected area, increase range of motion and decrease pain.
What does a cast do?
provides support and maintains anatomic position for bone healing or aids in correction of a deformity.
Also to ensure adherance to treatment protocals or to protect a wound
Who and how many to apply a cast?
the physician and another trained person, one to hold the extremity in correct allignment and one to apply the cast.
It is impotant to not move the affected area to be casted while applying the cast.
What is traction?
a pull or force exerted on one part of the body
can be applied to the skin or bone spine, pelvis, or long bones.
What is Bucks traction?
- traction- used
- to treat some fractures, hip disorders, contractures and muscle spasms.
What is Russell traction?
- stabilizes fracture femur until callus forms
What is the beds position while doing traction?
The part of the bed that holds the traction is tilted or elevated thereby assisting the traction.
How is traction described?
As continuous or intemittent.
The nurse shoul always assume that it is continuous unless the doctor states otherwise.
What is cervical traction?
- treat muscle or nerve irritation of
- shoulders/upper extremities
Who is skin traction most effective with?
Children who weigh less tha 15kg (33Lbs) or are younger than 2-3 years old.
What can happen if skin traction is not set up correct?
Types of Skeletal traction?
90/90 femerol traction
what is Crutchfield
- stabilize fractures/displacement
- of cervical/thoracic vertebrae
what is Balanced
- suspend/immobilize a leg without
- applying traction to body
what is 90/90
- for complicated fractures of femur
what is dunlop traction?
•treat supracondylar fractures of humerus
diffrence in skeletal traction from skin traction?
Exerts greater force than skin traction and can be physiologically tolerated for longer period of time.
care for child in traction
•Check components of device
•Prevent skin breakdown
- •Prevent complications of skeletal
- traction (osteomyelitis)
- •Prevent complications of skin
- traction (neuro)
•Analgesics for pain
•Nutrition for immobilized child
- •Encourage parental and child
- involvement in care.
•Age appropriate developmental activities
How is traction manitained in sketetal tractions?
A metal device is inserted into the bone.
What is the most serious complicaton associated with sskeletal traction?
Ostemylitis! an infection involving the bone.
What are Possible
consequences of immobility
What happens in compartment syndrome?
- •Muscles and nerves of extremities
- are enclosed in “compartments” by fascia which is tough and elastic
• Pressure increases
- •Results in paralysis and necrosis
- of tissues
How do you assess for compartment syndrome?
- •Severe, intense pain not relieved
- by analgesics
- •If forearm fracture—pain with
- extension of fingers
•Signs of neurovascular impairment
•Change in color, sensation, parasthesia
What do you check in neuovascular assessment?
Q 1-2 hours for 4
What are the 5 P’s OF VASCULAR IMPAIRMENT
•PARESTHESIA (BURNING SENSATION)
- •Pain or burning=tissue ischemia and
- requires immediate physician referral
What may a sluggish capillary refill indicate?
if a kid complains of pins and needles or falling asleep in a tractioned extremity what should you do?
Report the complaint.
What is a sprain?
- Sprains: trauma to joint in which
- ligaments are stretched or partially/completely torn
What is a strain?
Strain: excessive stretch of muscle
What is a contusion?
- Contusion: damaged soft tissue, muscle or
- subcutaneous tissue
Signs and symptoms of soft tissue injuries?
•Poor weight bearing
Pop or snapping sound (sprain
Treatment for soft tissue injuries?
- First 6-12 hours are most important
- in controlling swelling and reducing muscle damage.
What is osteomyelities?
•Bacterial infection of the bone
•Ages 5-14 yrs.
- •Usually secondary to other
- infections such as staph or strep.
- •Usually result of direct entry
- (wound) or cellulitis, or complication from traction
•May be acute or chronic
Why are sprains not usually seen in children?
because of poorly developed epiphyseal plates. a twisting or turning injury will likley result in a fracture.
Signs and symptoms of osteomylitis?
•Favoring affected extremity
- •Systemic manifestations such as
The treatment for osteomylitis?
- •Antibiotic therapy for 4-6 weeks,
- may be followed by oral antibiotics at home
•Immobility of affected extremity
- •Surgical interventions (I & D,
What are nursing care for osteomyelitis?
•Activity limitation considerations
Where does osteomyelitis most frequently occur?
In the metaphyseal region of the long bones especially the femur or tibia.
How does bacteria infiltrate the bone?
- Endogenous route
- resp infections
- abcessed teeth
- otitis media
- surgical procedures.
