Orthopedic Surgery on Hip Fractures

External Fixation and ORIF

• External fixation stabilizes fractures without a cast, allowing for soft tissue procedures like skin grafts.
• Open Reduction and Internal Fixation (ORIF) corrects fractures when closed methods are insufficient, using internal devices like plates and screws.
• ORIF provides direct exposure to the fracture for anatomical alignment.

Hip Fractures

• Intertrochanteric Fractures

  • Common in elderly women due to osteoporosis; occur between greater and lesser trochanters.
  • Extracapsular fractures; blood supply intact allows fixation with plates and screws.
  • Typically utilizes Dynamic Hip Screw (DHS) instrumentation.

• Femoral Neck Fractures

  • Requires reduction before fixation to prevent nonunion and avascular necrosis; blood supply compromised.
  • Two fixation types:
    • Stable fractures fixed using cannulated screws.
    • Unstable fractures require Total Hip Arthroplasty (THA), using either unipolar or bipolar components.

• Subtrochanteric Fractures

  • Treated with Intramedullary (IM) Nails; utilizes fluoroscopy for precision.
  • IM Rods distribute weight-bearing stresses effectively, minimizing complications.

Arthroscopy

• Common for knee, shoulder, and wrist joints; used for diagnostic and operative purposes.
• Utilizes a scope for visualization and normal saline for joint distention.
• Benefits include decreased recovery time, smaller incisions, and less postoperative pain.

Nursing Process Considerations

• Facial nerve monitoring necessary during surgeries.
• Rhinologic surgeries involve vasoconstrictor use to prevent bleeding.
• Laryngeal surgeries may use topical anesthetics like lidocaine.
• Surgical positioning generally supine with consideration for visualization.

Tympanoplasty

• Surgical repair of the tympanic membrane and reconstruction of ossicles.
• Indicated for conductive hearing loss.

Functional Endoscopic Sinus Surgery (FESS)

• Involves inserting an endoscope to address sinus issues.
• Indicated for conditions like polyps and severe allergies.

Radical Neck Dissection

• Removal of malignant tissues including nodes and major blood vessels.
• Supine position with a tracheostomy often required pre-surgery.

Tracheostomy

• Performed for prolonged intubation or airway obstruction.
• Includes insertion of a cannula through the trachea.

Neuro Surgery

• Involves careful dissection with attention to local infiltration and incision techniques.

Burn Surgery and Skin Grafts

• Warm operating room necessary to prevent hypothermia due to extensive tissue exposure.

• Vascular integrity is crucial for graft survival; immobilization is necessary.

• Split Thickness Skin Graft (STSG)

  • Involves epidermis and part of the dermis; heals quickly and can be meshed.
  • Aesthetic concerns as contractures may develop over time.

• Full Thickness Skin Graft (FTSG)

  • Includes both layers of the skin; minimizes contracture and enhances aesthetics.
  • Donor site closed primarily and cannot be reused.

Ophthalmology - Cataracts

• Cataracts refer to the clouding of the eye's lens.
• Cataract Surgery removes the opaque lens:
  • External methods like Extra Capsular Cataract Extraction (ECCE) and Intra Capsular Cataract Extraction (ICCE) are available.

Focal Virtues in Nursing

• Compassion: Focus on patient best interests.
• Discernment: Insightful judgment to benefit patient care.
• Trustworthiness: Foster relationships with patients and families.
• Integrity: Maintain dignity and ethical practice.
• Conscientiousness: Prioritize patient welfare in decision-making.

CNO Ethical Values

• Values like client well-being, privacy, truthfulness, and fairness guide perioperative nursing practices.
• Emphasis on safe patient care through collaborative multi-disciplinary approaches.

This quiz covers essential concepts in orthopedic surgery, focusing on external fixation techniques and Open Reduction and Internal Fixation (ORIF) for hip fractures. It highlights the differences between intertrochanteric and femoral neck fractures, their treatment options, and the importance of anatomical alignment in fracture healing.