NURSING CARE OF A FAMILY WHEN A CHILD HAS A

MUSCULOSKELETAL DISORDER

Apposition the amount of end-to-end contact there is

bone fragments.

Arthroscopy direct visualization of a joint with fiber optic

instrument.

Cartilage connective tissue

Compartment Syndrome phenomenon that can occur

when a cast or tight constrictive dressing put pressure
enclosed space eg. Forearm.
Diaphysis - lenghty central shaft

Distraction use of an external device to separate

opposing bones which encourage new bone growth.

Epiphysis rounded end portion of the long bone.

Fracture break in the continuity or structure of bone.

Malleoli rounded prominence on either side of the ankles

Metaphysis thin area of the long bone between

diaphysis and epiphysis.

Myophaty disease of the muscular system.

Periosteum central shaft of long bones are covered by

an enter sensitive layer.

Remodeling replacement old by new bone tissue.

Resorption bone breakdown.

Sequestrum dead bone tissue, which appears dense on

x-ray.
Traction used to reduce dislocation and immobilize
fractures.

Anatomy and Physiology OF the Musculoskeletal

System.
Types of Bones.

LONG bones found in extremeties.

Short bones found in wrist or ankle.

FLAT - still, rib, scapula and clavice.

IRREGULAR - vertebrae, pelvis and facial bones of
skull

Diagnostic test to assess the Musculoskeletal Functions

may

Radiography bones are opaque, the outline well on an

ex-ray or computerized homograph scan to provide
information about a specific bone or joint
- Radiation of epiphyseal plates can lead to uneven
growth

Bone scan (Scintigraphy) study of uptake by bones of

intravenously Injected radioactive substance, providing
information on very early stages of bone disease and
healing.

Electromyography
studies electrical activity of skeletal muscle and nerve
conduction to determine the location and cause of
disorders eg. myasthemaigravis, muscular dystrophy
and lower motor newton and peripheral nerve disorder.

Muscle or Bone Biopsy

removal of tissue sample for examination or it's
microscopic structure.

Arthroscopy
Usually done under local anesthesia in an ambulatory
care setting.
Therapeutic Management of Musculoskeletal Disordgus
an children

Casting -used to treat a wide range of musculoskoletal

disorders, from simple fracture in the extremeties to
correction of congenital structural bone disorders.

Cast Application
created either plaster of Paris, or fiberglass

A plaster cast takes 10-72 hrs to dry depending on size.

Fiberglass cast usually dry within 5-30 mins.

Management
- allow support person for children arrest
-Apply lotions
-Blowing cool air through cast

Cast Removal
- most cast remain in place for 4-8 weeks to reitung
epitation of Asay - can be removed w/ electric cast cutter

✓ a good both usually worth away most of the dirt

Medical Boots
- fracture immobilized by a supportive boot or splint

Crutches
- 3 reasons
* to keep weight off one or both legs
* to support weakened legs * to maintain balance

> Fit and Adjustments

- space of 1-1.5 inches between the axilla crusch pad
and the child's axilla
-the elbows should flex about 20 degress
> crutch walking
* two-point gait
*three point swing through gait.
SKIN TRACTION
- a child's extremity is wrapped in a material such as an
elastic bondage and then suspended from a nearby pole
or frame so the weight of body part produces traction.

SKELETAL TRACTION
- involve the use of a pin, such as a Steinmana pint or
for wire, such bar a Kirschner wire that is passed
through the skin into the end.

TRACTION-RELATED CARE bone

Assess extremity in traction every 15 mins during first
hour, hourly for 24 hrs and every 4 hours thereafter for
signs of pallor lack of warmth , tingling, absent
peripheral pulse edema or pain.

Distraction
- used to mobilize fraction or to correct defects if the
denne tis rotated or angled

Open Reduction
-is a surgical technique used to align and repair bone.
If there is spinal fracture or both bones of a forearm or
lower leg are fractured, open reduction and insertion of
not or screw stabilizes the bone.

Disorders of Bone Development

Flat Feet (Pes Planus)

- refers to relaxation of the longitudinal arch of the foot.
Bowlegs (Genu Varum)

- lateral bowing of the tibia - the malleoli will be touching

and the medial
surfaces of the knee will be more than 2 in (5cm) apart
common in 2 years old

gradually corrects in young children by about 3 yrs of

age on the latest by school age.

Knock knees (Genu Valgum)

- opposite of genu varum
- medical surfaces of the knees touch and the medial
surfaces of the ankle malleoli are seperated by more
than 3 inches (7.5 cm).

