ORTHOPEDIC DISORDERS

By Livson Thomas

MSc (N) 1st YearCMC, Ldh

CLUB FOOT

DEFINITION

Club Foot is a complex deformity of foot, result of complicated inter- relationships between bone ligaments and muscles.

CAUSES

Defective gene – Hereditary Excessive pressure of amniotic fluid Uterine compression Arrested fetal development Circulatory failure Irradiation (maternal)

CLASSIFICATION

1. Talipus Equinovarus

2. Talipus Calcaneovagus

3. Talipus Varus

4. Talipus Vagus

5. Talipus Equinovalgus

6. Talipus Calcaneovarus

PATHOPHYSIOLOGY

PRE DISPOSING FACTORS

DISTAL LIMB AMNIOTIC BANDING DEFECTIVE CARTILAGENOUS ANLAGE

AMNION FORMS CONSTRICTIVE BANDS AROUND A LIMB IN UTERO. RESULTING IN FURTHER

ABNORMAL OR ARRESTED DEVELOPMENT

CUTTING OF CIRCULATION TO LIMB

ARREST OF FETAL DEVELOPMENT IN THE FIBULAR STAGE

MEDICAL MANAGEMENT

1. CORRECTION

a) Stretching and casting (PONSETI METHOD)

b) Stretching and Taping ( French Method)

c) Dennis - Brown Brace

NSAIDs

SURGERY

DEFINITION

Juvenile rheumatoid arthritis ( JRA) is a chronic systemic inflammatory disease involving connective tissue of one or more joints.

PATHOPHYSIOLOGY

CHRONIC INFLAMMATION OF THE SYNOVIUM

JOINT EFUSION

EROSION, DISTORTION AND FIBROSIS OF THE ARTICULAR CARTILAGE

FIBROUS ANKYLOSIS WITH SUBLUXATION AND DISTORTION OF THE AFFECTED JOINT

GRANULATION TISSUE BECOMES HARD, TOUGH AND FIBROUS AND CONVERTED TO SCAR TISSUE

INHIBITION OF JOINT MOVEMENTS

CLASSIFICATION

1. Pauciarticular onset

2. Polyarticular Onset

3. Systemic Onset

CLINICAL MANIFESTATIONS

1. Involvement of both small and large joints

2. Joints are tender, swollen and warm

3. Reduced mobility

4. Prolonged fever

5. Muscle aches

C/M …

6. Weight loss

7. Subcutaneous nodules

8. Hepatosplenomegaly

9.Pericarditis, myocarditis

10. Pneumonia

MEDICAL MANAGEMENT

1. NSAIDs

2. Methotrexate

3. Physiotherapy

NURSING MANAGEMENT

RELIEVE PAIN

PROMOTE GENERAL HEALTH

ENCOURAGE EXERCISE

GIVE HOT BATH

PSYCHOLOGICAL SUPPORT

HEALTH EDUCATION

HIP DISPLACEMENT

DEFINITION

Hip displacement is referred to a condition in which the femoral head and the acetabulum are improperly aligned in which the ball of the femur is outside the hip socket.

TYPES

1. Hip dislocation or preluxation or acetabular dysplasia

2. Instability of hip or subluxation

3. Dislocation or subluxation of hip

PATHOPHYSIOLOGY

1. Physiologic factors

2. Mechanical factors

3. Genetic factors

CLINICAL MANIFESTATIONS

Laxity of ligaments

Assymetry of gluteal fold

Limited ROM

Apparent shorter femur on affected side

C/M …

Variation in gait

Extra fold at thighs and groins

Difference in length of limbs

Wading gait

MEDICAL MANAGEMENT

Pavlik harness

2. SKIN TRACTION

3. SURGERY AND CAST

NURSING MANAGEMENT

Teach parents regarding care and application of pavlik maneuver.

Feeding and bathing the child.

Skin care.

Assess warmth and color of feet.

Evaluate for any complication of cast.

NSG MNGMT…

Child not to be left unattended.

Assess for s/s of infection.

Proper diet.

Follow up.

Psychological support.

Prevent complications due to immobility.

FRACTURES

DEFINITION

A fracture is defined as a break in the continuity of a bone. This can occur either in the long bones as is most common or in flat bones such as skulls or pelvis.

