Science

1. Introduction to Orthopedic and
Orthopedic Nursing

2. WELCOME

3. Introduction
• Orthopedics is concerned with disorders/injuries
involving bones, joints, muscles, tendons and
nerves – the skeletal system and all that makes it
move.
• The important symptoms that patient may exhibit
include: pain, stiffness, swelling, deformity,
altered sensibility and loss of function, muscle
weakness which may be associated with any joint
dysfunction and may also suggest a more specific
neurological disorder or instability where a joint
gives way or moves out of position repeatedly

4. Cont…
• Taking care of orthopedic patients is challenging. The
challenge is in carrying out basic nursing care
procedures while understanding and working with
orthopedic devices used in the treatment of
musculoskeletal diseases and injuries. To avoid self-
injury, those engaged in orthopedic nursing must also
understand and apply principles of good body
mechanics.
• Many orthopedic patients are immobilized by casts,
traction, or other means for long periods of time.
Therefore orthopedic nursing usually includes
maintaining muscle tone and circulation, prevent
contractures, deformity, and pressure sores by
frequently changing the position of immobilized
patients.

5. Cont…
• Orthopedic patients are often confined to bed and in
many cases immobile, the orthopedic patient may
require a great deal of assistance with daily living
activities. His bedding should be kept clean, dry, and
wrinkle free. Because he is susceptible to skin
breakdown and pressure sores, he should be assisted
and encouraged to change positions within the limits
prescribed by the physician. He should be encouraged
to be as independent as possible within the limits of his
immobility and personal hygiene should be
emphasized. Nurses must encourage self-reliance, but
give help willingly and cheerfully when the patient
needs assistance.

6. Cont..
• Orthopaedics is a science which is a specialized
branch of surgery that involves the study and
treatment of the diseases of the bones. It
encompasses a number of conditions affecting
the musculoskeletal system such as fractures,
amputation, rheumatoid arthritis, septic arthritis,
osteomyelitis etc.
• “Ortho” means straighten while”paed” means
child in Latin, literally meaning straightening a
child (whose bones are soft).

7. Definition
• Orthopaedic nursing is a nursing specialty
focused on the prevention and treatment of
musculoskeletal disorders.
• These orthopedic issues include conditions like
arthritis, bone fractures, broken bones, joint
replacements, genetic malformations and
osteoporosis.
Therefore, orthopaedic nurses have specialized
skills in monitoring neurovascular status, traction,
casting, and care of patients with external fixation.

8. Terms used in Orthopedics
• Bone cysts - A growth containing liquid or semisolid
material on a bone.
• Bone metastases - The spread of malignant cancer cells to
bone.
• Bursa - a sac filled with fluid located between a bone and a
tendon or muscle.
• Bursitis – inflammation of the bursa and can be due to
repeated stress and overuse
• Chondrosarcoma - A type of cancer that forms in bone
cartilage. It usually starts in the pelvis (between the hip
bones), the shoulder, the ribs, or at the ends of the long
bones of the arms and legs.
Club feet - Turning of the heel inward with increased
plantar flexion (the toe-down motion of the foot at the
ankle).

9. • Kyphosis - Any forward-bending area or
deformity in the spine.
• Leg length inequity - One leg is shorter than
the other. This is a common sequel of many
congenital and acquired musculoskeletal
diseases.
Malunion - State of healing of the bone in
which bone unites but in abnormal position
and/or alignment.

10. Cont..
• Achilles tendonitis - Inflammation of the heel cord that is
the extension from the triceps surae group of muscles.
• Arthritis - inflammation of a joint, usually accompanied by
pain, swelling, and sometimes change in structure.
• Arthroscopy - a surgical procedure used to visualize,
diagnose, and treat problems inside a joint.
• Ankylosing Spondylitis - A rheumatoid arthritis-type disease
causing spontaneous fusion of the spine.
• Arthroplasty - Reconstructive surgery of a joint or joints to
restore motion because of ankylosis or trauma or to
prevent excessive motion.
• Asteonecrosis- Death of bone tissue.
• Atrophy - Reduction in size of an anatomic structure,
frequently related to disuse or decreased blood supply.

