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ortho peds notes

Terms in this set (70)

congenital talipes equinovarus known as
club foot
club foot treatment (non-operative)
serial (ponseti) casting weekly
club foot treatment (operatively)
3-12 months of age
realignment of foot bones and release of constricting soft tissues with tendon lengthening
club foot nursing management for non-operatively
cast care education
skin case
neurovascular checks
positioning techniques
club foot nursing management for operatively
pain management
genu varum (bow-legged) is normal in
toddlers up until 2-3 years old
genu varum causes
blount's disease
rickets
blount's disease
Growth disorder of the tibia that causes the lower leg to angle inward
obesity is a risk factor and is seen in late teens
rickets
Vitamin D deficiency
risk factors: exclusive breast feeding, prematurity, antiseizure and antiretroviral meds
rickets is a lot
more pronounced
genu valgus (knock kneed) is normal between
3-7 years old
genu valgus causes
skeletal dysplasia
physeal injury (fracture, trauma, infection)
benign tumors (osteochondromas, fibrous dysplasia)
physeal injury
injury that was at a young age that disrupted the growth plate and growth was interrupted
genu varum and genu valgus tx non-operative
leg bracing w/ KAFO > genu varus
bracing rarely works for which ortho disease
genu varum
genu varum and genu valgus tx operatively
proximal tibia/fibula or distal femur osteotomy (cut the bones and rearrange them)
genu varum and genu valgus nursing assessment and managment
safe mobility, s/s of infection, cast care
hip dysplasia goes hand in hand with
club foot
most common orthopedic disorder in newborns is
hip dysplasia
in hip dysplasia the
femoral head and acetabulum are improperly aligned
etiology of DDH
Unknown
genetics play a role: 1st degree relative of infants w. DDH
breech and first born
DDH symptoms in infants
palpable hip subluxation/dislocation on exam
limited abduction of affected hip
asymmetry of gluteal folds
DDH symptoms in older child
may walk with a limp
what is the goal standard diagnosis for DDH in infants
ultrasound
ortolani
click in hip, hip dysplasia
barlow
adduct the hip, audible clunk

development dyplasia of the hip
galeazzi test
difference in knee height
DDH non-operative tx
pavlik harness <3 months of age
knee hips abducted
DDH operative tx
closed reduction and spica casting - 6-18 months of age
open reduction and spica cast >18 months of age
DDH nursing management
screen all infants until 2 years of age
Legg-Calve-Perthes Disease
avascular necrosis of the femoral head
Legg-Calve-Perthes Disease presents between
4-8 years of age
Legg-Calve-Perthes Disease etiology
interruption of blood flow to femoral head
genetic
Legg-Calve-Perthes Disease sx early on
mild hip or anterior thigh pain
painless limp - aggravated by increased activity
Legg-Calve-Perthes Disease sx later on
limited hip range of motion
weakness and muscle wasting
Legg-Calve-Perthes Disease is typically diagnosed with
Pelvic x-ray
Legg-Calve-Perthes Disease tx non-operative
only works if caught early
non-weight bearing on affected leg
physical therapy
frequent follow-ups and x-rays
Legg-Calve-Perthes Disease tx operative stage I
adductor tenotomy and petrie casting/bracing
Legg-Calve-Perthes Disease tx operative stage II
pelvic/femoral osteotomy
Legg-Calve-Perthes Disease nursing assessment and management
ADLs (transportation issues, school attendance, PT, OT, SW, CM consults)
Slipped Capital Femoral Epiphysis
occurs when the head of the femur becomes displaced due to a separation at the growth plate
SCFE is most common in
adolescents
SCFE is associated with
Puberty
Slipped Capital Femoral Epiphysis etiology
obesity and can be associated with endocrine disorders (hypothyroidism)
Slipped Capital Femoral Epiphysis sx
groin and thigh pain
present for weeks/months
walks with leg externally rotated/out-toeing
Slipped Capital Femoral Epiphysis is diagnosed with
Pelvic x-ray
Slipped Capital Femoral Epiphysis tx operative
only choice for tx
percutaneous in-situ pinning
may prophylactically pin other hip 40-80% risk of SCFE
Slipped Capital Femoral Epiphysis assessment and management
endocrine
education
SW and CM consults
idiopathic scoliosis
-most common (75%)
-girls >boys
-detected early adolescence
- S or C shaped curvature
idiopathic scoliosis etiology
unknown
genetic
idiopathic scoliosis sc
uneven shoulder/hip height
upon forward ben, sides differ in height
severe curves cause back pain
idiopathic scoliosis tx non-operative <25 degrees
observation and monitoring with x-rays
idiopathic scoliosis tx non-operative 25-40 degrees
bracing and monitoring with x-rays
idiopathic scoliosis tx non-operative >40-45 degrees
requires surgical intervention
idiopathic scoliosis tx operative
posterior spinal fusion if spine is >40-45 degrees curved
growing rod insertion (rod grows with child)
VEPTR hardware insertion - used if curve affects rib/lungs
neuromuscular scoliosis
caused by an underlying condition such as spina bifida, cerebral palsy, spinal muscular atrophy
osteomyelitis
infection of the bone
osteomyelitis is common in
healthy children
osteomyelitis etiology
trauma to extremity - bacteremia leading to bacterial seeding in bone
osteomyelitis sx
limp or pain
fevers
restricted mobility
not toxic appearing
osteomyelitis is usually diagnosed with
MRI
risk factors of osteomyelitis
diabetes
sickle cell
immunocompromised
osteomyelitis tx
varies based on severity of infection
irrigation and debridement
most common organisms that cause osteomyelitis
staph aureus
group b strep
kingella
septic arthritis/joint
•Joint infection
•Most common joint affected = knee; followed by hip, ankle, shoulder, elbow
•Usually reaches joint through the bloodstream
•Typically only affects 1 joint
septic arthritis/joint etiology
infection that spreads from another area of the body
trauma/injury
open fracture
septic arthritis/joint common bacteria found
staph aureus, neisseria gonorrhoeae, kingella kingae
septic arthritis/joint sx
joint pain
joint swelling, redness, warmth
fever
inability to bear weight
septic arthritis/joint tx
irrigation and debridement
cultures
infectious disease
PT
What should we keep in mind when assessing a pediatric patient for septic arthritis
lyme disease because sx are similar
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