Orthopedics Flashcards
(exam) Ortho considerations in general ageing process
- Decreases in SC tissue and weight
- Muscle mass and strength decrease
- Bone demineralisation = porous and brittle bones.
- Joints stiffen and lose flexibility = range of motion decreases
- Mobility slows and posture tends to stoop
- Height decreases. Height average loss = 5cm.
- Weight – men peaks in mid 50’s then declines, Women peaks in mid 60’s then declines.
- Muscle mass 30% decrease, Bone mineral mass 25-30% decrease in women – 10-15% decrease in men.
What is KYPHOSIS?
Kyphosis or increased forward curvature of the thoracic spine is common in older adults – particularly those with osteoporosis. Esp among menopausal women
risk factors osteoporosis
Smoking, lack of exercise, long-term use of steroids, women
Assessment of the older adult- MSK
- Subjective assessment
- Posture
- Gait: steadiness
- Bone integrity: deformities, alignments, symmetry, fractures
- Joint function: active ROM (patient doing), stability
- Muscle strength and size
- Skin: edema, temp, color, cuts, bruises, circulation (pallour, ulceration, hairlessness, temp, sensation)
- Neurovascular status: check esp post-fracture. colour, warmth, movement, sensation, pulses. Compartment syndrome is the build up of pressure in muscle could be emergency
- Nutrition
- Social and family
Red flags in orthopaedics- possibly indication of infection, cancer or fracture (6)
- Non-mechanical pain
- Thoracic pain – possibly dissecting aneurysm
- Fever – infection/osteomyelitis
- Unexplained weight loss
- Presentation in people under 20 years or aged more than 55 years
- Cauda equina – difficulty with micturition, loss of anal sphincter tone, faecal incontinence, weakness of legs, sensory loss or gait disturbance
Cauda equina – a rare but serious condition that describes extreme pressure and swelling of the nerves at the end of the spinal cord
HIP FRACTURE
- associated with a 1 year mortality of 24% - most who survive do not return to the same level of mobility and independence.
- A displaced femoral head can cause serious disruption of the blood supply to the femoral head, resulting in necrosis of the femoral head.
S&S: external rotation, muscle spasm, shortening of affected leg, severe pain and tenderness.
Surgical intervention:
- education about keeping the hip abducted post operatively. Usually with pillows as they are as effective as traction but without the risk of pressure area issues.
Nursing concerns:
- pain relief
- exercise
- treatment plan – complications renal, cardiac, respiratory and neurovascular impairment. Good alignment post-surgery is important. Have to keep the body at less than 90 degrees flexion – issues with putting on shoes, sitting on low chairs, toilets – usually for at least 6 weeks.
Pelvic fractures range from the benign to life threatening – depends on mechanism of injury and associated bleeding. High mortality rate because of intra-abdominal injury, haemorrhage, laceration of urethra, bladder or colon. Also acute pelvic compartment syndrome. May survive the initial pelvic injury only to die from sepsis, or thromboembolism
Stable, non-displaced fractures require limited intervention and early mobilisation is encouraged.
More complicated or unstable may need traction or open reduction – extreme care in handling or moving the patient to prevent injury from a displaced fracture fragment. Rarely turned therefore skin integrity and pressure area care is important as well as monitoring bladder and bowel function
familiarise
Diagnostic methods for orthopaedic issues
- Bone x-rays or joint - multiple x-rays with multiple views eg anterior, posterior, lateral are needed for full assessment of the structure benign examined. – serial x-rays may be needed for status of healing.
- CT (computed tomography) – with or without contrast agent (may be oral or IV) – shows cross section of body – used to assess tumours, soft tissue damage, severe trauma Also fractures which are difficult to identify eg acetabulum on xray.
- MRI – non invasive imaging – magnetic fields and radio waves – high res picture of bones and soft tissues – torn muscles, ligaments, herniated discs, variety of hip/pelvic disorders
- Arthrography – radiopaque contrast or air is injected in to the joint cavity to visualise joint structures – joint goes through range of motion to distribute contrast and then x-rays are obtained – detects tears as contrast leaks.
- Bone density scan – evaluates bone mineral density – dexa = dual energy x-ray absorptiometry – differs in areas of the body – diagnoses and monitors osteoporosis
- Bone scan – to detect primary and metastatic tumours or osteomyelitis, fractures, aseptic necrosis and to monitor degenerative bone diseases – radio-isotype is injected via IV and then scan done 2- 3 hours later
- Arthroscopy – direct visualisation of a joint through the use of a fibre-optic endoscope – for diagnosing joint disorders – also used for biopsy, treatment of tears, defects and disease processes\
- Arthrocentesis – joint aspiration – to obtain synovial fluid for examination or to relieve pain due to effusion. Eg diagnosis of septic arthritis, presence of haemarthrosis (bleeding into the joint cavity). Anti inflammatories may be injected into the cavity eg cortisone.
- Electromyography – provides information about the electrical potential of the muscles and nerves leading to them – evaluates muscle weakness, pain and disability – muscle and nerve problems. Needle electrodes inserted into selected muscles and responses to electrical stimuli are recorded.
- Biopsy – to determine the structure and composition of the bone marrow, bone, muscle or synovium – excises a sample of tissue for analysis
- Blood and urinalysis – identify chemicals and substances and to identify infection, baseline for anticoagulants, response to therapy, causes for bone loss eg vit d, calcium. Coagulation studies to detect bleeding tendencies.
Common joint surgery
Joint replacement/arthroplasty – surgical reconstruction or replacement of a joint.
Synovectomy – removal of synovial membrane – used as a prophylactic measure and palliative treatment of rheumatoid arthritis. Done to prevent destruction of joint surfaces.
Osteotomy – removes a slice or wedge of bone to change alignment (in a joint or vertebrae) and to shift weight bearing, thereby correcting deformity and relieving pain. Often done in ankylosing spondylitis.
Debridement – removal of degenerative debris such as loose bodies, osteophytes, joint debris and degenerated menisci from a joint. Usually knee or shoulder using an arthroscope.
Arthrodesis – surgical immobilisation of a joint by fusion of the bones.
ARTHRITIS- define, medication, common type
Meds: ibuprofen, paracetamol, NSAID,
140 different types, most common are:
- osteoarthritis, rheumatoid arthritis (auto-immune), fibromyalgia, scleroderma (auto-immune connective tissue), gout, lupus, polymyalgia rheumatic, psoriatic arthritis, reactive arthritis, ankylosing spondylitis
