Infants' bones ossify __a__% at __b__ months, so they become less firm and brittle.
a. 65%
b. 8 months
T or F: Fractures are usual with children <1 y/o
False
When do sutures of cranium fuse?
16-18 months old
For skin traction: ___ lbs for <2-3 year olds
<30 lbs
What do you always want to worry about for skeletal tractions? How do you care for pin sites to prevent it?
Osteomyelitis: an infection of the bone, a rare but serious condition
Care: Pin site care with H202, abx ointment, split 2x2
Osteomyelitis is a bone infection that can turn chronic if...
Chronic if >1month or not responding to abx
Osteomyelitis, a bone infection, occurs higher in what age group?
<5 y/o and at growth spurts
T or F: Pts with osteomyelitis will be put on bedrest
True
T or F: Pts. with osteomyelitis shouldn't be immobilized to strengthen the infected bone
False: immobilized maybe used to prevent spread of infection
T or F: With a patient on lower extremity traction, keep the HOB at 45 degrees to keep counter traction
False: 20 degrees
If a pt. who is immobile has GI issues, you want to give them:
C.
The etiology of this congenital malformation of the lower extremity occurs in 1/1000 births. Boys have it more than girls (2:1).
Club foot
What is the tx for Club foot?
Serial stretching, manipulation to return foot to natural position
Casting QW for 3-6 months if not corrected with surgery
What is the Pavlik harness used to treat?
Hip dysplasia: maintains flexion, abduction and external rotation
What is the cardinal sign of compartment syndrome? What is the FIRST thing you do if you notice it?
Severe pain unrelieved by analgesics when a cast is in use
First thing: Call MD
IV Bisphosphonate is a preventing against what?
Osteogenesis Imperfecta: a brittle bone dz, similar to osteoporosis
Why is deafness a part of osteogenesis?
Deafness r/t occipital bones affected
Match
1. Stretched or partially/totally torn ligaments
2. excessive stretch of muscle
3. damage to soft tissue, muscle, or subq issue
a. strains
b. contusion
c. sprain
1. c
2. a
3. b
This term is repetitive stress from sports-related injuries, overuse of immature muscles/tendons.
When does it usually occur?
Osgood-Schlatter disease can cause a painful, bony bump on the shinbone just below the knee. It usually occurs in children and adolescents experiencing growth spurts during puberty.
How can kids playing sports prevent osgood-schlatter dz?
War up and stretch for 15-30 mins before and after activities
Never play through the pain
This is a childhood hip disorder initiated by a disruption of blood flow to the ball of the femur called the femoral head. Due to the lack of blood flow, the bone dies (osteonecrosis oravascular necrosis) and stops growing
Legg Calve Perthes
This a hip condition that occurs in teens and pre-teens who are still growing. For reasons that are not well understood, the ball at the head of the femur (thighbone) slips off the neck of the bone in a backwards direction.
SCFE
T or F: Legg Calve Perthes can occur with rapid growth, typically in adolescnce
False: That is SCFE
Cause for Legg calve perthes is unknown, but it is a disorder of "growth." Occurs 4-9yo mostly
This dz has bone weakness that can eventually die.
B.
T or F: SCFE has a risk of PERMANENT deformity
False: Legg calve perthes does
What are noticeable signs of SCFE?
Limp, gait disturbance, pain with activity at groin, thigh, and knee
This autoimmune inflammatory dz has no known cause. It is a multisystem disorder, affecting connective tissue.
It is the leading cause of blindness and disability in chidren.
Juvenile Arthritis (JA or JRA)
You want to give this NSAD with Juvenile Arthritis. 10mg/kg/day BID with food.
Naproxen
T or F: Tx for Juvenile Arthritis is Naproxen BID with food and corticosteroids.
False: corticosteroids now avoided r/t chronic side effects and others
What are the most affected muscles in Muscular dystrophy?
shoulder and pelvis
When does Muscular Dystrophy normally first show itself?
age 3-7 trouble with pedaling, going up stairs, and use of Gower's maneuver
What is Gower's maneuver and when do you usually see it?
Seen with muscular dystrophy, when kids use their hands to knees to get off floor
When is bracing indicated for scoliosis?
To stop a curve from getting worse
- This done by bracing when child is growing, and has an idiopathic curve more than 25 degrees
T or F: Bracing is indicated for a child with scoliosis when the child has at least 1 year of growth remaining
False: 2 years
T or F: You can still brace a girl with scoliosis if she has at least 2 years of growth remaining and she has already had her menstrual period
False
Match: This is used to treat some fx, hip disorders, contractures and muscle spasms.
It uses a continuous or intermittent boot or circular wrap applied to the skin.
a. Buck
b. Bryant
Buck
Match: this is used to treat very young children (<2 y/o) with femur fx or developmental dysplasia of the hip.
The child's lower extremities are wrapped, and the hips are flexed 90 degrees. Traction is applied overhead.
a. Buck
b. Bryant
Bryant
What is the preferred method of giving abx for osteomylitis?
IV abx through PICC line
T or F: you want to promote bed rest with osteomylitis
True: to prevent spread of infection
What is the indication for a palvik harness?
Hip dysplasia
What can these s/s indicate?
Discolored teeth
Osteoporosis
Blue sclera
Conductive hearing loss
Osteogenesis imperfecta
What is this term: Bilteral knee pain that occurs with running, jumping, or climbing stairs; associated with growth and more common in boys.
Osgood schlatter
List patient teaching for osgood schlatter dz
Kids should warm up and stretch 15-30 mins before and after activities
Never "play through the pain"
What is RICE?
Rest
Ice
Compression
Elevation
First 6-8 hours after injury to control swelling/dmg
Match: Inadequate blood supply to ball of hip joint, leading to death of bone.
a. Legg calve perthes
b. SCFE
What is the tx?
a. Legg calve perthes
Tx: keep femoral head snug in pocket (possible cast), rest (keep from baring weight affected hip), antiinflammatory mds, possible surgery
Match: a weakness of the growth plate in the upper end of the femur that causes the ball to sip off the neck of the thigh bone. It occurs during a period of rapid growth
a. LCP
b. SCFE
List therapeutic management
b. SCFE
Patient is put on bed rest to prevent exacerbation of the slip
Internal fixation into the growth plate (secure femoral head)
Use of crutches or wheelchair post op
How is Juvenile arthritis diagnosed?
This is the leading cause of what?
List tx
Child <16 y/o
Have swelling in at least one joint for at least 6 weeks with 2 or more signs of decreased ROM, discomfort on movement, or increased warmth
Blindness
Tx: *no known cure* NSAIDS
- Methotrexate
- DMARD
- Local corticosteroids
List possible complications of Muscular Dystrophies
Trouble walking
Shortening of muscles or tendons around joints (contractures)
Breathing problems (possible use of ventilators)
Scoliosis
Heart problems
Swallowing problems
What is gower's sign associated with?
Muscular dystrophy
Match:
1. Lateral curvature
2. Front to back rounding of thoracic spine
3. Exaggerated concave curvature in lumbar area
a. Lordosis
b. Scoliosis
c. Kyphosis
1. b
2. c
3. a
T or F: a doctor will advise a girl with scoliosis to wear a brace before her first menstrual period
true
Fill in: indications of wearing a brace for scoliosis is that they have to have at least __a__ uyears of growth remaining, and a curve that is between __b__ and __c__ degrees or a curve that is getting worse.
Surgery will be advised to correct a curve from worsening that is more than __d__ degrees, and has a curve that is getting worse.