ORTHOPEDIC NURSING

USM- CHS 3RD YEAR NURSING

2ND SEMESTER 2013-2014
ANATOMY & PHYSIOLOGY of the MUSCULOSKELETAL SYSTEM
1.
2.
3.
4.
5.
6.

Support
Protection
Body movement
Hemopoiesis
Fat storage
Mineral storage

SKELETON

Axial

Cranium
Vertebrae
Ribs
Appendicular
Limbs
Shoulder
Hips
A. Types of bone cells:

a) Osteogenic cells
b) Osteoblast
c) Osteocytes
d) Osteoclast
e) Bone-lining cell
B. Types of osseous tissue
a) Spongy/Cancellous
b) Compact/ Cortical
C. Bone classification according to shape:
1. long bones
often bears weight
2. short bones
- small & bear little or no weight
3. flat bones
- protect vital organs & often contain
blood forming cells
4. irregular bones
- has unique shape
D. long bones have several components:

diaphysis makes up most of the bones length

periosteum covers & protects the diaphysis

epiphyses ends of the long bone
epiphyseal line remnant of the epiphysial plate that closes when the growing
bone has reached its full length
endosteum covers the marrow cavity of the long bones & the spaces in spongy
bones
E. Bone marrow
1. Red bone marrow produces RBC,
WBC & platelets
2. Yellow bone marrow for storage area for
adipose tissue
Articulations
junctions or

spaces between 2 or more

bones
hold bones together securely
but give the rigid skeleton mobility
Ligaments
hold the bone & joint in
the correct position

Joint capsules
tough, fibrous sheath surrounding the
articulating
bone
SYNOVIUM
lined with synovial membrane which
secretes synovial fluid into the joint
capsule
BURSA
Is a sac filled with synovial fluid that
cushions the movement of tendons,
ligaments, and bones at a
point of friction.
Types of Joints
1. ball & socket permit full freedom of
movement. Ex: hipjoint
2. hinge permit movement in one plane
only
ex: knee, elbow, phalanges
=flexion and extension
3. Saddle-allows movement in 2 planes at right angles to each other.
ex: ossicles of ear
4. pivot allow for rotation, supination & pronation. Ex: radius, ulna
5. gliding allows limited movement in all direction. Ex: vertebrae, intercarpal/tarsal,
clavicle
6. Condyloid - flexion, extension, abduction and adduction & circumduction
ex: wrist, metacarpophalangeal joints
Skeletal Muscles
the only muscle type subject to conscious control
muscles are attached by tendons to bones
Functions
a) Provide the force to move bones
b) Assist in maintaining posture
c) Assist in heat production
Types of muscle contraction
isometric same length length of the muscle
remains constant but the force generated by the
muscle is increased
Ex: push
isotonic same tension characterized by shortening of the muscle
with no increase in tension within the muscle
Ex: pull
Minerals and Hormones affecting Musculoskeletal
1. Calcium
99% is in the bones
normal serum calcium = 8.6 10 mg/dl
small changes in Ca level is fatal since most function of nerve cells depends on Ca
ions
sources: milk & milk products
2. Phosphorus
85% is in the bone
normal serum phosphorus = 2.5 4.5 mg/dl

