Lecture 1 - MSK

In a child’s arm, the part of the growth plate that is distal to the shaft is called the _____. The middle is called the _____. and the part closer to the shft is called the _____. Children have a ____ periosteum which helps to hold the ____ together. It also allows for faster ____ and leads to _____ fractures.

THere is more ____ than bone which why they are softer compared to adults. This leads to increased ____ fractures. Bones can bleed a lot especially in ___ and knees.

The leading cause of death in children > 1 year is ____. These injuries can be age or developmentally related, for example, infants have larger ____, school aged children are gaving bone growth, and adolescents have are taking more _____ and playing complex sports. Other risk factors include obesity and poor ____. All fractures should be viewed as trauma and understand that children are resilient and can ___ these injuries that are not obvious fractures.

Emergency management includes:

1. ABCs, and _____

2. Spinal cord injury _____

3. EMS/BLS/ALS

4. ____ bleeding

5. Systematic Head-to-toe

epiphysis; physis; metaphysis; thicker; bones; healing; greenstick; cartilage; bending; elbows; trauma; heas; risks; nutrition; hide; LOC; immobilization; control

Fractures are common injuries for ____ children. Causes of fractures includes trauma, ____, and disease. Risk factors include ____, poor nutrition, and developmental characteristics.

Different types include:

1. Opened and ____

2. Complete and ____

3. Greenstick and ____(straight across(

4. Spiral and ____ (diagonal)

5. ____ one side buckles or bulges outward

6. Plastic deformity and _____ (3+ pieces)

Clinical Manifestatoins includes:

1. ____(swelling) and ecchymosis

2. ____ w point tenderness, deformity

3. Decreased ____, warmth, erythema

4. ____(sound)

Healing times fo rbones depends on age, ____ of fracture, location and complication of fracture..

In neonatal period, healing takes ___ to 3 weeks. Toddlers take ____ to 5 weeks. School age take ___ to 6 weeks. Adolescence take 6 to ___ weeks.

Nursing care includes:

1. A neurovascular assessment which consists of checking ____, capillary ____, skin ____/temperature

2. ____ the extremity above the heart

3. Palpate the cast for ____ spots for signs of infection

4. Promote ____ exercises for joints below/above fracture and unaffected areas

5. Maintain ____ of the bone

6. Promote nutrition specifically ___ and Vitamin D

7. Inspect the skin at cast ____ and keep the cast clean/dry

mobile; twisting; obesity; closed; incomplete; transverse; oblique; torus; comminuted; edema; pain; use; crepitus; type; 2; 3; 4; 12; pulses; refill; color; elevate; hot; ROM: alignment; calcium; edges

A ____ cast is specifically used to immobilize the hip and part of the leg to keep the hip joint or femur in correct position while it heals. The top concern is ____ breakdown so inspect the edges. It is important to keep the area dry especially around the ____ area. Assess for pain and do ____ for the unaffected extremetity. You need to do _____ checks and educate abt care/length of TXT. Most patients will need a feminine hygiene ___ stuffed into the cast and then a ___ on the outside. The patient will also need to change ____ frequently.

spica; skin; groin; ROM; neurovascular; pad; diaper; positions

Things that may cause immobility in a child include neuromuscular conditions, ____ defects, and infections/injuries. Effects of immobilization include:

1. Disuse atrophy leading to decreased _____ return which leads to dependent ____. Disuse also leads to ___ which leads to negative nitrogen balance.

2. Dec muscle activity leads to dec _____ which means dec need for O2 which means dec ____.

3. Bone _____which inc risk for osteoporosis and hypercalcemia which leads to ____ calculi.

Nursing care consists of continuous assessment, preventing injury/_____, and encourage activity and use of _____ devices. Use pressure reduction _____, position changes and ROM exercises. The ____ Q scale can be used to assess child’s risk of developing pressure injuries. Encourage child-life, ____, and school acitvities. Encourage independence by having them do _____ and support the family.

congenital; venous; edema; catabolism; metabolism; ventilation; demineralization; renal; complications; orthotic; mattresses; branden; visitors; ADL

Compartment syndrom is caused by ____. When looking at compartment syndrome, consider the 6 P’s

1. Pain that is ____

2. Feeling of _____ or numbness

3. Pulselessness or cap refill > ____ sec

4. Paralysis of movement ____ to the fracture

5. ____(color)

6. Poikilothermia

TXT includes ____ or remove any restrictions. This can include any ____, bi-valve cast, and dressings. You want to notify ____ immediately, and do NOT ____ the extremity as it can further cause ischemia.

edema; worsening; paresthesia; 5; distal; pallor; loosening; clothes; provider; elevate

An extended, steady pulling force that is used to keep the bones/joints aligned is called _____. It provides ____ for an extremity and can correct a bony deformity. It helps to prevent/improve a ____ deformity and can treat a dislocation. It does lead to immobilization and reduces muscle _____.

