Chapter 21: Caring for the Child With a Musculoskeletal Condition

Children's bones heal more rapidly due to a thick, vascular periosteum, but their incomplete ossification and the presence of growth plates create unique vulnerabilities to injury and potential long-term deformity. The chapter details essential immobilization techniques including cast application, where fiberglass is favored for its rapid drying time, and traction systems ranging from skin-based approaches like Bryant's traction to skeletal methods requiring pins inserted directly through bone. Critical nursing responsibilities center on continuous neurovascular assessment using the five P's—pain, pallor, pulselessness, paresthesia, and poikilothermia—to detect life-threatening complications such as compartment syndrome or cast syndrome. Common congenital and developmental conditions receive thorough coverage, including clubfoot management through serial casting and the Ponseti technique, developmental dysplasia of the hip treated with the Pavlik harness in infants, and acquired hip disorders such as Legg-Calvé-Perthes disease and slipped capital femoral epiphysis requiring containment or surgical intervention. The chapter addresses trauma-related injuries, inflammatory conditions including juvenile arthritis and osteomyelitis, and the genetic disorder osteogenesis imperfecta, each requiring distinct nursing approaches. Spinal deformities such as scoliosis demand screening protocols and may necessitate surgical fusion with postoperative logrolling techniques to maintain spinal alignment. Throughout all conditions, nursing care integrates family-centered principles, injury prevention strategies for hospitalized children, and nutritional support emphasizing protein, calcium, and vitamin D to optimize bone healing and development.