ORTHOPEDIC NURSING

EFREIM LOUIE S. ILANO, RN, MSN, MD, FIAMS

PART 1. ANATOMY AND
PHYSIOLOGY
SKELETA
L AND
ARTICUL
AR
SYSTEM
 SKELETAL AND ARTICULAR
ORTHOPEDIC NURSING

SYSTEM
Composed of bones and cartilages forming framework of body.

FUNCTIONS
1. Supports surrounding structures
2. It protects vital visceral organs
3. Gives attachment to the muscles and provides leverage so assisting in body
movements.
4. It produces blood cells. This occurs in the red bone marrow.
5. For storage of mineral salts, especially phosphorus and calcium, to supply
body needs.
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 SKELETAL AND ARTICULAR
ORTHOPEDIC NURSING

SYSTEM
Composed of bones and cartilages forming framework of body.

FUNCTIONS
1. Supports surrounding structures
2. It protects vital visceral organs
3. Gives attachment to the muscles and provides leverage so assisting in body
movements.
4. It produces blood cells. This occurs in the red bone marrow.
5. For storage of mineral salts, especially phosphorus and calcium, to supply
body needs.
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 SKELETAL AND ARTICULAR
ORTHOPEDIC NURSING

BONES CELLS
SYSTEM
1. osteoblasts (active in bone formation)
2. osteoclasts (active in bone resorption)
3. osteocytes (principal cells of mature bone)
BONE DEPOSITION AND RESORPTION
Bones develop from cells - osteoblasts. This occurs not only in initial formation
of bones but also during repair. Osteoblasts secrete the organic components of
the matrix.
Large cell called osteoclasts are present in almost all cavities of bone and they
function to cause resorption.
5 Osteocytes - are osteoblasts that are now surrounded by the bone matrix as the
bone is formed.
 SKELETAL AND ARTICULAR
ORTHOPEDIC NURSING

SYSTEM
Hormonal regulation of the release of calcium from bone matrix - one of the
important homeostatic regulatory mechanism for maintaining normal blood
calcium.

1. Parathyroid hormone (secreted by parathyroid gland)

- released when there is decreased blood calcium level.
Hormone increases: bone resorption resulting to increased blood calcium
2. Calcitonin (secreted by thyroid gland)
- released when there is increased blood calcium level.
Hormone inhibits bone resorption thus resulting to decreased blood calcium
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 SKELETAL AND ARTICULAR
ORTHOPEDIC NURSING

TYPES OF BONE TISSUE

SYSTEM
1. Compact
- dense and strong
e.g. outer surfaces of bones
2. Cancellous (spongy)
- with many spaces, red bone marrow where hemopoiesis takes place. Blood
cells like red blood cells and granular leucocytes and megakaryocytes becoming
platelet are produced here.
e.g. inside flat bones like in skull, sternum, ribs.

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 SKELETAL AND ARTICULAR
ORTHOPEDIC NURSING

TYPES OF BONE TISSUE

SYSTEM
1. Compact
- dense and strong
e.g. outer surfaces of bones
2. Cancellous (spongy)
- with many spaces, red bone marrow where hemopoiesis takes place. Blood
cells like red blood cells and granular leucocytes and megakaryocytes becoming
platelet are produced here.
e.g. inside flat bones like in skull, sternum, ribs.

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 SKELETAL AND ARTICULAR
ORTHOPEDIC NURSING

SYSTEM
• CLASSIFICATION OF BONES
• A. According to Shape
• 1. Long bones
• consist of a shaft, or diaphysis, and two extremities, each called epiphysis
• e.g - humerus, radius, tibia and fibula
• 2. Short bones
• typified by the carpal bones of the wrist and the tarsal bones of the ankle, with a somewhat
irregular shape.
• 3. Flat bones
• These bones consist of two flat plates of compact tissue enclosing a layer of spongy bone.
• e.g. - The ribs, the scapula, parts of the hip bone, and the bones of the skull are all examples of
flat bones

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 SKELETAL AND ARTICULAR
ORTHOPEDIC NURSING

• 4. Irregular bones
SYSTEM
• comprises bones of peculiar and differing shapes, such as the vertebrae and the ossicles of the
ear.

