Orthopedic Bone Disorders

Pediatric Orthopedic Problems

  • Childhood Fractures
    • Commonly types: Greenstick fractures
    • Healing time shorter than adults, may be cut in half due to better regenerative capacity in children.
    • Duration depends on the child's overall health and nutrition.

Clubfoot (Talipes Equinovarus)

  • Definition: Congenital deformation where one foot is adducted and turned inward, often positioned downward.
  • Identification:
    • Discrepancy between right and left foot positioning at birth.
    • Genetic predisposition should be explored; family history of clubfoot assessments are important.
  • Consequences of Late Treatment:
    • Might lead to difficulties in walking and negative body image due to improper foot development.
  • Treatment Approaches:
    • Casting:
    • Series of casts used to gradually stretch muscles and tendons.
    • Usually involves Plaster of Paris to ensure proper molding around the foot.
    • Surgery: Required if corrective measures fail during early childhood.
    • Diapering Issues: Caregivers need support on managing cast care without getting it wet.

Hip Dysplasia (Developmental Dysplasia of the Hip)

  • Definition: Incomplete coverage of the femoral head in the acetabulum; hip joint is underdeveloped leading to potential dislocation.
  • Assessment Techniques:
    • Look for asymmetry of gluteal folds when the child is held upright.
    • Barlow's Maneuver: Check if the hip slips out of the joint with pressure on aligned legs.
    • Assess limited abduction and femur shortening indicating dysplasia.
  • Consequences of Late Diagnosis:
    • If untreated, can lead to pain, mobility issues, and a requirement for surgery later in life (typically around age 18).
  • Treatment Strategies:
    • Pavlik Harness: Used for infants less than three months to keep hips abducted and allow proper tissue growth.
    • Parents advised on piloting diaper strategies to maintain appropriate positioning.
    • Older Than Three Months: Requires more intensive treatment such as traction or surgery.

Scoliosis

  • Definition: Abnormal lateral curvature of the spine, usually identified during adolescence.
  • Health Assessments:
    • Typically diagnosed in grades five to seven during routine school physicals.
    • Identify through physical examination—observing for asymmetrical shoulder height or pelvic alignment while having the child bend forward.
  • Key Diagnostic Tool:
    • X-rays used to determine the degree of curvature; critical to early detection.
  • Surgical Intervention:
    • Curvatures greater than 40 degrees require surgical correction with hardware (Harrington rods) to stabilize the spine.
  • Psychosocial Aspects:
    • Considerations for body image and emotional support during treatment and recovery due to visibility and effects of scoliosis.

Final Preparations for Exam

  • Review quiz answers for key concepts covered.
  • Be prepared for questions from peers based on today's discussions and treatments presented.