Musculoskeletal System Overview

Bones are made of cortical (compact) bone tissue for support, and cancellous (spongy) bone tissue for blood cell production.

Osteoblasts build bone, osteocytes maintain it, osteoclasts break it down, and osteogenesis is bone formation.

Bone healing has 3 phases: reactive (painful, clot formation), reparative (cartilage callus formation), and remodeling (bone forms).

Bones protect organs, enable movement, help blood flow, make blood cells, and store minerals.

Bones are constantly being broken down and rebuilt.

A serious condition where pressure builds up in a muscle compartment, potentially damaging tissues and nerves. It's a sign that a cast needs immediate adjustment.

A set of signs indicating potential blockage or damage to blood flow: pain, pallor, pulselessness, paresthesia (numbness/tingling), poikilothermia (coolness), paralysis.

Signs include: increased age, female gender, osteoporosis history, post-menopausal status due to low estrogen, fall history, externally rotated shortened leg, pain in hip, outer thigh, or groin with limited movement.

Immediate priorities include: respiratory support, circulation checks, pain management, preventing dislocation, preventing immobility and complications, and assessing past medical conditions.

Hip fractures can be repaired surgically. Types of approaches in surgery may include anterior (less precautions) and traditional (more precautions) approaches. Post-op care includes, positioning, movement, DVT prevention, and early mobilization.

Maintaining hip position, avoid internal/external rotation, use trochanter rolls and abductor pillows, and encourage isometric quad & gluteal exercises and use of a trapeze.

Potential complications include dislocation, deep vein thrombosis (DVT), vascular issues, pulmonary complications (like atelectasis), urinary retention, compartment syndrome, and limb shortening.

Key nursing actions include monitoring circulatory status, encouraging deep breathing and coughing, DVT prevention (e.g., compression devices), repositioning (using devices like abductor pillows to avoid hip dislocation) and frequent turning to prevent pressure sores and promote blood flow.

A plaster cast takes 24-72 hours to dry completely and reaches full strength after drying. It's important to note that a wet cast can be dried with a cold hairdryer.

Unrelieved pain within a cast should be reported immediately to the doctor. It could indicate pressure on nerves and tissues, leading to potential complications like paralysis or tissue death. Never ignore complaints of pain.

Maintaining skin integrity is vital. This includes applying dressings for wounds, bivalving the cast when needed, and monitoring for signs of pressure or infection. A tetanus booster may be required.

Regular assessment includes monitoring circulation, sensation, movement, and 6 Ps (pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia). Notify the doctor of any signs of compromise.

Elevate the affected extremity no higher than the heart to reduce swelling. Encourage frequent movement of fingers and toes.

Unrelieved pain may indicate compartment syndrome, a serious condition requiring immediate medical attention. Look for increased swelling, inability to move fingers or toes, and severe pain.

Fracture reduction aims to restore the bone to its anatomical position. This can be achieved through closed manipulation and traction or through open surgery with internal fixation devices.

Used for open fractures and complex bone breaks, the external fixator provides support and holds the bone in place. Carefully monitor for potential infection at the pin sites.

Early complications include shock, fat embolism, compartment syndrome, DVT, and PE. Closely monitor the patient for signs of these conditions.

Delayed complications involve complex regional pain syndrome (CRPS), a condition causing extreme pain, swelling, and limited range of motion. Another potential complication is heterogenic ossification, where bone forms in soft tissue.

The precautions for the Anterior Approach are less stringent compared to other surgical approaches. This is because it involves more muscle involvement, allowing for quicker healing. Complete recovery may take 6-8 weeks.

Traction is a method that applies a pulling force to the body, using weights or other devices. It serves as a temporary measure to reduce muscle spasms, reposition fractures, and improve alignment of the bones.

The two main types of traction are Skin Traction and Skeletal Traction. Skin traction uses lighter weights and is short-term, while Skeletal Traction utilizes heavier weights, pins, and wires for longer-term stabilization.

