Chapter 36: Musculoskeletal Disorders

Developmental dysplasia of the hip requires early recognition through clinical maneuvers such as the Ortolani and Barlow tests, with nursing management involving the application and monitoring of the Pavlik harness or spica cast to promote proper hip alignment during critical developmental periods. Clubfoot management progresses from conservative approaches including serial casting and manual manipulation to surgical correction when necessary, requiring detailed attention to neurovascular status and family education regarding long-term outcomes. Scoliosis screening using the Adam's forward bend test guides the prescription of bracing protocols that demand significant daily commitment, necessitating psychosocial support alongside spinal fusion procedures that require specialized postoperative care including logrolling techniques to maintain spinal alignment and prevent complications. Juvenile idiopathic arthritis presents with inflammatory joint symptoms managed through a tiered medication approach ranging from nonsteroidal anti-inflammatory drugs to disease-modifying agents and corticosteroids, combined with physical therapy to preserve range of motion and functional mobility. Marfan syndrome, a heritable connective tissue disorder, demands cardiac surveillance and vision monitoring alongside activity modification to prevent life-threatening complications. Legg-Calvé-Perthes disease involving avascular necrosis of the femoral head utilizes traction, casting, and surgical intervention to maintain proper hip positioning during remodeling phases. Fracture management requires systematic neurovascular assessment using the five P framework, emergency trauma response protocols, appropriate immobilization through various traction methods including Russell, balanced suspension, and 90-90 configurations, and meticulous cast care addressing skin integrity and complication prevention. Throughout all interventions, nursing care emphasizes early detection of serious complications such as compartment syndrome, maintenance of pin and wound sites, and comprehensive family teaching to optimize child outcomes and support developmental progress.