Children with Musculoskeletal Dysfunction Part 1

Children with Musculoskeletal or Articular Dysfunction (Part 1)

• This is a chapter focusing on children with musculoskeletal or articular problems

• The chapter objectives include analyzing history and physical findings related to intracranial pressure, neuromusculoskeletal, and endocrine disorders

• Objectives also include analyzing diagnostic data, managing family-centered care for these children, and examining nursing considerations for pediatric medications

Effects of Immobilization

• Immobilization is a significant aspect of illness in children
• Common reasons for immobilization:
  • Congenital defects
  • Degenerative disorders
  • Infections or injuries affecting integumentary, neurologic, or musculoskeletal systems
  • Therapies that prolong immobility

Soft-Tissue Injury

• Types of soft tissue injuries are illustrated:
  • Tendon (strain)
  • Muscle and soft tissue (contusion)
  • Ligament (sprain)
  • Joint (dislocation)
  • Epiphysis (separation)

Contusion

• Results from damage to soft tissue, subcutaneous tissue, and muscle
• Blood escapes into tissues, causing ecchymosis (bruising)
• Symptoms include swelling, pain, disability, and in some cases, crush injuries

Dislocation

• Displacement of opposing bone ends, or of bone ends to the socket
• Caused by a significant force on ligaments
• Symptoms include pain that increases with movement and possible loss of blood supply to affected areas (ex. hip dislocation may cause blood supply issues to the head of the femur).

Sprain vs. Strain

• Sprain:
  • Trauma to a joint from partially or completely torn/stretched ligaments
  • Can involve damage to blood vessels, muscles, tendons, and nerves
  • Often associated with joint laxity (a sign of severity)
  • Rapid onset of swelling and disability
• Strain:
  • Microscopic tears to musculotendinous units
  • Similar symptoms to sprains (swelling, pain)
  • Usually caused over time

Fractures

• Common in children
• Treatment methods differ between children and adults
• Rare in infants, requiring investigation
• Distal forearm is the most common broken bone in childhood

Types of Fractures

• Simple/Closed: Does not break the skin
• Open/Compound: Fractured bone protrudes through the skin
• Complicated: Bone fragments damage other organs/tissues
• Comminuted: Small bone fragments separate from the fractured shaft and reside around the injury site

Fracture Lines

• Includes different types of fracture lines (visuals are provided in the slideshow)
  • Plastic deformation
  • Buckle
  • Greenstick
  • Complete
  • Complete with periosteal hinge

Growth Plate Injuries

• The epiphyseal plate (growth plates) is the weakest point in long bones, and frequent trauma sites
• These injuries can affect future bone growth
• Treatments may involve surgical open reduction and internal fixation to prevent future issues

Bone Healing and Remodeling

• Bone healing in children is generally rapid
• Healing times:
  • Neonatal: 2-3 weeks
  • Early childhood: 4 weeks
  • Later childhood: 6-8 weeks
  • Adolescence: 8-12 weeks

Diagnosis and Management of Fractures

• Diagnostic approach includes radiographs and history taking, particularly when a young child refuses to walk or crawl
• Goals for management:
  • Reduction and immobilization of the fracture
  • Restoring function
  • Preventing deformities

Assessment of Fractures: The Six Ps

• Pain: Location and intensity of pain
• Pallor: Paleness of the affected area
• Pulselessness: Absence of pulse in the injured area
• Paresthesia: Loss of sensation in the area distal to the fracture
• Paralysis: Loss of movement in the area distal to the fracture
• Pressure: Determining if there is excessive pressure on the area

Cast Care

• Elevate the casted extremity for the first day
• Monitor for swelling and discoloration of fingers or toes
• Assess movement and sensation of fingers or toes
• Do not allow the child to put anything inside the cast
• Consider using a cool hair dryer to manage itching