Why does osteomyelitis of teh proximal femur generally require some type of surgical decompression?
Septic arthritis of the hip may accompany this infection.
What is osgod-schlatter disease?
- Bilateral knee pain that is
- exacerbated by running, jumping or climbing stairs. Occurs in children 8-16
- years of age.
•Usually in boys involved in sports
- •Conservative management—often
- resolves on its own
- Avascular necrosis of the femoral
•Usually unilateral involvement
- •Etiology: unknown…. Thought to be
- related to rapid growth
•Signs and Symptoms
–Hip/knee soreness & stiffness
–Quadriceps muscle atrophy
What is the treatment for osteochondritis?
Bedrest (7-10 days)
•Non-weight bearing brace
- •Goal is to avoid permanent
What is osteogenesis Imperfecta?
Bones brittle from birth
•Often mistaken for child abuse
What are symptoms of osteogenesis
•Excessive bone fragility
•Deafness by age 20-30
•Skin appears transparent
How do you manage osteogeniesis?
•Maintain skeletal integrity
•Traction, casting, fixation
•No effective treatment
what is JUVENILE
•An autoimmune inflammatory disease
- •Symptoms must be present 6 weeks or
- more for diagnosis
& Symptoms of Juvenile Arthritis
•Limited range of motion
•Inflammation of multiple joints
- •Symptoms present >6 weeks or
how do you manage Juvneile idiopatheic arthritis?
•Preserve joint function
•Reduce impact on child’s development
Drug therapy for Juvienile idiopathic arthritis?
- •Immunosuppressive & cytotoxic
In juvenile idiopathic arthrits what is the "gel Phnomenon"
stiffness in the joints that is worse in the morning or after a prologned period of rest. The gel in the joints seems to gel.
What are muscular dystrophies?
- A group of progressive
- degenerative, INHERITED diseases that affect the muscle cells of specific
- muscle groups causing weakness and atrophy.
•Gender-linked recessive disorder
•Duchenne’s most common form
•Occurs in 1 in 3000 males
- •Muscle fibers degenerate- Replaced
- by fat & connective tissue
S/S of muscular dystrophies?
- •Progressive/symmetric muscle
•Weakness without loss of sensation
- •Appears after walking achieved (3-7
•Waddling, wide based gait
What is scoliosis?
- lateral curvature of the spine
- •May develop on any part of the
•Occurs more frequently in girls
•Exhibit uneven hips and shoulders
catagories of Scoliosis?
•Idiopathic- predominant form
S/S of scoliosis?
•Visible curve of spine
- •Rib hump when child is bending
•Asymmetric rib cage
•Uneven shoulder/pelvic heights
- •Reduced vital capacity in severe
What is the treatment for scoliosis?q
•20 degrees or less- observation
- •20-40 degrees- bracing (worn 22-23
- hours per day). 85% effective in
- stabilizing mild curves)
- •40 degrees or greater- spinal
- fusion & Harrington rods
What is Congenital
- •Head of femur improperly seated in
- hip socket
- •Severity ranges from mild to
- •May be present at birth or develop
- after birth
Etiology of congenital hip dysplasia?
•Laxity of ligaments
s/s of congenital hip dysplasia?
- •Displacement of acetabulum upon
- manipulation (“click”)
•Asymmetry of gluteal skin folds
•Limited ROM of affected hip
- •Asymmetric abduction of affected
•Short femur on affected side
•Variations in gait in older child
Treatment of congenital hip dysplagia?
•*Pavlik harness worn 23/24 hours a day
•Osteotomy for severe cases
- •Goal: relocate head of femur within
- the acetabulum and protect vessels and nerves that sit on exterior of the bone.
- •*Earlier diagnosis—during newborn
- era is easier to correct
What is clubfoot?
- •Congenital anomaly characterized by
- adduction of the forefoot, inversion of the heel
•Associated with other disorders—spina bifida
•May be unilateral, or bilateral
Treatment for clubfoot?
- •Serial casting and manipulation
- weekly for 3-6 months…if no improvement, surgery
- •Long-term follow up until skeletal
- maturity is reached to prevent recurrence
Result from birth anomalies
•Can result from trauma
- •Webbing, extra digits, congenital
- absence of all or part of extremity
Pathophysiology of limb defects?
•In utero positioning
•Sitting/sleeping posture of child
•Heredity in mild defects
management of limb defects?
- •Exercises, splint, special shoes,
- •Surgical intervention for severe
•Long term immobility