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branch of medicine that deals with the prevention or correction of the disorders and diseases of the musculoskeletal system
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branch of medicine that deals with the prevention or correction of the disorders and diseases of the musculoskeletal system
Musculoskeletal system
muscle, bones, joint, ligaments, tendons
pertaining to movement or the ability to move
permanent shortening of a muscle
The prime concern of the nurse caring for a client with locomotor disorders
is the prevention of contractures.
Caring for orthopedic clients also requires
an understanding of basic principles that apply to all clients whether they are in traction, casts or recovering from surgery
The skeletal system consists of bones
attached to each other by cartilage and strong ligaments
Functions of the skeleton
provide the body with structural framework; protect internal organs such as heart, brain, lungs; allow movement by muscles attached; store calcium, phosphorus and magnesium and release these minerals when required; manufacture blood cells in red bone marrow
Classification of bones
long (humerus), short (phalanges), flat (occiput) and irregular (vertebrae)
Types of bones
cancellous (resembles a sponge with spaces found in the epipysis of long bones) and cortical (compact bone found in the shaft of long bones)
attach muscle to bone
Voluntary muscles
muscles attached to bone can function at the will of the person
Involuntary muscles
found within body organs, regulate so the organs can perform their function, located in the intestinal tract, the pupil and in the heart and blood vessels
A joint
is a junction of two or more bones
Three types of joints
diarthrosis, synarthrosis, amphiarthhrosis
Diarthrosis joints
freely movable such as the hinge (elbow, knee), ball and socket (hip, shoulder), pivot (skull and first vertebrae), gliding (wrist), saddle (thumb)
Synarthrosis joints
are immovable such as the suture line between the temporal and occipital bones of the skull
Amphiarthrosis joints
are slightly moveable, such as the vertebrae and pelvic bones separated by fibrous cartilage
Synovial fluid
clear fluid that lubricates the joints
Bursa sacs
filled with fluid that facilitate joint movement by making it possible for muscles and tendons to move or glide over ligaments or bones
connective tissue that covers a muscle
strong fibrous tissue attaching muscle to bones
grow out of the periosteum and lash bones together more firmly
grating or crackling sensation or sound
crooked back
hump back --- increased roundness of the thoracic spinal curve
sway back -- exaggeration of the lumber spine curvature
a partial separation of an articular (joint) surface
injury to a muscle or tendon caused by overuse or overstretching
A strain
may either acute or chronic
An acute strain
may be caused when an individual performs and unaccustomed exercises vigorously
A chronic strain
may develop after repeated overuse of certain muscles
Chronic strains
require no specific treatment
In the case of a severe strain
the muscle may be completely ruptured and surgical repair may be necessary
is an injury to ligaments surrounding a joint caused by a sudden twist, wrench or fall
Symptoms of sprains are
pain, edema, loss of motion and ecchymosis
rest, ice, compression and elevation
occurs when articular surfaces of a joint are no longer in contact -- "out of joint"
Tramatic dislocations
are considered orthopedic emergencies
is a break in the continuity of a bone
Individuals considered at high risk for fractures are
predisposing bone conditions (metastic) osteoporosis, poor coordination, diminished vision, dizzy spells or general weakness
Common types of fractures are
greenstick (incomplete), simple (closed) and compound (open), impacted (telescope), spiral and comminuted
Greenstick fracture
the continuity of the bone is not completely disrupted but has splintering on one side and bending on the other---common in children
Closed (simple, complete)
skin remains intact
Compound (open)
bone and skin are broken -- bone protrudes the skin -- greater chance of infection
Impacted (telescope)
one portion of a bone fragment is forcibly driven into another
Spiral fracture
twists around the shaft of the bone, may occur from a twisting force
bone is splintered into many unaligned fragments
Healing time for fractures
depends on age, type of injury or underlyingdisease -- can take weeks to years
Sequence of healing
hematoma, granulation tissue formation, callus formation, callus ossification and ultimately remodeling
