1. ORTHOPEDIC INJURIES Mary Claire Ikenberry RN, BSN, MS mikenberry@mcvh-vcu.edu

2. Goal: To better equip the school nurse on injury management in the school system. Objective: 1.To increase the participants knowledge of bones and muscles of the body. 2.To enhance the participants response to the most common musculoskeletal injuries among school age children.

3. Disclosure/ Bias I have nothing to disclose.

4. What you do know! If it ain’t broke don’t fix it! If able to use it to walk, lift, wave, eat then probably minor injury! Ice and bandaids do go a long way! Never assume! Always better to error on the side of caution, call parent/guardian.

5. What you need to know! 1.Mechanism of injury- direct blow, fall, pull or twist. 2.RICE 3.Pain with use is a strong indicator. 4.When in doubt call the parent/guardian. 5.Never diagnose- leave it up to provider.

6. HELPFUL INFORMATION 1.Muscles and Bones 2.Common injuries 3.Immediate treatment 4.Special considerations

7. Muscular System

8. Skeletal System

9. Common Injuries Abrasions Contusions Sprains Dislocations Fractures

10. Abrasions Friction to the skin causing Injury.

11. Treatment of abrasions Depends on thickness, location and size of abrasion. Most common on boney prominences like elbow and knees. Clean with soap and water, cover with dry bandage. If concerned about deepness or surface area involved, contact parent to obtain medical attention. Surface injuries can be very painful and require special attention for early treatment to avoid infection and scarring.

12. Contusions Blunt trauma to muscle or bone.

13. Treatment of a contusion Determine extend of injury, muscle versus bone. If causing child to limit use watch as may indicate more severe injury- fracture. Ice first 48 hours. Usually resolve spontaneously over 7- 10 days depending on the size.

14. Ankle Sprain Most common caused by inversion injury to ankle, ankle twist inward rolling fibula outward injuring the anterior talofibular ligament.

16. Treatment of Sprains Degree of sprain depends on the mechanism of injury- contributing factors are activity, weight, obstacles in the environment. RICE Recommend limited weight bearing and supportive shoes. Notify parent, if swelling and pain are significant follow up with medical provider may be indicated.

17. Dislocations Most frequent are fingers and shoulder.

18. Treatment of Dislocation Stabilize to protect further injury- Splint. Ice – VERY PAINFUL Notify parent- should obtain immediate medical attention. Dislocations can cause avulsion fracture of near by bone.

19. Fractures Most common involve wrist and elbow- radius and ulna, but also tibia and bones of feet.

20. Suprachondylar humerus fractures

21. Treatment of Fractures May involve any bone of the body, most common are wrist, elbow and ankle. Must be particularly aware of head injures. Deformity of bone may or may not be evident. Ice, Elevate, splint Notify parent to seek immediate medical attention.

22. Overuse injuries Common among athletes, higher incidence with those participating in year round sports, weight bearing exercises or when trying out for sports not in shape. Reocurring pain or tenderness, limited motion and altered mobility. Include stress fractures and muscle strains. Rest is the key. Remember elements of nutrition, for example adequate protein and calcium intake or obesity/anorexia may contribute.

23. Scoliosis Idiopathic scoliosis has no known cause. Peaks 3 different times during the growth phase, first year of life, age 5-6 and during puberty (12-14 for girls and 14-16 for boys). Diagnosed as Scoliosis when curve exceeds 15 degrees. More common in girls. AAP recommends screening at ages 10-12 for girls and 14-16 for boys.

24. Connective Tissue Disorder Ehlers Danlos (most common) Disorder characterized by hypermobile joints 6 Different connective tissue disorders Important to identify young because of hyper mobile/ flexibility can cause stress to joints, skin and blood vessels. Discourage students from dislocating joint like shoulder.

25. Extra Considerations 1.Ice is always a good idea. 2.Growth plates fuse at different rates, dependent on genetic and gender. 3.Body mass index is a general measurement and needs to take into consideration height and muscle mass of the individual. 4.The majority of bone growth is from the epiphysis (ends). 5.The monkey bars are not fun, either is the trampoline! 6.Noticing more overuse injuries related to electronic devices.

26. YOU NEVER KNOW WHAT YOU ARE GOING TO SEE!

27. QUESTIONS? Thank you. Mary Claire Ikenberry RN, MS 804-828-1501 mikenberry@mcvh-vcu.edu