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SKELETAL DISORDERS
PRESENTED BY : MS KAJAL
MSC(N) 1ST
YR.

CLEFT LIP AND CLEFT
PALATE
Presented by: Ms Kajal
M.Sc.‘N’1st
yr

INTRODUCTION
 It is a congenital malformation resulting from the failure
of fusion of maxillary process during intrauterine
development.
 This defect may occur alone or together.

Definition
 CLEFT LIP (CHEILOSCHISIS): It is result from failure of fusion of
maxillary process with nose elevation on frontal prominence.
TYPES :
1. Partial / incomplete
2. Complete
3. Bilateral
4. Unilateral

CLEFT PALATE ( PALATOSCHISIS)
It’s result from failure to fusion
of the hard palate with each
other and with the soft palate,
cleft lip usually occurs with
cleft palate.
TYPES:
1. Complete
2. Incomplete.

Child health nursing SKELETAL DISORDERS.pptx

ETIOLOGY / Causes
 Medication taken by mother. ( Ex- antimalarial,
anticonvulsion).
 Exposure of virus or chemicals.
 Maternal anemia
 Alcohol abuse
 Maternal smoking

COMPLICATIONS
 Feeding difficulties.
 Respiratory infections.
 Ear infections and hearing
loss.
 Speech problem.
 Aspirate pneumonia.

DIAGNOSTIC EVALUATION
 Maternal use and
counselling
 After birth –
physical
examination.

MANAGEMENT
 SURGICAL MANAGEMENT :
FOR CLEFT LIP:
1. TENNISON – Randal triangular flap ( Z- plasty).
2. MILLARDS rotational advancement technique .
FOR CLEFT PALATE: required multiple surgery.

LOGAN’S BOW:
 As part of a cleft lip
management to
maintain
postoperative
apposition and to
avoid excessive strain
after cheiloplasty for
a cleft lip.

MEDICAL MANAGEMENT.
 Antibiotics and analgesic.
NURSING MANAGEMENT:
 Maintaining adequate nutrition.
 Increasing family coping.
 Reducing the parents’ anxiety and guilt regarding
the newborn’s physical defects,
 preparing parents for the future repair of the
cleft lip and palate

DEVELOPMENTAL DYSPLASIA OF HIP
 DEFINITION: Its id refers to a variety of condition in which
the head of femur and acetabulum cavity are improperly
aligned and the femur head lies outside the hip socket or
acetabulum cavity.
DEGREE OF DDH
1. ACETABULAR DYSPLASIA OR PRELUXATION: mild
dislocation of hip joint to the acetabulum cavity.
2. SUBLUXATION : incomplete dislocation of hip joint.
3. COMPLETE DISLOCATION AND LUXATION : Complete
dislocation of hip joint.

ETIOLOGY
 common in females than male.
 Genetic factors.
 Intrauterine position.
 Maternal factors.
CLINICAL EVALUATION
 Shorting of legs.
 Asymmetry of legs.
 Gait abnormalities.

DIAGNOSIS
 BARLOW TEST
 ORTOLANI
 USG AND X- RAYS.
MANAGEMENT:
 Pavlik harness
 Brace- Von Rosen splint.
 SUREGERY: Closed reduction under
general anesthesia.
NURSING MANAGEMENT
 Maintain correct position of hip.
 Maintain physical mobility
 Educate and support parents.

CLUBFOOT (VARUS EQUINUS)
DEFINITION: A common deformity in which the foot is twisted out of its normal shape
or position.
Involving the ankle is known as TALIPES derived TALUS means ankle and PES means
FOOT.
TYPES:
1.TALIPES VARUS : There is an inversion or bending inward of foot.
2.TALIPES VALGUS: There is an eversion or bending outward of foot.
3.TALIPES EQUINUS: There is planter flexion and toes is lower than heel.
4.TALIPES CALCANEOUS: There is dorsiflexion and toes is higher than heel.

ETIOLOGY
 Monozygotic twins
 Genetic factors
 Unknown
 Teratogen
CLINICAL FEATURES
 Adduction of forefoot.
 Development of lower legs is also affected.
 Difficulty in walking and running

MANAGEMENT
NON-OPERATIVE MANAGEMENT :
 Casting and splinting.
OPERATIVE MANAGEMENT:
 SALVAGE PROCEDURE: Tarsectomy ( removing one or more of the bone of
the tarsus).
NURSING MANAGEMENT:
 Maintain skin integrity
 Family support
 Promote healthy healing.

