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Introduction to Orthopaedics

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?

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Introduction to Orthopaedics

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  1. Introduction to Orthopaedics

  2. 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.

  3. 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

  4. Bone Structure: Nursing Implications • Periosteum • Diaphysis • Epiphysis • Periosteum • Endosteum • Epiphyseal plates; bone growth, injury

  5. What is the significance of the epiphyseal plate?

  6. 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

  7. 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

  8. Types of Joints: Identification • Amphiarthrosis • Synarthrosis • Diarthrosis

  9. Diarthroidal Joint

  10. Significance of Diarthrotic Joint • Joint Capsule surrounded by ligaments • Synovial Membrane: secretes synovial fluid; lines tendon and muscle sheaths • Bursea: painful, but protective!

  11. Othropaedic Terminology

  12. 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

  13. Which foot has a valgus deformity? Hallus valgus How do you describe this foot deformity?

  14. Stressors of the Musculoskeletal System Trauma Infection Altered Metabolism

  15. 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

  16. How has orthopedic injury affected this PERSON?

  17. Components of Assessment • Pain • Chief Complaint • Why seeking care • Acute and chronic problem • History taking; its significance • Pain characteristics • location • character • what effects • Associated conditions Complications!

  18. 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?

  19. Principles of Assessment • Test your skills • Changes with age • Nurtitional status • Skin integrity • Rashes • Color changes, esp with cold; arterial vs. venous • Character of joints • Bruises, swelling • Normal first • Bilateral comparision • Inspect then gentle palpation • shape, size , contour • signs inflammation, ecchymosis • muscle condition • deformity

  20. Specific Sites....... • Hand, extremities • Herberden’ nodes, Bouchard’s nodes • Subcutaneous nodules • Bursal swelling • Synovial cysts • Tophaceous cysts

  21. Deformities • Ulnar drifts • valgus and varus deformities • atrophy • hypertrophy • general hygiene

  22. Subcutaneous nodules (Rheumatoid arthritis) Urate cystals in kidney (gout) Tophaceous cysts (gout)

  23. Structural changes with osteoarthritis Herberden’s nodes

  24. Describe this deformity. What disease does this person most likely have?

  25. 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

  26. Ballottment:force fluid into joint space; displace patella

  27. 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

  28. 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.

  29. Anterior Drawer test McMurray’s sign

  30. Diagnostic Tests • CT Scan • Bone Scan • MRI • Dual-Photon Absorptiometry • Arthrography • Arthrocenthesis • Arthroscopy

  31. 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 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

  32. 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

  33. Orthopaedic Interventions! • Traction • Casts • External Fixators • Pin, plates and screws • CPM • Crutch-walking

  34. Assistive Devices • Crutch-walking • Two-point • Three-point • Four-point • Swing-through • swing-to • Safety in crutch-walking • Cane • Traction • Definition • Uses • Types • Counter traction is provided by: • a. body weight • b. pulleys • c. traction weight • d. splints

  35. CPM • Purpose • Guidelines for Use • Teaching

  36. Bone Stimulators • Indications • Electronegativity • Bone Remodeling • Internal • Percutaneous • External

  37. External Bone Stimulator

  38. Autologous Blood Transfusions • Indications for • Criteria for Use • Ortho Cell Savers

  39. Cell Savers Autologous Blood

  40. Surgical /Medical Interventions • Tissue Allographs • Abductor Pillow, Carter Pillow • Hot Ice Machines that Aren’t! • Bone Paste!

  41. Tissue allografts, synthetic grafts

  42. Pins, plates, screws ORIF (open reduction, internal fixation)

  43. 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

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

  45. 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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