Chapter 68: Musculoskeletal Problems

Osteomyelitis represents a critical bone infection primarily caused by Staphylococcus aureus, developing through hematogenous spread in pediatric patients or direct inoculation in adults through wounds or surgical procedures. The infection creates sequestrum formation with surrounding involucrum, leading to chronic drainage and potential disability if inadequately treated with prolonged antibiotic therapy and surgical debridement. Bone neoplasms include benign tumors such as osteochondroma and malignant sarcomas, with osteosarcoma being the predominant primary bone cancer in adolescents and young adults, requiring aggressive chemotherapy and surgical resection. Metastatic bone disease from breast, prostate, and lung primaries creates significant fracture risk and hypercalcemia requiring stabilization procedures and bisphosphonate therapy. Muscular dystrophy encompasses genetic neuromuscular disorders characterized by progressive muscle fiber degeneration, with Duchenne and Becker variants requiring supportive care including corticosteroids, respiratory support, and mobility preservation strategies. Spinal disorders constitute a major clinical focus, ranging from acute low back pain managed conservatively with anti-inflammatory medications and physical therapy, to complex intervertebral disc disease causing radiculopathy and potential cauda equina syndrome requiring emergency decompression. Degenerative disc disease and spinal stenosis often necessitate surgical interventions including laminectomy, discectomy, and spinal fusion procedures. Nursing management emphasizes infection control, fracture prevention, pain assessment, neurological monitoring, postoperative alignment maintenance, and comprehensive patient education regarding mobility techniques, ergonomics, and long-term disease management strategies.