1. Chapter 24 The Child with a Musculoskeletal Condition

2. Pediatric Trauma Soft-tissue injuries include –Contusion –Sprain –Strain Injuries should be treated immediately to limit damage from edema and bleeding Prevention Proper use of pedestrian safety Car seat restraints Bicycle helmets and other protective athletic gear Pool fences Window bars Deadbolt locks Locks on cabinet door 2

3. Bryant’s Traction Used for the young child(under 2 yo; 20- 30LBS.) who has a fractured femur Note that the buttocks are slightly off the bed to facilitate countertraction Active infants may require a jacket restraint to maintain body alignment 3 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

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5. Spica Cast Seen with child with hip dysplasia Immobilize hips & thighs Care – Keep dry – Cleanse with damp cloth – Assess for tightness – Neurovascular checks – Reposition q 2-4 hrs – Sponge bath 5

6. Duchenne’s or Becker’s Muscular Dystrophy (MD) Group of disorders in which progressive muscle degeneration occurs –Duchenne’s MD is most common –Sex linked inherited- affects males only –Lack of dystrophin – protein in skeletal muscle Onset is generally between 2 and 6 years of age A history of delayed motor development during infancy may be evidenced Increase in calf size – muscle replaced by fat 6

7. Duchenne’s or Becker’s Muscular Dystrophy (MD) (cont.) Additional signs and symptoms –Progressive weakness as evidenced by Frequent falling Clumsiness Contractures of the ankles and hips Gower’s maneuver to rise from the floor –Intellectual impairment is common 7

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9. Duchenne’s or Becker’s Muscular Dystrophy (MD) (cont.) Diagnostics –Marked increase in blood creatine phosphokinase level –Muscle biopsy reveals a degeneration of muscle fibers replaced by fat and connective tissue –ECG abnormalities are also common 9

10. Legg-Calvé-Perthes Disease (Coxa Plana) One of a group of disorders called the osteochondroses in which the blood supply to the epiphysis, or end of the bone, is disrupted –Tissue death that results from inadequate blood supply is termed avascular necrosis –Affects the development of the head of the femur 10

11. Legg-Calvé-Perthes Disease (Coxa Plana) (cont.) Symptoms include –Painless limp –Limitation of motion X-ray films and bone scans confirm the diagnosis –Some may require hip joint replacement 11

12. Osteosarcoma Primary malignant tumor of the long bones –Mean age of onset is 10 to 15 years of age –Children who have had radiation therapy for other types of cancer and children with retinoblastoma have a higher incidence of this disease Metastasis occurs quickly because of the high vascularity of bone tissue –Lungs are primary site of metastasis 12

13. Osteosarcoma (cont.) Manifestations –Experiences pain and swelling at the site –Pathologic fractures can occur Diagnosis –Confirmed by biopsy –Radiological studies help to confirm Treatment –Radical resection or amputation surgery –Phantom limb pain can occur because nerve tracts continue to “report” pain 13

14. Ewing’s Sarcoma Malignant growth that occurs in the marrow of the long bones Mainly occurs in older school-age children and early adolescents When metastasis is present, prognosis is poor Primary sites for metastasis are lungs and long bones Treatment –Radiation therapy and chemotherapy –Amputation is not recommended due to effectiveness of chemo and radiation to tumors 14

15. Juvenile Idiopathic Arthritis (JIA) Formerly known as juvenile rheumatoid arthritis (JRA) Most common arthritic condition of childhood Systemic inflammatory disease involving joints, connective tissues, and viscera 15

16. Juvenile Idiopathic Arthritis (JIA) (cont.) Systemic –Intermittent spiking fever (above 103° F) persisting for over 10 days –Nonpruritic macular rash –Abdominal pain –Elevated ESR and C-reactive protein 16

17. Juvenile Idiopathic Arthritis (JIA) (cont.) Treatment –Goals of therapy Reduce joint pain and swelling Promote mobility and preserve joint function Promote growth and development Promote independent functioning Help the child and family to adjust to living with a chronic disease Moist heat packs before getting OOB NSAIDS, steroids, methotrexate 17

18. Scoliosis 18

19. Scoliosis (cont.) More common in girls Two types –Functional—caused by poor posture –Structural—caused by changes in the shape of the vertebrae or thorax Usually accompanied by rotation of the spine Hips and shoulders may appear to be uneven 19

20. Scoliosis (cont.) Treatment –Aimed at correcting curvature and preventing severe scoliosis Curves up to 20 degree- no treatment Curves 20 degrees to 40 degrees require - Milwakee brace Curves greater than 40 degrees –Spinal fusion is performed 20

21. Family Violence Affects children of all social classes Includes –Spousal and child abuse –Neglect –Maltreatment 21

22. Assessing for Child Abuse 22

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