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The Core Philosophy: Physiology Drives Care

The central theme across all sources is that children are not just "small adults." Their anatomy dictates specific risks and interventions:

• The Growth Plate (Physis): This is the weakest point of long bones. Injury here can stunt growth, making Salter-Harris fracture classifications critical knowledge.

• Healing Speed: A child’s thick periosteum and rich blood supply mean bones heal much faster than in adults, necessitating rapid alignment (often non-surgical) to prevent malunion.

• Myelinization: The nervous system is incomplete at birth. Voluntary control proceeds cephalocaudal (head-to-toe) and proximodistal (center-to-out). Deviations from this sequence or the persistence of primitive reflexes often signal disorders like Cerebral Palsy.

The "Vital Sign" of Orthopedics: Neurovascular Assessment

For any child in a cast, traction, or with a fracture, the nurse's priority is preventing Compartment Syndrome.

• The 5 P's: Pain (out of proportion/unrelieved by meds), Pulselessness, Pallor, Paresthesia, and Paralysis.

• Intervention: Elevate the limb and report "positive" findings immediately—this is a medical emergency.

Major Clinical Profiles (The "Big Few")

1. Neural Tube Defects (Spina Bifida/Myelomeningocele)

• Prevention: Maternal folic acid is the only known prevention.

• Acute Care: Keep the sac moist and sterile; position the infant prone (on stomach) to prevent rupture before surgery.

• Long-term: Assume Latex Allergy (high risk due to multiple exposures) and manage neurogenic bladder (catheterization).

2. Cerebral Palsy (CP)

• Nature: A non-progressive brain injury causing permanent motor impairment.

• Management: Focus on maximizing mobility and preventing contractures. Spasticity is managed with Baclofen (oral/pump) or Botulinum toxin injections.

• Key Sign: Persistent primitive reflexes or scissoring legs.

3. Muscular Dystrophy (Duchenne)

• Nature: X-linked recessive (boys), progressive muscle wasting starting in legs.

• Key Sign: Gower Sign (using hands to "walk" up legs to stand).

• Priority: Cardiopulmonary function is the life-limiting factor; prevent respiratory infection.

4. Hip & Foot Disorders

• DDH (Dysplasia of the Hip): Screen infants using Ortolani and Barlow maneuvers (listen for the "clunk"). Treatment is the Pavlik Harness (worn continuously) for infants <6 months.

• Clubfoot: Requires serial casting beginning immediately after birth (Ponseti method).

• SCFE (Slipped Capital Femoral Epiphysis): Occurs in adolescents (often obese) presenting with a limp or groin pain. Immediate non-weight bearing is required to prevent femoral head necrosis.

Trauma & Red Flags

• Scoliosis: Bracing is the primary intervention for moderate curves (25–45 degrees). Compliance (wearing it 18–23 hours/day) is the biggest hurdle due to body image issues.

• Osteogenesis Imperfecta: "Brittle bone disease." Never pull legs by ankles or lift under armpits; requires extremely gentle handling to prevent fracture