FRACTURE
DEFINITION: A break in the continuity of bone caused by trauma ,
twisting as a result of muscles spasm or indirect impairment of function
and bone decalcification.
CAUSES:
 Increase mobility.
 Insatiable curiosity.
 Immature level of motor coordination.
 Lack of calcium
 Fall from height
 Road traffic accident

CLASSIFICATION OF FRACTURE
Based on communication :
1. SIMPLE/ CLOSED FRACTURE.
2. COMPOUND/ OPEN FRACTURE.
3. COMPLETE FRACTURE.
4. INCOMPLETE FRACTURE.
5. SIMPLE/ CLOSED FRACTURE: Skin over the fracture are remain intact.
6. COMPOUND /OPEN FRACTURE: Bone is exposed destroy the continuity of the
bone.
7. COMPLETE FRACTURE: bone is broken across entirely, destroying continuity
of bone.
8. INCOMPLETE FRACTURE: Does not broken completely and destroy continuity
of bone.

CLASSIFICATION ON THE BASIC OF PATTERN
 TRANSVERSE FRACTURE: Bone is fracture straight across.
 OBLIQUE FEACTURE: Break extends in an oblique
direction.
 SPIRAL FRACTURE: Spiral fracture in which bone has been
twisted apart.
 LINEAR FRACTURE: The bone is fracture longitudinally

CLINICAL FEATURE
5P
 PAIN
 PALLOR
 PULSE
 PARESTHESIA
 PARALYSIS
 OTHER; SWELLING, MUSCLES SPASM,BRUISING.
DIAGNOSIS:
 Complete history
 X ray or CT scan
 Lab diagnosis.

COMMON SITES OF FRACTURE IN CHILDREN
 Clavicle
 Humerus
 Radius and ulna
 Femur
PROCESS OF BONE HEALING
 STAGE I: HEMATOMA FORMATION
 STAGE II: FIBRO CARTILAGE FORMATION
 STAGE III: CALLUS FORMATION
 STAGE IV: OSSIFICATION
 STAGE V : CONSOLIDATION AND REMODELILING

MANAGEMENT
 FRACTURE REDUCTION
 CAST
 TRACTION
NURSING MANAGEMENT:
 Promote comfort
 Maintain skin integrity
 To reduce pain
 Provide adequate fluid and nutrient.

DISORDERS OF SPINAL CORD
Spine has three types of curve:
1.KYPHOSIS
2.LORDOSIS
3.SCOLIOSIS
1.KYPHOSIS: It is a curving of the spine that cause a bowing or rounding of the
back, which leads to a hunchback or slouching posture.
ETIOLOGY:
 Certain endocrine disorder.
 Connective tissue disorder
 Infection ( POTS SPINE).
 Poliomyelitis.
 Spina bifida

CLINICAL FEATURES:
 Difficulty in breathing.
 Fatigue.
 Mild back pain
 Round back appearance
 Tenderness and stiffness in the spine.
DIAGNOSIS:
 X- ray.
 PFT (pulmonary function test).
 MRI

MANAGEMENT:
 BRACE THERAPY
 PHYSIOTHERAPHY

LORDOSIS
 Inward curvature of a portion of the lumbar and cervical vertebral
column.
ETIOLOGY:
 Congenital
 Neuromuscular problems.
 Surgery of spine.
CLINICAL FEATURES:
 Prominence of the buttocks.
 Back pain
 Pain down the legs.

MANAGEMENT:
 Physiotheraphy
 Bracing stabilizing
 Orthoplast jacket
NURSING MANAGEMENT:
 Assist for theraphy
 Counselling
 Psychological support

SCOLIOSIS
 Lateral curve of the spine, generally a sideway curve
greater than 10 degree is considered scoliosis.
ETIOLOGY:
 Congenital.
 Neuromuscular disorders
 Idiopathic causes
CLINICAL FEATURES:
 Backpain
 Fatique

DIAGNOSIS
 X-rays
 Bone scans
 MRI , CT
MANAGEMENT:
 Exercise
 Physical theraphy

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Child health nursing SKELETAL DISORDERS.pptx

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