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Introduction to Orthopaedics

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Title: Introduction to Orthopaedics Author: User Description: intro, cast, ext fixators Last modified by: Preferred Customer Created Date: 4/8/1997 3:46:48 AM – PowerPoint PPT presentation

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Title: Introduction to Orthopaedics


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
  • 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

16
How has orthopedic injury affected this PERSON?
17
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!
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
  • 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

20
Specific Sites.......
  • Hand, extremities
  • Herberden nodes, Bouchards 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
Herberdens 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
  • Ballottmentforce fluid into joint space
    displace patella

26
Ballottmentforce 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 McMurrays 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
McMurrays sign
30
Diagnostic Tests
  • CT Scan
  • Bone Scan
  • MRI
  • Dual-Photon Absorptiometry
  • Arthrography
  • Arthrocenthesis
  • Arthroscopy

31
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32
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

33
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

34
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35
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36
Orthopaedic Interventions!
  • Traction
  • Casts
  • External Fixators
  • Pin, plates and screws
  • CPM
  • Crutch-walking

37
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

38
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39
CPM
  • Purpose
  • Guidelines for Use
  • Teaching

40
Bone Stimulators
  • Indications
  • Electronegativity
  • Bone Remodeling
  • Internal
  • Percutaneous
  • External

41
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42
External Bone Stimulator
43
Autologous Blood Transfusions
  • Indications for
  • Criteria for Use
  • Ortho Cell Savers

44
Cell Savers Autologous Blood
45
Surgical /Medical Interventions
  • Tissue Allographs
  • Abductor Pillow, Carter Pillow
  • Hot Ice Machines that Arent!
  • Bone Paste!

46
Tissue allografts, synthetic grafts
47
Pins, plates, screws ORIF (open reduction,
internal fixation)
48
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
49
Application of Cast
  • Principles
  • Skin Assessment
  • Skin Protection
  • Heat Generated
  • Time to Dry

50
Cast Types
  • Sugar Tong/Splint
  • Spica Type
  • Body Cast
  • Hip spica
  • Gauntlet
  • Cast-Brace
  • Body Cast Care
  • Cast Syndrome
  • Hip Spica
  • Turning
  • Cast Drying

51
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?

52
External Fixators
  • How They Work
  • Principles of Care
  • The Iliazarov

53
External Fixator
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