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NSG 255 Orthopedics, Osteoporosis, and Hip Fractures
2025 EXAM QUESTIONS & 100% ACCURATE ANSWERS
what is the purpose of the musculoskeletal system?
- support and movement
- protection of organs
- mineral storage (Ca++ and PO4) which helps with fluid and electrolyte balance
- hemopoietic system (blood cell formation)
bone cells: what are osteoblasts and who has more?
builders that make new bone; young people have more
bone cells: what are the osteocytes?
mature bone cells
bone cells: what are the osteoclasts?
crushers that destroy and reform bone; old people have more
what do we call the place two bones come together?
articulation
what type of joint is fixed and immovable? it is found in the skull and sternum
synarthroses (its a sin to move this joint)
what type of joints have slight movement, but movement is limited? it is found in the intervertebral discs and pubic symphysis
amphiarthroses (amp the music up and I'll be swinging my hips/pelvis)
what type of joints are freely movable, packed with fluid between synovial joints and found in the limbs, shoulders, elbow, fingers, hips, and knees?
diarthroses - you need your movable joints to walk through diagon alley
where are the ball and socket joints?
shoulder and hip
where are the plane joints?
wrist and foot
where are the hinge joints?
knee and elbow
ligaments
which collagen connective tissue attaches muscle to bone?
tendons
name the surgery that either completely or partially replaces the joint
arthroplasty
name the surgery that removes the synovial membrane only - it is an elective surgery for palliative or preventative purposes
synovectomy
name of surgery that cuts into bone and resects it which is supposed to correct a deformity or relieve pain
osteotomy
remember photo of tibial wedge removed, YUCK
name of surgery done to decrease joint deformity and increase function; teacher calls it a "nip tuck"
tendon reassignment
surgery to fuse joints by fusing 2 bones to decrease pain and increase function
arthrodesis
surgery for carpal tunnel; resection of metatarsals heads; inflammation leads to the trapped nerves
nerve release
*note the surgery will need re-done because cut nerves regenerate (even though nerve damage cannot fix itself)
what is important in post op care after ortho surgery?
5 P's
pain, pallor, pulse, paresthesia, paralysis
discharge plans include home safety
care differs by joint; physical therapy differs by joint
positioning to reduce edema and promote healing
a break in the continuity of the bone
fracture
occurs when stress placed on bone is greater than the bone can absorb
this type of fracture is still aligned
non-displaced fracture
the two edges of this type of fracture are NOT aligned. it requires reduction to put them back in alignment
displaced fracture
this type of realignment requires surgery
open reduction
this type of realignment does NOT require surgery, only manipulation
closed reduction
this is the term for a fracture that heals at an abnormal angle - meaning the bone ends meet but are not aligned
angulation
how do you fix angulation?
rebreak it and put it back in alignment - done in surgery
*not necessary if ADLs are still able to be completed and patient is satisfied
how do we classify stable vs unstable fractures?
stable fractures have some of the periosteum still intact. the fracture is aligned or realigned through reduction and either naturally or through internal or external fixation. the ends won't displace.
unstable fractures are grossly misplaced (open fracture) or more than one piece (comminuted) and they are easily displaced
what is the temperature of the area?
hot usually means inflammation and cold means circulatory issue
what is the color of the area?
red means venous return circulatory issue, pales means circulatory issue, cyanotic means lack of o circulating
how do we assess the circulatory status?
1)- check capillary refill
- check pulse and grade 1 - 4+
if you cannot palpate a peripheral pulse, what should you do?
use a doppler
what type of diagnostic test do we move onto if problem continues or highly suspect fracture & x-ray negative?
Angiography (inject dye), bone scans, MRI's and CT scans
what does examine from joint to joint mean in regards to fractures?
examine from joint above fracture to joint below fracture; check function and ability
what are the 4 main complications of fractures?
infection
compartment syndrome
fat embolism
avascular necrosis
what is a bone infection called? what is required to treat a bone infection?
osteomyelitis; another surgery to take out old material, flush with antibiotics and put in new material
how do we diagnose compartment syndrome?
look at 5 P's
but EXTREME pain will be evident from the increased pressure in the compartment
what is the defining characteristic of fat embolism?
after a break or surgery in the long bone, fat embolism has same s/s as pulmonary embolism EXCEPT petechia on upper chest and neck
what makes avascular necrosis more common?
if you have CV issues
happens (most often) at the ends of the bones
will not heal
what is the purpose of traction?
it (1) relieves muscle spasm and (2) keeps the injury or extremity in alignment and (3) reduces a fracture or dislocation
what is the name of the traction with one pulling force that is a type of skin traction?