Different types of tractions includes:

1. Manual traction which is done by the provider’s ____ pulling distal to FX site.

2. Skin traction uses ____ material on the skin to pull.

3. Skeletal traction uses pins/wires that are inserted into the ____.

4. ____ traction involves putting screws into the skull and attaching it to a ____ that is attached to vest or weights.

Assess the patient for pain, traction ____, and make sure the weights are hanging ___ to ensure continuous pulling force. Pain control includes assessment for muscle _____. Provide skin care to prevent decubitus, abrasions, and provide ____ care following hospital protocols.

Monitor NV status, provide ROM using a ____,, and encourage deep ____ and IS. Change positions frequently and NEVER ___ traction unless provider says so or emergency.

traction; rest; contracture; spasms; hands; adhesive; bone; cervical; halo; alignment; freely; spasms; pin; trapeze; breathing; release

External fixation uses wires, rings, and telescoping rods that permits limb ___ to occur by manual distraction, allowing for gain up to ____cm. It can also be used to correct angular/____ defects and immobilize fractures. Encourage use of ____/walker, pin care, emotional suppport, and ____ care post fixator removal.

Internal fixation is ____ TXT for displaced fractures. It uses pins, ____,screws, and toher hardware. It is also known as ____. Assess for ____, encourage early mobilization, use meds for ___, assess NV changes, monitor hardware problems, etc. Also monitor for post-anesthesia issues like atelectasis, ____(GI), N/V, clots, etc.

lengthening; 15; rotational; crutch; cast; surgical; plates; ORIF; infection; pain; ileus

An abnormality in the development of the proximal femur, acetabulum, or both is called developmental ___ of the hip. ____ are affected 6:1. Risk factors include family HX, a ____ presentation, and a ___ born.

DX eval includes:

1. Universal screening before they can walk including _____ and barlow tests. The ortolani tests to see if the hip can be brough back ___ the socket while the barlow pushes the hip ____ of the socket.

2. Abnormal leg ___

3. The galeazzi sign which exams if there is a difference in ____ of the knees

4. Older children with a ___ or leg discrepancy

5. A ___ exam.

TXT includes:

1. For those < 6mon, the ____ harness

2. For those >6mon, use of ___ or spica

3. A hip ____.

Nursing care includes:

1. Maintaining harness in ____24/7

2. Check straps for alignment and ___ integrity

3. Promote nromal ___ and development

4. Educate on skin care

5. Follow guide on spica

dysplasia; girls; breech; first; ortolani; into; out; folds; height; limp; radiographic; pavlik; bracing; surgery; place; skin; growth

Tales equinovarus is called ____ ___. ____ are more affected than the other gender and this can be diagnosed in ___. It involves the ____ tissue and consists of 4 defmortities:

1. An inward twist at the ___ and foot

2. ____ of the achilles tendon

3. An ____ gastrocnemius

TXT should begin ASAP after ____. It invovles manipulation w serial ____ for 4-12 weeks. Then they will get an achilles _____ which is cutting/releasing the tendon. The child will then use ____ after casting/tenotomy until 4-6 yrs. A ____ correction is rare but may be needed if full correction not achieved w casting and tenotomy.

Nursing considerations include:

1. Inspect areas around cast for ___

2. Teach parents to perform ___ checks daily

3. Alert provider if cast gets ___ or slips off

4. Educate on TXT and long-term expectatons

club foot; boys; utero; soft; ankle; contracture; atrophied; birth; casting; tenotomy; bracing; surgical; breakdown; NV; wet

Osteogenesis imperfecta is a genetic disorder that affects the body’s production of ____. This is also called “____ bone disease.” Collagen is major protein in the body’s ____ tissue, and less than normal amounts leads to ___ bones that fracture easily.

Characteristics includes:

1. Demineralization and cortical ____

2. Multiple fractures with ____ or false joints

3. Exuberant ____ formation

4. A ____ sclera

5. Wide suture

6. Pre-senile ____ in 2nd/3rd decade of life.

There are diffierent classifications:

1. Type 1 is the most ____ form. There is ____ bone fragility, blue scerla, normal teeth, pre-senile deafness, poor ____.

2. Type 2 is ____

3. Type 3 is ____ bone fragility, progressive deformities, and marked ___ failure

4. Type 4 is mild-mod bone fragility, a ____ sclera, short stature, and possible ____ dentition.

Type 1 and 4 most common and TXT is primarily ___ care. A med that can be used is _____ which is a bisphosphonate to slow bone breakdown. Those with Type 3 should be handled w ____ to prevent fractures. Children may use splints, braces, and ____. A sport that may be OK include ____

collagen; brittle; connective; weak; thinning; pseudoarthrosis; callus; blue; deafness; common; mild; nutrition; lethal; severe; growth; blue; abnormal

Legg-Calve-Perthes disease is avascular ____ of the femoral head. This is self-limited and idiopathic with 10-15% cases having ____ hip involvement. Most have ____ bone age and may present with ___ pain and/or intermittent painless ____.

