peads fractures

Care of the child with fractures, traction, kyphosis, scoliosis & lordosis

Instructor Asif Shah Khan

Mph, BscN

Fractures

Bone fractures occur when the resistance of bone against the stress being exerted yields to the stress force.

• Fortunately, fractures also heal faster in Fortunately, fractures also heal faster in children. children.

• Newborns: 2-3 weeksNewborns: 2-3 weeks• Early childhood: 4 weeksEarly childhood: 4 weeks• Later childhood: 6 – 8 weeksLater childhood: 6 – 8 weeks• Adolescence: 8 – 12 weeks Adolescence: 8 – 12 weeks

Causes:o Accidentso Every day activitieso Physical abuse

Cont..

• A partial or complete break in a bone.– Bone is the only tissue in the human body other

than liver that heals by regeneration instead of by scarring.

– For regeneration to occur the bone must be immobilized to allow uninterrupted formation of new bone.

Types of fractures

•Transverse: crosswise, at right angles to the long axis of the bone

Types of fractures cont’d

Oblique: slanting but straight, between a horizontal and perpendicular direction

Cont..

•Spiral: slanting and circular, twisting around the bone shaft

Green stick fractures

It occurs when a bone is angulated beyond the limits of bending. The compressed side bends causing an incomplete fracture

Types of fractures cont’d

• Closed or simple fracture: If the fracture does not produce a break in the skin, it is simple, or closed fracture

• Open or compound fracture: Are those with an open wound through which the bone is protruded.

• Complicated fracture: Bone fragments cause damage to the other organs

Clinical manifestations of a fracture

• Generalized swelling• Pain or tenderness• Diminished functional use of affected part May be• Bruising• Severe muscular rigidity• Crepitus

Diagnostic Evaluation

• History• X-Rays• Computed tomography (CT) and magnetic

resonance imaging (MRI) • Physical examination

Therapeutic management

The goals of the therapeutic management are the following

To regain alignment To restore function to the injured parts To prevent further injury

Nursing consideration

• Assess the extent of injury• Determine the mechanism of injury• Move the injured part as little as possible• Cover open wounds with a sterile or clean

dressing• Immobilize the limb• Assess neurovascular status• Apply cold compressions to the injured

area

Long Bone Fractures

• Fractures of the femur, humerus, tibia/fibula• Blunt and penetrating trauma• Requires high energy to break bone, therefore

look for other injuries.• Bone has a generous blood supply.• Does patient have associated bleeding

disorder?

Long Bone Fracture

Management

• ABC’s• Neurovascular exam (vascular +/- nerve injury)• Splint involved extremity – Reduction decreases pain, bleeding

• Orthopedic consultation for definitive management

• Complications:– Blood loss

Treatment

• fractures require immediate attention• pain and loss of function for the person • after emergency treatment • immobilization with • casts or traction, or fixation with surgery.

Cast care

• Before the cast is applied, the extremities are checked for any abrasions, cuts in the skin.

• Protect the cast with a large plastic bag during bathing

• Skin care• Circulation check

• Don’t put toys or bits of food down a cast.Don’t put toys or bits of food down a cast.• Clear paths for crutch-walkingClear paths for crutch-walking• Quiet activities and rest. Quiet activities and rest. • Home care

Fracture Complications

• Vascular Injuries– Most commonly occur in open fracture and

dislocations, or widely displaced fracture and at sites where the vessels lie in close proximity to the bone or at sites where the vessels are held in a relatively fixed position.

• Classic signs: • The 5 P’s: Pain, Pallor, Pulselessness (or diminished

pulse), Paresthesia, decrease sensation) and Paralysis.

Fracture Complications

• Nerve Injuries– Occur more frequently than vascular injuries – Nerves are at increased risk of injury when they

are superficial to the skin, lie close to the bone, or span a joint, making them susceptible to stretch injury.

Pulmonary Embolism

• Pulmonary Embolism:• Pulmonary embolism is the sudden blocking

of a lung artery by an embolus, nearly always resulting from a blood clot that can travel to the lungs, especially from the deep veins of the leg

Traction • Traction refers to the set of mechanisms for

straightening broken bones or relieving pressure on the spine and skeletal system.

Purposes • To regain normal length and alignment of involved

bone. • To reduce and immobilize a fractured bone. • To lessen or eliminate muscle spasms. • To relieve pressure on nerves, especially spinal. • To prevent or reduce skeletal deformities or muscle

contractures.

Types of traction

• Manual traction• Skin traction• Skeletal traction• Cervical traction

Nursing considerations

• Check pin site frequently.• Clean pin sites as ordered• Apply topical antiseptic as ordered• Check pin screw• Cover ends of pin with padding• Prevent skin breakdown• Prevent complications.• Check pulse in affected area, compare with counter

lateral site.

cont,…

• Assess circular dressing for excessive tightness• Encourage deep breathing exercise.• Note any neurovascular changes• Active passive exercise of uninvolved joints

and muscle• Applying foot board to prevent foot drop.

Kyphosis

• Kyphosis also called round back, is a common condition of a curvature of the upper back. Abnormally increased convex angukation in the curvature of the thoracic spine.

Types of kyphosis• Postural kyphosis (common)• Scheuermann’s kyphosis• Congenital kyphosis

Treatment option

• This include exercise (weight lifting, dancing & swimming)

• Braces may be prescribed by a doctor.• Surgical fusion.

Scoliosis

• Is an abnormal lateral curvature of the spine, causing the spinal column to bend to the left or right. It make the spine look more like an “S” or “C” than a straight “I”. The one shoulder, scapula or hip appears higher than the other.

• Can run in the families • Can occur at any age.

Types of scoliosis

• Congenital scoliosis (infantile), juvenile.• Idiopathic scoliosis occurs without known

cause.Diagnostic evaluation• Physical examination• X-rays.

Post operative care• Close monitoring in ICU• Skin caring• Assessment of wound, circulation & vital sign.• Neurological status of the extremities.• N/G tube care and bowel assessment.• I/O measurement• Pain management• Physiotherapy• Ambulation• Family involvement.

Lordosis

• Is a disorder defined by an excessive inward curve of the spine (lumbar curvature). Severe lordosis is accompanied by pain.

• It can be caused by trauma, contracture of the hip, scolosis & obesity.

Treatment

• Analgesic & anti-inflammatory medication• Physical therapy• Bracing• Reduction of body weight• Correction of deformities.