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?A B

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

• PTH – What effect of low Ca?

• Calcitonin– Effect on Ca?

– Source?

• Thyroxin

• Estrogen• Glucocorticoids

– What effect on bones 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

Hallus valgus

Which foot has a valgus deformity?

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

• History taking; its significance

• Pain characteristics– location– character– what effects

• Associated conditionsComplications!

•Pain

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• Bilateral comparision• Inspect then gentle

palpation– shape, size , contour

– signs inflammation, ecchymosis

– muscle condition

– deformity

• Test your skills– Changes with age

– Nurtitional status

– Skin integrity

– Rashes

– Color changes, esp with cold; arterial vs. venous

– Character of joints

– Bruises, swelling

Specific Sites.......• Hand, extremities

– Herberden’ nodes, Bouchard’s 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

Herberden’s 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: McMurray’s 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.

McMurray’s sign

Anterior Drawer test

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 6-12 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 crutch-walking

• Cane

CPM

• Purpose • Guidelines

for Use • Teaching

Bone Stimulators

• Indications• Electronegati

vity• 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

Aren’t!• Bone Paste!

Tissue allografts, synthetic grafts

Pins, plates, screws

ORIF (open reduction, internal fixation)

Casts, Casting!

• Purposes• Casting Material

– Plaster– Fiberglass

For more information on casts, traction and external fixators, return to C Morse’s Home Page

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