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Orthopedic disorders in Children

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Orthopedic disorders in Children

  1. 1. ORTHOPEDIC DISORDERS By Livson Thomas MSc (N) 1st Year CMC, Ldh
  2. 2. CLUB FOOT
  3. 3. DEFINITION Club Foot is a complex deformity of foot, result of complicated inter- relationships between bone ligaments and muscles.
  4. 4. CAUSES Defective gene – Hereditary Excessive pressure of amniotic fluid Uterine compression Arrested fetal development Circulatory failure Irradiation (maternal)
  5. 5. CLASSIFICATION1. Talipus Equinovarus
  6. 6. 2. Talipus Calcaneovagus
  7. 7. 3. Talipus Varus
  8. 8. 4. Talipus Vagus
  9. 9. 5. Talipus Equinovalgus
  10. 10. 6. Talipus Calcaneovarus
  11. 11. PATHOPHYSIOLOGY PRE DISPOSING FACTORSDISTAL 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 LIMBARREST OF FETAL DEVELOPMENT IN THE FIBULAR STAGE
  12. 12. MEDICAL MANAGEMENT1. CORRECTION a) Stretching and casting (PONSETI METHOD)
  13. 13. b) Stretching and Taping ( French Method)
  14. 14. c) Dennis - Brown Brace
  15. 15. NSAIDs
  16. 16. SURGERY
  17. 17. DEFINITION Juvenile rheumatoid arthritis ( JRA) is a chronic systemic inflammatory disease involving connective tissue of one or more joints.
  18. 18. 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
  19. 19. GRANULATION TISSUE BECOMES HARD, TOUGH AND FIBROUS AND CONVERTED TO SCAR TISSUE INHIBITION OF JOINT MOVEMENTS
  20. 20. CLASSIFICATION1. Pauciarticular onset
  21. 21. 2. Polyarticular Onset
  22. 22. 3. Systemic Onset
  23. 23. CLINICAL MANIFESTATIONS1. Involvement of both small and large joints2. Joints are tender, swollen and warm3. Reduced mobility4. Prolonged fever5. Muscle aches
  24. 24. C/M …6. Weight loss7. Subcutaneous nodules8. Hepatosplenomegaly9.Pericarditis, myocarditis10. Pneumonia
  25. 25. MEDICAL MANAGEMENT1. NSAIDs2. Methotrexate3. Physiotherapy
  26. 26. NURSING MANAGEMENT RELIEVE PAIN PROMOTE GENERAL HEALTH ENCOURAGE EXERCISE GIVE HOT BATH PSYCHOLOGICAL SUPPORT HEALTH EDUCATION
  27. 27. HIP DISPLACEMENT
  28. 28. 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.
  29. 29. TYPES1. Hip dislocation or preluxation or acetabular dysplasia2. Instability of hip or subluxation3. Dislocation or subluxation of hip
  30. 30. PATHOPHYSIOLOGY1. Physiologic factors2. Mechanical factors3. Genetic factors
  31. 31. CLINICAL MANIFESTATIONS Laxity of ligaments Assymetry of gluteal fold Limited ROM Apparent shorter femur on affected side
  32. 32. C/M … Variation in gait Extra fold at thighs and groins Difference in length of limbs Wading gait
  33. 33. MEDICAL MANAGEMENT Pavlik harness
  34. 34. 2. SKIN TRACTION
  35. 35. 3. SURGERY AND CAST
  36. 36. 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.
  37. 37. 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.
  38. 38. FRACTURES
  39. 39. 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.
  40. 40. HEALING OF FRACTURE HEMATOMA 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
  41. 41. FORMATION OF CARTILAGINOUS INTERWOVEN BONE BONE HEAL WITH STABILITY MATURITY OF BONE OCCURS
  42. 42. CLINICAL FEATURES Pain Pallor Paralysis Generalized Swelling Bruising Tenderness Deformity Severe muscle rigidity
  43. 43. MEDICAL MANAGEMENT1. CLOSED REDUCTION
  44. 44. 2. OPEN REDUCTION
  45. 45. 3. TRACTION
  46. 46. NURSING MANAGEMENT Prepare child for surgery. Keep affected part immobilized. Proper application of traction. Maintain hygiene of the child. Prevent infections.
  47. 47. 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.
  48. 48. OSTEOMYELITIS
  49. 49. DEFINITION Osteomyelitis is a bacterial infection of the bone involving the cortex and/ or the bone marrow.
  50. 50. TYPES ACUTE OSTEOMYELITIS CHRONIC OSTEOMYELITIS
  51. 51. ETIOLOGY Caused by micro-organisms. Endogenous sources. Exogenous sources.
  52. 52. 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
  53. 53. NECROSIS AND DEVASCULARIZATION OF THE CORTEX NECROSIS AND DETACHMENT CHRONIC OR ACUTE OSTEOMYELITIS
  54. 54. CLINICAL MANIFESTATIONS Pain Swelling Tenderness Erythema Limited ROM Systemic – fever & lethargy
  55. 55. MANAGEMENT Antibiotic therapy Complete bed rest Immobilization Regular blood check up Wound care Skin assessment Asepsis Home care
  56. 56. KYPHOSIS
  57. 57. 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.
  58. 58. CAUSES It can develop due to defective posture. Rickets May be congenital or secondary to compression fracture. Malignancy Juvenile Rheumatoid Arthritis
  59. 59. MANAGEMENT Orthotic devices Orthopaedic surgery Pre and post operative care Psychological support
  60. 60. SCOLIOSIS
  61. 61. 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.
  62. 62. CAUSES Idiopathic Defective embryonic development of the spine. Neuromuscular paralysis Cerebral palsy Post polio Rickets Fractures Disease of hip and spine.
  63. 63. CLINICAL MANIFESTATIONS Leg length discrepancy Shoulder asymmetry in breast size Uneven waist line Scapular prominence Bone pain Poor posture
  64. 64. MANAGEMENT Orthotic devices Surgery Pre and post op casting Psychological support Health education Exercise Counseling of parents
  65. 65. LORDOSIS It is an abnormally increased forward curvature of lumbar spine. It is also called sway back or saddle back.
  66. 66. 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.
  67. 67. CAUSES Rickets Traumatic Developmental anomalies Physiological
  68. 68. MANAGEMENT Early detection of condition. Orthopedic intervention Surgical corrections
  69. 69. 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
  70. 70. CAUSES Pathological : rickets, JRA. Cerebral palsy Fractures Neoplastic disease
  71. 71. MANAGEMENT Early detection Orthopedic intervention Correction using orthopedic devices.
  72. 72. POLYDACTYLY It is defined as an extra finger or toe. Usually occurs at metacarpophalangeal joints of little finger or thumb.
  73. 73. CAUSES Carpenter syndrome Trisomy 13 Mekhel gruber syndrome Isolated trait
  74. 74. SYNDACTYLY It is fussion of digits and toes.
  75. 75. CAUSES Isolated trait Compound of certain syndrome a) carpenter syndrome b) trisomy 21, 13 & 18
  76. 76. THANK YOU
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