Fractures
This is the reason that fractures heal quicker in children than adults?
Children have a thicker periosteum and a good blood supply
Expected assessment findings with fractures?
Pain
crepitus
deformity
edema
ecchymosis
decreased use of the affected area
What is clubfoot
Deformity of the ankle or foot (can be unilateral or bilateral)
What is Osteogenesis Imperfecta?
A condition where the bones break easily or have deformity
Inherited connective tissue disorder
Can often be mistaken for abuse
What is scoliosis?
A lateral curve of the spine
Can also affect the ribs due to the rotation
What is legg-calve-perthes disease?
Impaired circulation to the femoral head that results in necrosis
What is hip dysplasia?
Abnormal development of the hip structures
What is Cerebral Palsy?
A non progressive impairment of motor function, especially that of muscle control, coordination and posture
What is spina bifida?
A neural tube defect present at birth and is characterized by failure of the osseous spine to close with CNS effects.
Can affect anywhere from brain/skill to spine
What is muscular dystrophy?
A group of inherited disorders with progressive degeneration of symmetric skeletal muscle groups causing progressive muscle weakness and wasting, which can lead to disability and deformity.
Fractures in this area can cause altered bone growth
Epiphyseal plates (growth plates)
Adults do not have these!
Neuro checks for fractures would consist of what?
Sensation
Skin temperature
Skin color
Capillary refill
Pulses
Movement
What are the risk factors for clubfoot?
Heredity
More common in males
What are the risk factors for OI?
Having a parent with OI-MOST COMMON WAY
(autosomal dominant-need only 1 copy of the abnormal gene)
Can be autosomal recessive (both parents are carriers) but less common
New mutations are found in(de novo) but not as common
What are the 2 types of scoliosis?
Idiopathic (typically occurs at puberty)
Neuromuscular (found with other disorders)
What are the 3 stages of Legg-calve-perthes disease?
Synovitis
Necrotic
fragmentation
Reconstruction
Who is at higher risk for hip dysplasia?
firstborn
Females
family history
breech
improper swaddling
joint instability
oligohydramnios
LGA
What are the 2 types of Cerebral palsy?
Congenital (present at birth)
Acquired (obtained after birth)
Then the types are broken down into their clinical classifications:
1. Spastic (80% of the cases)
2. Dyskinetic (15% of the cases)
3. Ataxic (5% of the cases)
What are the risk factors for spina bifida?
Medications
drug use
Maternal malnutrition
insufficient folic acid intake
exposure to radiation/ chemicals
genetic predisposition
What are the risk factors for muscular dystrophy?
Genetics
X-rays that reveal old fractures can be a sign of what?
Osteogenesis Imperfecta
or
Child abuse
What types of medications do we use for fractures?
antibiotics
analgesics
Opioids
Vaccinations (tetanus)
What are the expected findings for a patient with clubfoot?
Affected foot is shorter and smaller
May have an empty heel pad
May have a visible plantar crease at the mid foot
What are the signs and symptoms of OI?
Multiple bone fractures
blue sclera
early hearing loss
small discolored teeth
What are the risk factors for scoliosis?
Genetics (can run in families)
Female gender 8-15 years of age
What are the risk factors for Legg-calve-perthes disease?
2-12 years of age
males
trauma
decreased circulation
Inflammation
How do we diagnose hip dysplasia?
Infants: Physical exam (Barlow and ortolani-can hear clicks and clunks as the hip goes in and out of the hip socket)
Unequal gluteal folds can be a clue (not diagnostic)
Ultrasound (if less than 6 months)-the hip is not ossified prior to 6 months and will not show up on X-ray
xray-over 4-6 months of age
What are some risk factors for Cerebral palsy?
Prenatal: malnutrition, drug use, genetics, infections, placental insufficiency, bleeding, RH incompatability
Perinatal: infections, sepsis, seizures, preeclampsia, PROM, prolonged labor, premature birth, meconium aspiration, asphyxia
Postnatal: anoxia to the brain, stroke, cerebral infections, brain injury or trauma
How do we diagnose spina bifida?
Prenatal ultrasound
amniocentesis
What are the expected findings for muscular dystrophy?
