Chapter 29: Musculoskeletal & Articular Dysfunction in Children

Musculoskeletal & Articular Dysfunction in Children begins by detailing the systemic consequences of immobilization, such as muscle atrophy, bone demineralization leading to osteopenia, circulatory stasis, and potential skin breakdown, alongside the nursing management strategies required to mitigate these effects through exercise, high-protein nutrition, and play therapy. The text explores traumatic injuries, distinguishing between soft-tissue injuries like contusions, sprains, and strains—managed via Rest, Ice, Compression, and Elevation (RICE)—and various types of fractures including plastic deformation, buckle, greenstick, and complete fractures. Special attention is given to the Salter-Harris classification for growth plate injuries and the critical nursing assessment for compartment syndrome using the six Ps (pain, pulselessness, pallor, paresthesia, paralysis, and pressure). Therapeutic interventions such as casting (including spica casts) and traction methods (Buck, Russell, and skeletal traction) are thoroughly examined. The chapter further delves into congenital and developmental defects, explaining the pathophysiology and management of Developmental Dysplasia of the Hip (DDH) using the Pavlik harness or surgical reduction, Congenital Clubfoot (Talipes Equinovarus) treated via the Ponseti method, and Osteogenesis Imperfecta, which requires meticulous handling to prevent fractures. Acquired defects are also covered, including Legg-Calvé-Perthes disease, Slipped Capital Femoral Epiphysis (SCFE), and spinal deformities like kyphosis, lordosis, and idiopathic scoliosis, the latter of which may necessitate bracing or spinal fusion. Finally, the discussion encompasses infectious processes like Osteomyelitis and Septic Arthritis, as well as chronic autoimmune disorders such as Juvenile Idiopathic Arthritis (JIA) and Systemic Lupus Erythematosus (SLE), focusing on pharmacological management with NSAIDs, DMARDs, and biologics to preserve joint function and general health.