Transcript Fertilization

Chapter 24
The Child with a Musculoskeletal
Condition
Pediatric Trauma
• Prevention
• Proper use of pedestrian
safety
– Contusion
• Car seat restraints
– Sprain
• Bicycle helmets and other
– Strain
protective athletic gear
• Injuries should be
• Pool fences
treated immediately to • Window bars
limit damage from
• Deadbolt locks
edema and bleeding • Locks on cabinet door
• Soft-tissue injuries
include
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Bryant’s Traction
• Used for the young child(under 2 yo; 2030LBS.) 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
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
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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
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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
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Duchenne’s or Becker’s Muscular
Dystrophy (MD) (cont.)
• Additional signs and symptoms
– Progressive weakness as evidenced by
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Frequent falling
Clumsiness
Contractures of the ankles and hips
Gower’s maneuver to rise from the floor
– Intellectual impairment is common
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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
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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
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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
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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
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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
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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
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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
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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
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Juvenile Idiopathic Arthritis (JIA)
(cont.)
• Treatment
– Goals of therapy
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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
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Scoliosis
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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
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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
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Family Violence
• Affects children of all social classes
• Includes
– Spousal and child abuse
– Neglect
– Maltreatment
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Assessing for Child Abuse
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