Health alterations class 4-Mobility

Fractures and scoliosis

Most common fracture

Distal forearm

Most commonly broken bone in childhood

Clavicle (especially in those under 10)

How do most fractures occur in infants

They’re rare, may be from falling (change table etc), MVA or abuse

How do most school age fractures occur

Bike, automobile, skateboard injuries

Why are growth plate (physeal) injuries not always casted

May stunt growth

Weakest point of long bones

Cartilage growth plate (epiphyseal plate)

Why do children’s fractures heal faster than adults

The periosteum is thick and vascular

Why are young children less prone to severe fractures than adults

Their skeleton is more cartilaginous

Complete fracture

Broken into 2 parts that are not touching

Incomplete fracture

Part of the bone is still touching

Transverse fracture lines

Cross wise (right angle)

Oblique fracture

Slanted Line

Spiral fracture

Often seen with child abuse, twisted

Simple or closed fracture

Doesn’t produce a break in the skin

Compound or open fracture

Bone protrudes through skin

Complicated fracture

Bone fragments have damaged other organs or tissues (broken rib puncturing lungs)

Comminuted fracture

Small fragments of bone are broken from fractured shaft and lie in surrounding tissue (not damaging anything)

What kind of damage can be present with a fracture but is less common in children

Neurological and vascular damage

Crepitus

Crackling, bone on bone sound

Goals of fracture management

1. Reduction (open or closed)

2. Immobilization

3. Restore function

4. Prevent further injury

Techniques for putting a cast on kids (preschool/toddler)

1. Distraction (screens, books, bubbles etc)

2. Put a cast in their stuffy/doll

3. Let them pick the colour

4. Let them feel the cast material before application

What does shadowing a wound mean

Drawing a border around bleeding/drainage to track the severity

Characteristics of a plaster cast

1. Can’t get wet

2. Moulds better

3. Takes longer to dry (up to 72 hours)

4. Heavier

5. Cheaper

Characteristics of a synthetic cast

1. Can get wet (some)

2. Lighter

3. Dry faster

4. Can pick more colours

5. More expensive

Cast removal considerations (kids)

May fear the saw, show them it can’t cut skin

Skin care after cast removal

1. Moisturize

2. Soak area in the bath to remove dry pieces of skin

3. Do not pick off dry skin!

How can you itch when you have a cast on

Dryer on cool, don’t stick stuff down the cast!

Nuerovascular assessment (6 P’s)

1. Pain

2. Pallor

3. Paresthesia

4. Paralysis

5. Pulselessness

6. Pressure

Compartment syndrome

1. When swelling has nowhere to go.

2. Compresses nerves, blood supply and muscles (can lose limb)

3. Leads to ischemia and neurovascular impairment

What group is compartment syndrome more common in

Adults, kids get it more with burns than fractures

Signs and symptoms of compartment syndrome

1. Increased sensitivity

2. Increased pain

3. Weakness

4. Shiny, taut skin

What are the main purposes of traction?

1. Fatigue muscle to reduce spasm to help with realignment

2. Align bone fragments

3. Immobilize fractures until alignment is achieved

4. Allow for preoperative and postoperative positioning and alignment

Traction

Forward force produced by attaching weight to distal bone fragments (adjusted by adding or subtracting weights)

Counter traction

Backward force provided by body weight

How can you increase counter traction

By elevating the foot of the bed

Frictional force

Provided by patients contact with the bed

Cervical traction

Halo brace or vest inserted through burr holes to fatigue neck muscles so vertebral bodies gradually separate so spinal cord isn’t pinched between vertebrae

Principles of skeletal traction

1. Counter traction with weights

2. Make sure all ropes and pulleys are aligned and weights are free hanging

3. Don’t remove weights without instruction

4. Traction must be applied at all times

5. Physician orders amount of weight to be applied

Traction nursing considerations

1. Maintain traction and alignment

2. Care for skin or skeletal setup

3. Prevent skin breakdown

4. Monitor for infection

5. Prevent complications (get patient to take deep breaths)

Prevention of fractures

1. Eat calcium rich foods

2. Exercise several times a week

3. Shoes with good traction

4. Keep rooms free from clutter

Most common spinal deformity

Scoliosis

Who is at an increased risk of developing scoliosis

Patients with cerebral palsy or myelomingiceal

Most common cause of scoliosis

Idiopathic (unknown cause)

When does scoliosis generally become noticeable

After the preadolescent growth spurt

Why is routine school screening not recommended for scoliosis

Not always accurate

What can be used to determine the degree of a scoliosis curve

Standing radiograph (x ray)

Risser scale

Assesses the maturity of the skeleton

Cobb technique

Assessment that helps determine the degree of a scoliosis curve

What is considered a postural variation

Curves less than 10 degrees

What is considered a mild curve and requires no treatment

Curves less than 25 degrees

What degree of curve requires treatment

Over 25 degrees

Signs and symptoms of scoliosis

1. Asymmetry of shoulder and hip height

2. Prominent scapula

3. Asymmetry of ribs and flank

4. Early stages may have no pain

Possible complications of scoliosis

1. Decreased lung capacity

2. Shortened life span

3. Arthritic changes in the spine

4. Neurological sequelae and paralysis

What is the first line of scoliosis treatment

Bracing and exercise

How does bracing and exercise treat scoliosis

Prevents curve from worsening, not a cure

What is the second line of scoliosis treatment

Surgical intervention is used for severe curvature

How should a scoliosis patient be moved post op?

Multiple person assist log roll for the first 24 hours

What form of pain control is normally used post op scoliosis surgery

PCA to give patient a sense of control