Hematoma formation
begins with the formation of a clot that serves as a fibrin network
Complications of a fracture
infection, fat embolism syndrome, compartment syndrome
Infections may result
from an open fracture allowing contamination
Fat embolism syndrome
usually associated with fractures of the long bones, multiple fractures or crushing injuries
An embolus
usually occurs within 24-72 hours after injury
Treatment for embolus
consist of bed rest, repiratory support, oxygen and IV fluids
Symptoms of an embolus are
(small area) pain, tachycardia and dispnea. (large area) severe pain, dyspnea, cyanosis, restlessness and shock
curshing injuries most commonly cause--myoglobin, creatine kinase (CK) and other inflammatory mediators escape from the injured muscle tissue into the circulation
Circulating myoglobin (rhabdomyolysis)
filtered by the kidneys can precipitate, causing renal tubular obstruction...also respiratory distress and fluid/electrolyte imbalance
Treatment for rhabdomyolysis
includes IV fluids to maintain circulating blood volume and renal perfusion so the myoglobin is flushed from the kidneys
Compartment syndrome
form of neurovascular impairment that may lead to permanent injury of an affected limb caused by progressive constriction of blood vessels and nerves
Compartment syndrome can occur
with any orthopedic injury as a result of bleeding into the tissue, tissue edema or prolonged external pressure (cast or tight dressing)
Untreated compartment syndrome
4-6 hours can lead to irreversible damage to nerves and muscles.....24-48 hours permenant loss of normal limb function
Neurovascular assessment for compartment syndrome
pain not relieved by narcotic analgesics, greater pain with passive motion than active, diminished cap refill, weak/unequal pulses, parasthesia, and paralysis
Treatment for compartment syndrome consist
of relieving pressure by removing the cast or dressing or by performing a fasciotomy
numbness or tingling
Fasciotomy, surgical
an incision into the fascia to relieve pressure on the nerves and blood vessels
Treatment of fractures
requires immediate attention
Most important objective for treatment of fractures
realign the fracture, maintain the alignment and regain the function of the injured part
Closed reduction
repair of a fracture accomplished without surgical intervention
External manipulation requires three maneuvers
traction and countertraction, angulation and rotation
Major purposes of casts are
immobilization, support and protection of the affected part, prevention of deformities that may be the result of conditions such as arthritis and the correction of deformities such as scoliosis
Dry cast
should be odorless, shiny in appearance, resonant when percussed and temp similar to room air
Moisture in a cast
from any underlying drainage will give the cast a musty smell, dullness on percussion, lusterless color and cool temp
Long and short arm cast
allow the fingeers to be visible
Long and short leg cast
allow the toes to be visible
Spica cast
used for hip, shoulder and thumb dislocations or injuries
Body cast
used to immobilize the spine following surgical spinal fusions, unstable spinal injuries or degenerative disorders
cut in a cast to allow visualization of a body area or to relieve pressure
principle is to have two forces pulling in opposite directions
Traction is used
to reduce a fracture, immobilize an extremity, lessen muscle spasms or correct or prevent a deformity
Types of tractions
skeletal, skin and manual
Skeletal traction
requires the surgical insertion of pins (Steinman) or wires (Kirschner) through the bones. used for fractures of femur, tibia and cervical spine
Skin traction
non-surgical method of providing necessary pull for shorter periods, Buck's traction..frequently used to temporarily immobilize a part or stabilize a fracture
Skin traction disadvantage
does not adequately control rotation and cannot be maintained for the length of time necessary for adult healing
Open reduction
surgical procedure that enable the surgeon to reduce (repair) the fracture under direct visualization...use of pins, screws, nails, plates, wire, rods
Open reduction disadvantage
possibility of introducing infection into the bone
Meds for fractures
analgesics, Flexeril (muscle relaxant), Colace (stool softener)
maintaining constant resistive force --exercises help maintain muscle strength of immobilized muscles
Immobility complications include
constipation, skin breakdown, urinary calculi and respiratory complications

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