HEALING OF FRACTUREHEMATOMA FORMATION AT FRACTURED END OF

BONE

IN GROWTH OF CAPILLARIES AND FIBROBLAST KNOWN AS GRANULATION TISSUE

GRANULATION REPLACES HEMATOMA

CHANGES IN GRANULATION TISSUE FORMATION OF CARTILAGE CELLS AND OSTEOBLASTS

FORMATION OF CARTILAGINOUS INTERWOVEN BONE

BONE HEAL WITH STABILITY

MATURITY OF BONE OCCURS

CLINICAL FEATURES

Pain Pallor Paralysis Generalized Swelling Bruising Tenderness Deformity Severe muscle rigidity

MEDICAL MANAGEMENT

1. CLOSED REDUCTION

2. OPEN REDUCTION

3. TRACTION

NURSING MANAGEMENT

Prepare child for surgery.

Keep affected part immobilized.

Proper application of traction.

Maintain hygiene of the child.

Prevent infections.

NSG MANGMT…

The child with cast observed for :

a) Prevention of circulatory, neurologic or respiratory distress.

b) Maintain normal body temperature.c) Maintain skin integrity.d) Improve muscle activity.e) Provide comfort measures.f) Prevent urinary stasis and constipation.g) Health education of parents.

OSTEOMYELITIS

DEFINITION

Osteomyelitis is a bacterial infection of the bone involving the cortex and/ or the bone marrow.

TYPES

ACUTE OSTEOMYELITIS

CHRONIC OSTEOMYELITIS

ETIOLOGY

Caused by micro-organisms.

Endogenous sources.

Exogenous sources.

PATHOPHYSIOLOGY

OCCUR MOSTLY AT THE METAPHYSEAL REGION OF LONG BONES, ESPECIALLY FEMUR AND TIBIA

BACTERIA ENTERS THROUGH OSEOUS CIRCULATION TO METAPHYSIS

PUS FORMATION AND MEDULLARY CANNAL & CORTEX GET AFFECTED

NECROSIS AND DEVASCULARIZATION OF THE CORTEX

NECROSIS AND DETACHMENT

CHRONIC OR ACUTE OSTEOMYELITIS

CLINICAL MANIFESTATIONS

Pain

Swelling

Tenderness

Erythema

Limited ROM

Systemic – fever & lethargy

MANAGEMENT

Antibiotic therapy Complete bed rest Immobilization Regular blood check up Wound care Skin assessment Asepsis Home care

KYPHOSIS

DEFINITION

It is the deformity of the spine. The term kyphosis refers to an enhanced angulations

in the thoracic or thoraco-lumbar spine in the saggital plane or a round back deformity.

CAUSES

It can develop due to defective posture. Rickets May be congenital or secondary to

compression fracture. Malignancy Juvenile Rheumatoid Arthritis

MANAGEMENT

Orthotic devices

Orthopaedic surgery

Pre and post operative care

Psychological support

SCOLIOSIS

DEFINITION

It is a lateral or side curvature of spine due to abnormality in alignment of spine.

Scoliosis develops two curves – one is original abnormal curve and second a compensatory curve in the opposite direction.

CAUSES

Idiopathic Defective embryonic development of the spine. Neuromuscular paralysis Cerebral palsy Post polio Rickets Fractures Disease of hip and spine.

CLINICAL MANIFESTATIONS

Leg length discrepancy Shoulder asymmetry in breast size Uneven waist line Scapular prominence Bone pain Poor posture

MANAGEMENT

Orthotic devices Surgery Pre and post op casting Psychological support Health education Exercise Counseling of parents

LORDOSIS

It is an abnormally increased forward curvature of lumbar spine.

It is also called sway back or saddle back.

BOW LEG (Genu Varum)

the term bow leg refers lateral angulation of knee joints because of inward deviation of longitudinal axis of tibia and femur.

CAUSES

Rickets

Traumatic

Developmental anomalies

Physiological

MANAGEMENT

Early detection of condition.

Orthopedic intervention

Surgical corrections

KNOCK KNEE ( Genu Valgum)

Knock knee is abnormal convergent of knee with divergent ankles.

This occurs due to outward deviation of longitudinal axis of both tibia and femur

CAUSES

Pathological : rickets, JRA. Cerebral palsy Fractures Neoplastic disease

MANAGEMENT

Early detection Orthopedic intervention Correction using orthopedic devices.

POLYDACTYLY

It is defined as an extra finger or toe.

Usually occurs at metacarpophalangeal joints of little finger or thumb.

CAUSES

Carpenter syndrome

Trisomy 13

Mekhel gruber syndrome

Isolated trait

SYNDACTYLY

It is fussion of digits and toes.

CAUSES

Isolated trait

Compound of certain syndrome

a) carpenter syndrome

b) trisomy 21, 13 & 18

THANK YOU