Alterations in Musculoskeletal Function (Module 3)

What is a fracture?

A break in the continuity of a bone.

Why are children's bones more susceptible to certain types of fractures?

They are more flexible and have a thicker periosteum than adult bones.

What is a greenstick fracture?

The bone bends and breaks on one side while the opposite side remains intact.

What is a buckle (torus) fracture?

The bone compresses and bulges outward without completely breaking.

What is a complete fracture?

The bone breaks completely into separate pieces.

What is a growth plate (physeal) fracture?

A fracture involving the growth plate that can interfere with normal bone growth.

Why are growth plate fractures concerning in children?

They can cause growth disturbances, limb-length differences, and bone deformities.

What are common clinical manifestations of a fracture?

Pain, swelling, bruising, tenderness, deformity, and decreased movement.

What are the 6 Ps of neurovascular assessment?

Pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia.

What does paresthesia mean?

Abnormal sensations such as tingling, numbness, or pins and needles.

What is the priority nursing action for a suspected fracture?

Immobilize the extremity and assess distal neurovascular status.

How should an open fracture be managed initially?

Cover with a sterile dressing, control bleeding, immobilize, and anticipate antibiotics and surgical treatment.

What is compartment syndrome?

Increased pressure within a closed muscle compartment that reduces circulation and compresses nerves.

What causes compartment syndrome after a fracture?

Bleeding and swelling increase pressure inside the muscle compartment, reducing tissue perfusion.

What is the earliest concerning sign of compartment syndrome?

Severe pain disproportionate to the injury, especially pain with passive stretching.

What are other manifestations of compartment syndrome?

Increasing pain, tight swelling, paresthesia, and decreased movement; pulselessness and paralysis are late findings.

Why can a patient with compartment syndrome still have a pulse?

Compartment pressure may impair smaller vessels and tissue perfusion before arterial pulses disappear.

What is the priority intervention for suspected compartment syndrome?

Notify the provider immediately, perform neurovascular assessments, and anticipate pressure-relieving interventions.

What is a fasciotomy?

A surgical incision through fascia to relieve compartment pressure and restore circulation.

What is fat embolism syndrome (FES)?

A complication in which fat droplets enter circulation, commonly following long-bone fractures, and impair organ function.

What is the classic triad of fat embolism syndrome?

Respiratory distress, neurological changes, and petechial rash.

When does fat embolism syndrome commonly occur?

Usually within 24–72 hours following a significant long-bone fracture.

What is the priority nursing intervention for fat embolism syndrome?

Support airway and oxygenation, administer oxygen, and notify the provider immediately.

What is a cast used for?

Immobilizes a fractured bone, maintains alignment, reduces pain, and promotes healing.

What is the most important nursing assessment after cast application?

Frequent distal neurovascular assessments.

What should the nurse assess when checking circulation under a cast?

Color, temperature, pulses, capillary refill, sensation, movement, pain, and swelling.

Why should a wet plaster cast be handled with the palms?

Fingertips can create dents that cause pressure injuries to the underlying skin.

Why should objects never be inserted inside a cast?

They can injure the skin and cause breakdown or infection.

What should a patient report while wearing a cast?

Increasing pain, numbness, tingling, burning, swelling, foul odor, drainage, or inability to move fingers or toes.

What is traction?

A continuous pulling force used to maintain alignment, reduce muscle spasms, and promote fracture healing.

What are the two major types of traction?

Skin traction and skeletal traction.

What is skin traction?

Pulling force applied through straps, boots, or adhesive materials attached to the skin.

What is skeletal traction?

Pulling force applied through a metal pin or wire inserted directly into the bone.

What is Buck's traction?

A form of skin traction commonly used temporarily for lower-extremity fractures.

What is the major complication associated with skin traction?

Skin breakdown and pressure injuries.

What is the major complication associated with skeletal traction?

Pin-site infection.

What must the nurse ensure about traction weights?

Weights hang freely and are not resting on the floor or bed.

What should the nurse do if traction weights are resting on the floor?

Restore the prescribed traction setup so weights hang freely and notify the appropriate team member if adjustment is needed.

Should a nurse independently remove or add traction weights?

No. Traction weights should only be changed with an appropriate order.

What is developmental dysplasia of the hip (DDH)?

Abnormal development of the hip joint in which the femoral head does not fit securely inside the acetabulum.

What are risk factors for DDH?

Female sex, breech positioning, family history, firstborn status, and oligohydramnios.

What are common manifestations of DDH in infants?

Unequal thigh or gluteal folds, limited hip abduction, and apparent leg-length differences.

