N124IN

Spring 2013
Anatomy and Physiology
 Children’s bones contain large amount of
cartilage
 More flexible and porous
 Bones bend rather than break
 Periosteum is thicker, more vascular, stronger,
tougher
 Bones absorb more energy prior to breaking
 Periosteum is more metabolically active
 Quicker healing and remodeling
Anatomy and Physiology, cont.
 Epiphyseal growth plate
 Thin cartilage layer
 Controls bone growth
 Epiphyseal side of growth plate: new cartilage is
laid down
 Metaphyseal side of growth plate: cartilage
converted to bone
 Fracture in this area could result in growth
complications
 Growth hormone: increases bone length
Anatomy and Physiology, cont.
 2nd month of life
 Bone formation begins
 Birth
 Ossification is almost complete
 2-3 months of age
 Posterior fontanel fusing
 16-18 months of age
 Anterior fontanel fusing
 Maturation and bone modeling continues to occur
until 21 years
Sports and Recreation Injuries
 Boys are 6x more likely to be hospitalized
than girls for sports injuries
 Blunt trauma to chest wall is 2nd leading
cause of death in athletes 7-16 years old
Sports and Recreation Injuries,
cont.
 Overuse injury: mictrotraumatic damage to a
bone, muscle, or tendon which has been used
repeatedly without enough time to heal or
repair itself
 1-pain after physical exertion
 2-pain during physical exertion; no performance
restriction
 3-pain during performance; pain restricts
performance
 4-chronic pain, even at rest
 Compartment Syndrome
Sports and Recreation Injuries,
cont.
 Sports injury prevention
 Understanding risk factors
 Proper coaching/supervision
 Protective equipment
 Safe playing conditions
 Adequate conditioning
 Sufficient warm-ups, cool-downs
Sports and Recreation Injuries,
cont.
 Anabolic steroids
 Signs/Symptoms
 Temper tantrums
 Personality changes
 Decreasing body fat
 Increasing acne
 Stunted growth
 Decreased sperm production
 Irreversible breast enlargement in males
 LDL increase
 HDL decrease
Soft-Tissue Injuries
 Incidence and Etiology
 Sprains: forceful sports activities
 Football, wrestling
 Strains: excessive physical activity or effort
 High action sports, lifting
 Muscle contusions: contact and collision
type sports
 Football
Soft-Tissue Injuries, cont.
 Pathophysiology
 Sprain
 Due to twisting or turning injury to joint

 Ligament stretches or tears

 Strain
 Excessive stretching or tearing of muscle or tendon

 Contusion
 Damage to soft tissues, subcutaneous structures, small
vessels and muscles
 Skin integrity not disrupted
Soft-Tissue Injuries, cont.
 Clinical Manifestations
 Sprain
 Mild sprain: local tenderness, minimal
swelling, no joint instability
 Moderate sprain: partial tearing of ligament,
partial joint instability, immediate pain,
swelling, ecchymosis
 Severe sprain: less pain than moderate, diffuse
swelling, severe ecchymosis, complete tearing
of ligament, joint instability, loss of function
Soft-Tissue Injuries, cont.
 Clinical Manifestations, cont.
 Strain
 Mild muscle strain: microscopic tear in
muscle, local tenderness, minimal
swelling/ecchymosis
 Moderate strain: more muscle fibers are torn,
“pop” felt, small defect palpated
 Severe strain: popping/snapping sound,
rupture of muscle, severe pain, marked
ecchymosis, loss of function
Soft-Tissue Injuries, cont.
 Clinical Manifestations, cont.
 Contusion
 Soft tissues and small blood vessels tear
 Inflammatory response
 Ecchymosis
 Pain to move injured body part
Soft-Tissue Injuries, cont.
 Diagnosis
 Clinical manifestations
 Radiographic studies
Soft-Tissue Injuries, cont.
 Treatment
 RICE (rest, ice, compression, elevation)
 Pain control
 Bandages, splints
 Casting, bracing
 Surgery
 Strengthening/stretching exercises
 Physical Therapy
Soft-Tissue Injuries, cont.
 Nursing Management
 Monitoring neurovascular status
 Pain management
 Elevate affected limb
 Activity restriction
 Help patient return to previous
functioning levels
Soft-Tissue Injuries, cont.
 Family Teaching
 Rest
 Elevation
 Ice
 Crutch-walking principles
 Activity restrictions
Dislocations
 Incidence and Etiology
 Occurs when force of stress on ligament is
great enough to displace a bone from its
normal articulation within a joint
 Fingers and elbows most common in
children
 Pathophysiology
 Ligament and joint capsule damage
Dislocations, cont.
 Clinical Manifestations
 Pain
 Immobility
 Joint contour change
 Extremity length change
 Diagnosis
 Physical Assessment
 Radiographs
Dislocations, cont.
 Treatment
 Closed manual reduction
 Splint, sling, cast
 Nursing Management and Family Teaching
 Pain management
 Neurovascular status assessments
 Educate family on caring for equipment
and how to prevent reinjury
Fractures
 Incidence and Etiology
 Upper extremity fractures
 Finger/hand
 Clavicle
 Proximal humerus
 Elbow
 Supracondylar fractures of humerus
 Distal radius fracture
Fractures, cont.
 Incidence and Etiology, cont.
 Lower extremity fractures
 Pelvic and tibial eminence avulsion fractures
 Femoral shaft
 Metatarsal/phalanx
 Tibia fractures
 Ankle
 Femoral neck
Fractures, cont.
 Pathophysiology
 Simple (closed) vs. compound (open)
 Classified based on type of break
 Transverse
 Oblique
 Spiral
 Greenstick
 Buckle (torus)
Fractures, cont.
 Pathophysiology, cont.
 Epiphyseal growth plate injuries
 Epiphyseal growth plate vulnerable to injury
 Salter fracture
 Can result in growth disruption, arrest,
uneven growth
Fractures, cont.
 Pathophysiology, cont.
 Physiologic process after fracture occurs
 Inflammatory
 Reparative

