Orthopedic Module 19: Spine and Shoulder Anatomy
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Questions and Answers

What is the primary purpose of spinal fusion surgery?

  • To treat scoliosis and stabilize the spine (correct)
  • To remove lamina bone
  • To relieve pressure on the spinal cord
  • To restore blood flow to the spinal area

    • Which instrument is utilized for removing intervertebral disc tissue during spinal surgery?

  • Bayonet forceps
  • Pituitary rongeur (correct)
  • Cobb periosteal elevator
  • Kerrison rongeur

    • What is a significant risk associated with spinal surgery due to extensive skin exposure?

  • Hypothermia from cold operating room conditions (correct)
  • Delayed healing of the incision site
  • Excessive bleeding during the procedure
  • Infection from surgical instruments

    • Which option describes a common fixation instrumentation used during spinal fusion?

    <p>Harrington Rods</p> Signup and view all the answers

    Who typically performs spinal surgeries such as lumbar laminectomy or spinal fusion?

    <p>Orthopedic or neurosurgeons</p> Signup and view all the answers

    Which muscle is NOT part of the rotator cuff in the shoulder?

    <p>Deltoid</p> Signup and view all the answers

    What structure completes the socket for the femur at the hip joint?

    <p>Acetabulum</p> Signup and view all the answers

    Which ligaments are primarily responsible for reinforcing the knee capsule?

    <p>Medial collateral ligament and lateral collateral ligament</p> Signup and view all the answers

    What is the primary function of the periosteal elevator during bone repair?

    <p>To strip the periosteal layer away</p> Signup and view all the answers

    Which bones make up the wrist and hand structure?

    <p>8 Carpals, 14 Metacarpals, and 14 Phalanges</p> Signup and view all the answers

    Where are the cruciate ligaments located in relation to the knee joint?

    <p>Inside the joint capsule between femur and tibia</p> Signup and view all the answers

    Which structure is located on the radial side of the hand?

    <p>Radial artery</p> Signup and view all the answers

    Which part of the femur serves as an insertion point for the iliopsoas muscle?

    <p>Lesser trochanter</p> Signup and view all the answers

    How many cervical vertebrae are present in the human spine?

    <p>7</p> Signup and view all the answers

    Which instrument is specifically used to stabilize a fracture during orthopedic procedures?

    <p>Bone Holder</p> Signup and view all the answers

    What is the function of a drill in orthopedic surgery?

    <p>To create a hole for the screw</p> Signup and view all the answers

    Which position is NOT typically used for orthopedic surgery?

    <p>Sitting</p> Signup and view all the answers

    What is the purpose of the depth gauge in orthopedic surgery?

    <p>To measure the screw length</p> Signup and view all the answers

    What type of joints connect the vertebral bodies in the spine?

    <p>Cartilage joints</p> Signup and view all the answers

    Which of the following is a common method of draping in orthopedic surgeries?

    <p>Limb draping</p> Signup and view all the answers

    What is the total number of tarsal bones in the human foot?

    <p>7</p> Signup and view all the answers

    What type of positioning aid is commonly used for lateral positioning during orthopedic surgery?

    <p>Beanbags</p> Signup and view all the answers

    What is indicated by a Minor count in orthopedic surgery?

    <p>A count completed for all orthopedic cases</p> Signup and view all the answers

    What is the primary purpose of a prosthesis in joint surgery?

    <p>To replace a degenerated or fractured joint capsule</p> Signup and view all the answers

    Which of the following best describes the sequence of instruments used to fixate a bone?

    <p>Hold, Drill, Tap, Measure, Screw</p> Signup and view all the answers

    What is the primary advantage of arthroscopic procedures compared to traditional surgery?

    <p>Decreased recovery and rehabilitation time</p> Signup and view all the answers

    What is the function of the tap in the bone fixation sequence?

    <p>To create a stable channel for the screw</p> Signup and view all the answers

    Which type of fracture repair is NOT typically handled by orthopedic surgeons?

    <p>Fractures of the jaw</p> Signup and view all the answers

    What role does Normal Saline play in an arthroscopic procedure?

