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• Care modalities
• Rehabilitation
ORTHOPAEDICS
• 1840, French orthopédique,
from orthopédie,
• French physician Nicholas
Andry (1658-1742), from
• Greek orthos "straight,
correct"
• paideia "rearing of children,"
from pais (genitive paidos)
"child" (see pedo- ).
206 bones in the human body
Basic Bone structure
Joints
Basic anatomy
Sprains
• Stretching, partial or
complete tearing of
ligaments
• Typically occur when
joint overextended
• Ankles, knees, wrists,
fingers
• Swelling, pain,
bruising
• Inability to use joint
Strains
• Tearing of muscle or
tendon
• Occurs due to
overstretching
• Causes pain, swelling
and sometimes inability
to use muscle
• Can be prevented by
avoiding overexertion,
good body mechanics,
sports safety
Care for Musculoskeletal Injuries
• Proper care vs identifying the type of injury
• Stable fractures
– Occur when a part of the periosteum is
intact across the fracture
OR
– External or internal fixation has rendered
the fragments stationary
Description
• Unstable fractures
-Grossly displaced
-Poor fixation
Clinical Manifestations
– Immediate localized pain
– Loss of Function
– Inability to bear weight or use affected part
– Guarding
– May or may not see obvious bone
deformity
Fracture Healing
Collaborative Care
• Overall goals of treatment:
– Anatomic realignment of bone fragments
(reduction)
– Immobilization to maintain alignment
(fixation)
– Restoration of normal function
• 3 ‘R’ s
Collaborative Care - Fracture Reduction
• Closed reduction
– Nonsurgical, manual realignment
• Open reduction
– Correction of bone alignment through a
surgical incision
Fracture Reduction (Closed)
• Traction (with simultaneous counter-traction)
– Application of pulling force to attain
realignment
• Skin traction (short-term: 48-72 hrs.)
• Skeletal traction (longer periods)
• Manipulation under anesthesia
• To control pain and overcome muscle spasm
Collaborative Care
Fracture Immobilization
• Traction
Application of a pulling force to an injured
part of the body while counter traction pulls
in the opposite direction
• Purpose of traction:
– Prevent or reduce muscle spasm
– Reduction
– Immobilization
– Treat a pathologic condition
Collaborative Care
Fracture Immobilization
• Casts
– Circumferential
immobilization device
– Common following
closed reduction
Collaborative Care
Fracture Immobilization
• External fixation
• device composed of pins that are inserted into
the bone and attached to external rods
Open fractures external fixation
Collaborative Care
Fracture Immobilization
• Internal fixation
Pins, plates, intramedullary rods, and screws
Surgically inserted at the time of realignment
Nursing Management
Nursing Assessment for Fractures
• AMPLE history
Nursing Management
Nursing Assessment
• Neurovascular assessment
– Color and temperature
• cyanotic and cool/cold: arterial insufficiency
• Blue and warm: venous insufficiency
– Capillary refill (< 2 sec)
– Peripheral pulses (↓ indicates vascular
insufficiency)
Nursing Management
Nursing Diagnoses
• Risk for peripheral neurovascular dysfunction
• Acute pain
• Risk for infection
• Assessment of fall risk
• Decubitus ulcer policy
• Prolonged immobilization
• DVT prophylaxis
Nursing Management
Nursing Diagnoses
• Ineffective therapeutic regimen management
– Analgesia
– Antibiotic prophylaxis(treatment)
– Thromboprophylaxis
– Medication for co-mobidities
– Non prescription medication
Nursing Management
Nursing Implementation
• General post-op care
– Assess dressings/casts for bleeding/drainage
• Pathology
• Part of the supporting joint capsule and some of
its ligaments disrupted.
Deformity of a limb
• Clinical indication of dislocation
Types of dislocation
• Congenital
– Developmental Dysplasia of Hips
– Congenital dislocation of knee
– Arthrogryposis multiplex
• Acquired
1. Traumatic
2. Pathological e.g. TB hip, Septic Arthritis
3. Paralytic e.g. Poliomyelitis, cerebral palsy, etc
4. Inflammatory disorders, rheumatoid arthritis,etc
Dislocation
• No joint is immune from dislocation
• Most commonly occur in the following joints.
• Shoulder
• Hip
• Elbow
• Metacarpophalengeal joint
• Facet joint dislocation in cervical spine.
• Acromiclavicular joint dislocation.
Investigations- Xrays
Complication
1. Acute: Injury to peripheral nerve and vessels
2. Chronic: Unreduced dislocation
Recurrent dislocation
Traumatic osteoarthritis
Joint stiffness
Avascular necrosis
Myositis ossificans
Caution !
• Excessive force should not be used in close
reduction.
• Forceful manipulation may lead to fracture.
• Interposition of soft tissue, bony fragment or
buttonhole in capsule may make close
reduction impossible.
Remember
• It is an orthopedic emergency.
• Reduction should be quick and prompt.
• Reduction should always be under G/A or
sedation.
Fracture Dislocation
Lot of swelling Swelling is less
Some restriction of Movements grossly restricted
movements
Osteomyelitis
• Infection of the
– Bone
– Bone marrow
– Surrounding soft tissue
• Caused by a variety of microorganisms
• Most common infecting microorganism –
staph. aureus
Clinical Manifestations
Acute Osteomyelitis
• Initial infection
–Infection of <1 month in duration
–Both systemic and local
Clinical Manifestations
Acute Osteomyelitis
• Systemic
- Fever
– Unwell
• Local
– Constant bone pain that worsens with activity
– Swelling, tenderness, warmth at infection site
– Restricted movement of affected part
– Later signs: drainage from sinus tracts
Diagnostic Studies
• Bone or soft tissue biopsy
– Definitive way to determine causative
microorganism
• Patient’s blood and/or wound culture
– Frequently positive for presence of microorganism
• Lab Studies
– WBC
– Erythrocyte sedimentation rate (ESR)
Radiologic Studies
• Radiologic signs
Usually do not appear until 10 days to weeks after
start of clinical symptoms
• Radionuclide bone scans
Helpful in diagnosis and usually positive in areas
of infection
• Magnetic resonance imaging (MRI)
• Computed tomography (CT)
Help identify extent of infection, including soft
tissue involvement
Collaborative Care
Acute Osteomyelitis
• Vigorous and prolonged intravenous (IV)
antibiotic therapy
– Treatment of choice for acute osteomyelitis
– As long bone ischemia has not occurred
– Cultures or bone biopsy should be done if possible
Disarticulation
“Surgical removal of
hole limb or part of the
limb through a joint”
Epidemiology
Hematoma
Infection
Phantom Necrosis
Contractures
Neuroma
• Prompt, uncomplicated wound healing
• Control of edema
• Control of Postoperative pain
• Prevention of joint contractures
• Rapid rehabilitation
Care of the Stump