-
Closure of the anterior fontanel
12-18 months
-
Posterior fontanel closes in
2-3 months
-
Long bone growth completed by
20 years old
-
Calcium intake is essential to prevent what?
Osteoporosis and osteopenia
-
Types of musculoskeletal conditions
- Conjenital
- Anomaly
- Developmental variations
- Trauma
-
grating, crackling or popping sounds and sensations experienced under the skin and joints
crepitus
-
A break or disruption in the structure of the bone when more stress is placed on the bone than it can absorb.
fracture
-
Asymmetric startle reflex is seen in the
asymmmetrical moro reflex
-
-
Scoliosis, Kyphosis, Lordosis
Spinal column defects
-
Clubfoot aka talipes equinovarus
dysplasia of the foot
Foot and hand deformitites
-
Ortolani-Barlow Maneuer
Hip click heard during gentle abduction and external rotation. Used to diagnose developmental dysplasia of the hip
-
When an injury was unlikely to occur due to the developmental age
possible physical abuse
-
Franctures in different stages of healing
possible physical abuse
-
Femur fractures in children less than 1 year of age
possible physical abuse
-
Sternal fracture
possible physical abuse
-
Rib fracture
possible physical abuse
-
Inconsistant explanation of how injury occured
possible physical abuse
-
Skull, nose of facial fractures
possible physical abuse
-
Spiral fractures
possible physical abuse
-
Used to see soft tissue masses or bone tumors. May need to use sedation
CT (Computerized tomography scan)
-
Test to find spinal or joint structural defects, bonde deformaties. The machine is noisy, and the client must remain immobility
Magnetic resource imaging
-
Direct visualization of joints, joint liagament damage and synovial disease
Arthroscopy
-
Used to diangose bone pain, osteomyelitus, metastatic bone disease. Use of injected radioactive isotopes. Client must void prior to procedure.
Bone scan
-
Inability to return foot and ankle to alignment.
Clubfoot
-
Higher incidence of clubfoot
Mexican and south african groups
-
clubfoot is MMOST COMMONLY found in
Hawaiian polynesians
-
Diagnostic for talipes equinovarius
Visual, Xray, MRI
-
Serial casting is tx for
talapis equinovarus
-
Change weekly for manual manipulation
Serial casting
-
Braces used to maintain after casting
Talipes equinovarius
-
Surgery, tendonotomy if the condition is severe...tx for
Talipes equinovarus
-
-
(Genu Varum) Bowlegs are normal until
2-3 years old
-
Normal assessment of of bolegs
Norm <5cm (2 in) space
-
-
Genu Valgus (knock knees) normal at what age?
4-5
-
Tx for Genu Valgus
Braces, possible surgery
-
Genu recurvature (back knee)
backward curvature o fknee
-
Femoral head and acetabulum not properly aligned
Developmental dysplasia of Hip
-
Assemetry of thigh and gluteal folds seen in
Developmental dysplasia of Hip
-
Limited abduction of the hip
Developmental dysplasia of Hip
-
Apparent shortening of the femur
Developmental dysplasia of Hip
-
Positive ortolani's sign is an assessment findings of
developmental dysplasia of Hip
-
Allis sign
Shortening of affected leg
-
Allis sign an assessment finding in
developmental dysplasia of the hip
-
Waddling gait in older children is an assessment finding of
Developmental dysplasia of hip
-
Pavik harness used to treat
DDH (developmental dysplasia of the hip)
-
Why do you use Palvik harness
<3 mo allows some movement, allows flexion and abduction not extension or adduction
-
Closed reduction of hip is used as a treatment of
Developmental dysplasia of Hip
-
Age to used closed reduction of hip
6-18 mo.
-
how long is a Pavik harness used?
24 hrs a day for 3-4 months
-
Child in supine position with both legs flexed slightly less than 90 degrees.
