1. 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.
  2. What causes fractures?
    •Falls (forearm)

    •MVA (hip and femur)

    •Sports injuries

    •Child abuse (especially in infants)

    •Bone diseases (osteogenesis imperfecta)
  3. What are S/S of fractures?
    Pain or tenderness at site

    •Immobility or decreased ROM

    • •Deformity of extremity; abnormal
    • rotation




    •Muscle spasm

    • •Inability to bear weight, limp or
    • abnormal gait

  4. What are treatments for fractures?
    •Reduction—closed or open

    •Retention—casts or traction
  5. how do you take care of a cast?
    •Keep dry

    • •Applied with waterproof tape around
    • groin or perineum

    •Cool blow dryer to decrease itching

    •Report foul smell or drainage

    • •Assess sensation, color and
    • temperature

    •Keep clean
  6. 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.
  7. Why are splints used?
    To stablilize and protect or rest an affected area,  increase range of motion and decrease pain.
  8. 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
  9. 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.
  10. 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.
  11. What is Bucks traction?
    • •Bucks
    • traction- used
    • to treat some fractures, hip disorders, contractures and muscle spasms.
  12. What is Russell traction?
    • •Russell
    • traction-
    • stabilizes fracture femur until callus forms
  13. 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.
  14. How is traction described?
    As continuous or intemittent.

    The nurse shoul always assume that it is continuous unless the doctor states otherwise.
  15. What is cervical traction?
    • treat muscle or nerve irritation of
    • shoulders/upper extremities
  16. Who is skin traction most effective with?
    Children who weigh less tha 15kg (33Lbs) or are younger than 2-3 years old.
  17. What can happen if skin traction is not set up correct?
    Neurovascular impairment.
  18. Types of Skeletal traction?
    Crutchfield tongs

    Balance suspension

    90/90 femerol traction

    Dunlop traction
  19. what is Crutchfield
    • stabilize fractures/displacement
    • of cervical/thoracic vertebrae
  20. what is Balanced
    • suspend/immobilize a leg without
    • applying traction to body
  21. what is 90/90
    femoral traction
    • traction
    • for complicated fractures of femur
  22. what is dunlop traction?
    •treat supracondylar fractures of humerus
  23. diffrence in skeletal traction from skin traction?
    Exerts greater force than skin traction and can be physiologically tolerated for longer period of time.
  24. Nursing
    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
  25. How is traction manitained in sketetal tractions?
    A metal device is inserted into the bone.
  26. What is the most serious complicaton associated with sskeletal traction?
    Ostemylitis! an infection involving the bone.
  27. What are Possible
    consequences of immobility
    •Skin integrity




    •Impaired mobility

  28. What happens in compartment syndrome?
    • •Muscles and nerves of extremities
    • are enclosed in “compartments” by fascia which is tough and elastic

    •Swelling increases

    • Pressure increases

    • •Results in paralysis and necrosis
    • of tissues
  29. 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
  30. What do you check in neuovascular assessment?








    Q 1-2 hours for 4
  31. What are the 5 P’s OF VASCULAR IMPAIRMENT





    • •Pain or burning=tissue ischemia and
    • requires immediate physician referral
  32. What may a sluggish capillary refill indicate?
    Neurovascular impairment.
  33. if a kid complains of pins and needles or falling asleep in a tractioned extremity what should you do?
    Report the complaint.
  34. What is a sprain?
    • Sprains: trauma to joint in which
    • ligaments are stretched or partially/completely torn
  35. What is a strain?
    Strain: excessive stretch of muscle
  36. What is a contusion?
    • Contusion: damaged soft tissue, muscle or
    • subcutaneous tissue
  37. Signs and symptoms of soft tissue injuries?


    •Localized tenderness

    •Limited ROM

    •Poor weight bearing

    Pop or snapping sound (sprain
  38. Treatment for soft tissue injuries?
    • First 6-12 hours are most important
    • in controlling swelling and reducing muscle damage.
  39. 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
  40. 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.
  41. Signs and symptoms of osteomylitis?

    •Favoring affected extremity




    •Limited ROM

    • •Systemic manifestations such as
    • fever/lethargy
  42. The treatment for osteomylitis?