What are possible manifestations of DDH in older children?

Limping, waddling gait, delayed walking, and unequal leg lengths.

What is the Barlow maneuver?

A maneuver that attempts to dislocate an unstable femoral head from the hip socket.

What is the Ortolani maneuver?

A maneuver that relocates a dislocated femoral head into the hip socket.

What is the difference between Barlow and Ortolani?

Barlow dislocates; Ortolani relocates.

What diagnostic test is commonly used to evaluate DDH in young infants?

Hip ultrasound.

What is the purpose of a Pavlik harness?

Keeps the infant's hips flexed and abducted to maintain proper femoral head positioning.

What are important nursing interventions for an infant wearing a Pavlik harness?

Check skin, circulation, leg movement, and strap positioning; never independently adjust straps.

What is a complication of Pavlik harness treatment?

Skin breakdown, impaired circulation, or femoral nerve palsy.

What is a spica cast used for in DDH?

Maintains hip alignment after closed reduction.

What are important nursing interventions for a child with a spica cast?

Monitor skin, circulation, and leg movement; protect the perineal area and assess for abdominal distention.

What is scoliosis?

A lateral curvature of the spine accompanied by vertebral rotation.

What is the most common type of scoliosis in adolescents?

Adolescent idiopathic scoliosis, which has no clearly identified cause.

What are common physical findings of scoliosis?

Uneven shoulders, prominent shoulder blade, uneven waistline, and rib prominence.

What is Adam's forward bend test?

A screening test in which the child bends forward so the nurse can assess for spinal asymmetry and rib prominence.

What is the Cobb angle?

An X-ray measurement used to determine the degree of spinal curvature.

What is the purpose of scoliosis bracing?

To prevent progression of the spinal curvature while the child is still growing.

Does a scoliosis brace reliably correct an existing spinal curve?

No. Its primary purpose is to prevent progression.

When is spinal fusion considered for scoliosis?

For severe or progressive curves, often around 45–50 degrees or greater.

What is the priority assessment after spinal fusion?

Neurological assessment, including lower-extremity movement and sensation.

What postoperative finding after spinal fusion requires immediate reporting?

New weakness, numbness, or loss of sensation in the lower extremities.

What is slipped capital femoral epiphysis (SCFE)?

Slipping of the femoral head relative to the femoral neck through the growth plate.

Which population is most commonly affected by SCFE?

Adolescents, particularly those with obesity.

What are common risk factors for SCFE?

Obesity, adolescence, rapid growth, and endocrine disorders such as hypothyroidism.

What are common manifestations of SCFE?

Hip, groin, thigh, or referred knee pain; limping; decreased internal rotation; and external rotation of the affected leg.

Why is knee pain in an obese adolescent concerning for SCFE?

SCFE hip pathology can cause referred pain felt in the knee.

What is the priority nursing intervention for suspected SCFE?

Stop weight-bearing, keep the child non-weight-bearing, and obtain urgent orthopedic evaluation.

How is SCFE typically treated?

Surgical stabilization, usually with in-situ screw fixation.

What is avascular necrosis (AVN) following SCFE?

Death of femoral head bone tissue caused by compromised blood supply.

What is osteomyelitis?

An infection of bone and bone marrow.

What is the most common bacterial cause of pediatric osteomyelitis?

Staphylococcus aureus.

How does osteomyelitis commonly develop in children?

Bacteria travel through the bloodstream and infect bone tissue (hematogenous spread).

What are common manifestations of osteomyelitis?

Fever, localized bone pain, swelling, warmth, tenderness, and refusal to bear weight.

Which laboratory markers may be elevated in osteomyelitis?

WBC count, ESR, and CRP.

What is the most sensitive commonly used imaging study for early osteomyelitis?

MRI.

Why might an early X-ray be normal in osteomyelitis?

Bone changes may not become visible on X-ray until later in the infection.

Why are blood cultures obtained in suspected osteomyelitis?

To identify the causative organism and guide antibiotic selection.

What is the primary treatment for acute bacterial osteomyelitis?

Prolonged antibiotic therapy, initially often IV, followed by oral therapy when appropriate.

What is an important nursing consideration when administering vancomycin?

Monitor renal function, drug levels when ordered, and infusion-related reactions.

What is an important adverse effect of clindamycin?

Diarrhea and risk of Clostridioides difficile infection.

When might surgery be needed for osteomyelitis?

When an abscess, dead bone, or infection requires drainage or debridement.

What should parents understand about antibiotic treatment for osteomyelitis?

Complete the entire prescribed antibiotic course even when symptoms improve.