Chapter 50: The Child With a Musculoskeletal Alteration

Children's bones contain significantly more cartilaginous tissue and undergo mineralization at variable rates, with open growth plates at the epiphyses creating unique vulnerabilities distinct from adult injuries. Accurate assessment requires understanding these developmental features to prevent misinterpretation of radiographic findings and inappropriate clinical interventions. A cornerstone of pediatric musculoskeletal nursing involves frequent neurovascular monitoring to detect early signs of ischemia, including persistent pain unrelieved by analgesics, sensory changes, and diminished peripheral pulses, as timely recognition prevents serious complications such as compartment syndrome and permanent tissue damage. The chapter explores immobilization management across multiple modalities, ranging from traditional plaster and fiberglass casts to advanced external fixation systems like the Ilizarov device and skeletal traction setups including Buck's extension and halo vests for spinal stabilization. Injury classification and management are detailed through examination of soft tissue trauma managed with RICE and ICES protocols, fracture patterns specific to children including greenstick and spiral fractures, and the Salter-Harris classification system for growth plate injuries. Chronic conditions requiring specialized nursing knowledge include osteomyelitis necessitating prolonged intravenous antimicrobial therapy, adolescent idiopathic scoliosis managed through orthotic bracing or surgical fusion, and various developmental hip disorders such as dysplasia treated with the Pavlik harness, Legg-Calve-Perthes disease causing avascular necrosis, and slipped capital femoral epiphysis presenting with rapid femoral head displacement. Congenital abnormalities such as clubfoot are addressed through the Ponseti casting method, while progressive neuromuscular conditions including Duchenne muscular dystrophy and autoimmune disorders like juvenile idiopathic arthritis require multifaceted nursing interventions. Throughout all conditions, nursing care integrates nutritional optimization, wound and skin care, pain management, and psychosocial support to address the complex needs of pediatric patients and their families navigating acute injuries and chronic skeletal conditions.