Bryant traction
-
Used to treat developmetnal hip dysplasia and fractured femurs in children youngger than
2-3 years of age
-
Even if one leg is broken both legs are suspended, in what kind of traction
Bryant traction
-
Risk of using bryant traction
can create a tourniquet
-
How long does it take for a cast to dry?
24-48 hours
-
How to reduce swelling and improve circulation in a cast
elevate cast on a pillow at above the lefel of the heart
-
Avoid getting plaster casts wet, T or F
T
-
How to protect the child's skin from rough and irritating edges
Petal the edges with moleskin or adhesive tape
-
Importatnt to assess neurovascular status where on the cast?
distal to the cast
-
do not use small or sharp objects under the cast because
it can damage skin
-
How to fix itching in a cast
- Set hairdryer on cool.
- Use of antihistamine
-
Smelly casts may indicate
infection or skin breakdown
-
Bleeding, excessive pain or swelling indicate
problem not to be ignored
-
Report any slipping, cracking and softenes sof a cast to
healthcare provider
-
Spica casting used for
treatment of DDH, developmental dysplasia of the hip
-
How often to check straps on pavlik harness
q 2 weeks. Skin care important, and use of special car seat
-
Known as osteochondroisis of the femoral head
Legg-Calve-Perthes Disease
-
Avascular necrosis of the femoral head
Legg-Calve-Perthes disease
-
Seen in boys 4 x as often
Legg Calve Perthes disease
-
Complains of hip or thigh pain, limp, weakness spasms and pain
Legg Calve Perthes Disease
-
How to dx Legg Calve Perthes disease
Xray, bone scan, arthrogram, MRI
-
Goal in treatmetn of Legg Calve Perthes disease
Keep femoral head in acetabulum until ossification complete
-
Used to treat Legg Calve Perthes Disease
Traction, casting, bracing or surgery
-
Tx for Lgg calve Perthes disease
- Antiinflammatory
- Physical therapy
-
Physical therapy for how long to treat legg calve perthes
18mo - 2 years
-
Femoral head displaced from femoral neck
Clipped Capital Femoral Epiphysis
-
Common during addolescent growth spurts
Slipped Capital Femoral Epiphysis
-
Limp, pain, loss of hip mobility seen in
Slipped Capital Femoral Epiphysis
-
Stabilize femoral head and maintain hip function is the goal in
Slipped Capital Femoral Epiphysis
-
Screws/pins through physis into epiphysis to stabilize femoral head; and traction
Surgery/traction for slipped capital femoral epiphysis
-
Open correction (Osteotomy) may be performed for chronic cases of
Slipped Capital Femoral Epiphysis
-
Lateral curvature of spine with vertebral body rotation > 10 degrees
Scoliosis
-
Truncal asymmetry classic sign of
Scoliosis
-
Assymmmetric shoulders and hips
Classic signs of scoliosis
-
One sided rib hump classisc sign of
Scoliosis
-
Prominnent scapula classic sign of
Scoliosis
-
A& P xrays used in dx of
Scoliosis
-
placed on the back
and used to measure the apex (the highest point)
of the curve
Scoliometer
-
MRI and CT used to diagnose
Scoliosis
-
Mild scoliosis
10-11 degree curvature
-
Moderate scoliosis
24-40 degree curvature
-
Exercise may improve muscle tone, and preent atrophy of spind and improve flexibility of spine in which degree of scoliosis?
Mild
-
Brace to prevent increase in curvature (which won't correct, but slows progress of Scoliosis)
Moderate scoliosis
-
Bending brace for small flesible curves
Charleston brace
-
Brace hidden under clothes
Boston
-
Most effective braces
Charleston and boston
-
Poor compliance, can't hide, and has a flat bar on front for chin rest...what kind of brace?
Milwaukee
-
MMuscles contacrat at regular intervals and causes spine to sraighten
electrical stimulation
-
Osteopyelitis
Infection of long blones caused by microorganism which my abe bacterial, viral or fungal.
