Orthopedic Surgery and Bone Treatment

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Questions and Answers

What component is mixed with methyl monomer to create PMMA cement?

Sodium Chloride

Barium Sulfate (correct)

Calcium Carbonate

Polyethylene Glycol

What is a major health risk associated with excessive exposure to PMMA fumes during mixing?

Skin irritation

Respiratory tract irritation (correct)

Nausea

Headaches

Which option is not a recommended practice for handling prosthetics?

Visually inspect for defects

Use bare hands for better grip (correct)

Rinse with Bacitracin if applicable

Place on a lint free surface

What is the primary goal of fracture surgery?

To restore anatomical function and alignment Signup and view all the answers

Which procedure allows manipulation of bone fragments without making an incision?

Closed Reduction Signup and view all the answers

In which situation is external fixation most commonly utilized?

For severe open fractures Signup and view all the answers

What must be present during the sterilization process of an implant?

A sterilization indicator Signup and view all the answers

What is the most common infectious process leading to bone issues?

Osteomyelitis Signup and view all the answers

Which focal virtue emphasizes an active regard for the best interests of the person being cared for?

Compassion Signup and view all the answers

What is critical for a perioperative nurse to identify in order to align with ethical values in nursing practice?

Patient and family values Signup and view all the answers

Which of the following is NOT one of the CNO Ethical Values implemented in perioperative nursing care practice?

Resource allocation Signup and view all the answers

Which perioperative nurse practice standard relates to the use of knowledge from various disciplines?

Knowledge integration Signup and view all the answers

What virtue is characterized by ensuring the best actions are taken for the patient without bias?

Conscientiousness Signup and view all the answers

What is a primary advantage of Open Reduction and Internal Fixation (ORIF) over closed methods?

It allows for direct visualization of the fracture site. Signup and view all the answers

Which statement about Intertrochanteric fractures is correct?

They can be fixed with plates and screws without compromising blood supply. Signup and view all the answers

Which fixation method is indicated for unstable femoral neck fractures?

Total Hip Arthroplasty (THA). Signup and view all the answers

What is a requirement for internal fixation of femoral neck fractures?

Reduction must be performed before fixation. Signup and view all the answers

What is included in the fixation instrumentation for a stable femoral neck fracture?

Cannulated screws using the AO technique. Signup and view all the answers

Which procedure allows for additional soft tissue procedures like skin grafts?

External fixation. Signup and view all the answers

Which condition may arise from improper treatment of femoral neck fractures?

Avascular necrosis. Signup and view all the answers

What type of fractures are most commonly associated with osteoporosis in elderly women?

Intertrochanteric fractures. Signup and view all the answers

What type of fracture might not require a cast following stabilization?

External fixation managed fractures. Signup and view all the answers

Which component is essential in the application of a Dynamic Hip Screw (DHS)?

Reduction of fracture alignment. Signup and view all the answers

What differentiates unipolar from bipolar hip prosthetics?

Unipolar has no inner head to reduce friction, whereas bipolar has both a head and an acetabulum. Signup and view all the answers

Which structures are primarily reinforced by the two collateral ligaments in the knee?

The femur and tibia. Signup and view all the answers

What is considered the gold standard for fixation of fractures according to the content?

Intramedullary (IM) rods. Signup and view all the answers

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

Less post-operative inflammation and scarring. Signup and view all the answers

Which of the following procedures allows for both diagnostic and operative interventions in joint surgeries?

Arthroscopy. Signup and view all the answers

When performing a bilateral total hip replacement, what is crucial for ensuring symmetry and alignment?

Modular method of construction. Signup and view all the answers

What is the purpose of normal saline irrigation during an arthroscopy?

To regulate distention of the joint. Signup and view all the answers

IM nails are primarily used for what type of fractures?

Subtrochanteric fractures. Signup and view all the answers

Which ligament is NOT classified as a cruciate ligament in the knee?

Medial collateral ligament (MCL). Signup and view all the answers

What is a common name for systems used in intramedullary fixation?

Russel-Taylor system. Signup and view all the answers

Which hemostatic agent is specifically used for scalp hemostasis during neurosurgery?

Raney clips Signup and view all the answers

What is the purpose of the Galea during a surgical procedure?

Connects muscles to the skull Signup and view all the answers

During the closing process of the dura, which instrument is employed?

#15 blade Signup and view all the answers

Which device is commonly used to prevent movement of the head during neurosurgery?

Sugita Pins Signup and view all the answers

What type of flap maintains the original blood supply and includes muscle during surgical procedures?

Pedicle flap Signup and view all the answers

Why is it important to pad a patient's pressure points properly during neurosurgery?

To prevent skin breakdown and pressure ulcers Signup and view all the answers

What is the typical duration range for neurosurgery procedures?

3-8 hours Signup and view all the answers

What is the primary consideration when using skin meshers in plastic surgery?

To stretch the graft covering area Signup and view all the answers

What tool is utilized for creating a burr hole in the skull?

Perforator Signup and view all the answers

What must occur before closing the dura in neurosurgery?

Dura count for minor instruments Signup and view all the answers

Which focal virtue primarily emphasizes the relationship built between the care provider and the patient or family?