• 5. Sesamoid bone
• sesamoid bones are enclosed in tendon and fascial tissue and are found adjacent to joints.
• e.g - patella

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 SKELETAL AND ARTICULAR
ORTHOPEDIC NURSING

SYSTEM
• DIVISIONS OF THE SKELETON
• there is a total of 206 bones in the skeleton
• A. AXIAL SKELETON
• Consists of 80 bones
• The axial part consists of the skull (28 bones) (8 cranial, 14 facial, 6 ear ossicles) the hyoid
bone, the vertebrae (26 bones) the ribs (24 bones) and the sternum
• B. APPENDICULAR SKELETON
• consists of 126 bones
• 1. Bones of Upper extremities
• (64 bones, including the shoulder girdle)
• 2. Bones of Lower extremities
• (62 bones including pelvic girdle)

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 SKELETAL AND ARTICULAR
ORTHOPEDIC NURSING

SYSTEM
• DIVISIONS OF THE SKELETON
• there is a total of 206 bones in the skeleton
• A. AXIAL SKELETON
• Consists of 80 bones
• The axial part consists of the skull (28 bones) (8 cranial, 14 facial, 6 ear ossicles) the hyoid
bone, the vertebrae (26 bones) the ribs (24 bones) and the sternum
• B. APPENDICULAR SKELETON
• consists of 126 bones
• 1. Bones of Upper extremities
• (64 bones, including the shoulder girdle)
• 2. Bones of Lower extremities
• (62 bones including pelvic girdle)

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 SKELETAL AND ARTICULAR
ORTHOPEDIC NURSING

SYSTEM
JOINTS (ARTHROSES) - area of union between 2 or more bones
• Types of joints:
• These joints are classified on the basis of material between the bones and also according
to degree of movement allowed.
1. Fibrous joints
• fibrous connective tissue holds the bones together
• e.g. suture
• this is immovable and is called Synarthroses
2. Cartilagenous joints
• cartilage holds the bones together
• e.g. symphysis pubis
• intervertebral disk
• this is slightly movable is called Amphiarthroses
• 3. Synovial joints
16 • a cavity (synovial cavity) with fluiid is found between bones.
• e.g. most joints in body like in extremities
• this is freely movable and is called Diarthroses
 SKELETAL AND ARTICULAR
ORTHOPEDIC NURSING

Types of Synovial joints

SYSTEM
• Classified according to types of movements allowed or shapes of joining bones

• 1. Ball and socket joint

• allows movement in many directions
• e.g. shoulder joint (between head of humerus and glenoid fossa of scapula)
• 2. Hinge joint
• allows movement in one direction
• e.g. elbow and knee joints
• 3. Pivot joint
• allows rotation around length of bone
• e.g. atlantoaxial joint

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 SKELETAL AND ARTICULAR
ORTHOPEDIC NURSING

• 4. Condyloid joint
SYSTEM
• allows movement in 2 directions
• e.g. wrist joint
• 5. Saddle joint
• like condyloid only with deeper articulating surface
• e.g. carpometacarpal joint of the thumb
• 6. Gliding joint
• bones slide over one another
• e.g. carpal joints; tarsal joints

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 PART 2. FRACTURE
ORTHOPEDIC NURSING

What is a fracture?
• A fracture is a partial or complete break in the bone. When a fracture happens, it’s
classified as either open or closed:

• Open fracture (also called compound fracture): The bone pokes through the skin and can be
seen, or a deep wound exposes the bone through the skin.
• Closed fracture (also called simple fracture). The bone is broken, but the skin is intact.

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 PART 2
FRACTURE
 FRACTURE
ORTHOPEDIC NURSING

Fractures have a variety of names. Here is a listing of the common types that may happen:

• Avulsion Fracture: when a fragment of bone is separated from the main mass.
• Buckled Fracture: (or impacted fracture), ends are driven into each other; commonly seen in
arm fractures in children.
• Comminuted Fracture: the bone breaks into several pieces.
• Compression or Wedge Fracture: usually involves the bones in the back (vertebrae).
• Greenstick Fracture: an incomplete fracture in which the bone is bent; occurs most often in
children.
• Linear Fracture: the break is parallel to the bone’s long axis.
• Oblique Fracture: the break has a curved or sloped pattern.
• Pathologic Fracture: caused by a disease that weakens the bones.
• Spiral Fracture: one part of the bone has been twisted at the break point.
• Stress Fracture: a hairline crack.
21 • Transverse Fracture: the broken piece of bone is at a right angle to the bone’s axis.
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ORTHOPEDIC NURSING
 FRACTURE
ORTHOPEDIC NURSING

What causes fractures?

Fractures most often happen when more force is applied to the bone than the bone can take.
Bones are weakest when they are twisted.

Bone fractures can be caused by falls, trauma, or as a result of a direct blow or kick to the body.

Overuse or repetitive motions can tire muscles and put more pressure on the bone. This causes
stress fractures. This is more common in athletes.

Fractures can also be caused by diseases that weaken the bone, such as osteoporosis or cancer in
the bones.

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 FRACTURE
ORTHOPEDIC NURSING

What are the symptoms of a fracture?

