Musculoskeletal

• Fracture


  Break in the continuity of bone
• Types of fractures


  • Close fracture
  • Open fracture
• Grading of open fractures

  • Grade 1: Clean wound less than 1 cm long
  • Grade 2: Larger wound without extensive soft tissue damage
  • Grade 3: Highly contaminated, has extensive soft tissue damage, and is most severe
• Fracture


  • Diagnostic test
  • Nursing diagnoses
  • Interventions
• Fracture management


  1. Immobilization

  2. Reduction - Restoration of fracture fragments to anatomic alignment and positioning

  3. Open reduction

  4. Close reduction
• Open reduction


  Internal fixation devices may be used to hold the bone fragments in position
• Immobilization methods


  • Bandages
  • Casts
  • Splints
  • Continuous tractions
  • External fixators
• Cast


  A rigid external immobilizing device that is molded to the contours of the body
• Nursing interventions


  • Maintain effective traction
  • Maintain positioning
  • Preventing skin breakdown
  • Monitor neurovascular status
  • Provide pin site care
  • Promote exercise
  • Assess anxiety
  • Assist in self care
  • Prevent and manage complications
• Fracture complications


  • Shock
  • Fat embolism
  • Compartment syndrome
  • DVT/Pulmonary embolism
  • Delayed union/Malunion/Nonunion
• Bone diseases


  • Osteoporosis
  • Osteomalacia
  • Osteomyelitis
  • Paget's disease
• Osteoporosis


  A metabolic bone disease characterized by decreased bone mass and deterioration of bone structure
• Osteoporosis risk factors


  • Genetics
  • Age
  • Nutrition
  • Medications
  • Lifestyle
  • Physical exercise
• Osteoporosis diagnostic tests


  • Dual energy X-ray absorptiometry (DXA)
  • Serum calcium
  • Serum phosphate
  • Alkaline phosphatase
  • ESR
  • X-rays
• Osteoporosis nursing diagnoses and interventions

  • Nursing diagnoses
  • Nursing interventions
• Osteomalacia


  A metabolic bone disease characterized by inadequate mineralization of bone, resulting in weakening and softening of the bone
• Causes of osteomalacia


  • Calcium deficiency
  • Lack of vitamin D
  • Renal disease
  • Hyperparathyroidism
  • Malnutrition
• Paget's disease


  A disorder of localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae
• Paget's disease diagnostic tests

  • Elevated alkaline phosphatase levels
  • Increased hydroxyproline in the urine
  • X-rays
  • Bone scan
  • Biopsy
• Paget's disease management


  • Calcitonin
  • Bisphosphonates
  • Plicamycin
  • Rehabilitation
  • Pain relievers (NSAIDs)
• Paget's disease complications


  • Fractures
  • Arthritis
  • Hearing loss
• Osteomyelitis


  An infection of the bone that results in inflammation, necrosis, and formation of new bone
• Osteomyelitis classifications


  • Hematogenous osteomyelitis
  • Contiguous-focus osteomyelitis
  • Osteomyelitis with vascular insufficiency
• Osteomyelitis pathophysiology


  1. Initial response is inflammation, increased vascularity, and edema

  2. After 2-3 days, thrombosis of local blood vessels occurs, resulting in ischemia and bone necrosis

  3. Infection extends into medullary cavity and under periosteum, may spread to adjacent soft tissues and joints

  4. Bone abscess forms, containing dead bone tissue (sequestrum)

  5. New bone growth (involucrum) forms around sequestrum

  6. Chronic infected sequestrum remains, producing recurring abscesses
• Osteomyelitis signs and symptoms

  • Bone pain
  • Fever
  • Leukocytosis
  • Elevated ESR
• Osteomyelitis diagnostic tests


  • Culture and sensitivity
  • CBC
  • ESR
  • X-ray
• Osteomyelitis management


  • Prevention
  • Medical management (antibacterial drugs, NSAIDs)
  • Surgical management (drainage)
• Joint diseases


  • Rheumatoid arthritis
  • Gouty arthritis
  • Osteoarthritis
• Rheumatoid arthritis


  An autoimmune disease that causes chronic inflammation of the joints
• Rheumatoid arthritis risk factors

  • Genetic factors
  • Hormonal factors
  • Environmental factors (e.g. sunlight, thermal burns)
• Rheumatoid arthritis diagnostic tests


  • Not provided
• Rheumatoid arthritis management


  • Not provided
• Osteoarthritis


  A degenerative joint disease
• Osteoarthritis etiology and risk factors

  • Not provided
• Osteoarthritis diagnostic tests


  • Not provided
• Osteoarthritis management


  • Not provided
• Gouty arthritis


  A type of arthritis caused by the buildup of uric acid crystals in the joints
• Gouty arthritis etiology and risk factors

  • Not provided
• Gouty arthritis diagnostic tests

  • Not provided
• Gouty arthritis management


  • Not provided