Skin Traction is a type of traction that involves attaching weights to the skin. It's mainly used to reduce muscle spasms before surgery, typically applied to the hip using a boot and weights.

Skeletal Traction involves inserting a pin or wire into the bone, attached to a heavier weight. It's used for more severe injuries and provides longer-term stabilization.

Traction must be continuous for effectiveness, especially with Skeletal Traction. Weights should not hang freely or touch the floor. Equipment needs careful maintenance, including ropes, pulleys, and footplates.

Counter Traction refers to the patient's own body weight acting against the applied traction force. It helps stabilize and hold the fracture.

Reduce/Reduction refers to putting a fracture back into its proper alignment. This helps immobilize the fracture and reduce any deformity. It's often a temporary measure used before surgery.

Nursing care for traction focuses on proper application and maintenance. Monitoring for complications like skin breakdown, nerve pressure, and circulation problems is crucial. Regular assessments of the 6Ps (Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia) and prompt reporting of any changes are essential.

Complications of traction include skin breakdown, nerve pressure, circulatory impairment, and deep vein thrombosis (DVT).

Nursing interventions to prevent traction complications include: inspecting skin regularly, assessing 6Ps, encouraging movement in the unaffected leg, using compression devices, administering anticoagulants, and promoting hydration and mobility.

Compartment Syndrome is a serious condition that occurs when pressure within a muscle compartment increases, restricting blood flow and potentially causing muscle damage.

Common injuries include: Contusion (bruising), Strain (pulled muscle), Sprain (ligament/tendon injury), and Dislocation (joint displacement) which can lead to avascular necrosis (tissue death) if not treated quickly.

The PRICE principle (Protect, Rest, Ice, Compression, Elevation) provides initial management for contusions, sprains, and strains.

Total Hip Replacement is a procedure that replaces the damaged hip joint with an artificial joint. This involves placing a femoral stem into the femur and attaching a socket (ball) to replace the natural hip joint.

Hip Fracture is a break in the femur close to the hip joint. This is often seen in older adults with osteoporosis. Symptoms include leg adduction, shortening, external rotation, pain, and limited mobility.

Six signs indicating possible blood flow compromise: Pain, Pallor (pale skin), Pulselessness, Paresthesia (numbness/tingling), Poikilothermia (coolness), Paralysis.

Keeping the pins clean and free of infection is crucial. Clean the pin site with chlorhexidine solution and apply bacitracin every 8 hours.

A method using a pulling force to maintain alignment of a bone. It's a temporary solution until surgery can be performed.

Watch for signs of infection around pins: redness, swelling, warmth, pus, increased pain, fever. Report these to the healthcare provider.

Casts or fixators can put pressure on the skin, leading to sores or breakdowns. Look for redness, odor, or drainage.

A psychological and physical reaction to a cast, especially a spica cast. Symptoms include anxiety, sweating, dilated pupils, increased heart rate, and high blood pressure.

A dangerous condition where fat globules from a bone fracture enter the bloodstream, blocking small blood vessels in organs like the lungs, brain, and kidneys.

The pelvic bone is made up of the sacrum, ileum, pubis, and ischium.

A stable pelvic fracture involves a break in one part of the pelvis. An unstable fracture involves multiple breaks, making the pelvis unstable.

Joint replacement is used for severe joint pain, disability, repair of fractures, joint necrosis, and conditions like osteoarthritis, rheumatoid arthritis, congenital deformities, and trauma.

Reasons for total hip replacement include arthritis, hip fracture, failed reconstruction surgery, and avascular necrosis (bone death due to lack of blood supply).

After hip replacement, keep the leg abducted, avoid internal/external rotation, and prevent turning on the operative side.

Unrelieved pain within a cast should be reported immediately to the doctor. It could indicate pressure on nerves and tissues, leading to potential complications like paralysis or tissue death. Never ignore complaints of pain.

Unrelieved pain may indicate compartment syndrome, a serious condition requiring immediate medical attention. Look for increased swelling, inability to move fingers or toes, and severe pain.

