orthopedic disorders in children
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ORTHOPEDIC DISORDERS
By Livson Thomas
MSc (N) 1st YearCMC, Ldh
CLUB FOOT
DEFINITION
Club Foot is a complex deformity of foot, result of complicated inter- relationships between bone ligaments and muscles.
CAUSES
Defective gene – Hereditary Excessive pressure of amniotic fluid Uterine compression Arrested fetal development Circulatory failure Irradiation (maternal)
CLASSIFICATION
1. Talipus Equinovarus
2. Talipus Calcaneovagus
3. Talipus Varus
4. Talipus Vagus
5. Talipus Equinovalgus
6. Talipus Calcaneovarus
PATHOPHYSIOLOGY
PRE DISPOSING FACTORS
DISTAL LIMB AMNIOTIC BANDING DEFECTIVE CARTILAGENOUS ANLAGE
AMNION FORMS CONSTRICTIVE BANDS AROUND A LIMB IN UTERO. RESULTING IN FURTHER
ABNORMAL OR ARRESTED DEVELOPMENT
CUTTING OF CIRCULATION TO LIMB
ARREST OF FETAL DEVELOPMENT IN THE FIBULAR STAGE
MEDICAL MANAGEMENT
1. CORRECTION
a) Stretching and casting (PONSETI METHOD)
b) Stretching and Taping ( French Method)
c) Dennis - Brown Brace
NSAIDs
SURGERY
DEFINITION
Juvenile rheumatoid arthritis ( JRA) is a chronic systemic inflammatory disease involving connective tissue of one or more joints.
PATHOPHYSIOLOGY
CHRONIC INFLAMMATION OF THE SYNOVIUM
JOINT EFUSION
EROSION, DISTORTION AND FIBROSIS OF THE ARTICULAR CARTILAGE
FIBROUS ANKYLOSIS WITH SUBLUXATION AND DISTORTION OF THE AFFECTED JOINT
GRANULATION TISSUE BECOMES HARD, TOUGH AND FIBROUS AND CONVERTED TO SCAR TISSUE
INHIBITION OF JOINT MOVEMENTS
CLASSIFICATION
1. Pauciarticular onset
2. Polyarticular Onset
3. Systemic Onset
CLINICAL MANIFESTATIONS
1. Involvement of both small and large joints
2. Joints are tender, swollen and warm
3. Reduced mobility
4. Prolonged fever
5. Muscle aches
C/M …
6. Weight loss
7. Subcutaneous nodules
8. Hepatosplenomegaly
9.Pericarditis, myocarditis
10. Pneumonia
MEDICAL MANAGEMENT
1. NSAIDs
2. Methotrexate
3. Physiotherapy
NURSING MANAGEMENT
RELIEVE PAIN
PROMOTE GENERAL HEALTH
ENCOURAGE EXERCISE
GIVE HOT BATH
PSYCHOLOGICAL SUPPORT
HEALTH EDUCATION
HIP DISPLACEMENT
DEFINITION
Hip displacement is referred to a condition in which the femoral head and the acetabulum are improperly aligned in which the ball of the femur is outside the hip socket.
TYPES
1. Hip dislocation or preluxation or acetabular dysplasia
2. Instability of hip or subluxation
3. Dislocation or subluxation of hip
PATHOPHYSIOLOGY
1. Physiologic factors
2. Mechanical factors
3. Genetic factors
CLINICAL MANIFESTATIONS
Laxity of ligaments
Assymetry of gluteal fold
Limited ROM
Apparent shorter femur on affected side
C/M …
Variation in gait
Extra fold at thighs and groins
Difference in length of limbs
Wading gait
MEDICAL MANAGEMENT
Pavlik harness
2. SKIN TRACTION
3. SURGERY AND CAST
NURSING MANAGEMENT
Teach parents regarding care and application of pavlik maneuver.
Feeding and bathing the child.
Skin care.
Assess warmth and color of feet.
Evaluate for any complication of cast.
NSG MNGMT…
Child not to be left unattended.
Assess for s/s of infection.
Proper diet.
Follow up.
Psychological support.
Prevent complications due to immobility.
FRACTURES
DEFINITION
A fracture is defined as a break in the continuity of a bone. This can occur either in the long bones as is most common or in flat bones such as skulls or pelvis.