TXT includes rest and non-weight bearing ____ when painful. No high impact or ___ sports. They may need bracing and ___ TXT for non-contained femoral head.

Nursing considerations include ID those w disease, education, encourage compliance, and educate that there is high incidence of hip ____ in future.

necrosis; bilateral; delayed; knee; limp; crutches; running; SX; replacement

Slipped capital femoral epiphysis is a spontaneous displacement of the ______ femoral epiphysis in a posterior and _____ direction. It occufrs shortly before/during accelerated _____ periods during puberty. It is usually idiopathic and multifactorial w contributing factors being obesity, puberty ___ changes, and bone changes.

Clinical manifestations includes episode of ____ w acute displacement, a ____ displacement w/o definite injury, or intermittent displacement.

TXT goal is to keep the head of the femor in the _____. This involves initially ___ and no weight bearing. _____is used in all cases. Nursing care includes lifestyle modifications for ____ loss

proximal; inferior; growth; hormone; trauma; gradual; acetabulum; rest; surgery; weight

The most common spinal deformity is ____. It is complex and occurs in 3 planes leading to following:

1. A _____ curvature

2. A spinal rotation causing ___ asymmetry

3. A thoracic _____

Most cases are idiopathic and this can occur at ___ age. Other causes could be neurofibromatosis, a ____ spinal cord, and spinal tumors. The most common case is ____ idiopathic scoliosis (AIS). May have complaint of ill-fitting _____.

The gold standard for DX are standing _____ to determine the degree of curvature with a ___ angle. Have them do a ____ bending test and look for asymmetry of the ___, scapula, flank shape, or ____ height.

There may be concerns of body ___, prolonged TXT, family issues, and compliance w ___ use.

Therapeutic management includes use of brace to stop the ____ from progressing and _____ intervention if severe in which there will be a spinal _____ w instrumentation.

Pre-op considerations include HX, MRI, ___ status, education. Post-op includes pain, early motion, ____ checks, and drainage.

Family issues include ____ from rest of family, loss of school/vacation time, change in body ____

scoliosis; lateral; rib; hypokyphosis; any; tethered; adolescent; clothes; radiographs; cobb; forward; shoulders; hip; image; brace; curve; SX; infusion; NPO; NV; separation; shape

Inflammation and infection of bony tissue is called ____. S/S begin ____ and resemble symptoms of ____ and leukemia. There is marked leukocytosis or ___ WBC. Cultures are obtained from biopsy or ____ of the bone. Early x-rays may appear ____ but DX is via bone ___ or MRI. In children 1-15 years, the infection is restricted to ___ the epiphysis. There are 2 types:

1. Exogenous is when the infectious agent invades bone after penetrating ____, open fracture, contamination in ____, or secondary extension from an abscess or _____.

2. Hematogenous which is when a _____ infection spreads to bone. An infective _____ can travel to arteries in te bone metaphysis, causing abscess formation.

TXT includes prompt use of vigorous IV ____ for extended period. Monitor ___ markers for TXT response. May initially need ___ to manage pain.

osteomyelitis; abruptly; arthritis; high; aspiration; normal; scans; below; wound; surgery; burn; preexisting; emboli; antibiotics; inflammatory; opioids

Juvenile idiopathic arthritis peaks from 1-3 and 8-___ years old. Diff types:

1. Pauciarticular onset involves at least ____ joints

2. Polyarticular involves at least ___ joints

3. Systemic onset includes high ___, rash, enlarged ____, pericarditis, pleuritis, and lymphadenopathy

Clinical manifestations includes:

1. ____, swelling, loss of ___ in affected joints

2. Warm to touch without ____

3. Symptoms increase with ____ and ___ retardation

4. Iridocyclitis and uveitis

10; 4; 5; fever; liver; stiffness; mobility; erythema; stressors; growth

Cerebral palsy is a non-progressive impairment of ____ function especially that of muscle control, posture, and ___. It can cause seizures, ___impairments, abnormal vision, hearing, sensation, and perception. It is the most common ___ disability in childhood.

Possible motor signs of CP include:

1. Poor head control after age ___ months

2. Stiff/___ limbs, arching _____ or pushing away

3. A floppy tone and unable to sit w/o ____ at 8 months

4. Having ___ fists after 3 months

Behavioral signs include:

1. Excessive irritability and no ____ by age 3 mon

2. Feeding difficulties like persistent ____ thrusting, frequent gagging or ___ w feeds

Common causes including existing ____ abnormalities, intrauterine ____/asphyxia. The most common cause of brain damage is ____. The single most important determinant of BP is _____ VLBW or ELBW.

There are different types:

1. The most common type is ____. This is associated w hypertonicity, ____(reflex), impairments in ____/gross motor skills, can be present 1-4 extremeties, abnormal gait like ____, and