Blunt Disease (Tibia Vara)

-is a developmental disorder of unknown etiology that
primary affects the posteromedial portion of the proximal
tibial growth plate and results in bowed legs.

Assessment

• Xray identify if disorders is present

- medial espets of the proxivnal tibia will show a sharp
beaklike appearance.
Management
- Either bracing or osteotomy may be necessary to
connect this deformity

Toeing - in
- as a result of poot, tibial, femoral, or hip displacements
- more pronounced in infant who sleep prone with feet
adducted Management
- can be corrected by passive stretching exercise
osteocht
- may require casts or splints
Growing Pains
- may be symptoms Of indicative of rheumatic fever or
JIA
- occur most frequent in the muscles of the calf.
- most often in pre-school and school-aged children
 Osteogenesis Imperfecta
-Connective tissue disorders in which fragile bone
formation leads to recurring fractures

Severe autosomal dominant form that is recognized at

birth

Assessment:
Type 1
-born with countless fractures
-Xrays reveal a partimlar ribbon like or mosaic pattem
their bones rol -sclera of eye is unsually blue
Type 3
*deafness
*dental deformities.

Management:

Biphosphohairs increase bone mineral defectly

- light wight leg brace or intramedullary rod insertion
techniques
- Always be careful in taking care of child w/ this
disorders.

Legg-Calve-Perthes DISEASE (COXA PLANA)

-Avascular necrosis of the proximal epiphysis
-more often in boys than in girls between 4- 12 years of
age

4 stages
Synovitis stage - period of inflammation.
Necrotic Stage - bone in within the femur, head shrink in
size and shows increased density on an x-ray
-this stage 6-12 mos.

Fragmentation stage - resorption of dead bones occurs

over 1-2 years period

Reconstruction Stage -mark the final healing with

deposition of bone (new)
Management
*NSAID'S
* If child is 6 yrs old. - reconstructive surgery.

OS GOOD SCHLATTER DISEASE

-the thickening and enlargements of the tibial tuberosity
resulting from micro trauma probably cause from
overuser
-move often in boys than girls of pre adolescence or
early adolescence.

Management:
*NSAID'S
*Ice
* limit strenuous physical exercise

Slipped Capital Femoral Epiphysis

- slipping or displacement of the capital femoral
epiphycis from the femoral neck through the epiphageal
plate

-twice of frequently in young blocks than in children of

other races: twice in boys than in planes.
Assessment :
*children- begin to limp
*report pain first in the knee
*internal rotation of the hip is difficult and painful
*X-ray reveals the slipped epiphysis of the femoral head.

Management:
• precaution in site formation
* total hip replacement
Infectious and Inflammatory Disorders BONES and
JOINT
Osteomyelitis
- infection of the bone
- Acute osteomyelitis is often the result of
hematogeneous spread of a bacteria such as
Staphylococcus aureus in older children.
Assessment
*systemic malaise
*increased WBC, C-practive protein level, sedimentation
rate
*Fever
*irritability
*sharp pain at the bone.
* bone feels worm to touch.
*edema
*positive blood culture

Management:
*limitations on weight bearing on the affected part
*bed rests
*immobilization
*IV antibiotic (oxacillin).

Oral antibiotic for 3-4 more weeks

Transient Synovitis
-an acute non purulent inflammation of the synovial
membrane of a joint that occurs most commonly in the
hip joint in children with an age of incidence between 2
and 10 years peaking at age 6yrs.

Assessment:

pain in the grin...

pain is intence in the morning.
low grade pover
pain of the hip

Management:

NSAIDS (ibupropen)
rest (few days)
short course of coctiorteroids

Apophystitis
- considered an over use injury that is self-limiting
Management
*add a lift or cup to the heel shoe on the affected side
*Ice
*NSAID's

Disorders olSkeletal structure.

Function (Postural Scoliosis)
-Scoliosis is a three-dimensional spine deformity
characterized by lateral and rotational curvature of
spine.
-the depormity is characterized by a lateral curvature of
the spine of 10° or more

Structural Scoliosis
-most common form of scoliosis, occurs in or near
adolescence and is termed ideophatic scoliosis.

Assessment:
*scoliometer to determine the extent of a spinal curve
*X-rays and CT-scan to estimate the extent of the
deformity.

Management
*Bracing -23 hrs a day
*Surgical Intervention
- necessary if the spinal curvature is greater than 40°

Halo traction - Use of opposing forces to straighten and

reduce spinal curve that are reverse when first
diagnosed or that are progressing despite brasing .