-
Osteomyelitis caused by
Contaminated surgery, open wounds and trauma
-
Exogenous osteomyelitis
from other infection
-
Hematogenous osteomyelitis cased by
respiratory or tooth decay
-
Assessment for osteomyelitis in newborn
Fussiness when moved, immobility of limb and poor feeding. Assess site for inflammation.
-
Prohpylactic antibiotics with bone surgery is tx for
osteomyelitis
-
Antibiolics used for osteomyeleits
Vancomycin or clindomycin.
-
Sterile dressing changes important in treatment of
osteomyelitis
-
surgical drainage prn
osteomyelitsis
-
Check eosinophil sedamentary rate in
-
Check CBC -wbc in
- Osteomylitis
- WBC - 4300-10800
-
Xray used for dx of
osteomyelitis
-
ct used for dx of
osteoylitis
-
mmage fluids and diet important in
osteomyelitis
-
manage pain in
osteomyelitis
-
Scoliosis greater than 45 degree curvature requires
surgery, traction may be used prior
-
Removal of vertebral process replaced with autograph from hip/spine
Spinal fusion for severe scolios
-
Instrumentation-Harrington rods
Inserted to stabilize spine and improve alignment, correction of spin is usually 50%...used for tx of severe soliosis
-
-
May require serial castin
Milwaukee brace
Spinal fusion
Infantile scoliosis
-
Visual spine and scapula when child bends 90 deg a twaist, curavatre great than 50 is abnormal
Schueurmann kyphosis (hunchback)
-
Treatment of scheurmann kyphosis if no pain
Exercise regimimen and antiinflamatory agents, brace worn utnil child reaches skeletal maturity
-
Swayback, excessive concave curvature of lumbar spine
Lordosis
-
back and hip pain
Lordosis
-
-
tx of lordosis
postureal exercieses
-
Lordosis normal in school age and should disappear by
school age
-
Inheritated autosomal dominant
Marfan
-
Effects connective tissue
Marfan syndrome
-
Mitral valve prolapse, aorta regurtigation, abnormal aortic root dimensions, big aorta
Marfansundrome
-
May hear murmor at assessment, adn risk of aorti dissection
Marfan syndrome
-
Pectus excavatum, long arms, dital infarct, scoliosis, elaongated head, long slender face, high arched palate
Marfan
-
Ocular lens subluxation
Marfan
-
pneumothorax, respiratory problem found in
Marfan's syndrom
-
-
Defect in collagen, a biochemical defect
osteogenesis imperfeta
-
Blue sclera
Osteogenesis imperfectal
-
poor teeth enamel,
osteogenesis imperfecta
-
thin soft skin
osteogenesis imperfecta
-
Enlarged anterior fontnel
osteogenesis imperfecta
-
weak muscles, hearing loss, short stature, decreased ROM
osteogenesis imperfecta
-
No cure and may be dx in ureto w/u/s or callagen analysis of chorionic villi
osteogenesis imperfecta
-
Dient importatn in
osteogenesis imperfecta
-
Pamidronate- bone resorption inhibitor IV q 6 mo. reduces fx adn pain....tx for
osteogenesis imperfecta
-
Telescoping rods inserted into long bones
osteogenesis imperfecta
-
Hematologic Stem Cell transplant, tx for
osteogenesis imperfecta
-
No cure, and most severe and common form of Muscular Dystophy
Duchenne muscular dystrophy
-
Pseudohyertrophy
Replaement of muscle tissue with fatty deposits and connective tissue.
-
Muscle fiber degeneration, muscle wasting and weakenss
Duchenne muscular dystrophy
-
Dystrophin
Mutation of gene that decodes dystrophin a protein product in skeletal muscle resulting in degeneration of voluntarrly muscles that control movement
-
X lihked disorder
Duchenne muscular dystrophy
-
Almost seen only in males...females are the cariers; 1/3 no family history
Duchennne Muscular dystrophy
-
2-4 years pelvic muslce weakness
duchenne muscular dystrophy
-
difficulty walking, running, waddling gain and frequent falls
Duchenne muscular dystrophy
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