Fatigue
muscle weakness
lordosis
delayed motor skills
learning difficulties
Progressive loss of muscle mass
There are several types of fractures (14 to be exact). Name 2
Bend, buckle, greenstick, transverse, oblique, spiral, growth plate, stress, complete, incomplete, simple/closed, compound/open, complicated, comminuted
Name 4 types of traction
Skin traction
Skeletal traction
Halo traction
Manual
Treatment for clubfoot
Casting and bracing
Usually begins pretty early on in the first month of life
How do we diagnose OI?
Bone biopsy
How do we screen for scoliosis?
Typically done during yearly exams
Have patient bend over and touch their toes (look for any curvature of the back or uneven hips)
Can also look at shoulders while standing to see if they are even
Xrays, CT or MRI
What are the expected findings for Legg-calve-perthes?
Intermittent PAINLESS limp initially-then progresses to the following:
hip stiffness
pain: hip, groin, thigh or knee
listed ROM (especially abduction/internal rotation)
shortening of the affected leg (muscle wasting)
What would we see clinically with hip dysplasia?
asymmetry
limited hip abduction (affected leg will not move out as far as the other)
clicking sound
Widened perineum
toe walking on 1 foot
limping
waddle gait
Expected findings for cerebral palsy
Motor (choking, poor feedings, tongue thrusting, asymmetric crawl, early hand preference, toe walking)
Reflex (Persistent moro or tonic neck reflex, hyperreflexia)
Posturing (Ridge posture and extremities, scissoring and extension of the legs)
Muscle Tone (arching back, stiff posture, difficult diapering child)
Associating Conditions (vision, speech, or hearing impairments, seizures, cogitative impairments, difficulty meeting developing milestones)
What are the types of spina bifida?
Spina bifida occulta (defect is below the skin within the spinal column)
Meningocele (protruding sac containing CSF)
myelomeningocele (protruding sac containing CSF and nerves)
How is muscular dystrophy diagnosed?
Muscle biopsy
Genetics
EMG
Risk factors for fractures
obesity
poor nutrition
What is the purpose of casting?
Immobilization and maintaining bone alignment
What is important to teach parents of children with clubfoot?
Cast care
Braces/application
Routine appointments for close monitoring
What is the treatment of OI?
Supportive care-NO CURE
Bisphosphonates (Zometa)-to increase bone mineral density
Physical Therapy (strengthen muscles)
Gentle handling
Surgery (Rodding as needed) to help support long bones
Bone marrow transplant is investigational
Treatment for Scoliosis
bracing (usually around 20 degrees)
surgery (good rule of thumb is about 50 degrees)
Treatment will depend on degree of curvature and the patient's age and the amount of growth that is left.
How do we diagnose this?
MRI of hip and pelvis
What is the treatment for hip dysplasia?
Pavlik harness
Surgery
Spica casting
How do we diagnose Cerebral Palsy?
Complete neurological data collection
Metabolic and genetic testing
General movement data collection
MRI
EEG
Ultrasound
What physical signs might you expect to see with spina bifida occulta
Dimpling of skin
Tufts of hair
Port wine angioma nevi (flat area of pigmentation)
What are the complications of muscular dystrophy?
Obesity (inability to exercise-often wheel chair bound)
Contractures
Scoliosis
Infection
Respiratory compromise
What are some complications you would need to consider when taking care of a patient with a known fracture?
Compartment syndrome
Embolism (Fat with long bone fractures like tibia, femur or pelvis or pulmonary if the patient is immobilized for a long period of time)
Osteomyelitis (could the patient have this????))
Infection (teach patients and parents what to watch for with fractures-this is mostly for those that are open)
When treating patients with fractures and/or sprains, what is important to teach for at home care?
(hint: RICE)
Rest
Ice
Compression
Elevation
What other 2 disorders are commonly seen with clubfoot?
Spinabifida
Cerebral palsy
What interprofessional collaboration may be needed with these patients?
What is the surgical procedure called to correct scoliosis?
Posterior spinal fusion
What is the treatment for Legg Calve Perthes Disease?
Surgical: Osteotomy of hip or femur
What complications might you see in hip dysplasia?
Osteonecrosis
Complications with cerebral palsy
aspiration
injury
Skin integrity
What might you see on exam with spina bifida cystic (MYELOMENINGOCELE AND MENINGOCELE)
Flaccid muscles flaccid paralysis, absent deep tendon reflex
Lack of bowel control
Constant dribbling of urine or urine overflow
Foot contractures
Spinal curvature abnormalities (scoliosis, kyphosis)
Protruding sac midline of the osseous spine
What is the main cause of death in a muscular dystrophy patient?
Respiratory compromise