Tag Archives: orthopedics

Nursing Tips for Managing Pediatric Orthopedic Trauma

Nurses have a complementary role with physicians in caring for children with orthopedic injuries. Typically, the child will have been evaluated and had some sort of fracture management implemented. In children, nursing management is easer than in adults since a child is less likely to need an invasive surgical procedure. Many fractures can be dealt with using casts and splints alone.

Here are a few tips for providing the best care for your pediatric patients:

  • Ensure adequate splinting / casting. You will have an opportunity to see the child at their usual level of activity. If it appears likely that their activity may defeat the purpose of the cast or splint, inform the surgeon or extender so they can apply a better one.
  • Focus on pain control. Nothing aggravates parents more than seeing their child in pain! Make sure acetominophen or ibuprofen is available prn if pain is very mild, or scheduled if more significant. Ensure that mild narcotics are available if pain levels are higher. Remember, stool softeners are mandatory if narcotics are given.
  • Monitor compartments frequently. If a cast is used, check the distal part of the extremity for pain, unwillingness to move, numbness or swelling. If any are present, call the physician or extender and expect prompt attention to the problem.
  • Always think about the possibility of abuse. Fractures are rarely seen in children under 3, and almost never if less than 1 year old. If you have concerns about the physical findings or parent interactions, let the physician and social workers know immediately.

A New Way To Repair Damaged Muscle?

For patients with severely damaged skeletal muscles, the best way to heal them is a combination of splinting and physical therapy, right? These serve to increase the size of existing muscle fibers. And a few cellular therapies are also available involving stem cells or stimulating their production, which may actually add new muscle. But what about something cheaper and less complicated?

Researchers at the engineering school at Harvard are working on a new approach, mechanotherapy. They tried two therapeutic interventions in mice with hindleg muscle damage and ischemia. 

The first was implantation of a magnetic gel pack directly in contact with the muscle. A magnet placed on the other side of the muscle was pulsed to repeatedly squeeze the muscle gently.

The second group had a small pneumatic cuff placed which encircled the leg (a tiny mouse BP cuff?). If was inflated cyclically to massage the muscle.

Both therapies resulted in a 2.5x increase in muscle regeneration and less scarring and fibrosis, compared to control animals that had neither therapy.

Left image: control animal. Right image: mechanotherapy. Note the increased muscle cell density.

Bottom line: Unfortunately, we typically think about medicine from a chemical standpoint. That’s why we are so reliant on drugs for just about everything. But this study suggests that merely squeezing the muscle regularly and early after injury may greatly improve healing. There are significant implications for trauma patients, of course. Might it also be possible to help decrease muscle mass loss in denervated muscles, as in para- and quadriplegics? And we may find that if we combine this with some of the biologics already in use, the results may be even better. Stay tuned for developments.

Related post:

Reference: Biologic-free mechanically induced muscle regeneration. Proc Natl Acad Sci USA 113(6):1534-1539, 2016.

Nursing Tips for Managing Pediatric Orthopedic Trauma

Nurses have a complementary role with physicians in caring for children with orthopedic injuries. Typically, the child will have been evaluated and had some sort of fracture management implemented. In children, nursing management is easer than in adults since a child is less likely to need an invasive surgical procedure. Many fractures can be dealt with using casts and splints alone.

Here are a few tips for providing the best care for your pediatric patients:

  • Ensure adequate splinting / casting. You will have an opportunity to see the child at their usual level of activity. If it appears likely that their activity may defeat the purpose of the cast or splint, inform the surgeon or extender so they can apply a better one.
  • Focus on pain control. Nothing aggravates parents more than seeing their child in pain! Make sure acetominophen or ibuprofen is available prn if pain is very mild, or scheduled if more significant. Ensure that mild narcotics are available if pain levels are higher. Remember, stool softeners are mandatory if narcotics are given.
  • Monitor compartments frequently. If a cast is used, check the distal part of the extremity for pain, unwillingness to move, numbness or swelling. If any are present, call the physician or extender and expect prompt attention to the problem.
  • Always think about the possibility of abuse. Fractures are rarely seen in children under 3, and almost never if less than 1 year old. If you have concerns about the physical findings or parent interactions, let the physician and social workers know immediately.

New Technology: The Next Generation Antibiotic Bead?

A number of surgical disciplines use antibiotic beads to deliver antimicrobial drugs to sites that may not have ideal serum penetration. Unfortunately, beads require multiple operations for placement and replacement until the desired effect is achieved.

What if there was a way of delivering antimicrobial therapy directly to the tissues that works for up to two weeks, then dissolves with no trace? A system that does this is being developed by engineers at Tufts University and the University of Illinois at Urbana. They created a small magnesium coil that can be heated using magnetic induction. It is enclosed in a silk pocket and then implanted into the infected tissues. 

The tissues surrounding the device can be heated to different temperatures by placing an induction coil over it and delivering a specific amount of power.

It is also possible to deliver antibiotic doses directly to the tissue by embedding the drug into the silk pocket. As the coil heats up, the antibiotic is released from the fabric. 

The magnesium coil normally dissolves within a few hours when immersed in water, and it takes a bit longer when in direct contact with living tissue. The silk pocket prolongs the time to dissolution, depending on how thick it is. In the rat experiment described in the paper, there was little or no trace after 15 days.

Bottom line: This exciting technology has the potential to simplify the delivery of antimicrobial therapy directly to deeper tissues for extended periods, without the need for a second procedure to retrieve the device. We’ll see how this implant works in studies in larger animals. I’m sure other derivative applications are soon to follow.

Reference: Silk-based resorbable electronic devices for remotely controlled therapy and in vivo infection abatement. Proceedings in the National Academy of Sciences. Published online November 24, 2014.

Nursing Tips for Managing Pediatric Orthopedic Trauma

Nurses have a complementary role with physicians in caring for children with orthopedic injuries. Typically, the child will have been evaluated and had some sort of fracture management implemented. In children, nursing management is easer than in adults since a child is less likely to need an invasive surgical procedure. Many fractures can be dealt with using casts and splints alone.

Here are a few tips for providing the best care for your pediatric patients:

  • Ensure adequate splinting / casting. You will have an opportunity to see the child at their usual level of activity. If it appears likely that their activity may defeat the purpose of the cast or splint, inform the surgeon or extender so they can apply a better one.
  • Focus on pain control. Nothing aggravates parents more than seeing their child in pain! Make sure acetominophen or ibuprofen is available prn if pain is very mild, or scheduled if more significant. Ensure that mild narcotics are available if pain levels are higher. Remember, stool softeners are mandatory if narcotics are given.
  • Monitor compartments frequently. If a cast is used, check the distal part of the extremity for pain, unwillingness to move, numbness or swelling. If any are present, call the physician or extender and expect prompt attention to the problem.
  • Always think about the possibility of abuse. Fractures are rarely seen in children under 3, and almost never if less than 1 year old. If you have concerns about the physical findings or parent interactions, let the physician and social workers know immediately.