ORTCAS99

8/20/2019 ORTCAS99

http://slidepdf.com/reader/full/ortcas99 1/53

Introduction to Orthopaedics

8/20/2019 ORTCAS99


Test Yourself

• List the bones of the body. (More pts more

bones!)

• Bone forming cells are called .

• Local stress stimulates bone formation. T

or "

• The #nee is a$an %oint.

8/20/2019 ORTCAS99


&hat do you #no' from the

slides"

Which is the hand of

the elderly adult?

How old do you think

the individual is on

slide A?A B

8/20/2019 ORTCAS99


Bone tructure *ursing

Implications• +eriosteum

• ,iaphysis

• -piphysis

• +eriosteum

• -ndosteum

• -piphyseal platesbone gro'th/ in%ury

8/20/2019 ORTCAS99


What is the significance

of the epiphyseal plate?

8/20/2019 ORTCAS99


Bone ormation and

Maintenance• Types

• Bone 0 cells/ protein

matri1/ mineraldeposits

• Types of bone cells

• unction of each typebone cell

• +rotein matri1 234

collagen/ 54 other

• Mineral saltsinsoluble 6a$+hos 0

hydro1yapitite 7

• +rocess of ossification

8/20/2019 ORTCAS99


actors Influencing Bone

8ro'th and ormation• +T9

– &hat effect of lo' 6a"

• 6alcitonin – -ffect on 6a"

– ource"

• Thyro1in

• -strogen

• 8lucocorticoids

– &hat effect on bones'ith long term use of

glucocorticoids"

• :it 6 ; ,

8/20/2019 ORTCAS99


Types of <oints Identification

• =mphiarthrosis

• ynarthrosis• ,iarthrosis

8/20/2019 ORTCAS99


Diarthroidal Joint

8/20/2019 ORTCAS99


ignificance of ,iarthrotic <oint

• <oint 6apsule

surrounded by

ligaments• yno>ial Membrane

secretes syno>ial

fluid lines tendon

and muscle sheaths

• Bursea painful/ but

protecti>e!

8/20/2019 ORTCAS99


Othropaedic Terminology

8/20/2019 ORTCAS99


,escripti>e Orthopaedic Terms

• :algus part of body

distal to %oint directed

a'ay from midline• :arus +art of body

distal to %oint directed

to'ard midline

• 9allus

• 8enu >arus

• 8enu >algus• pes >arus

• metatarus >algus

• metatarus >arus

8/20/2019 ORTCAS99


Hallus valgus

Which foot has a

valgus deformity?

How do you

describe this

foot deformity?

8/20/2019 ORTCAS99


Stressors of the

Musculoskeletal System

Trauma

Infection

=ltered Metabolism

8/20/2019 ORTCAS99


For the person with a

musculoskeletal condition• List effects on

+-?O*

•

• List @most @ freAuent

nursing diagnosis

• !eripheral neurovascular

dysfunction

• !ain "acute# chronic$

• %mpaired skin integrity• %nfection# high risk for

• &isuse syndrome

• Activity intolerance

•'rauma( high risk for

• )nowledge deficit

• %mpaired ad*ustment

• Fear# an+iety

8/20/2019 ORTCAS99


How has orthopedic in*ury affected this

!,-S./?

8/20/2019 ORTCAS99


6omponents of =ssessment • 6hief 6omplaint

– &hy see#ing care

– =cute and chronic problem

• 9istory ta#ing its

significance

• +ain characteristics

– location

– character

– 'hat effects• =ssociated conditions

Complications!

• +ain

8/20/2019 ORTCAS99


How will you handle this situation?

• Mr 0( reports to thenurse at the lealth clinicthat he can no longer

walk because 1it *ustshurts too much23

• What 4uestions will youasks?

• How will you conductthe physical assessment?

8/20/2019 ORTCAS99


8/20/2019 ORTCAS99


Specific Sites(((((((• 9and/ e1tremities

– 9erberdenC nodes/ BouchardCs nodes

– ubcutaneous

nodules

– Bursal s'elling

– yno>ial cysts

– Tophaceous cysts

8/20/2019 ORTCAS99


Deformities

• Ulnar drifts

• valgus and varus deformities

• atrophy

• hypertrophy

•

general hygiene

Subcutaneous

8/20/2019 ORTCAS99


Subcutaneous

nodules "-heumatoid

arthritis$

'ophaceous cysts"gout$

5rate cystals in

kidney "gout$

8/20/2019 ORTCAS99


Structural changes with

osteoarthritis

Herberden6s

nodes

8/20/2019 ORTCAS99


&escribe this deformity(

What disease does this person most

likely have?