The following are the most common symptoms of a fracture. However, each person may
experience symptoms differently. Symptoms of a broken or fractured bone may include:

• Sudden pain
• Trouble using or moving the injured area or nearby joints
• Swelling
• Obvious deformity
• Warmth, bruising, or redness

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 FRACTURE
ORTHOPEDIC NURSING

What are the symptoms of a fracture?

The following are the most common symptoms of a fracture. However, each person may
experience symptoms differently. Symptoms of a broken or fractured bone may include:

• Sudden pain
• Trouble using or moving the injured area or nearby joints
• Swelling
• Obvious deformity
• Warmth, bruising, or redness

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 FRACTURE
ORTHOPEDIC NURSING

How is a fracture diagnosed?

In addition to a complete medical history (including asking how the injury happened) and
physical exam, tests used for a fracture may include the following:

• X-ray. A diagnostic test which uses invisible electromagnetic energy beams to make pictures
of internal tissues, bones, and organs on film.

• Magnetic resonance imaging (MRI). An imaging test that uses large magnets,
radiofrequencies, and a computer to produce detailed pictures of structures within the body.

• Computed tomography scan (also called a CT or CAT scan). This is an imaging test that uses
X-rays and a computer to make detailed images of the body. A CT scan shows details of the
bones, muscles, fat, and organs.

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 FRACTURE
ORTHOPEDIC NURSING

How is a fracture treated?

The goal of treatment is to put the pieces of bone back in place, control the pain, give the bone
time to heal, prevent complications, and restore normal use of the fractured area.

Treatment may include:

• Splint or cast. This immobilizes the injured area to keep the bone in alignment. It protects the
injured area from motion or use while the bone heals.
• Medicine. This may be needed to control pain.
• Traction. Traction is the use of a steady pulling action to stretch certain parts of the body in a
certain direction. Traction often uses pulleys, strings, weights, and a metal frame attached over
or on the bed. The purpose of traction is to stretch the muscles and tendons around the broken
bone to help the bone ends to align and heal.
• Surgery. Surgery may be needed to put certain types of broken bones back into place.
Occasionally, internal fixation (metal rods or pins located inside the bone) or external fixation
devices (metal rods or pins located outside of the body) are used to hold the bone fragments in
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place while they heal.
 PART 3
IMMOBILIZATION
 CAST
ORTHOPEDIC NURSING

Is a temporary immobilization.
Types:
• Plaster
• Fiber glass

Function
 To promote healing and early weight bearing.
 To support, maintain and protect realigned bone.
 To prevent or correct deformity
 To immobilize

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 CAST
ORTHOPEDIC NURSING

CAST CAN BE APPLIED IN THE EXTREMITIES, TO THE TRUNK AND TO

EXTREMITY AND TRUNK , IT CAN ALSO BE APPLIED IN WHOLE BODY, OR
APPLIED AS A SPLINT OR MOLD.

Complications of Cast
• Neurovascular compromise- it compromises the circulation and function of the tissues
within that space.
• Incorrect fracture alignment
• Cast syndrome:
• superior mesenteric artery syndrome occurs with the body casts
• traction on superior mesenteric artery causes decrease in supply to bowel
• signs and symptoms: abdominal pain nausea, and vomiting
• COMPARTMENT SYNDROME ( IS A CONDITION WHICH INCREASED PRESSURE
WITHIN A LIMITED SPACE, COMPROMISES THE CIRCULATION AND FUNCTION OF
THE TISSUES WITHIN THE SPACE.

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 CAST
ORTHOPEDIC NURSING

Nursing Interventions

• Handle wet cast with palms of hands, not fingers.

• Cast should be allowed to air dry.
• Elevate the cast on one or two pillows during drying.
• Observe “hot spot” and musty odor, which is signs and symptoms of
infection.
• Maintain skin integrity – “petalling”
• Do neurovascular checks such as skin color, skin temperature, sensation,
mobility and pulse.
• Assess for vascular occlusion.
• Adhesive tape petals reduce irritation at cast edges.
• Prevent complication of mobility.

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PRESENTATION TITLE

• Complication of immobilization
• 1. too fit – pressure sore, compartment syndrome
• 2. too loose – inadequate immobilization,( loss reduction, delayed, mal or
nonunion.)
• Too long interval – muscle atrophy, osteoporosis, joint stiffness, maceration of
the skin.
• Too short interval – inadequate immobilization.

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 QUADRILATERAL CAST
ORTHOPEDIC NURSING
BODY CAST
• Affection of the dorso-lumbar space -Or ischial weight bearing cast
-fracture of the shaft of femur

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 DOUBLE HIP SPICA CAST
ORTHOPEDIC NURSING
1 ½ HIP SPICA CAST
-Affection of the hip and femur -bilateral affection of the hip and femur

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 BASKET CAST
ORTHOPEDIC NURSING
DELVIT CAST
–affection of the proximal tibia fibula and allow -to immobilize foot, knee and ankle while allowing
flexion and extension of the knee wound for exposure

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 SHOULDER SPICA CAST
ORTHOPEDIC NURSING
FUNCTIONAL CAST
-affection of the shaft with callus formation. Allow -affection of the upper portion of the humerus and
flexion and extension of the upper extremity. shoulder joint.

