Semiotics of the Bone and Muscle System Lesions and the Care of the Affected Child

Nancy B. Alston

This is another very important aspect of the medical assessment of a developing child. Common bone and Muscle system lesions include Conginetal dislocation of femur, Congenital Club foot and Osteomyelitis, which are major ailments of a child giving us calls for concern.

Conginetal dislocation of Femur(hip)
Malformations of the hip with various degrees of deformity are present at birth. Congenital displesia of the hip joint (acetabular displasia)- the mildest form, in which there is neither subluxation nor dislocation. The femoral head remains in the acetabulum.

In congenital hip subluxation, the femoral head loses contact with the acetabulum and is displaced posteriorly and superiorly over the fibrocartilaginous rim. The femoral head remains in contact with the acetabulum, but a stretched capsule and ligamentum teres causes the head of the femur to be partially displaced.

In dislocation, the femoral head loses contact with the acetabulum and is displaed posteriorly and superiorly over the fibro-cartilaginous rim.

Clinical symptom
1. Dislocated or subluxated hip
� Limitation in hip abduction
� Unequal gluteal or leg folds
� Unequal knee height (Allis or Geleazzi sign)
� Audible click on abduction (Ortolani sign)- If infant is under 4 weeks of age.

2. In older children
� Affected leg is shorter than the other
� Telescoping or piston mobility of the joint (the ad of the femur can be felt to move up and down in the buttock when the extended thigh is pushed first toward the child’s head and then pulled distally).
� Trendelenburg’s sign (when the child stands first on one foot and then on the other, holding unto a chair or someone’s hands) bearing weight on the affected hip, pelvis tilts downward on the normal side instead of upward as it would with normal stability
� Greater trochanter is prominent and appears above a line from the anterior superior iliac spine to the tuberosity of the ischium.
� Marked lordosis (bilateral dislocation)
� Wadding gait (bilateral dislocation)).

Paraclinic diagnostic procedures

Child caring plan
� Improve the means of transportation of the child
� Devise the self-mobilization equipment.
� If prescribed, supervise a proper use of orthopedic splints or braces.

It is a common deformity in which the foot is twisted out from its normal shape or position. It must be described according to position of ankle and foot;
� Talipes varus is an inversion or bending inward
� Talipes valgus is an eversion or bending outward
� Talipes equines is a plantar flexion, in which toes are lower than the heel
� Talipes calcaneus is a dorsiflexion, in which toes are higher than the heel
� Talipes equinovarus is a composite deformity, in which the foot is pointed downward and inward in varying degrees of severity.

It is important to determine if the deformity can be passively corrected or is fixed.

Osteomyelitis is an infection of the Bone.
Manifestations of acute Osteomyelitis
1. General
� History of the trauma of the affected bone (frequent)
� Child appears very ill
� Irritability
� Restlessness
� Elevated temperature
� Rapid pulse
� Dehydration
2. Local
� Tenderness
� Increased warmth
� Diffuse swelling over the involved bone
� Involved extremity is painful, especially on movement
� Involved extremity is held in semi-flexion
� Surrounding muscles are tense and resists to passive movement

Paraclinic diagnostic procedures
Radiography, tomography, scintigraphy, blood culture, WBC (White blood count), erythrocyte sedimentation rate.

Child care plan
� To administer antibiotics as prescribed, wound care, to maintain asepsis.
� To cleanse the area as ordered, including irrigation if prescribed
� To apply appropriate medication and dress wound according to instructions
� To maintain immobilization with positioning or devices such as casts, splints, traction
� To ensure a nutrition diet.
� To maintain integrity and sterility of venous access.

Every one involved, parents, the medical practitioner, guardian and other stake holders are responsible for the care of such children. No one is left out and no stone should be left unturned.

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