Broken bones: common pediatric fractures--part I.

Musculoskeletal injuries are one of the most frequently encountered problems in pediatric practice, with fractures accounting for a surprisingly large percentage of these injuries. A fracture occurs when bone is subjected to more energy than it can absorb. Pediatric healthcare providers must have a good understanding of normal bone growth and development and must recognize common mechanisms of injury and fracture patterns seen in children. Nearly 20% of children who present with an injury have a fracture, and it is estimated that 42% of boys and 27% of girls will sustain a fracture during childhood (Wilkins, 1996). The immature skeleton has several unique properties that directly affect the management of fractures in children.

Developmental dysplasia of the hip: nursing implications and anticipatory guidance for parents.

Developmental dysplasia of the hip (DDH) is a comprehensive term used to describe an abnormal relationship between the femoral head and the acetabulum. Developmental dysplasia of the hip includes a very wide spectrum of abnormality from a frank dislocation (very unstable) to a stable hip with a slightly shallow acetabulum. As many of these findings may not be present at birth, the term developmental more accurately reflects the biologic features than does the term congenital. Despite the recent increased awareness of DDH and the importance of thorough screening programs, hip dysplasia continues to be a frequently missed diagnosis in pediatrics. Earlier detection and diagnosis of DDH is associated with a much more successful and less invasive outcome.

The newborn foot: diagnosis and management of common conditions.

An assessment of the foot should be a part of every newborn physical examination. The newborn foot, although complex in structure, can be examined quickly in any office setting. Many foot deformities are diagnosed immediately after birth, allowing for earlier and often more successful treatment. A neonate with a foot deformity can be a source of anxiety to parents. Adequate knowledge of commonly encountered neonatal foot problems enables the nurse to give appropriate anticipatory guidance to the parents. Foot abnormalities usually occur as isolated findings in an otherwise healthy newborn. However, these deformities can also be seen in newborns with underlying neuromuscular disorders and syndromic conditions. Common newborn foot abnormalities include equinovarus deformity (clubfoot), metatarsus adductus, calcaneovalgus, congenital vertical talus, polydactyly (supernumerary digits), and syndactyly (webbed toes). These common foot disorders, their treatment, and their prognosis are discussed. This article also discusses fundamental nursing implications needed to care for these young patients and their families.

Femoroacetabular impingement in adolescents and young adults.

Femoroacetabular impingement (FAI) is a recently described hip disorder resulting from an abnormal morphology between the proximal femur and acetabulum (socket). It is now recognized as a cause of hip pain in adolescents and young adults, and research has shown that it may also lead to early degenerative changes and osteoarthritis. Femoroacetabular impingement as a cause of precocious hip arthrosis was originally described by Ganz et al. in 2001, and a quick literature search on this topic will confirm that it has become a topic of cutting edge research within the orthopaedic community. The abnormal morphology in FAI results in increased hip contact forces with hip motion, especially flexion. This results in abnormal contact that can lead to acetabular labral tears and cartilaginous injury. Early diagnosis and treatment may possibly delay the future onset of hip arthritis. Although the precise cause of FAI is not well understood, the condition has become increasingly recognized as a cause of hip pain in active adolescents and young adults. The purpose of this article is to outline the history, physical examination and radiographic findings, and current conservative and surgical treatment modalities for FAI.