Orthopedic Surgery and Bone Treatment

Bone Cement (Polymethylmethacrylate) (PMMA)

• PMMA is formed by mixing a powder (10% Barium Sulfate) with a liquid (methyl monomer) to create radiopaque cement.
• Flammable liquid requires proper OR ventilation; fumes can irritate respiratory tract and eyes.
• Antibiotic-impregnated PMMA effectively reduces infection rates.

Medications for Bone Treatment

• Bacitracin mixed with sterile saline is used for irrigation of contaminated bone or tissue.

Handling Prosthesis

• Prosthetic devices must be meticulously handled to prevent damage or contamination.
• They should be placed on a lint-free surface and visually inspected for defects.
• Minimal handling is essential, and rinsing with Bacitracin may be needed.
• Detailed implant information (Serial Number, Lot Number, Size, Expiry) must be documented.
• A biological indicator must be present during the sterilization process for implants.

Orthopedic Surgery Causes and Procedures

• Fractures can arise from trauma, infection, or bone diseases such as osteoporosis.
• Osteomyelitis is the most common infection associated with fractures; osteoarthritis is a prevalent degenerative condition.
• The goal of fracture surgery is to restore the anatomical function of fractured bones or joints.

Closed Reduction

• Involves manipulation of bone fragments without skin incision.
• Radiography confirms reduction, reduces infection risk, and minimizes recovery time.

External Fixation

• Used for severe open fractures and allows management of soft tissue wounds.
• Stabilizes fractures without requiring a cast, facilitating additional procedures as necessary.

Open Reduction and Internal Fixation (ORIF)

• Utilized when closed reduction fails; allows direct exposure to the fracture site.
• Applicable for long bones and hip fractures using internal fixation devices such as plates and screws.

Hip Fractures

• Intertrochanteric fractures are common in elderly women due to osteoporosis and can be fixed using Dynamic Hip Screw (DHS) instrumentation, preserving blood supply.
• Femoral neck fractures may compromise blood supply, requiring internal fixation with cannulated screws or Total Hip Arthroplasty (THA) if unstable.
• Subtrochanteric fractures utilize Intramedullary (IM) nails with fluoroscopy guidance.

Arthroscopy Surgery

• Knee joint includes the femur-tibial plateau and patella-femur articulations.
• Collateral ligaments (MCL, LCL) and menisci (medial and lateral) reinforce the knee, along with anterior and posterior cruciate ligaments.
• Arthroscopy allows visualization and irrigation of joints, promoting quicker recovery and minimal scarring.

Surgical Counts and Hemostatic Agents

• Dura counts are required during neurosurgery to ensure all materials are accounted for.
• Hemostatic agents include Raney clips, neuro patties, bone wax, Surgicel, and Gelfoam.

Positioning Devices in Neurosurgery

• Devices like Mayfield head fixation and Sugita pins prevent head movement during lengthy procedures.

Nursing Considerations in Neurosurgery

• Care for pressure points is crucial, as surgeries can last several hours.
• Patients need to be securely positioned due to potential mobility during the procedure.

Plastic Surgery Techniques

• Dermatomes remove split-thickness skin grafts, with mineral oil used for functionality.
• Skin meshers create slits in grafts to increase coverage area.

Flap Techniques

• Pedicle flaps maintain original blood supply; free flaps require microvascular anastomosis.
• Two teams often work together for harvesting and preparation of recipient sites.

Perioperative Nursing Virtues and Ethics

• Key virtues include compassion, discernment, trustworthiness, integrity, and conscientiousness.
• Perioperative nursing practice standards emphasize knowledge, the nursing process, professional accountability, and safe patient care.

CNO Ethical Values

• Core values include client well-being, choice, privacy, respect for life, commitments, truthfulness, and fairness, guiding daily nursing practice.

Orthopedic Surgery Anatomy

• Muscles provide movement by covering bones and interacting with the skeletal system.
• Ligaments connect bone to bone, ensuring joint stability.
• Tendons transmit force from muscles to bones or cartilage.
• Cartilage is elastic, covering the ends of bones for support and stability.
• Joints are the points where two bones articulate.

