| Condition | Definition | Age at Onset/Sex Difference | Treatment | Nursing Considerations |
|---|
| Congenital Musculoskeletal Disorders |
| Clubfoot | Downward, inward rotation of one or both feet: talipes equinovarus (95%) | Newborn (congenital); twice as common in boys | Series of casts changed weekly followed by Denis Browne splint and then corrective shoes (severe cases—surgery) | - Care of child in cast/brace.
- Stress need for follow-up.
- Encourage compliance.
|
| Developmental dysplasia of the hip (see Figure. 5.12. Signs of Developmental Dysplasia of the Hip) | Abnormal development of hip joint (most frequently unilateral) | Newborn (congenital); more common in girls | Newborn—Pavlik harness; older infant or toddler—possible surgery, spica cast | - Early identification.
- Care of child in traction/cast: check circulation; turn q2h while cast is wet.
- Encourage compliance.
- Check for other anomalies (e.g., spina bifida).
|
| Legg-Calvé-Perthes disease | Aseptic necrosis of the head of the femur (cause unknown) | Peak: 4–8 years; range: 3–12 years; 5 times more common in boys; 10 times more common in Caucasians than non-Caucasians |  Conservative therapy lasts 2–4 years, usually begins with bedrest and traction, followed by non–weight-bearing devices such as brace, cast | - Early identification.
- Care of child in traction/cast: check for frayed pulley ropes.
- Provide diversion.
- Assist child and family to cope with child’s prolonged immobility.
|
| Scoliosis (see Figure. 5.13. The Four Major Curve Patterns in Idiopathic Scoliosis) | Lateral curvature of the spine (cause unknown) | Adolescence; more common in girls | Braces specific to type of curvature; halo-pelvic traction; Harrington rod; Luque, Cotrel-Dubousset, or Dwyer/Zielke instrumentation | - Care of child in traction/cast/brace.
- Teach that brace is worn 16–23 hr/day, 7 days/wk for 6 months–2 years.
- Encourage compliance.
- Promote positive self-image.
|
| Acquired Defect |
| Osteomyelitis | Most frequently occurring bone infection among children | 5–14 years; twice as common in boys | Blood cultures to diagnose causative organisms—select appropriate antibiotic; bedrest, immobilization with splint or cast | - Care of child in splint/cast.
- Provide diversion.
 Pain medications/antibiotics per physician order.
|
| Joint Disorder |
| Juvenile idiopathic arthritis (JIA) (formerly known as juvenile rheumatoid arthritis) | Chronic systemic inflammatory disease (cause unknown) | Peak: 1–3 years and 8–10 years; more common in girls | Prevent joint deformity by exercise, splints, medications (NSAIDs, SAARDs, corticosteroids, biological agents [Etanercept], cytotoxic agents); relieve symptoms (as per adult with arthritis) | - Care of child in brace/splint.
- Provide diversion.
- Encourage compliance.
|
| Bone Tumor |
| Osteosarcoma | Most frequently occurring bone cancer among children | Adolescence (10–25 years); more common in boys and men | Limb salvage procedure; amputation → prosthesis; chemotherapy | - Prepare child for loss of limb
- Help cope with prosthesis, life-threatening illness
- Assist with grieving process
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