 sources: milk & meats

3. PTH
secreted by parathyroid glands

increases serum Ca level &

decreases serum Phosphate level
how?
bones = release Ca
kidneys = reabsorption of Ca & urinary excretion of phosphate
intestine = reabsorption of Ca via activation of Vit. D
4. Calcitonin
secreted by parafollicular cells (C cells) in the thyroid
Decreases serum Ca level, how?
bones = inhibits release of Ca
kidneys = increases renal excretion of Ca
5. Vitamin D functions as a hormone in regulating serum Ca by:
- Increase absorption of Ca from the intestine
- promotes the action of PTH on bones
6. Growth hormone secreted by anterior part of the pituitary gland; increases bone
length
7. Sex hormones initially cause growth spurt that occurs during teenage years
Musckuloskeletal Assessments
1. Subjective Data
a. PAIN- Present in patients with diseases and traumatic conditions or disorders of
muscles, bones, and
joints; example
Bone pain- described as a dull, deep ache that is boring in nature
Muscular pain- described as soreness or aching and is referred to as muscle
cramps.
Sharp pain-bone infection with muscle spasm or pressure on a sensory nerve &
Fracture
Pain that increases with activity: indicate joint sprain or muscle strain
Radiating pain conditions in which pressure is exerted on a nerve root
b. Altered Sensations/Sensory Changes
Paresthesias: caused by pressure on nerves or by circulatory impairment
2. Objective Data
a. Posture
a.1 Kyphosis, an increased forward curvature of the thoracic spine
a.2 Lordosis, or swayback, an exaggerated curvature of the lumbar spine
a.3 Scoliosis, a lateral curving deviation of the spine
b. Bone Integrity - deformities and alignment, Symmetry
c. Joint function - range of motion, deformity, Stability, nodular formation and
crepitus
3. Goniometer- a protractor designed for evaluating joint motion

DIAGNOSTIC EXAMINATION
1. Radiography
detects musculoskeletal structure, integrity, texture
or density problems
allows evaluation of disease progression &
treatment efficacy
instruct to remain still while the x-rays are taken
2. CT Scans
show soft tissue, bone & spinal cord in 3 dimensional, cross-sectional images
may be performed with or without contrast agents; lasts for 1 hour; must remain
still during the procedures
3. MRI
allows to study of soft tissue in multiple planes of the body
patients with metal implants & pacemakers are not candidate
remove metals
sedate patients with claustrophobia
may be performed with or without contrast agents; lasts for 1-2 hours; must
remain still during the procedures
inform that he will hear rhythmic knocking sound during the procedure
4. Arthrography
injection of radiopaque substance or air into the joint cavity to identify acute or
chronic tears of the joint capsule or supporting ligaments
after injecting dye, the joint is put through ROM while a series of x-rays are
obtained
if a tear is present, contrast agent leaks out of the joint & will be evident on the xrays
5. Arthrocentesis
involves aspirating of synovial fluid, blood or pus via a needle inserted into a joint
cavity for examination or to relieve pain
normal synovial fluid = clear, pale, scanty in volume
after the procedure, apply compress bandage & rest the joint for 8 24 hours
6. Arthroscopy
allows direct visualization of a joint; treatment of tears, defects and disease may
also be preformed
NPO for 8-12 hours
after the procedure, wear elastic wrap for 2 4 days; limit activities for 1 4 days;
put ice & elevate extremity
7. BONE SCAN
Imaging study with the use of a contrast radioactive material

Pre-test: Painless procedure, IV radioisotope is used, no special preparation,

pregnancy is contraindicated
Intra-test: IV injection, Waiting period of 2 hours before X-ray, Fluids allowed,
Supine position for scanning
Post-test: Increase fluid intake to flush out radioactive material
8. Electromyography
measures muscle electrical impulses for diagnosing muscle or nerve disease
instruct that needle insertion is uncomfortable
slight bruising may occur at the needle insertion sites
9. BONE MARROW ASPIRATION
Usually involves aspiration of the marrow to diagnose diseases like leukemia,
aplastic anemia
Usual site is the sternum and iliac crest
Pre-test: Consent
Intratest: Needle puncture may be painful
Post-test: maintain pressure dressing and watch out for bleeding
10. ANA (Anti Nuclear Antibody)-positive results are associated with SLE, RA, RF
11. ESR (Erythrocyte Sedimentation Rate) -elevation common in arthritic
conditions, infection, inflammation, cancer or cell destruction
12. RF (Rheumatoid Factor) -measures the presence of a macroglobulin type of
antibody found in RA & other connective tissue disease
13. SUA (Serum Uric Acid) -used to detect gouty arthritis
MUSKULOSKELETAL INJURIES
1. Strain - muscle pull from overuse, overstretching, or excessive stress
2. Sprain - injury to the ligaments surrounding a joint, caused by wrenching or
twisting motion
Signs & Symptoms- Pain, Swelling, Discoloration, Decrease in function
Management:
Rest Ice Compression
Elevation
Heat
Immobilization
Surgery
3. Joint Dislocation Displacement/disalignment, or partial loss of contact with
joints
Signs & symptoms: Pain, Change in contour of the joint, Change in length of
extremity, Loss of normal mobility, Popping sound at affected site
4. Fracture break in the continuity of the bone
Types of fracture: Simple, compound, comminuted, delayed union, mal union, greenstick,
non-union, spiral, oblique, transverse