    • •Antibiotic therapy for 4-6 weeks,
    • may be followed by oral antibiotics at home

    •Complete bedrest

    •Immobility of affected extremity

    • •Surgical interventions (I & D,
    • decompression)
  43. What are nursing care for osteomyelitis?
    •Immobilization, positioning


    •IV antibiotics

    •Wound care

    •Activity limitation considerations

    •Home care

    •Developmental issues
  44. Where does osteomyelitis most frequently occur?
    In the metaphyseal region of the long bones especially the femur or tibia.
  45. How does bacteria infiltrate the bone?
    • Endogenous route
    • skin
    • resp infections 
    • abcessed teeth
    • otitis media
    • injury
    • surgical procedures.
  46. Why does osteomyelitis of teh proximal femur generally require some type of surgical decompression?
    Septic arthritis of the hip may accompany this infection.
  47. 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
    DISEASE (Osteochondritis
    • Avascular necrosis of the femoral
    • head.

    •Usually unilateral involvement

    • •Etiology: unknown…. Thought to be
    • related to rapid growth

    •Signs and Symptoms

    –Hip/knee soreness & stiffness

    –Painful limp

    –Quadriceps muscle atrophy
  49. What is the treatment for osteochondritis?
    Bedrest (7-10 days)


    •Non-weight bearing brace


    • •Goal is to avoid permanent
    • deformity
  50. What is osteogenesis Imperfecta?
    Bones brittle from birth

    •Inherited disorder

    •Often mistaken for child abuse

    •Normal intelligence
  51. What are symptoms of osteogenesis

    •Excessive bone fragility

    •Blue sclerae

    •Discolored teeth

    •Deafness by age 20-30

    •Skin appears transparent

    •Frequent fractures
  52. How do you manage osteogeniesis?
    •Maintain skeletal integrity

    •Prevent fractures

    •Traction, casting, fixation

    •No effective treatment
  53. what is JUVENILE
    •Incidence 1.4:1000

    •An autoimmune inflammatory disease

    • •Symptoms must be present 6 weeks or
    • more for diagnosis

    •Multi-system disease
  54. Signs
    & Symptoms of Juvenile Arthritis
    •Joint swelling

    •Limited range of motion



    •Inflammation of multiple joints

    • •Symptoms present >6 weeks or
    • more
  55. how do you manage Juvneile idiopatheic arthritis?

    •Preserve joint function

    •Control inflammation

    •Minimize deformity

    •Reduce impact on child’s development
  56. Drug therapy for Juvienile idiopathic arthritis?

    •Anti-rheumatic drugs


    • •Immunosuppressive & cytotoxic
    • agents
  57. 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.
  58. 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
  59. S/S of muscular dystrophies?
    • •Progressive/symmetric muscle
    • wasting

    •Weakness without loss of sensation

    • •Appears after walking achieved (3-7
    • yrs)

    •Waddling, wide based gait

    •Hip/knee contractures

    •Foot deformities

  60. What is scoliosis?
    • lateral curvature of the spine

    • •May develop on any part of the
    • spine

    •Occurs more frequently in girls

    •Exhibit uneven hips and shoulders
  61. catagories of Scoliosis?
    •Idiopathic- predominant form


  62. S/S of scoliosis?
    •Visible curve of spine

    • •Rib hump when child is bending
    • forward

    •Asymmetric rib cage

    •Uneven shoulder/pelvic heights

    • •Reduced vital capacity in severe
    • cases
  63. 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
  64. What is Congenital
    hip dysplasia
    • •Head of femur improperly seated in
    • hip socket

    • •Severity ranges from mild to
    • severe.

    • •May be present at birth or develop
    • after birth
  65. Etiology of congenital hip dysplasia?
    •Genetic factors

    •Prenatal/postnatal positioning

    •Laxity of ligaments

    •Family history
  66. 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
    • hip

    •Short femur on affected side

    •Variations in gait in older child
  67. Treatment of congenital hip dysplagia?
    •*Pavlik harness worn 23/24 hours a day

    •Spica cast

    •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
  68. 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
  69. 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
  70. Limb
    Result from birth anomalies

    •Can result from trauma

    • •Webbing, extra digits, congenital
    • absence of all or part of extremity


  71. Pathophysiology of limb defects?
    •In utero positioning

    •Sitting/sleeping posture of child

    •Heredity in mild defects
  72. Therapeutic
    management of limb defects?
    •Mild self-correct

    • •Exercises, splint, special shoes,
    • casts

    • •Surgical intervention for severe
    • deformities

    •Long term immobility

    •Orthoses/physical therapy
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