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ORTHOPEDIC NURSING
FROG CAST
-Congenital hip dislocation
SINGLE HIP SPICA POSTERIOR MOLD
-immobilize injuries and reconstructive surgeries of the
pelvis, hip, joint, and areas of the knee infection, open
wound and swelling.

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ORTHOPEDIC NURSING
FROG CAST
-Congenital hip dislocation
SINGLE HIP SPICA POSTERIOR MOLD
-immobilize injuries and reconstructive surgeries of the
pelvis, hip, joint, and areas of the knee infection, open
wound and swelling.

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ORTHOPEDIC NURSING
SHORT ARM CIRCULAR CAST
-affection of the wrist and fingers
LONG ARM CIRCULAR CAST
-affection of the radius and ulna
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CYLINDER CAST
-fracture of patella
CYLINDER POSTERIOR MOLD
-affection of the patella infection, open wound and
swelling
 HANGING CAST
ORTHOPEDIC NURSING
RIZZERS JACKET
-scoliosis -affection of the shaft of the humerus

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ORTHOPEDIC NURSING
COLLAR CAST
-affection of the cervical spine
MINERVA CAST
-used to immobilize the various levels of the cervical
and thoracic spine.

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 SINGLE HIP SPICA CAST
ORTHOPEDIC NURSING
SHOULDER SPICA POSTERIOR MOLD
-affection of the upper portion of the humerus and -Affection of the hip and femur
shoulder joint with infection, open wound and swelling

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 LONG LEG CIRCULAR CAST
ORTHOPEDIC NURSING
PATELLAR TENDON BEARING CAST
-ex. Shaft tibia fibula with callus formation -fracture tibia fibula
SHORT LEG CIRCULAR CAST
-affection of the ankle and legs

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 LONG ARM POSTERIOR MOLD
ORTHOPEDIC NURSING
MUNSTER CAST
-affection of the radius ulna with callus formation -affections on radius ulna with infection, open wound
allows extension and flexion of the elbow. and swelling.
SHORT ARM POSTERIOR MOLD
-affections of the wrist and fingers with infections and
open wounds.

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 BRACE CAST
ORTHOPEDIC NURSING
LONG LEG POSTERIOR MOLD
-affections of the tibia fibula with infection, open -affection of the end of femur and allows gradual
wounds. flexion of the knee.
SHORT LEG POSTERIOR MOLD
-affections of the ankle and toes with infections and
open wounds

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 PANTALON CAST
ORTHOPEDIC NURSING

-affection of the pelvis

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ORTHOPEDIC NURSING

SIDE ARM TRACTION 90-90 LOWER EXTREMITY TRACTION

-supracondylar fracture humerus shoulder -displaced femoral fracture
SkT

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ORTHOPEDIC NURSING

HALO PELVIC TRACTION HALO FEMORAL TRACTION

Scoliosis Severe scoliosis
SkT SkT

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ORTHOPEDIC NURSING

BRYANT TRACTION HAMMOCK SUSPENSION TRACTION

-fracture of femur, injuries to the hip among children -pelvis region
before 3 y/o; skin traction ST

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ORTHOPEDIC NURSING

BUCKS EXTENSION TRACTION BOOT TRACTION

-affection of femur and hip - ankle metatarsal fracture
SkT SPECIAL TYPE OF TRACTION

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ORTHOPEDIC NURSING

DUNLOP TRACTION HEAD HALTER TRACTION

-supracondylar fracture humerus - cervical spine affection
ST - ST

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ORTHOPEDIC NURSING

PELVIC TRACTION HEAD HALTER/PELVIC GIRDLE

-lumbar spine such as HNP, low back syndrome - non-adhesive lumbar affection
ST - severe cervical sprain, cervical strain, torticollis,
mild cervical trauma, potts dse.
- ST

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ORTHOPEDIC NURSING
HEAD HALTER TRACTION
Cervical spine affectation.
ST

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ORTHOPEDIC NURSING
BALANCE SKELETAL TRACTION
Hip and femur affectation
SkT

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PRESENTATION TITLE

• https://youtu.be/juEijU1SLCA

• https://nursingcrib.com/nursing-notes-reviewer/medical-surgical-nursing/type
s-of-cast-and-indications/

• https://docshare.tips/orthopedic-nursing-lecture-notes-philipine-orthopedic-
center_574ce264b6d87ff10f8b5647.html

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