congenital malformation of the lower extremity that affects the lower leg, ankle, and foot

foot is twisted out of normal position

genetic predisposition

children with sliblings with disorder at risk

abnormal uterine position

1.2 of 1000 births

2:1 boys to girls

higher is Pacific Islanders

plantar flexed foor with an inverted heel and adducted forefoot

smaller, shortened achilles heel

normal leg length

readily apparent on clinical examination at birth

radiographic imaging for extent of deformity

started ASAP after birth

stretching, manipulation, casting performed weekly

if above is not sufficient, surgery is indicted and further casting necessary

educate parents about clubfoot and treatments and outcomes

may need assistance acknowledging their disappointments

promote parent/infant bonding

elevate feet postop

watch for skin breakdown and drainage

assess NV status every 1-2 hours in post op

teach parents how to care for baby including keeping cast clean, bathing and diapering w/o getting case wet

remind parents of need for followup care until child reaches skeletal maturity

incomplete development of the acetabalum which allows head of femur to slip out of the socket and become dislocated

can be congenital or developmental

multifactoral in orgin: genetic, prenatal, and postnatal positioning (breech births)

laxity of the ligaments holding the femur head within the acetabulum is any underlying predisposing factor

family hx most significant predisposing factor

unstable hip joint: partial dislocation, dislocated with manual manipulation, hip ligaments are lax

subluxated: head of femur is under lip of acetebalum but not well seated

dislocated: head of femur is out of the acetabalum

newborns: lax ligaments

older infants: contractures and stiffness of hip

adduct the hips and apply gentle pressure down and back with the thumbs

hip dysplasia: feel the femoral head move out of the acetabulum

abduct the hips and apply gentle pressure over the greater trochanter

positive: clunking sensation indicates a dislocated femoral head moving into the acetabulum

limited abduction

assymatry in gluteal folds

possible change in gait -- significan limp

one femur appears shorter

Pavlik harness

surgery -- osteotomy (surgical cutting of the bone) and repositioning of the femur follow by spica cast

proper use of harness: onsie and socks to prevent rubbing, proper positioning of hips

adequate skin care

techniques for holding and feeding

follow up necessary bc modifications in treatment may be necessary

acknowledge pt feelings, let them ask questions

soft stuffed animals

crib mobiles

rattles

mirrors

musical toys

contrasting colors

blocks

books

puzzles

appropriate tv and videos

safety scissors

board games

reading

listening to radio, watching TV

videos

movies

music

reading

lateral curvature of the spine

3 dimensional deformity involving rotation of the vertebral bodies

causes ribcake to become misshapen

body develops a compensatory curve to maintain posture and balance

slight: 10-20 degrees

moderate: 20-40, may require bracing

severe: 40+ degrees, usually requires surgery

more than 80 can cause resp distress

-- does not involve rotational or muscular deformity

-- can result from poor posture, increased weight bearing on one should or other conditions that can cause leaning in one direction

-- treated by correcting the underlying contributing factor

Idiopathic: predominent form, no recongnizable cause but appears to have genetic component, more in adolescent girls, progress more rapidly during growth spurts

Congenital: results of vertebral abnormalities, such as hemivertebra or vertebral bars, associated with other congenital abnormalities

Nueromuscular: common in individuals with certain neuromuscular conditions such as cerebral palsy, muscular dystrophy, paraplegia, quariplegia

-- muscle weakness on one side of the spine results in shortening of the muscles and ligaments on the opposite side

-- tight ligaments cause the spinal column to curve, compressive the vertabrae on the side into a concave spine

-- compression of the vertabrae causes an imbalance in bone production during growth, which exacerbates the progression of the curvature

visible curve of the spine

rip hump when the child is bending forward

-- asymmetric ribcage

-- uneven shoulder or pelvic heights and prominence of the scapular or hip

-- difference in the space b/t the arms and the trunk when the child is standing

-- apparent leg-length discrpancy

-- severe cases: decreased vital capacity

-- used extensively in past, used today to stabilize some curves less than 40 degrees

-- will not resolve an exisiting curve

-- may reduce progression of the curve during growth

-- must be worn 18-23 hours/day

-- monitor skin meticulously for breakdown

-- results in cessation of growth of the fused vertebrae

-- rods and wires correct curve and hold spine

-- blood loss can often be replaced by pt's own blood

skin irritation

pressure ulcers

-- neurologic damage from mechanical injury during surgery or from stretching of spinal column

-- superior mesenteric artery syndrome

-- fluid or electrolyte imabalance

-- sluggish bowel function

-- superficial or deep wound infection

-- psuedoarthrosis

teach pt and family about scoliosis and treatments

encourge pt to talk about diagnosis, treatments, and feelings

provide information about the disorder and treatment

-- id and address anxiety

-- explain post op interventions like icu care, nv check q 1-2 hours, turning by log rolling, deep breathing and incentive spirometer

-- wound dressing

--brace application and skin care

-- encourage to ask ?s

-- monitor pain level and provide analgesics as ordered

-- wound care and signs of infection

-- activity restrictions

-- look for skin breakdown, numbness or tingling in extremities, difficulty breathing

-- importance of follow up

support soft tissue

decrease formation of fluids

decrease edema, protect and shape

hasten healing

minimize pain

compression bandage

residual limb shrinker