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Introduction to Orthopaedics

Test Yourself
List the bones of the body. (More pts more
bones!)
Bone forming cells are called ______.
Local stress stimulates bone formation. T
or F?
The knee is a/an _______joint.

What do you know from the


slides?

Which is the hand of


the elderly adult?

How old do you think


the individual is on
slide A?

Bone Structure: Nursing


Implications

Periosteum
Diaphysis
Epiphysis
Periosteum
Endosteum
Epiphyseal plates;
bone growth, injury

What is the significance


of the epiphyseal plate?

Bone Formation and


Maintenance
Types
Bone = cells, protein
matrix, mineral
deposits
Types of bone cells
Function of each type
bone cell

Protein matrix: 98%


collagen, 2% other
Mineral salts:
insoluble Ca/Phos =
hydroxyapitite +
Process of ossification

Factors Influencing Bone


Growth and Formation
Estrogen
What effect of low Ca? Glucocorticoids
Calcitonin
What effect on bones
PTH

Effect on Ca?
Source?

Thyroxin

with long term use of


glucocorticoids?

Vit C & D

Types of Joints: Identification


Amphiarthrosis
Synarthrosis
Diarthrosis

Diarthroidal Joint

Significance of Diarthrotic Joint


Joint Capsule
surrounded by
ligaments
Synovial Membrane:
secretes synovial
fluid; lines tendon
and muscle sheaths

Bursea: painful, but


protective!

Othropaedic Terminology

Descriptive Orthopaedic Terms


Valgus: part of body
distal to joint directed
away from midline
Varus: Part of body
distal to joint directed
toward midline

Hallus
Genu varus
Genu valgus
pes varus
metatarus valgus
metatarus varus

Which foot has a


valgus deformity?

Hallus valgus

How do you
describe this
foot deformity?

Stressors of the
Musculoskeletal System
Trauma
Infection
Altered Metabolism

For the person with a


musculoskeletal condition:
List effects on
PERSON

List most frequent


nursing diagnosis

Peripheral neurovascular
dysfunction
Pain (acute, chronic)
Impaired skin integrity
Infection, high risk for
Disuse syndrome
Activity intolerance
Trauma. high risk for
Knowledge deficit
Impaired adjustment
Fear, anxiety

How has orthopedic injury affected this


PERSON?

Components of Assessment
Chief Complaint
Why seeking care
Acute and chronic problem

Pain

History taking; its


significance
Pain characteristics
location
character
what effects

Associated conditions

Complicatio
ns!

How will you handle this situation?


Mr J. reports to the
nurse at the lealth clinic
that he can no longer
walk because it justs
hurts too much!
What questions will you
asks?
How will you conduct
the physical assessment?

Principles of Assessment
Normal first

Test your skills


Bilateral comparision
Changes with age
Inspect then gentle
Nurtitional status
palpation
shape, size , contour
signs inflammation,
ecchymosis
muscle condition
deformity

Skin integrity
Rashes
Color changes, esp
with cold; arterial vs.
venous
Character of joints
Bruises, swelling

Specific Sites.......

Hand, extremities
Herberden nodes,
Bouchards nodes
Subcutaneous
nodules
Bursal swelling
Synovial cysts
Tophaceous cysts

Deformities
Ulnar drifts
valgus and varus deformities
atrophy
hypertrophy
general hygiene

Subcutaneous
nodules (Rheumatoid
arthritis)

Tophaceous cysts
(gout)

Urate cystals in
kidney (gout)

Structural changes with


osteoarthritis

Herberdens
nodes

Describe this deformity.


What disease does this person most
likely have?

Assessment of the Knee


Fluid in the Knee
Bulge sign:

medial aspect knee, displace


fluid upward, tap lateral patellar margin and
note fluid return

Ballottment:force fluid into joint space;


displace patella

Ballottment:force fluid into joint space; displace


patella

Knee Stability
Anterior cruciate ligament: limits anterior
motion
Posterior cruciate ligament: limits posterior
motion
Lateral collateral ligament: limits adduction
Medial collateral ligament: limits abduction
Meniscal injury: McMurrays sign

Knee Support and Stability


Anterior and posterior cruciate
ligaments connect the inner surfaces
of the head of the femur with the head
of the tibia.
They cross each other, anterior
ligament extend from the inside of the
lateral condyle of the femur to the
medial side of the tibial head, and
posterior ligament extend from the
inside of the medial condyle of the
femur to the lateral side of the tibial
head.

Anterior Drawer test

McMurrays sign

Diagnostic Tests

CT Scan
Bone Scan
MRI
Dual-Photon Absorptiometry
Arthrography
Arthrocenthesis

Arthroscopy

Diagnostic Tests
Arthrography
Radiographic exam,
use air or contrast
medium:; 90-95%
accuracy
Teaching
Complications:
infection, allergy
Post-op: Rest joint 612 hrs, use ice

Arthrocenthesis
Aspiration synovial
fluid; reduce pain; dx;
treatment
Analysis joint fluid:
usual clear, high
viscosity, scant fluid
Teaching: no
restrictions; consent
form; slight pain
Post-op: RICE

Arthroscopy
Therapeutic /diagnostic
Visual recording; surgical removal of
meniscus, foreign bodies, etc
Rare complications; depends on
procedure, operative length, use of
tourniquet
Teaching
Post-op care

Orthopaedic Interventions!

Traction
Casts
External Fixators
Pin, plates and screws
CPM
Crutch-walking

Assistive Devices
Traction
Definition
Uses
Types

Counter traction is
provided by:

a. body weight
b. pulleys
c. traction weight
d. splints

Crutch-walking

Two-point
Three-point
Four-point
Swing-through
swing-to

Safety in crutchwalking
Cane

CPM
Purpose
Guidelines
for Use

Teaching

Bone Stimulators
Indications
Electronegativ
ity
Bone
Remodeling
Internal
Percutaneous
External

External Bone Stimulator

Autologous Blood Transfusions


Indications
for
Criteria for
Use
Ortho Cell
Savers

Cell Savers

Autologous Blood

Surgical /Medical Interventions


Tissue Allographs
Abductor Pillow, Carter
Pillow
Hot Ice Machines that
Arent!
Bone Paste!

Tissue allografts, synthetic


grafts

Pins, plates,
screws

ORIF (open
reduction,
internal fixation)

For more information on casts,


traction and external fixators,
return to C Morses Home
Page

Casts, Casting!

Purposes
Casting Material
Plaster
Fiberglass

Casts
External Fixator

Application of Cast
Principles
Skin
Assessment
Skin
Protection
Heat
Generated
Time to Dry

Cast Types
Sugar
Tong/Splint
Spica Type
Body Cast
Hip spica
Gauntlet
Cast-Brace

Body Cast Care


Cast Syndrome
Hip Spica
Turning
Cast Drying

Nursing Interventions
Amy, a 24 yr
old is
discharged
from the ER
with a long
arm cast.
What INITIAL
care?

What
discharge
teaching
should you
do?
Can you
delegate
this?

External Fixators
How They Work
Principles of Care
The Iliazarov

External Fixator