11. Cont…
• Nonunion - State of healing of the bone in which there
is no healing.
• Orthopaedic surgeon (or orthopaedist) - the physician
who diagnoses, treats, manages the rehabilitation
process, and provides prevention protocols for patients
who suffer from injury or disease in any of the
components of the musculoskeletal system.
• Orthopaedic surgery (or orthopaedics) - the medical
specialty devoted to the diagnosis, treatment,
rehabilitation, and prevention of injuries and diseases
of the body's musculoskeletal system.

12. Cont…
• Osteoarthritis - generally, a condition caused by wear and tear that
causes inflammation of the joint, causing swelling, pain, and
stiffness.
• Osteomyelitis - Inflammation of bone marrow, cortex, tissue and
periosteum; can be caused by any organism, but usually bacteria.
• Osteoporosis - (porous bone) - a condition that develops when bone
is no longer replaced as quickly as it is removed.
• Osteotomy - Surgical procedure that changes the alignment of bone
with or without removal of a portion of that bone.
• Prosthetics - The science that deals with functional and/or cosmetic
restoration for all or part of a missing limb. (prostheses = artificial
limb)
• Scoliosis - Side-to-side curve in the back, a lateral and rotational
deviation of the spine from the normally straight vertical line of the
spine. Such a curve may be termed fixed, which means that any
attempt to eliminate the curve by body motion is not successful.

13. Cont….
• Sprain - a partial or complete tear of a ligament.
• Strain - a partial or complete overstretched muscle or
tendon.
• Stress Fractures - a bone injury caused by overuse.
• Tendon - The extension of muscle into a firm, fibrous
cord that attaches into a bone or other firm structure.
Tendonitis - Inflammation of a tendon.
• Total Joint Replacement - A joint replacement involving
an internal prosthesis by removing the diseased joint
and replacing the acetabluar components with either
metal or plastic materials and a metal prosthesis of the
femoral segment

14. Principles of Orthopaedic Nursing and
Treatment
1. The first priority in the management of a fracture
is considering the client’s airway, his breathing and
ensuring blood circulation (ABCs) but do not let the
obvious fractures deter from ABCs.
2. Hypovolaemic shock may be possible after
sustenance of fractures. The shock may result from
blood loss and body fluids as well as from severe
pain. Hence reassess the client’s blood, fluid and
pain threshold to prevent and or treat shock.
3. Always immobilize the joint proximal and distal
by plaster splinting

15. Cont…
4. Circumferential casting is rarely done for an acute
fracture due to evolving oedema may lead to
compartment syndrome
5. Always apply Ice and elevate for 48 hours post injury
6.Healing occurs over 4 – 10 weeks if properly immobilized
7. For joint injuries: immobilize the affected part or joint
only. Immobilization helps further soft tissue injury and
continued pain
8. Reassess the patient’s neurovascular status after
immobilization or manipulation
9. Always consider analgesia and/or sedatives prior to
attempting reduction

16. Role of Orthopedic Nurse
An orthopedic nurse is an expert in orthopedic conditions
and caring for patients experiencing these conditions.
Their role are as follows:
• Collaborator and coordinator - Orthopedic nurse works
closely with the patient, their family, and the orthopedic
team to ensure clear client education, a smooth
recovery, and minimal complications.
• Carer- The orthopedic nurse performs musculoskeletal
health examinations, assists with casting and traction,
and administers pain medication to patients.
• Educator - The nurse is involved in continuous teaching
helps the patient to understand his/her condition and
limitations and enable him/her to become more
independent as his condition improves and is
rehabilitated.

17. Cont….
• Counselor - Immobility, fear of deformity, and a
potentially long hospitalization may cause the
patient to become depressed or discouraged. The
understanding and encouragement of nursing
personnel can increase morale.
• Therefore, an orthopedic nurse spends time
encouraging patients to increase their mobility,
educates about how to protect their joint and bone
health, and implements strategies to minimize
their pain and complications.