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for congenital defects, degenerative disorders and infections or injuries that impair the integumentary system, the musculoskeletal system or neurologic system
Name the types of fractures
- Bend, Buckle (raised or bulging at fracture site),
- Greenstick (incomplete fractures),
- Spiral (twisting, forms a spiral encircling the bone),
- Transverse (occurs at a 90 degree angle to longitudinal axis of bone),
- Oblique (occurs at 45 degree angle across longitudinal axis of bone),
- Complete (breaka cross entire section of bone),
- Closed (does not break the skin), Compound (open wound through which the bone has protruded),
- Complicated (bone fragments that cause damage to other organs or tissues), Comminuted (more than one fracture line, more than 2 bone fragments either splintered or crushed)
What does a fracture look like?
Deformity, muscle spasm, swelling, bruising, crepitus, muscle rigidity
What do you check for neurovascularily?
sensation, movement, circulation, cap refill, pulses
Define reduce, Closed reduction, ORIF, & OREF
- Reduce-manipulation of bone to restore realignment
- Closed-reduction-manual traction to move fracure fragments and restore bone alignment
- ORIF-surgical procedure where fragments are realigned with an internal fixation such as screws, plates, pins
- OREF-surgical procedure to realign bones with an external fixation such as cast or pins
What are the 5 P's of ischemia?
- Pain and point of tenderness
- Pulses-distal to the fracture site
- Paresthesia-sensation distal to the fracture site
- Paralysis-movement distal to the fracture site
What are the goals of fracture management?
Regain alignment and length, retain alignment and length, restore function, prevent further injury
Name the types of casts
Lower extremity, spinal or cervical, spica, plaster, fiberglass
What is compartment syndrome?
Edema that occurs in response to a fracture that causes pressure in the muscle compartment that reduces cap blood perfusion, therefore unable to meet tissues metabolic need and ischemia begins.
What are types of traction?
- Traction-application of a pulling force to an injured body part or extremity while countertraction pulls in the opposite direction
- Skin-application of a pulling force directly to the skin through use of skin straps, boots, or foam splints
- Skeletal-uses int to apply force to the bone
- Manual-applied to body part by the hands placed distal to the fracture site
What is a strain?
- twist, pull, and/or tear of muscle and/or tendon
- caused by direct or indirect trauma that knocks a joint out of position or overstreches or ruptures
What is a sprain?
Stretch and/or tear of ligament, may hear a tear or pop of joint, pain bruising, edema
Describe shin splints, plantar fasciitis, patellar tendinopathy and osteomyelitis
- Shin splints-strain of posterior tibial muscle origin
- Plantar fasciitis-strain to plantar fascia
- Patellar tendinopathy-tennis elbow, tendinitis of hand or wrist
- Osteomyelitis-severe pyogenic infection of the bone and surrounding tissues
What is club foot and what causes it
Complex deformity of the ankle and foot caused by abnormal positioning and restricted movement in utero, abnormal embryonic development, relationship with other disorders or syndromes
What are the 4 types of club foot? and what is the most common?
- Talipes varus-inversion or bending inward
- Talipes valgus-eversion or bending outward
- Talipes equinus-plantar flexion, toes lower than heels
- Talipes calcaneus-dorsiflexion, toes higher than heels
- Most common-Talipes equinovarus (TEV)
What are the names of two common back problems
How are spinal deformities classified?
- Infantile (up to 3 years)
- Childhood (juvenile, during childhood)
- Adolescent (during adolescent growth spurt) MOST COMMON
How is scoliosis differentiated
- congenital (caused by vertebral anomalies present at birth)
- idiopathic (cause unknown, subclassified as infantile, juvenile, adolescent, or adult, according to when onset occurred)
- neuromuscular (having developed as a secondary symptom of another condition, such as spina bifida, cerebral palsy, spinal muscular atrophy, or physical trauma)
What is scoliosis?
- Lateral curvature of the spine.
- Less than 10 degrees is postural deviation
- Less than 20 degrees is mild, no progression, no treatment
- 40-45 degress excessive curvature surgical intervention
What do you do for scoliosis?
Observation, bracing, spinal fusion if severe, and exercise
Explain juvenile rheumatoid arthritis
An idiopathic autoimmune inflammatory disease causing inflammation of joints and other tissues. It starts before age 16 and has no known cause.
What is the age onset for Juvenile RA?
- Between 1-3 years and between 8-10 years of age.
- Twice as many girls than boys get it
What are the goals of treatment
There is no treatment, goals are to control pain, preserve joint ROM and function, minimize effects of inflammation such as deformity and promote normal growth and development
What is happening with Juvenile RA?
Chronic inflammation of the synovium, joint effusion, destruction and fibrosis of articular cartilage, adhesion between joint surfaces, ankylosis of joints
How is Juvenile RA diagnosed?
ESR (sed rate), rheumatoid factor, x-ray to show soft-tissue swelling and joint space widening
How to minimize effects of Juvenile RA
NSAIDS, methotrexate, corticosteroids (potent immunosuppressives), Slow-acting antirheumatic drugs, splinting as necessary, support
What is Septic Arthritis?
- A bacterial infection in the joint affecting adults under 30 usually caused by N. gonorrhoeae or MRSA.
- Most joints affected, knee, hip, shoulder, wrist, ankle
- Confirmed by blood work, synovial fluid analysis
What is the treatment for Septic Arthritis?
- IV antibiotic therapy for 2-3 weeks
- Additional oral ABX if needed
What is osteogenesis imperfecta?
- Characterized by excessive fractures and bone deformities
- Also known as brittle bone disease
- Characterized by hearing loss, bone fragility, blue sclerae, fractures, discolored teeth
What is the management for osteogenesis imperfecta?
Careful handling to prevent fractures, careful repositioning to prevent contractures, physical therapy to build strength, surgery to correct deformities, family support, braces and splints to help support limbs and prevent fractures
What are the types of OI or brittle bone disease
- Type 1-most common, mild bone fragility, normal teeth, hearing loss, autosomal dominant inheritance
- Type 2-lethal, stillborn or die in early infancy
- Type 3-Severe bone fragility leading to severe progressive deformities, normal sclerae
- Type 4-Mild to moderate bone fragility, normal sclerae, short stature, variable deformity
- Type 5-Clinically similar to Type 4
- Type 6-Sclerae and dentition normal, moderate to severe bone fragility, diagnosed by bone biopsy