MUSCULOSKELETAL AND NEUROMUSCULAR DYSFUNCTION

SOFT TISSUE INJURY:

• CONTUSION (Bruise)
• Damage to the soft tissue, subcutaneous structures,
and muscle
• Tearing of these tissues and small blood vessels and
the inflammatory response lead to hemorrhage,
edema, and associated pain when the child attempts
to move the injured part.
• The escape of blood into tissues is observed as
ECCHYMOSIS, a black-and-blue discoloration
 SOFT TISSUE INJURY:

• STRAIN
• Injury to tendon and
muscle
• overstretching

• SPRAIN
• Injury to the ligaments
• Twisting
SOFT TISSUE INJURY:

• ASSESSMENT
• PAIN = principal complaint
• (+) swelling
SOFT TISSUE INJURY:

• THERAPEUTIC MANAGEMENT
(12-24 hours)
R- Rest
I- Ice (<30 minutes at a time)
C- Compression
E- Elevate
S- Support
FRACTURE

• Occur when the resistance of bone

against the stress being exerted yields to
the stress force
• More likely to occur in children and
older adults
• Heal much faster than in adults
• Most often a result of traumatic incidents
at home, at school, in a motor vehicle, or
in association with recreational activities
FRACTURE

• Most common fracture in children:

• Distal forearm
• Clavicle
• Fracture line:
• Transverse – crosswise at right angles to the long axis
of bone
• Oblique – slanting but straight between a horizontal
and a perpendicular direction
• Spiral – slanting and circular, twisting around the bone
shaft
TYPES OF FRACTURE

• Plastic deformation—Occurs when the bone

is bent but not broken. A child’s flexible bone
can be bent 45 degrees or more before
breaking
• Buckle, or torus, fracture—Produced by
compression of the porous bone; appears as
a raised or bulging projection at the fracture
site
• Greenstick fracture—Occurs when a bone is
angulated beyond the limits of bending.
(Incomplete fracture)
• Complete fracture—Divides the bone
fragments.
FRACTURE

• Diagnostic Evaluation
• X-ray is most useful diagnostic tool

• Assessment of Fractures (6 Ps)

• PAIN and point of tenderness
• PULSE – distal to the fracture site
• PALLOR
• PARESTHESIA – sensation distal to the fracture site
• PARALYSIS – movement distal to the fracture site
• PRESSURE – involved limb may feel tense and warm
FRACTURE

• 4 Rs of treatment
• Recognition
• Reduction- restore proper
alignment
• Retention
• Rehabilitation
FRACTURE

• Bone healing
• Neonate (2 to 3 weeks)
• Early childhood (4 weeks)
• Late childhood (6-8 weeks)
• Adolescence (8-12 weeks)

• Thicken periosteum & generous blood supply

• Apply cold to injured area
• Limitation of complication
• Control of pain, hemorrhage & edema
NURSING MANAGEMENT

• Nursing Management
• Immobilize
• Cover with sterile gauze (open)
• Elevate part
• Prevent complications
• Compartment syndrome
• Infection
• Renal calculi
• Fat metabolism (72 hours after fracture)
 A spectrum of disorders related to
abnormal development of the hip
that may occur at any time during
fetal life, infancy, or childhood

DEVELOPMENTAL
DYSPLASIA OF Incidence of hip instability is
approximately 1.5 per 1000 live
THE HIP (DDH) births, and approximately 15% to
50% of infants with DDH are born
breech.

Girls are affected more commonly

(80%) and there is a positive family
history in approximately 12% to
33% of affected individuals.
 Physiologic factors (maternal
hormone secretion and
intrauterine positioning)

PREDISPOSING Mechanical factors (breech

FACTORS presentation, multiple fetus,
oligohydramnios, and large
infant size)

Genetic factors
DEGREES OF DDH

• Acetabular dysplasia (Mildest form)

• Mildest form in which there is neither subluxation nor
dislocation.
• Subluxation
• Implies incomplete dislocation of the hip and is sometimes
regarded as an intermediate state in the development from
primary dysplasia to complete dislocation.
• Dislocation
• The femoral head loses contact with the acetabulum and is
displaced posteriorly and superiorly over the
fibrocartilaginous rim.The ligamentum teres is elongated and
taut.
DIAGNOSTIC EVALUATION

• Galeazzi Test
• Ortolani’s Test
• Barlow Test
• Ultrasonography
(<4 mos.)
• Radiographic
examination (>4
mos.)
• CT scan
 THERAPEUTIC MANAGEMENT

• Newborn to 6 months
• Pavlik harness (6-12 weeks)
• Bryant traction (adduction contracture)
• Hip spica Cast (difficulty maintaining stable
reduction)
• 6 to 24 months
• Surgical closed reduction
• Hip spica Cast (12 weeks) or Abduction
Orthosis
• Open reduction (Hip remains unstable)
 THERAPEUTIC MANAGEMENT

• Older children
• Operative reduction
• Preoperative traction
• Tenotomy of contracted muscles
• Innominate osteotomy procedures combined with
proximal femoral osteotomy
• Casting
• ROM exercises
NURSING CARE
MANAGEMENT
• Early detection and
assessment
• Maintenance of the
device and adaptation
of nurturing activities
to meet the patient’s
needs
• Skin care
• Congenital malformation of the lower
extremities
• Boys
• Unilateral/ bilateral
• Defect are rigid and cannot be manipulated
into a neutral position
• Long term follow up is required until the
child reaches skeletal maturity
• Common foot malformation:
• TALIPES VARUS
• Inversion or bending inward
• TALIPES VALGUS
• Eversion or bending outward
• TALIPES EQUINUS
• Plantar flexion, toes are lower than the heel
• TALIPES CALCANEUS
• Dorsi-flexion, toes are higher than the heel
• TALIPES EQUINO-VARUS
• Toes are lower than the heel and facing inward
• Categories
• Positional
• Stretching, casting, exercise

• Teratologic/ syndromic
• Surgical

• Congenital
• Surgical if (+) bone involvement
• Goal: painless, plantigrade, and stable foot

• Therapeutic Management
• Correction of deformity
• Maintenance of correction
• Follow-up observation
• Treatment (Ponseti method)
• Begins soon after birth
• Weekly gentle
manipulation and serial
long-leg casting (6-10
weeks)
• Percutaneous heel
tenotomy performed at
the end of serial casting
then a long-leg cast is
applied (3 weeks)
• Dennis Browne splints
• Nursing care management:
• Observation of skin and circulation
• Cast Care health teachings
THANK
YOU!