Bone Tissue and Blood Supply

• Two types of bone tissue:
  • Cortical bone: dense, forms outer shell, supports tissue.
  • Cancellous bone: soft, spongy; found in locations like the iliac crest and contains red marrow.
• Long bones consist of a shaft (diaphysis) and two ends (epiphysis), with cancellous bone at the ends.
• Epiphyseal plate (cartilage) separates epiphysis from diaphysis until skeletal maturity.
• Periosteum is a connective tissue layer covering bones; must be stripped for fracture repair.
• Synovial membrane covers articulating surfaces of joints.

Instrumentation for Bone Fixation

• Bone holder stabilizes the fracture.
• Drill creates holes for screws; tapped for stability.
• Depth gauge measures screw length; screw is inserted with a screwdriver.

Minor Count Protocol

• A minor count is conducted during orthopedic surgeries, involving tracking instruments from initial setup to closure.

Bone Grafts

• Bone grafts fill cavities after large bone removals and promote fracture union.
• Allografts come from tissue banks; autografts are from the patient’s own iliac crest.
• Cancellous bone grafts are spongy and grow into host bones, harvested from the iliac crest's anterior/posterior.
• Cortical bone grafts need stabilization with hardware; harvested from iliac crest, ilium, tibia, or ribs.

Instruments Identification

• Kerrison Rongeur: used to grasp and resect lamina bone.
• Pituitary Rongeur: grasping and removing intervertebral discs.

Powered Surgical Instruments

• Drill safety must be ensured to prevent accidental activation.
• Proper testing and handling protocols are essential for safety.
• Surgeons must be informed of drill size and ensure correct equipment connections.

Operating Room Equipment

• Fracture Table: used for femoral and tibial fixation procedures.
• Jackson Spinal Table: used when the patient is prone for spinal surgeries.
• C-Arm provides real-time imaging; all OR personnel must wear X-ray protective gear.

Pneumatic Tourniquets

• Used for extremities to create a bloodless field, enhancing visibility.
• Inflation should not exceed specific pressure ranges based on extremity size and duration guidelines.
• Monitoring of inflation and deflation times is critical, documented in patient charts.

Open Reduction and Internal Fixation (ORIF)

• Used when closed methods fail for fracture correction.
• Involves skin incision for direct fracture site access and utilizes internal fixation devices.

Hip Fractures

• Intertrochanteric fractures are common in elderly women due to osteoporosis, treated with plates and screws.
• Femoral neck fractures require reduction prior to fixation to avoid nonunion risks.
• Two fixation methods for femoral neck: stable internal fixation with cannulated screws and total hip arthroplasty (THA).

Knee Injuries

• Torn medial collateral, medial meniscus, and anterior cruciate ligament (ACL) are the most common knee injuries.
• Meniscus tears require arthroscopic resection or repair to maintain joint stability.
• ACL repair often involves a patellar tendon graft, especially important for active individuals.

Total Knee Arthroplasty (TKA)

• TKA replaces worn knee surfaces, primarily due to arthritis.
• Goal is to improve joint mobility and stability; does not require lead gowns during surgery.
• Implants must preserve normal ligaments for proper knee function and are side-specific.

Otolaryngology (ENT) Surgery Basic Anatomy

• Middle ear consists of tympanic membrane and ossicles (malleus, incus, stapes) for sound amplification.
• Nose includes various sinus cavities; trachea is in front of the esophagus.
• Thyroid gland regulates hormones; parathyroid gland manages calcium levels in the blood.

Perioperative Nursing Considerations

• Compassion, discernment, trustworthiness, integrity, and conscientiousness are key virtues in patient care.
• Knowledge of treatment goals, patient values, and conflict resolution strategies is essential in perioperative settings.

CNO Ethical Values

• Client well-being, choice, privacy, respect for life, and fairness are fundamental in nursing practices.
• Professional standards emphasize knowledge, clinical decision-making, accountability, and safe patient care through teamwork.

Test your knowledge of orthopedic surgery procedures and the treatment of bone conditions using PMMA and other medications. This quiz covers handling prosthetics, infection control measures, and the necessary documentation for surgical implants. Perfect for medical students and professionals in orthopedics.