Introduction to Orthopaedics

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Introduction to Orthopaedics
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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.

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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
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Bone Structure Nursing Implications

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

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What is the significance of the epiphyseal plate?
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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

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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

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Types of Joints Identification

• Amphiarthrosis
• Synarthrosis
• Diarthrosis

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Diarthroidal Joint
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Significance of Diarthrotic Joint

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

• Bursea painful, but protective!

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Othropaedic Terminology
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Descriptive Orthopaedic Terms

• Hallus
• Genu varus
• Genu valgus
• pes varus
• metatarus valgus
• metatarus varus

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

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Which foot has a valgus deformity?
Hallus valgus
How do you describe this foot deformity?
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Stressors of the Musculoskeletal System

• Trauma
• Infection
• Altered Metabolism

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For the person with a musculoskeletal condition

• 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

• List effects on PERSON
• List most frequent nursing diagnosis

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How has orthopedic injury affected this PERSON?
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Components of Assessment

• Chief Complaint
• Why seeking care
• Acute and chronic problem
• History taking its significance
• Pain characteristics
• location
• character
• what effects
• Associated conditions

• Pain

Complications!
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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?

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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

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Specific Sites.......

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

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Deformities

• Ulnar drifts
• valgus and varus deformities
• atrophy
• hypertrophy
• general hygiene

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Subcutaneous nodules (Rheumatoid arthritis)
Urate cystals in kidney (gout)
Tophaceous cysts (gout)
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Structural changes with osteoarthritis
Herberdens nodes
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Describe this deformity. What disease does this
person most likely have?
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Assessment of the Knee

• Fluid in the Knee
• Bulge sign medial aspect knee, displace fluid
  upward, tap lateral patellar margin and note
  fluid return
• Ballottmentforce fluid into joint space
  displace patella

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Ballottmentforce fluid into joint space
displace patella
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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

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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.
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Anterior Drawer test
McMurrays sign
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Diagnostic Tests

• CT Scan
• Bone Scan
• MRI
• Dual-Photon Absorptiometry
• Arthrography
• Arthrocenthesis
• Arthroscopy

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Diagnostic Tests

• 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

• Arthrography
• Radiographic exam, use air or contrast medium
  90-95 accuracy
• Teaching
• Complications infection, allergy
• Post-op Rest joint 6-12 hrs, use ice

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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

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Orthopaedic Interventions!

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

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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

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CPM

• Purpose
• Guidelines for Use

• Teaching

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Bone Stimulators

• Indications
• Electronegativity
• Bone Remodeling
• Internal
• Percutaneous
• External

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External Bone Stimulator
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Autologous Blood Transfusions

• Indications for
• Criteria for Use
• Ortho Cell Savers

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Cell Savers Autologous Blood
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Surgical /Medical Interventions

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

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Tissue allografts, synthetic grafts
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Pins, plates, screws ORIF (open reduction,
internal fixation)
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Casts, Casting!
For more information on casts, traction and
external fixators, return to C Morses Home Page

• Purposes
• Casting Material
• Plaster
• Fiberglass

Casts External Fixator
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Application of Cast

• Principles
• Skin Assessment
• Skin Protection
• Heat Generated
• Time to Dry

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Cast Types

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

• Body Cast Care
• Cast Syndrome
• Hip Spica
• Turning
• Cast Drying

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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?

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External Fixators

• How They Work
• Principles of Care
• The Iliazarov

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External Fixator