    <p>It provides irrigation for joint distention</p> Signup and view all the answers

    What is the common name given to the system that includes various instruments for fixing fractures?

    <p>Association for the Study of Internal Fixation (ASIF)</p> Signup and view all the answers

    Which of the following statements about screws used in fracture fixation is FALSE?

    <p>All screws are designed for dynamic compression</p> Signup and view all the answers

    What is the primary characteristic of a shoulder prosthesis compared to a hip prosthesis?

    <p>It is flattened and smaller in size</p> Signup and view all the answers

    What does dynamic compression across the fracture site facilitate?

    <p>Improved stability of the bone fragments</p> Signup and view all the answers

    What is the primary purpose of a meniscus tear repair during arthroscopy of the knee?

    <p>To enhance joint loading distribution</p> Signup and view all the answers

    Which of the following methods of anesthesia can be utilized for knee arthroscopy?

    <p>Combination of spinal and local anesthesia</p> Signup and view all the answers

    In the context of ACL repair, what is the most common graft used for ligament replacement?

    <p>Patellar tendon graft</p> Signup and view all the answers

    What condition is NOT commonly treated during knee arthroscopy?

    <p>Fractured femur</p> Signup and view all the answers

    What is a key procedural consideration during meniscal tear repair?

    <p>Tears must be debrided before any suturing</p> Signup and view all the answers

    What role does a tourniquet play in knee arthroscopy?

    <p>It is rarely inflated, focusing on limiting blood loss</p> Signup and view all the answers

    Which of the following factors is primarily responsible for an ACL injury?

    <p>Simultaneous anterior and rotational stresses</p> Signup and view all the answers

    What ingredient is NOT typically included in surgical instrumentation for knee procedures?

    <p>Patellar tendon wrap</p> Signup and view all the answers

    During which procedure is it crucial to cut the attachments of the anterior horn of the meniscus?

    <p>Arthroscopic resection of meniscal tear</p> Signup and view all the answers

    What is a common consequence of anterior cruciate ligament tears in active individuals?

    <p>Instability affecting activities of daily living</p> Signup and view all the answers

    What is the primary reason for marking the correct operative side and site before surgery?

    <p>To prevent surgical errors</p> Signup and view all the answers

    Which of the following best describes the function of a drill in the bone fixation process?

    <p>To create openings for screws</p> Signup and view all the answers

    During orthopedic surgeries, which position is typically utilized for spinal patients to minimize the risk of injury?

    <p>Prone position</p> Signup and view all the answers

    Which instrument is primarily used to hold a bone in place while stabilizing a fracture?

    <p>Bone holder</p> Signup and view all the answers

    What role does the depth gauge play in the sequence of instruments used to fixate a bone?

    <p>It measures the depth for screw length</p> Signup and view all the answers

    What is the most commonly used positioning aid for patients in a lateral position during orthopedic surgery?

    <p>Vac pack</p> Signup and view all the answers

    What constitutes a 'Minor count' in orthopedic surgical procedures?

    <p>Tracking of all gauze and sponge materials used</p> Signup and view all the answers

    Which of the following instruments is generally NOT included in a basic orthopedic instrument set?

    <p>Total knee implant</p> Signup and view all the answers

    What is a significant procedural step when performing ACL reconstruction involving the patellar tendon graft?

    <p>Heavy sutures are placed into each drill hole of the patellar tendon</p> Signup and view all the answers

    Which type of knee implant is most commonly used for TKA to replace the opposing femorotibial joint and patellofemoral joint?

    <p>Tricompartmental implant</p> Signup and view all the answers

    What is the primary purpose of irrigating the surgical site during ACL reconstruction?

    <p>To remove blood and debris before suturing the skin</p> Signup and view all the answers

    Which fixation technique is typically appropriate for a knee implant in cases of significant bone loss?

    <p>Fully constrained prosthesis</p> Signup and view all the answers

    What anatomical feature is targeted with the guide pin during ACL reconstruction?

    <p>Intercondylar notch for ACL attachment</p> Signup and view all the answers

    What is the maximum inflation pressure recommended for a pneumatic tourniquet applied to the upper extremity during orthopedic procedures?

