Chapter 51: Musculoskeletal Disorders in Children Nursing Care

Musculoskeletal Disorders in Children Nursing Care provides a detailed overview of musculoskeletal disorders in children, addressing the dramatic physical and psychosocial changes associated with these conditions, and highlighting the difference between pediatric and adult orthopedic care, particularly emphasizing that growth plate injuries carry a serious risk for abnormal growth and that childhood fractures heal quickly. The underlying anatomy is explored, detailing how the skeletal system provides support and protection while producing blood components in the marrow, and how bones are active, living tissue that rely on calcium and Vitamin D for remodeling and strength. Nursing care requires careful assessment, including routine gait checks, as a limp is never normal and can signal serious underlying issues. Diagnostic procedures covered include standard X-rays, CT scans, bone scans, electromyography for muscle function, and biopsies. Therapeutic management frequently involves immobilization techniques such as casts, which require diligent neurovascular monitoring to prevent dangerous complications like compartment syndrome or Volkmann ischemic contracture, which can arise from excessive pressure. The use of external fixators for distraction is also discussed as a method to lengthen bones. Furthermore, the chapter reviews common variations in bone development, such as genu varum (bowlegs) and genu valgum (knock knees), most of which resolve naturally with time, and distinguishes these from serious conditions like Blount disease. Key bone disorders addressed include Osteogenesis Imperfecta, a connective tissue disorder causing bone fragility and frequent fractures, and Legg-Calvé-Perthes disease, which involves avascular necrosis of the femoral head and may require non-weight bearing devices or surgery. Slipped Capital Femoral Epiphysis (SCFE) is presented as a displacement of the femoral head, commonly seen in obese or rapidly growing males, necessitating timely surgical fixation. Infectious and inflammatory disorders detailed are osteomyelitis, a severe bone infection requiring prolonged antibiotic therapy and immobilization, and Juvenile Idiopathic Arthritis (JIA), a chronic autoimmune disease managed through rest, exercise (like swimming), heat application, and multi-modal drug therapies including NSAIDs, DMARDs, and tumor necrosis factor inhibitors. The chapter also examines disorders of skeletal structure, such as idiopathic scoliosis (lateral spinal curvature), which is managed primarily through observation, body bracing (worn for 23 hours a day), or, for curves exceeding 40 degrees, spinal instrumentation and fusion surgery. Finally, muscle disorders are covered, including Myasthenia Gravis, an autoimmune condition treated with acetylcholinesterase inhibitors to improve muscle contraction, and Muscular Dystrophies, which are progressive genetic diseases, with Duchenne disease being the most common type, requiring ongoing physical support and weight management to maximize mobility.