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?
A
B
How old do you think
the individual is on
slide A?
Bone Structure: Nursing
Implications
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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
• Estrogen
– What effect of low Ca? • Glucocorticoids
• Calcitonin
– What effect on bones
– 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
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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
Complications!
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 • Test your skills
– 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,
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)
Urate cystals in
kidney (gout)
Tophaceous cysts
(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.
Anterior Drawer test
McMurray’s 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!
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Traction
Casts
External Fixators
Pin, plates and screws
CPM
Crutch-walking
Assistive Devices
• Traction
– Definition
– Uses
– Types
• Counter traction is
provided by:
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–
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a. body weight
b. pulleys
c. traction weight
d. splints
• Crutch-walking
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Two-point
Three-point
Four-point
Swing-through
swing-to
• Safety in crutchwalking
• Cane
CPM
• Purpose
• Guidelines
for Use
• Teaching
Bone Stimulators
• Indications
• Electronegativity
• 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)
For more information on casts,
traction and external fixators,
return to C Morse’s Home
Page
Casts, Casting!
• Purposes
• Casting Material
– Plaster
– Fiberglass
Casts
External Fixator
Application of Cast
• Principles
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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