8/20/2019 ORTCAS99


Assessment of the Knee

• Fluid in the Knee

– Bulge sign: medial aspect knee, displace

fuid upward, tap lateral patellar margin andnote fuid return

– Ballottment :force uid into joint space;

displace patella

8/20/2019 ORTCAS99


Ballottment :force uid into joint space; displace

patella

8/20/2019 ORTCAS99


Knee Stability

• =nterior cruciate ligament limits anterior

motion

• +osterior cruciate ligament limits posterior

motion

• Lateral collateral ligament limits adduction• Medial collateral ligament limits abduction

• Meniscal in%ury McMurrayCs sign

8/20/2019 ORTCAS99


Dnee upport and tability

=nterior and posterior cruciate

ligaments connect the inner surfaces

of the head of the femur 'ith the head

of the tibia.

They cross each other/ anterior

ligament e1tend from the inside of thelateral condyle of the femur to the

medial side of the tibial head / and

posterior ligament e1tend from the

inside of the medial condyle of the

femur to the lateral side of the tibialhead.

8/20/2019 ORTCAS99


McMurray6s sign

Anterior &rawer test

8/20/2019 ORTCAS99


&iagnostic 'ests• CT can

• Bone can

• "#

• $ual%&hoton '(sorptiometry

• 'rthrography

•

'rthrocenthesis• 'rthroscopy

8/20/2019 ORTCAS99


8/20/2019 ORTCAS99


&iagnostic 'ests

• Arthrography

– ?adiographic e1am/

use air or contrast

medium 2EF2G4

accuracy

– Teaching

– 6omplications

infection/ allergy

– +ostFop ?est %oint HF

5 hrs/ use ice

• =rthrocenthesis

– =spiration syno>ial

fluid reduce pain d1treatment

– =nalysis %oint fluid

usual clear/ high

>iscosity/ scant fluid – Teaching no

restrictions consent

form slight pain

– +ostFop ?I6-

8/20/2019 ORTCAS99


Arthroscopy

• Therapeutic $diagnostic• :isual recording surgical remo>al of

meniscus/ foreign bodies/ etc

• ?are complications depends on procedure/ operati>e length/ use of

tourniAuet

• Teaching • +ostFop care

8/20/2019 ORTCAS99


8/20/2019 ORTCAS99


Orthopaedic Inter>entions!

• Traction

• 6asts

• -1ternal i1ators• +in/ plates and scre's

• 6+M

• 6rutchF'al#ing

8/20/2019 ORTCAS99


8/20/2019 ORTCAS99


6+M

• &urpose

• )uidelinesfor Use • Teaching

8/20/2019 ORTCAS99


Bone timulators

• #ndications

• *lectronegativ

ity • Bone

"emodeling

–#nternal

– &ercutaneous

– *+ternal

8/20/2019 ORTCAS99


8/20/2019 ORTCAS99


!ternal "one Stimulator

8/20/2019 ORTCAS99


=utologous Blood Transfusions

• #ndicationsfor

• Criteria forUse

• ,rtho Cell

avers

8/20/2019 ORTCAS99


7ell Savers Autologous Blood

8/20/2019 ORTCAS99


urgical $Medical Inter>entions

• Tissue 'llographs

• '(ductor &illo-. Carter&illo-

• /ot #ce achines that

'ren0t!• Bone &aste!

'i ll ft th ti

8/20/2019 ORTCAS99


'issue allografts# synthetic

grafts

8/20/2019 ORTCAS99


!ins# plates#

screws

.-%F "open

reduction#

internal fi+ation$

8/20/2019 ORTCAS99


#asts$ #astin%&

• &urposes

• Casting aterial – &laster

– Fi(erglass

For more information on casts#

traction and e+ternal fi+ators#

return to 7 Morse6s Home

!age

#asts

!ternal 'i!ator

http://www2.austin.cc.tx.us/cmorse/2410/immob/gauntlet.htm

http://www2.austin.cc.tx.us/cmorse/2410/immob/fixator.htm

http://www2.austin.cc.tx.us/cmorse/2410/immob/fixator.htm

http://www2.austin.cc.tx.us/cmorse/2410/immob/gauntlet.htm

8/20/2019 ORTCAS99


=pplication of 6ast

• &rinciples

– 1in

'ssessment – 1in

&rotection

–

/eat)enerated

– Time to $ry

8/20/2019 ORTCAS99


•6ast Types

• ugarTong2plint

•

pica Type– Body Cast

– /ip spica

–

)auntlet – Cast%Brace

• Body Cast Care

– Cast Syndrome

• Hip Spica– Turning

– Cast $rying

8/20/2019 ORTCAS99


*ursing Inter>entions

• 'my. a 34 yrold is

dischargedfrom the *"-ith a long

arm cast5– 6hat #7#T#'8

care9

•6hatdischarge

teachingshould youdo9

•Can youdelegate

this9

8/20/2019 ORTCAS99


-1ternal i1ators

•

/o- They 6or1 • &rinciples of Care

• The #liaarov

8/20/2019 ORTCAS99


,+ternal Fi+ator

ORTCAS99

Documents

Transcript of ORTCAS99