An abnormal sensation of tingling, numbness, or burning, often caused by nerve damage or compression.

A check of blood circulation, nerve function, and sensation in an injured limb to detect any potential problems.

Elevate the injured limb above the heart to reduce swelling and improve blood flow.

Encourage movement of fingers or toes to prevent stiffness and monitor for changes in sensation.

Report any unrelieved pain, redness, swelling, warmth, or drainage around the cast immediately.

A test that measures the electrical activity of muscles and nerves, often used to diagnose nerve damage or muscle disorders.

Signs include: increased age, female gender, osteoporosis history, post-menopausal status due to low estrogen, fall history, externally rotated shortened leg, pain in hip, outer thigh, or groin with limited movement.

Immediate priorities include: respiratory support, circulation checks, pain management, preventing dislocation, preventing immobility and complications, and assessing past medical conditions.

Hip fractures can be repaired surgically. Types of approaches in surgery may include anterior (less precautions) and traditional (more precautions) approaches. Post-op care includes, positioning, movement, DVT prevention, and early mobilization.

Key nursing actions include monitoring circulatory status, encouraging deep breathing and coughing, DVT prevention (e.g., compression devices), repositioning (using devices like abductor pillows to avoid hip dislocation) and frequent turning to prevent pressure sores and promote blood flow.

The goal is to quickly stabilize a fractured hip to prevent further injury and complications.

A condition where bones become weak and brittle, making them prone to fractures.

Lifestyle changes like increasing calcium and vitamin D intake, exercising, and avoiding excessive caffeine and alcohol can help prevent osteoporosis.

Factors that increase your chance of developing osteoporosis include aging, genetics, certain medications, and lifestyle choices.

An infection of the bone causing inflammation, tissue death, and new bone formation.

Individuals with diabetes, weakened immune systems, recent surgeries, or IV drug use are at higher risk of developing osteomyelitis.

Following hip surgery, certain precautions are needed to prevent dislocation and ensure proper healing.

Avoid actions that could strain the hip, such as bending too far forward, crossing your legs, and turning the hip inwards or outwards.

Nurses play a vital role in caring for patients with hip fractures, focusing on pain management, preventing complications, and promoting mobility.

Precautions for anterior approach hip surgery are less strict due to more muscle involvement, healing faster in 6-8 weeks.

Traction uses pulling force on the body to reduce muscle spasms, align fractures, and immobilize injuries, often temporary until surgery.

Skin traction uses lighter weights, attached to the skin, for short-term muscle spasm reduction. Often for hip fractures before surgery.

Skeletal traction uses heavier weights, attached to pins in bones, for longer-term stabilization of severe injuries. Requires pin care.

Traction must be continuous, especially skeletal traction. Weights should not hang freely or touch the floor. Equipment needs regular maintenance.

The patient's own body weight provides counter traction, opposing the pulling force of the weights, to stabilize the fracture.

Reducing a fracture means putting the bones back into their correct alignment, often a temporary solution before surgery.

Hip fractures often show leg adduction (close together), shortening, external rotation, pain in the hip, groin, or knee, and limited mobility.

Intracapsular hip fracture occurs in the neck of the femur, risking blood flow to the head and neck of the femur, potentially causing avascular necrosis.

Extracapsular hip fracture is located in the trochanter region, healing more readily but with more tissue damage.

Hip fracture mortality is high (12-30% within 1 year), largely influenced by pre-existing health conditions.

Regular bone density tests, fall precautions, weight-bearing exercises, and calcium intake can help prevent hip fractures.

Treatment includes X-rays, skin traction, and usually surgery within 12-24 hours. Surgical options include open or closed reduction, internal fixation, or joint replacement.

PRICE (Protect, Rest, Ice, Compression, Elevation) is the initial management for contusions, sprains, and strains.

Total hip replacement involves replacing the damaged hip joint with an artificial joint, using a femoral stem and a socket.