Anatomy and Functions of Bones and Joints

Anatomy and Functions

• Muscles: Tissues that cover bones, enabling movement within the skeletal system.
• Ligaments: Connective tissue bands that link bones and stabilize joints.
• Tendons: Structures at muscle ends that transmit force to bones or cartilage.
• Cartilage: Elastic tissue at bone ends, providing support and stability.
• Joints: Connections between bones allowing movement and flexibility.

Bone Tissue and Supply

• Types of Bone Tissue:
  • Cortical Bone: Dense outer shell providing strength.
  • Cancellous Bone: Soft, spongy tissue housing red bone marrow found in specific locations like the iliac crest.
• Long Bones: Comprise a shaft (diaphysis) and ends (epiphysis), distinguished by an epiphyseal plate until skeletal maturity.
• Periosteum: Connective tissue layer covering all bones, critical in fracture repair which requires stripping during surgery.

Surgical Instrument Sequence

• Stabilize bone with a holder.
• Drill a hole for the screw.
• Tap the hole for secure screw placement.
• Measure screw depth for sizing.
• Insert screw with a screwdriver.

Bone Grafts

• Purpose: Fill voids post-bone removal, manage defects, and promote fracture healing.
• Types of Bone Grafts:
  • Allograft: Bone from tissue banks.
  • Autograft: Bone harvested from the patient's body, typically from the iliac crest.

Bone Cement (PMMA)

• Components: Powder with Barium Sulfate mixed with methyl monomer, producing a radiopaque cement.
• Safety: Flammable and requires proper ventilation; can irritate the respiratory system.

Medications in Orthopedics

• Bacitracin: Used with saline for irrigating contaminated bone/tissue.

Prosthesis Handling

• Meticulous management to avoid damage or contamination.
• Visual inspections and appropriate documentation of implants, ensuring sterilization with biological indicators.

Orthopedic Surgical Procedures

• Fractures: Breaks due to trauma, infections, or diseases like osteoporosis; goal is to restore functionality.
• Closed Reduction: Non-invasive manipulation confirmed by radiography.
• External Fixation: Rigid stabilization for severe or open fractures, allowing soft tissue injury treatment.
• Open Reduction and Internal Fixation (ORIF): Direct exposure for effective alignment and stabilization using metal devices.

Hip Fractures and Fixation Techniques

• Intertrochanteric Fractures: Common in elderly due to osteoporosis; fixed with plates and screws.
• Femoral Neck Fractures: Require meticulous reduction to avoid nonunion; treated with cannulated screws or Total Hip Arthroplasty (THA).

Burn Surgery and Skin Grafts

• Warm Operating Room: Essential to prevent hypothermia during procedures.
• Skin Graft Types:
  • Split Thickness Skin Graft (STSG): Contains epidermis and part of dermis; faster healing but risks contractures.
  • Full Thickness Skin Graft (FTSG): Both epidermis and dermis, less contracture risk and better aesthetic outcome.

Ophthalmology: Cataract Surgery

• Cataracts: Clouding of the lens, treated by lens removal techniques.
• Extraction Methods:
  • Extra Capsular Cataract Extraction (ECCE): Controlled capsule rupture and lens cortex removal.
  • Intra Capsular Cataract Extraction (ICCE): Rare, involves complete lens removal within the capsule.

Strabismus Repair

• Alters ocular misalignment with procedures such as recession (weakening) and resection (strengthening).

Medications for Eye Procedures

• Diverse agents including mydriatics, cycloplegics, and hyperosmotics maintain ocular function and manage pressures.

Laser Safety Precautions

• Protective Gear: Must include goggles and eye pads; controlled access to laser areas.
• Fire Safety: Annual training required on fire protocols; documentation essential for laser use.

Ethical Considerations in Surgery

• Ethics guide moral decision-making and impact nurse-client relationships; understanding frameworks helps to mitigate conflicts in surgical settings.