1 force in the longitudinal direction is Bucks Traction for femur or hip replacement
what is the name of the traction with 2 pulling forces that when applied will produce a 3rd area of pull?
Russell's Traction for femur or hip
two of more pulling forces is called?
balanced traction
traction must be maintained
continuously
Keep the weights off the
floor and moving freely through the pulleys.
what are the advantages for skin traction?
easy to apply
usually used for short periods of time
relieves muscle spasms
what are the disadvantages of skin traction?
only for short term
weight limit is less than 10 lbs
do you increase or decrease the weight if there is greater muscle spasm?
increase
what are nursing considerations when your patient is in traction?
}Remove boots/splints each shift to inspect 5 P's
}Assess for tenderness/redness
}Check under bony prominences
}Be sure no pressure areas noted
}Check CSM - circulation, sensation, movement
}Skin intact? Patient is often on their back
}Good back care
nursing considerations for skeletal traction
pin care - check for signs of infection
what is the difference between running and balanced traction?
running has a straight line of pull; balanced has more than 1 line of pull
when the pt is in traction, never put the HOB up higher than
45 degrees
when you move a traction patient up in bed, always get a
2nd person to help support the weights so the pull is continual
Pulses
Sensation
Motion
Interspace (edema)
Temperature
Hue (color)
what type of suspension traction can the patient pull himself off the bed for care?
balanced suspension traction; maintain continual traction but morning care on bedpan can be done with minimal turning
external fixation
is composed of metal pins and wires that are inserted into the bone and attached to external rods to stabilize the fracture while it heals (Fig. 62.13). It can be used to apply traction or to compress fracture fragments and immobilize reduced fragments when the use of a cast or traction is not appropriate. The external device holds fracture fragments in place similar to a surgically implanted internal device. External fixation is used mainly for complex fractures with extensive soft tissue damage, correction of congenital bony defects, nonunion or malunion, and limb lengthening.
External fixation is often used to try to salvage extremities that otherwise may require amputation. Because the use of an external device is a long-term process, ongoing assessment for pin loosening and infection is critical. Infection may require removal of the device. Teach the patient and caregiver about meticulous pin care. Although each HCP has a protocol for pin care cleaning, chlorhexidine is often used
when is external fixation necessary?
if injury is too extensive for internal fixation or if surgery for internal fixation would be life threatening
sometimes used after compartment syndrome fasciotomy
in cases when the injury is open and infected, internal fixation is CA
anytime there is loss of bone - we can't make the bone ends meet with internal fixation
Devices (pins, plates, intramedullary rods, metal and bioabsorbable screws) are surgically inserted to realign and maintain position of bony fragments (Fig. 62.14). These metal devices are biologically inert and made from stainless steel, vitallium, or titanium. Proper alignment and bone healing are evaluated regularly by x-rays.
Internal fixation
what is internal fixation often combined with?
open reduction (open reduction internal fixation ORIF)
This type of osteoporosis occurs due to loss of estrogen and it's protective effects on bone; only women
Primary or type I
This type of osteoporosis occurs due to other causes (ex: medications like tobacco, steroids, anticonvulsants, ETOH (alcohol), PPIs- interferes with calcium and bone metabolism.
Secondary
thyroid disease
diverticulitis - decreased Ca+ absorption
diabetes
dietary insufficiencies/restrictions
polypharmacy
risk factors for osteoporosis
}Genetics or Cultures
}Increased risk for Whites and Asians-Highest for northeastern European cultures
}Small framed thin people
}Increased risk for those with a family history
}Increased risk for those postmenopausal
}Increased risk for those with decreased calcium intake, decreased Vitamin D or lactose intolerance
}Cigarette Smoking
}Alcohol abuse
}History of multiple pregnancies
}Increased risk with liver, endocrine, renal disease
}Medications-steroids, thyroid, heparin, antiseizure or sedatives, PPIs, ETOH
s/s of osteoporosis
•Dowager's Hump
•Height loss
•Increased amount of fractures
•Occasionally spinal pain-lumbar
non medicine treatments for osteoporosis
increase intake of calcium rich foods (dairy, sardines, green leafy veggies, whole grains, nuts)
increased weight bearing exercise
what are foods high in calcium?
dairy
sardines
whole grains
dark leafy veggies
nuts
why is vitamin D supplement important?
Vitamin D is needed to increase the absorption of calcium
it is in fortified dairy products
what are the calcium supplements?
calcium carbonate - oscal or tums