    <p>250-300 mmHg</p> Signup and view all the answers

    Which consideration is critical in preventing hypothermia during orthopedic procedures?

    <p>Implementing forced-air warming blankets</p> Signup and view all the answers

    What is the primary purpose of the pneumatic tourniquet during orthopedic procedures?

    <p>To minimize blood loss in the surgical area</p> Signup and view all the answers

    When using powered surgical instruments, which safety measure must be adhered to in the operating room?

    <p>Ensure the drill's safety lock is always engaged when not in use</p> Signup and view all the answers

    What is a critical step in preparing to use a pneumatic tourniquet before surgery?

    <p>Exsanguinate the extremity using an Esmark bandage</p> Signup and view all the answers

    What is the role of the C-Arm in orthopedic surgery?

    <p>To provide fluoroscopy during the procedure</p> Signup and view all the answers

    Which of the following is a consequence of failing to properly control airflow in the orthopedic operating room?

    <p>Introduction of microorganisms into the sterile field</p> Signup and view all the answers

    For how long can a pneumatic tourniquet be inflated on the upper extremity during surgery?

    <p>Up to 60 minutes</p> Signup and view all the answers

    What is the recommended overlapping distance for pneumatic tourniquet cuffs?

    <p>3-6 inches</p> Signup and view all the answers

    What is a primary characteristic of absorbable sutures in orthopedic surgery?

    <p>They can degrade over time within the tissue.</p> Signup and view all the answers

    What is the significance of mixing PMMA with Barium Sulfate in orthopedic procedures?

    <p>It makes the cement radiopaque for imaging purposes.</p> Signup and view all the answers

    Why is face shield usage mandatory in orthopedic surgery?

    <p>To shield the face from potential flying debris.</p> Signup and view all the answers

    What role does pulsative lavage play in orthopedic surgery?

    <p>It delivers antibiotics for infection control.</p> Signup and view all the answers

    Which type of material is commonly preferred for handling ligaments during surgery?

    <p>Bioabsorbable polylactide</p> Signup and view all the answers

    What is an important consideration when applying bone wax during surgery?

    <p>It should be applied to minimize blood loss from bone surfaces.</p> Signup and view all the answers

    What are protective measures taken in orthopedic surgeries primarily aimed at?

    <p>Preventing damage or contamination of instruments.</p> Signup and view all the answers

    What type of gloves may be worn in orthopedic surgeries and why?

    <p>Double or triple gloves due to sharp bone handling.</p> Signup and view all the answers

    What is a common consequence of excessive exposure to the mixture of PMMA and methyl monomer?

    <p>Irritation of the respiratory tract and eyes.</p> Signup and view all the answers

    What advantage does antibiotic-impregnated PMMA provide during surgeries?

    <p>It decreases the probability of infection at surgical sites.</p> Signup and view all the answers

    What is the primary reason for using a bone graft in surgical procedures?

    <p>To promote union of fractures</p> Signup and view all the answers

    Which bone type requires stabilization with orthopedic hardware due to its inability to fuse on its own?

    <p>Cortical bone grafts</p> Signup and view all the answers

    Which instrument is typically used to remove the periosteum during bone grafting procedures?

    <p>Periosteal elevator</p> Signup and view all the answers

    What is documented as part of the implant information for surgical procedures involving bone grafts?

    <p>Serial Number, Lot Number, Size</p> Signup and view all the answers

    What defines a bone fracture in medical terms?

    <p>A break in the continuity of the bone</p> Signup and view all the answers

    What type of bone is cancellous bone and where is it usually harvested from?

    <p>Spongy and vascular bone from the iliac crest</p> Signup and view all the answers

    In fracture repair, which type of screws is specifically classified for use in cortical bone?

    <p>Cortical screws</p> Signup and view all the answers

    What bacterial infection is most commonly associated with fractures?

    <p>Osteomyelitis</p> Signup and view all the answers

    What is the primary effect of inserting a drain after a bone graft procedure?