Trustworthiness Signup and view all the answers

What ethical value focuses on the expectation to maintain patient confidentiality during perioperative care?

Privacy and Confidentiality Signup and view all the answers

Which practice standard relates predominantly to accountability and professional responsibility in perioperative nursing?

Professional responsibility and accountability Signup and view all the answers

Which virtue is defined as ensuring actions taken are solely in the best interests of the patient, devoid of any biased opinions?

Conscientiousness Signup and view all the answers

What is a primary focus when identifying goals and patient values in perioperative nursing?

Determining and respecting patient and family values Signup and view all the answers

What is the main purpose of menisci in the knee joint?

To distribute load across the joint and provide stability Signup and view all the answers

Which ligament is most frequently torn due to combined anterior and rotational stresses?

Anterior cruciate ligament Signup and view all the answers

What component is commonly used for ACL repairs?

Patellar tendon graft Signup and view all the answers

What is the primary diagnosis for patients undergoing Total Knee Arthroplasty (TKA)?

Arthritis Signup and view all the answers

What is essential to verify before opening knee prosthesis implants?

The correct sided implant Signup and view all the answers

What does the Parathyroid hormone (PTH) primarily regulate in the body?

Calcium levels in blood Signup and view all the answers

Which structure does the Estachain tube connect to the middle ear?

Pharynx Signup and view all the answers

Which statement is true regarding knee prostheses following Total Knee Arthroplasty?

They should preserve normal ligaments Signup and view all the answers

What ensures the improvement of mobility and stability in the knee joint post-TKA?

Proper alignment of the implants Signup and view all the answers

What is a potential consequence of excessive parathyroid hormone secretion?

Hypercalcemia Signup and view all the answers

What is the primary function of ligaments in the skeletal system?

To hold bone to bone and provide joint stability Signup and view all the answers

Which type of bone tissue is primarily responsible for the structural integrity of the long bone's outer shell?

Cortical bone Signup and view all the answers

At what location is cancellous bone typically harvested for bone grafts?

Iliac crest Signup and view all the answers

What is the purpose of the periosteal layer during the bone repair process?

To assist in bone stability during repairs Signup and view all the answers

Which instrument is utilized to create a hole in the bone for screw fixation?

Drill Signup and view all the answers

What is the primary reason for conducting a minor count in orthopedic surgeries?

To track instruments during the procedure Signup and view all the answers

What distinguishes an allograft from an autograft in bone grafting practices?

Allografts come from a tissue bank Signup and view all the answers

Which structure remains present until skeletal maturity and separates the epiphysis from the diaphysis?

Epiphyseal plate Signup and view all the answers

What is the primary purpose of using pneumatic tourniquets during surgical procedures?

To create a bloodless surgical field Signup and view all the answers

What should be the maximum inflation pressure for a pneumatic tourniquet on the thigh?

350 mmHg Signup and view all the answers

Which of the following instruments is specifically designed to grasp and remove intervertebral discs?

Pituitary Rongeur Signup and view all the answers

What is a critical safety consideration when using powered surgical drills?

Safety must be ensured by not resting drills on drapes Signup and view all the answers

What is the recommended maximum duration a pneumatic tourniquet should be inflated for the upper extremity?

60 minutes Signup and view all the answers

What type of table is primarily used for femoral neck or shaft fixation procedures?

Fracture Table Signup and view all the answers

Which of the following statements is true regarding the documenting of tourniquet inflation and deflation times?

It must be documented in the patient’s chart Signup and view all the answers

When operating a C-Arm for fluoroscopy, who is primarily responsible for its operation?

The surgeon or an x-ray technician Signup and view all the answers

What is a potential risk associated with improper usage of powered surgical instruments?

Accidental activation causing a strike through Signup and view all the answers

How much overlap should pneumatic tourniquet cuffs have when applied?

3-6 inches Signup and view all the answers

What is a primary concern during internal fixation of femoral neck fractures?

Risk of avascular necrosis Signup and view all the answers

Which fixation method is suitable for stable femoral neck fractures?

Internal fixation with cannulated screws Signup and view all the answers

What is an advantage of Open Reduction and Internal Fixation (ORIF) compared to closed methods?

Direct visualization of the fracture site Signup and view all the answers

What type of fracture is directly linked to a compromised blood supply?

Unstable femoral neck fractures Signup and view all the answers

What is the method commonly used for stabilizing intertrochanteric fractures?

Dynamic Hip Screw Signup and view all the answers

What is a common complication associated with femoral neck fractures if not properly treated?

Avascular necrosis Signup and view all the answers

Which step must be taken before internal fixation of a femoral neck fracture?

Reduction of the fracture Signup and view all the answers

What is the primary advantage of using external fixation over other methods?

Reduced soft tissue trauma Signup and view all the answers

What is often utilized to guide the insertion of a lag screw during hip screw instrumentation?

Guide pin Signup and view all the answers

Why are lead gowns worn by all OR personnel during hip surgery involving fixation?

To protect against radiation exposure Signup and view all the answers

Study Notes

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.

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Description

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.