Anatomy of Joints and Bones

Bone Repair and Joint Structure

• Periosteal elevators are used to strip the periosteal layer during bone fracture repair.
• The synovial membrane lines all articulating surfaces of joints.

Shoulder and Upper Extremity

• Shoulder joint is a ball and socket joint, consisting of four rotator cuff muscles: supraspinatus, infraspinatus, teres minor, subscapularis.
• Humerus is the longest bone in the upper extremity, connecting the shoulder joint capsule at the proximal end and the ulna and radius at the distal end.

Wrist and Hand

• The wrist and hand comprise eight carpals, fourteen metacarpals, and phalanges.
• Median nerve runs through the palm, extending beneath the wrist.

Hip Joint

• The hip joint includes a capsule, ligaments, and muscles for stability.
• Hip bone is made up of ilium, pubis, and ischium, forming the acetabulum which articulates with the femur.
• Greater trochanter serves as an insertion point for abductor muscles; lesser trochanter is for the iliopsoas muscle.

Knee Joint

• Composed of two articulations: one between the femur and tibial plateau, another between the patella and femur.
• The knee joint capsule is connected to femoral condyles and tibia/fibula condyles, reinforced by MCL and LCL ligaments.
• Menisci (medial and lateral) enhance stability, while anterior and posterior cruciate ligaments (ACL and PCL) provide additional reinforcement.

Ankle and Foot

• Ankle is a hinge joint formed by the tibia and fibula.
• Comprises seven tarsal bones, five metatarsal bones, and fourteen phalanges.

Spine

• Vertebrae create the longitudinal skeleton axis, with connections providing mobility.
• Comprising seven cervical, twelve thoracic, and five lumbar vertebrae; sacrum and coccyx are fused.

Nursing Assessment in Orthopedic Surgery

• Correct operative side and site must be marked by the surgeon, verified during surgical safety checklist.
• Aseptic technique is crucial in orthopedic surgeries.

Patient Positioning

• Patient's position during orthopedic surgery varies: supine, lateral, or Fowler's position.
• Spinal patients require prone positioning with careful padding to prevent injury.

Instrumentation and Counting

• Common orthopedic instruments: periosteal elevators, rongeurs, and retractors.
• Essential sequence for bone fixation includes holding the bone, drilling, tapping, and screwing.
• A minor count is mandatory for all orthopedic procedures.

Arthroscopy of the Knee

• Common diagnostic and treatment method for knee issues including ACL reconstruction and meniscus repair.
• Tourniquet may be applied during the procedure; injuries frequently involve MCL and ACL.

Meniscal Tear Repair

• Meniscus stabilizes the knee and distributes load; repair typically involves cutting and debriding tears.
• Sutures may be used for vascular zone tears, followed by joint irrigation.

ACL Repair

• Crucial stabilizing ligament often torn from rotational stress; common in active individuals.
• Repair involves using patellar tendon graft; fluoroscopy helps confirm screw placement.

Total Hip Replacement (THR)

• This involves using a metal-ceramic prosthesis for femoral head fractures, designed to reduce friction.
• Involves preparing the acetabulum and femur, potentially using bone cement for prosthesis fixation.

Spinal Surgery

• Commonly performed on lumbar and cervical regions to address injuries and degenerative conditions.
• Lumbar laminectomy removes disc pressure from the spinal cord; spinal fusion treats scoliosis.

Key Instruments for Spine Surgery

• Involves tools such as Kerrison rongeur for lamina removal, and pituitary rongeur for disc extraction.
• Jackson table aids in positioning, while warming blankets mitigate risk of hypothermia.

Spinal Fusion Overview

• Addresses scoliosis, often in adolescents where curvature is still flexible.
• Harrington rods stabilize and straighten the spine during the procedure.