Signs & Symptoms:

Pain or tenderness over the involved

area
Loss of function
Obvious deformity
Crepitation
Erythema, edema, ecchymosis
Muscle spasm and impaired sensation

MEDICAL MANAGEMENT
The principles of fracture treatment include:
1. reduction
2. immobilization
3. regaining of normal function and strength through rehabilitation
1. REDUCTION
- restores the bone to proper alignment
a. Closed reduction
is performed by manual manipulation
may be performed under local or general
anesthesia
a cast may be applied following reduction
b. Open reduction
correction and alignment of the fracture after surgical dissection and exposure of
fracture
treatment of choice for compound fractures
May be treated w/ internal fixators
2. FIXATION
a. Internal fixation
follows open reduction
involves the application of screws, plates, pins, or nails to
hold the fragments in alignment
provides immediate bone strength.
b. External fixation
an external frame is used with multiple pins applied
through the bone
Minimal blood loss than internal fixators
Provides more freedom of movement than with traction
Prone to pin tract infection
3. Traction
is the exertion of a pulling force applied in two directions to reduce and immobilize
a fracture
provides proper bone alignment and reduces
muscle spasms
a. Skeletal traction
is applied mechanically to the bone with pins,
wires, or tongs
allows use of longer traction time & heavier weight
(15-30 lbs)
Provide pin care
b. Skin traction
Traction is applied by the use of elastics bandages or adhesive
Decreases painful muscle spasm that accompany fractures

 Weight is limited to (5-10lbs)

B.1.Bucks traction
- Alleviates muscle spasms & immobilizes a lower limb by maintaining a straight pull on
the limb
- The affected leg is in extension
B.2. Russells traction
- Similar to Bucks traction, but a sling under
the knee suspends the leg
B. 3. Balanced Suspension Traction
- is used with skin & skeletal traction
- Used to treat fractures of the
femur, tibia or fibula

Bryants Traction
Traction Interventionst:
Maintain proper body alignment
Ensure that the weights hang freely
and do not touch the floor
Do not remove or lift the weights without a physician's
order
Ensure that pulleys are not obstructed and that ropes in
the pulleys move freely
Check the ropes for fraying
Avoid moving or jarring the bed
Inspect traction sites for signs of irritation or infection; do circulatory checks

4. CASTS
Casts are made of plaster or fiberglass to provide immobilization of bone and
joints after a fracture or injury
Interventions:
Instruct to expect sensation of heat while the cast is drying.

Keep the cast and extremity elevated.

Handle with palms of the hands and not with the fingertip.
Turn the extremity unless contraindicated.
Expose the cast to air and avoid use of fans, heat lamps, hair
to unnaturally dry the cast.
Petal edges when cast is totally dried.
Instruct the patient not to place sticks or any objects inside the
cast
Use additional padding around bony prominences
Monitor for the presence of a foul odor or hot spots
(infection) ; wet spots (need for drying / drainage)
Teach the client to keep the cast clean and dry
Instruct the client in isometric exercises to prevent muscle atrophy
Neurovascular checks; 6 Ps
Prepare for window or bivalving if circulatory impairment occurs

drier