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

This is another very important aspect of the medical evaluation of the developing child. Common lesions of the musculoskeletal system include congenital dislocation of the femur, congenital clubfoot and osteomyelitis, which are the main diseases of the child that call us for concern.

Congenital dislocation of the femur (hip)

Hip malformations with varying degrees of deformity are present at birth. Congenital dysplasia of the hip joint (acetabular dysplasia) – 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 moves backward and upward over the fibrocartilaginous rim. The femoral head remains in contact with the acetabulum, but the stretched capsule and ligamentum teres cause partial movement of the femoral head.

In dislocation, the femoral head loses contact with the acetabulum and moves backward and upward across the fibrocartilaginous rim.

Clinical symptom

1. Dislocated or subluxated hip

� Limitation in hip abduction

� Uneven gluteal or leg folds

� Unequal knee height (Allis or Geleazzi sign)

� Audible abduction click (Ortolan sign)- If the newborn is less than 4 weeks old.

2. In older children

� The affected leg is shorter than the other

� Telescoping or reciprocating motion of the joint (the femur can be felt to move up and down in the buttocks when the extended thigh is first pushed toward the child’s head and then pulled distally).

� Trendelenburg’s sign (when a child stands first on one leg and then the other, holding on to a chair or someone’s hands) bearing weight on the affected hip, the pelvis tilts down on the normal side instead of up as it would in a normal stability

� The greater trochanter is prominent and appears above the line from the anterior superior iliac spine to the tuberosity of the ischium.

� Marked lordosis (bilateral dislocation)

� Vata gait (bilateral dislocation)).

Paraclinical diagnostic procedures

Radiography

Sonography

Child care plan

� Improve the child’s means of transportation

� Design equipment for self-mobilization.

� If prescribed, supervise proper use of orthopedic splints or braces.

CONGENITAL VALVE FOOT

It is a common deformity in which the foot is twisted out of its normal shape or position. It must be described according to the position of the ankle and foot;

� Talipes varus is inversion or inward bending

� Talipes valgus is eversion or outward bending

� Talipes equines is plantar flexion, in which the toes are lower than the heel

� Talipes calcaneus is dorsiflexion, in which the toes are higher than the heel

� Talipes equinovarus is a composite deformity, in which the foot points downward and inward in varying degrees of severity.

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

OSTEOMYELITIS

Osteomyelitis is a bone infection.

Manifestations of acute osteomyelitis

1. General

� History of trauma to the affected bone (common)

� The child looks very sick

� Irritability

� Restlessness

� High temperature

� Rapid pulse

� Dehydration

2. Local

� Tenderness

� Increased heat

� Diffuse swelling over the affected bone

� The affected limb is painful, especially when moving

� The affected limb is kept in semi-flexion

� The surrounding muscles are tense and resistant to passive movement

Paraclinical diagnostic procedures

Radiography, tomography, scintigraphy, blood culture, WBC (white blood count), erythrocyte sedimentation rate.

Child care plan

� Administration of antibiotics as prescribed, wound care, maintenance of asepsis.

� To clean the area as ordered, including irrigation if prescribed

� Apply appropriate medication and bandage the wound as directed

� To maintain immobilization by positioning or devices such as casts, splints, traction

� To ensure a nutritional diet.

� To maintain the integrity and sterility of the venous access.

Everyone involved, parents, doctor, guardian and other stakeholders are responsible for the care of such children. No one is left out and no stone should be left unturned.

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