HEALING OF FRACTUREHEMATOMA FORMATION AT FRACTURED END OF
BONE
IN GROWTH OF CAPILLARIES AND FIBROBLAST KNOWN AS GRANULATION TISSUE
GRANULATION REPLACES HEMATOMA
CHANGES IN GRANULATION TISSUE FORMATION OF CARTILAGE CELLS AND OSTEOBLASTS
FORMATION OF CARTILAGINOUS INTERWOVEN BONE
BONE HEAL WITH STABILITY
MATURITY OF BONE OCCURS
CLINICAL FEATURES
Pain Pallor Paralysis Generalized Swelling Bruising Tenderness Deformity Severe muscle rigidity
MEDICAL MANAGEMENT
1. CLOSED REDUCTION
2. OPEN REDUCTION
3. TRACTION
NURSING MANAGEMENT
Prepare child for surgery.
Keep affected part immobilized.
Proper application of traction.
Maintain hygiene of the child.
Prevent infections.
NSG MANGMT…
The child with cast observed for :
a) Prevention of circulatory, neurologic or respiratory distress.
b) Maintain normal body temperature.c) Maintain skin integrity.d) Improve muscle activity.e) Provide comfort measures.f) Prevent urinary stasis and constipation.g) Health education of parents.
OSTEOMYELITIS
DEFINITION
Osteomyelitis is a bacterial infection of the bone involving the cortex and/ or the bone marrow.
TYPES
ACUTE OSTEOMYELITIS
CHRONIC OSTEOMYELITIS
ETIOLOGY
Caused by micro-organisms.
Endogenous sources.
Exogenous sources.
PATHOPHYSIOLOGY
OCCUR MOSTLY AT THE METAPHYSEAL REGION OF LONG BONES, ESPECIALLY FEMUR AND TIBIA
BACTERIA ENTERS THROUGH OSEOUS CIRCULATION TO METAPHYSIS
PUS FORMATION AND MEDULLARY CANNAL & CORTEX GET AFFECTED
NECROSIS AND DEVASCULARIZATION OF THE CORTEX
NECROSIS AND DETACHMENT
CHRONIC OR ACUTE OSTEOMYELITIS
CLINICAL MANIFESTATIONS
Pain
Swelling
Tenderness
Erythema
Limited ROM
Systemic – fever & lethargy
MANAGEMENT
Antibiotic therapy Complete bed rest Immobilization Regular blood check up Wound care Skin assessment Asepsis Home care
KYPHOSIS
DEFINITION
It is the deformity of the spine. The term kyphosis refers to an enhanced angulations
in the thoracic or thoraco-lumbar spine in the saggital plane or a round back deformity.
CAUSES
It can develop due to defective posture. Rickets May be congenital or secondary to
compression fracture. Malignancy Juvenile Rheumatoid Arthritis
MANAGEMENT
Orthotic devices
Orthopaedic surgery
Pre and post operative care
Psychological support
SCOLIOSIS
DEFINITION
It is a lateral or side curvature of spine due to abnormality in alignment of spine.
Scoliosis develops two curves – one is original abnormal curve and second a compensatory curve in the opposite direction.
CAUSES
Idiopathic Defective embryonic development of the spine. Neuromuscular paralysis Cerebral palsy Post polio Rickets Fractures Disease of hip and spine.
CLINICAL MANIFESTATIONS
Leg length discrepancy Shoulder asymmetry in breast size Uneven waist line Scapular prominence Bone pain Poor posture
MANAGEMENT
Orthotic devices Surgery Pre and post op casting Psychological support Health education Exercise Counseling of parents
LORDOSIS
It is an abnormally increased forward curvature of lumbar spine.
It is also called sway back or saddle back.
BOW LEG (Genu Varum)
the term bow leg refers lateral angulation of knee joints because of inward deviation of longitudinal axis of tibia and femur.
CAUSES
Rickets
Traumatic
Developmental anomalies
Physiological
MANAGEMENT
Early detection of condition.
Orthopedic intervention
Surgical corrections
KNOCK KNEE ( Genu Valgum)
Knock knee is abnormal convergent of knee with divergent ankles.
This occurs due to outward deviation of longitudinal axis of both tibia and femur
CAUSES
Pathological : rickets, JRA. Cerebral palsy Fractures Neoplastic disease
MANAGEMENT
Early detection Orthopedic intervention Correction using orthopedic devices.
POLYDACTYLY
It is defined as an extra finger or toe.
Usually occurs at metacarpophalangeal joints of little finger or thumb.
CAUSES
Carpenter syndrome
Trisomy 13
Mekhel gruber syndrome
Isolated trait
SYNDACTYLY
It is fussion of digits and toes.
CAUSES
Isolated trait
Compound of certain syndrome
a) carpenter syndrome
b) trisomy 21, 13 & 18
THANK YOU
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