    <p>To prevent fluid accumulation</p> Signup and view all the answers

    During bone harvesting from the iliac crest, which procedure is NOT typically performed?

    <p>Inserting metal plates</p> Signup and view all the answers

    Study Notes

    Bone Repair and Joint Anatomy

    • Periosteal elevators are used to strip the periosteal layer during bone fracture repair.
    • The synovial membrane envelops all articulating surfaces of joints, facilitating smooth movement.
    • Cortical (hard) bone and cancellous (spongy) bone are vital for blood supply in the skeletal structure.

    Shoulder and Upper Extremity

    • The shoulder functions as a ball and socket joint comprising four rotator cuff muscles: supraspinatus, infraspinatus, teres minor, and subscapularis.
    • The humerus, being the longest bone in the upper extremity, connects at the shoulder joint's proximal end and the ulna/radius at the distal end, which branches into medial and lateral condyles.

    Wrist and Hand Structure

    • Composed of three parts: 8 carpal bones, 14 metacarpals, and phalanges.
    • The wrist has radial and ulnar sides, with the median nerve extending through the palm beneath the wrist.

    Hip Joint Anatomy

    • Encapsulated by ligaments and muscles providing stability, the hip joint comprises the ilium, pubis, and ischium, which form the acetabulum for femur articulation.
    • Greater trochanter serves as the insertion point for hip abductor muscles; lesser trochanter is for the iliopsoas muscle.

    Knee Joint Composition

    • The knee features two main articulations: between the femur and tibial plateau, and the patella and femur.
    • Medial collateral ligament (MCL) and lateral collateral ligament (LCL) reinforce the knee capsule, while the medial and lateral menisci provide cushioning.
    • Anterior and posterior cruciate ligaments (ACL and PCL) stabilize the knee through fibrous connections.

    Ankle and Foot Structure

    • The ankle, a hinge joint, is formed by the distal ends of the tibia and fibula.
    • Consists of 7 tarsal bones, 5 metatarsal bones, and 14 phalanges.

    Spine Anatomy

    • The vertebral column, forming the skeleton's longitudinal axis, includes 7 cervical, 12 thoracic, and 5 lumbar vertebrae, with the sacrum and coccyx fused together.
    • Intervertebral discs allow for mobility between vertebrae.

    Perioperative Nursing Considerations

    • Verification of the correct operative side and site by the surgeon is crucial and is part of the surgical safety checklist.
    • Aseptic technique is mandatory for orthopedic surgical procedures involving fixation systems.

    Patient Positioning

    • Patient positioning during surgery varies: supine, lateral, or Fowler's position, depending on the procedure.
    • Spinal patients are positioned prone, requiring careful padding to prevent injury.

    Instrumentation and Counting

    • Essential orthopedic instruments include periosteal elevators, retractors, rongeurs, and bone cutters, tailored to the specific surgical intervention.
    • A minor count is performed for all orthopedic surgeries.

    Fixation and Prosthesis

    • Plates and screws stabilize fractured bones, with variations selected based on injury type and surgeon preference; ASIF systems include various specialized tools.
    • Prostheses replace degenerated or fractured joint capsules, commonly in hip, knee, and shoulder surgeries.

    Arthroscopy Overview

    • Typically used for knee, shoulder, and wrist diagnostics and repairs, with smaller incisions leading to reduced recovery time.
    • Normal Saline infusion promotes knee joint distention during procedures.

    Common Knee Procedures

    • Arthroscopic Meniscus Repair:
      • Involves detaching the anterior horn of the meniscus and repairing chronic tears, possibly suturing in vascular zones.
    • ACL Repair:
      • Most frequently torn ligament, often requiring graft replacement; common source includes the patellar tendon.

    Spinal Surgery Details

    • Lumbar Laminectomy: Removes lumbar disc to relieve spinal cord pressure, treating conditions like spinal stenosis.
    • Spinal Fusion: Treats scoliosis by stabilizing the spine using internal fixation devices like Harrington rods, often performed during adolescence.

