Chapter 24: Musculoskeletal Conditions & Pediatric Trauma

Musculoskeletal Conditions & Pediatric Trauma review explores the nursing management of the child with a musculoskeletal condition, highlighting the anatomical and physiological differences between pediatric and adult skeletal systems, such as the thicker periosteum and the presence of cartilaginous epiphyses (growth plates) that allow for rapid healing but also pose risks for growth disturbances following trauma. The text details the assessment of motor milestones and gait, noting that toddlers typically exhibit a wide, unstable stance that narrows over time, and emphasizes the importance of neurovascular checks—assessing pain, pulse, pallor, paresthesia, paralysis, and capillary refill—to detect complications like compartment syndrome or Volkmann’s ischemia in immobilized patients. Traumatic injuries are a major focus, covering soft tissue injuries treated with the PRICE principle (protection, rest, ice, compression, elevation) and various fracture types, including greenstick and spiral fractures, the latter of which may indicate child abuse in non-ambulatory infants. Nursing care for immobilization devices is extensively described, differentiating between plaster and fiberglass casts, and outlining specific traction methods such as Bryant traction for infants, Buck skin traction for lower extremity extension, Russell traction using knee slings, and skeletal traction involving pin insertion, all requiring vigilant skin and circulation monitoring. Congenital and developmental abnormalities are examined, including clubfoot (talipes equinovarus) managed through serial casting or surgery, and developmental dysplasia of the hip (DDH), diagnosed via Ortolani and Barlow tests and treated with Pavlik harnesses or spica casts to maintain flexion and abduction. The chapter also addresses infectious and inflammatory disorders like osteomyelitis, which requires long-term intravenous antibiotics, and Juvenile Idiopathic Arthritis (JIA), an autoimmune condition requiring multidisciplinary care to preserve joint function and manage systemic symptoms like uveitis. Neuromuscular and degenerative conditions are covered, specifically Duchenne Muscular Dystrophy (DMD) with its characteristic Gower sign and progressive muscle weakness, as well as hip disorders like Slipped Capital Femoral Epiphysis (SCFE) often seen in obese preadolescents, and Legg-Calvé-Perthes disease involving avascular necrosis of the femoral head. Malignant bone tumors, including osteosarcoma and Ewing sarcoma, are discussed regarding their aggressive nature, metastatic potential to the lungs, and treatments ranging from amputation to chemotherapy and radiation. Furthermore, the text reviews spinal deformities such as torticollis and scoliosis, detailing the use of the Milwaukee brace and surgical spinal fusion for severe curvatures. Finally, the summary encompasses broader child safety issues, including the prevention of sports injuries through proper equipment and conditioning, and the critical legal and ethical responsibilities of nurses to recognize and report signs of child abuse, neglect, and maltreatment, which may manifest as inconsistent injury histories or bruises in various stages of healing.