 Bony callus formation or ossification

 Bone remodeling
Fractures, cont.
 Clinical Manifestations
 Pain/tenderness
 Edema
 Decreased range of motion
 Extremity deformity
 Bruising
 Muscle spasms
 Crepitus
Fractures, cont.
 Diagnosis
 Signs/Symptoms
 History
 Physical examination
 Radiographs
 Ultrasound
 CT
 MRI
Fractures, cont.
 Treatment
 Closed reduction
 Open reduction
 Slings/braces/splints
 Casts
 External Fixation
 Internal Fixation
Fractures, cont.
 Treatment, cont.
 Traction
 Skin traction
 Buck extension

 Short-term continuous immobilization, treat contractures

and muscle spasms before surgery
 Bryant traction

 Developmental hip dysplasia, femur fractures

 Russell traction

 Reduce and immobilize hip fractures, tibial plateau

fractures, femur fractures
 Cervical skin traction

 Mild cervical trauma without spinal cord injury, cervical

strains and sprains, whiplash, spastic neck contractions,
degenerative spine and disc disorders, arthritis, subluxations
Fractures, cont.
 Treatment, cont.
 Traction, cont.
 Skeletal Traction
 Skeletal (Crutchfield or Garner-Wells) tong

 Stabilize fractures or displaced vertebrae in cervical or high

thoracic spinal areas
 Balanced suspension

 Femur, hip, tibia fractures

 90/90 Femoral traction

 Complicated femur fractures

 Dunlap or sidearm traction

 Fractured elbow or dislocations of elbow, humerus, shoulder

Fractures, cont.
 Complications
 Malunion
 Compartment syndrome
 Growth disturbances
Fractures, cont.
 Nursing Management
 Immobilization
 Neurovascular status assessments
 Assess and manage pain
 Be aware of psychological responses
 Continue schoolwork
 Promote mobility when able to do so
 Encourage visits from family and friends
Fractures, cont.
 Family Teaching
 Initially: hospital routine, casts, traction devices,
mobility restrictions
 Before discharge: cast care, mobility restrictions
 Identify any modifications for home or school
environment
 Referral to social services and physical therapy
 Safety equipment
Osteomyelitis
 Incidence and Etiology
 Routes
 Hematogenous: infection starts elsewhere in
body and spreads to bone via bloodstream
 Exogenous: bone is infected from external
factor
 Penetrating wounds, open fractures,
contamination in surgery, trauma
Osteomyelitis, cont.
 Pathophysiology
 Organisms travel to arteries in bone
metaphysis
 Inflammation, hyperemia, edema
 Pus increases pressure
 Elevation/bump of periosteum
Osteomyelitis, cont.
 Clinical Manifestations
 Infant: irritability; diarrhea; poor feeding
 Toddlers: pseudoparalysis; pain with passive
movement; limping
 Older children: Pain that is constant,
localized, and increases with
movement/palpation; restricted movement;
swelling; heat; red skin; fever; night sweats;
weight loss; anorexia; systemic fever
Osteomyelitis, cont.
 Diagnosis
 History and physical
 Radiographs
 Lab tests (CBC w/ differential, ESR, C-
reactive protein, blood cultures)
 Ultrasound
 Bone scanning
 CT
 MRI
Osteomyelitis, cont.
 Diagnosis, cont.
 Osteomyelitis diagnosis requires at least 2 of
the following:
 Aspiration of pus from site
 Positive bone or blood culture
 Classic signs (localized pain, swelling, increased
skin temperature, limited joint mobility)
 Positive imaging study (radiography, bone scan,
CT, MRI)
Osteomyelitis, cont.
 Treatment
 Antibiotics
 Splint limb
 Surgery
Osteomyelitis, cont.
 Nursing Management
 Pain control
 Splint/traction care
 Proper alignment; move limb cautiously
 Neurovascular/skin assessments
 Administer antibiotics
 Family Teaching
 Antibiotics
Septic Arthritis
 Incidence and Etiology
 Haemophilus influenzae type b
 Staphylococcus aureus
 Pathophysiology
 Inflammation in synovial membrane
 Pus forms, causing the synovial fluid to
thicken
 Articular cartilage destroyed

 Scar tissue replaces cartilage

 Joint mobility affected
Septic Arthritis, cont.
 Clinical Manifestations
 Nonweight bearing on affected side
 Painful, limited range-of-motion
 Warmth or redness over area
 Fever
 Toxic (sickly) appearance
 Joint swelling
 Increased WBC count
Septic Arthritis, cont.
 Diagnosis
 Lab tests: CBC w/ differential, ESR, CRP
 Joint fluid aspiration/culture
 Radiography, ultrasound, bone scan
 Treatment
 Needle aspiration/open surgical drainage
 Antibiotics
 Immobilize joint
 Pain relief
Septic Arthritis, cont.
 Nursing Management
 Maintain comfort
 Administer antibiotics
 Avoid complications related to impaired
mobility
 Family Teaching
 Antibiotic therapy
 Enforcing bedrest