    Considerations for Surgical Procedures

    • Blood replacement may be required due to extensive tissue dissection, necessitating pre-and post-operative confirmation of blood product availability.
    • Common instruments for spine surgery include rongeurs for lamina and disc removal, and spinal retractors for visibility.

    Anatomy of the Foot and Spine

    • The foot consists of 7 tarsal bones, 5 metatarsal bones, and 14 phalanges.
    • Vertebral anatomy includes 7 cervical, 12 thoracic, and 5 lumbar vertebrae; the sacrum and coccyx are fused.
    • Disc spaces are filled with cartilage joints allowing mobility.

    Perioperative Nursing Considerations

    • Verification of the correct operative side and site is critical, involving a surgical safety checklist and x-ray.
    • Orthopedic surgery necessitates adherence to strict aseptic techniques and use of fixation systems.

    Patient Positioning

    • Surgical positioning is determined by the procedure: supine, lateral, or Fowler's position is common; spinal surgeries require prone positioning with padding.
    • Specific aids (e.g., Vac packs) are utilized for lateral positioning.

    Draping and Instrumentation

    • Limb draping is standard; tourniquets are applied pre-prepping to restrict blood flow.
    • A basic orthopedic instrument set is standard; specialized sets are used based on the procedure (Hip set, Total Knee set, etc.).
    • Common instruments: periosteal elevators, Hommann retractors, bone rongeurs, drill and bone cutter.

    Instrumentation for Bone Fixation

    • Sequence for bone fixation includes holding the bone, drilling a hole, tapping, measuring depth, and inserting a screw.

    Equipment and Safety Measures

    • Powered surgical instruments reduce reliance on handheld tools; safety locks must be engaged to prevent accidental activation.
    • Forced-air warming blankets mitigate hypothermia risk due to significant skin exposure.
    • C-arm imaging aids fluoroscopy during surgery, requiring lead protection for all personnel.

    Tourniquet Use

    • Pneumatic tourniquets create bloodless fields during surgery; inflation must be monitored based on patient characteristics and procedure time (ideally not exceeding 60-120 minutes).
    • Cuffs overlap by 3-6 inches for effective application.

    Air Flow and Infection Control

    • Airflow management within the OR is crucial to minimize microbial introduction and reduce SSI risk.

    Suture and Bone Cement

    • Suture materials vary by healing speed; absorbable options are best for slower-healing tissues.
    • Bone Cement (PMMA) is radiopaque and made from a powder-liquid mix, necessitating proper ventilation during use.

    Medications in Orthopedic Procedures

    • Antibiotics and hemostatic agents are critical; irrigation solutions often include Bacitracin.
    • Bone wax and topical thrombin assist in managing bleeding.

    Protective Protocols

    • Enhanced safety measures for orthopedic operations include double or triple gloves, mandatory face shields, and X-ray protection.

    Management of Prostheses

    • Prostheses must be handled carefully to avoid damage; inspection for defects and proper documentation of implant details (serial number, lot number, etc.) is essential.

    Bone Grafts

    • Bone grafts help restore stability after bone loss; allografts (from tissue banks) and autografts (from the patient) are used.
    • Cancellous bone (spongy) promotes healing better than cortical bone and must often be stabilized with hardware.

    Fracture Surgery

    • Fractures result from trauma or disease; osteomyelitis is a common complication.
    • Instrumentation involves specific tools for diagnostic and repair procedures.
    • The classical approach includes creating incisions, using guide pins, and suturing.

    Total Knee Arthroplasty (TKA)

    • TKA is performed to replace worn knee surfaces, commonly needed in arthritis cases.
    • Various implant types are available: unicompartmental, bicompartmental, and tricompartmental, each with specific constraints and fixation preferences.
    • Selection considers joint conditions, patient age/activity, and surgeon choice, with implants designed for specific knee sides.

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    Related Documents

    Module 19: Orthopedic & Spine Surgery PDF

    Description

    Test your knowledge on orthopedic concepts covered in Module 19, focusing on the spine and shoulder anatomy. This quiz includes questions about bone repair, the synovial membrane, and the rotator cuff muscles. Enhance your understanding of the human skeletal system.

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