Mild pain in knee hip or limp relieved with rest 4 Stages o Prenecrosis – vascular insult; blood flow stops o 1-Necrosis
Asymptomatic; Xray normal 3-6 mo after injury o 2-Revascularzation Pain arrives, limited movement; have ability to fracture femoral head & growth plate, pivotal stage, watch pt closely, Xray will show bone deposition & pronounced limp o 3-Bone healing re-ossification Decreasing pain; healing o 4-Remodeling No pain, regain more joint movement Diagnosis Bone scan and MRI ( xray will be normal ) Look for coagulation issue (cause of decreased blood supply to femoral head) Therapy: Toronto or Scottish Rite brace, PT, traction Anti-inflammatory meds Good outcome if caught early Otherwise may develop osteoarthritis Braces Scottish Rite – spika cast but removeable & less problems with skin breakdown Toronto Brace – helps with problems with knee, keeps entire legs abducted, skin integrity issues Scoliosis Lateral S or C shaped curve of spine with a rotational deformity of the spine and ribs Most often seen in girls, start assess around 4 th grade Most often age 10-13 Curvatures > 10 degrees is considered abnormal Problems with breathing, constipation, cardiac issues common Diagnostic Tests Observation – hips asymmetrical, shoulders, curve of pt Scoliometer (school screens) Xray Treatment Braces Surgery – spinal fusion
o For 40 degree or greater deviation o post op child is logrolled o Up with brace o Post Op complications Painful! OT/PT – relearn how to do things, cant twist Drains – deep & superficial, clots & output (clear & yellow – CSF; HA) ICU after surgery, 12 hr surgery, incision all the way down back Urinary retention – pain meds & laying flat Paralytic ileus – bowels don’t restart, N/V, hypotension Hemodynamically unstable Skin integrity – 12 hr = skin breakdown Curvature of Spine Kyphosis: curvature of the thoracic spine. No pain. Lordosis: accentuated cervical or lumbar curvature. Pain . Osteomyelitis Infection of the bone – usually bacterial, can be viral Twice as common in boys Most often in femur or tibia Diagnosis Pain, swelling in extremity, can have fever Increased WBC, ESR inflammation & infection May have positive bone and blood cultures X-rays may be normal Treatment Antibiotics for 4 weeks + o Will come back terribly if not gone! Sepsis risk Soft Tissue Injury Crush injuries Dislocations o “nursemaid’s elbow” o Parents swinging kid between them o Humerus detaches & painful Child just won’t want to use/bend elbow
o Shoulder dislocations Sprains o Ligament torn or stretched Strain o Tear to tendon Interventions o R - Rest o I - Ice Immediately Towel between ice and skin On and off skin for 24 – 36 hours o C - Compression o E – Elevation Types of Fractures o Spiral fracture occurs with twisting o Can happen if child in crib & falls turns & breaks leg o Parents cant explain fall with twisting expect abuse bone scan for hx Fractures o Fractures heal faster in kids o Rarely occurs in infancy – thinking OI or abuse
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- Spring '17