Orthopaedic Nursing

Orthopaedic nursing focuses on disorders affecting bones, joints, muscles, ligaments, tendons, and mobility. Because musculoskeletal injuries may impair circulation, sensation, movement, and independence, early assessment and complication prevention are essential. Nurses play a central role in neurovascular monitoring, pain management, immobilization care, mobility support, postoperative care, and rehabilitation. Effective orthopaedic care integrates assessment, diagnostics, pharmacologic therapy, surgical intervention, assistive devices, and interdisciplinary collaboration.

1️⃣ 🦴 Musculoskeletal Assessment Overview

🧬 Pathophysiology & Core Concepts

🔷 Musculoskeletal system supports posture, movement, protection

🔷 Bones store calcium/phosphate and produce blood cells

🔷 Joints enable movement, stability, weight-bearing function

🔷 Muscle weakness may indicate nerve or tissue injury

🔷 Circulation impairment threatens limb viability quickly

🔷 Trauma, aging, infection, inflammation affect mobility

🔎 Clinical Manifestations & Diagnostics

🔷 Assess pain, swelling, deformity, mobility limitation

🔷 Neurovascular checks: pain, pallor, pulse, paresthesia, paralysis

🔷 Capillary refill normal ≤2 seconds

🔷 Muscle strength graded 0–5 scale

🔷 X-ray identifies fracture, dislocation, degeneration

🔷 MRI evaluates ligaments, tendons, soft tissues

💊 Medical / Surgical Management

🔷 Analgesics: acetaminophen, ibuprofen, morphine PRN

🔷 Immobilization reduces pain and prevents injury worsening

🔷 Reduction realigns displaced bones or joints

🔷 Surgery repairs severe fractures or joint damage

🔷 Antibiotics needed for open fractures/infection

🔷 Physical therapy restores function and strength

🩺 Nursing & Collaborative Management

🔷 Perform neurovascular checks regularly after injury

🔷 Elevate limb to reduce swelling if appropriate

🔷 Apply ice initially for swelling/pain

🔷 Encourage ROM exercises unaffected joints

🔷 Maintain safe mobility and fall precautions

🔷 Collaborate PT/OT for rehabilitation planning

2️⃣ 🦴 Fractures: Types, Healing, Complications

🧬 Pathophysiology & Risk Factors

🔷 Fracture = break in bone continuity

🔷 Causes: trauma, stress, osteoporosis, malignancy

🔷 Healing stages: hematoma, callus, ossification, remodeling

🔷 Poor blood supply delays bone healing

🔷 Smoking, diabetes, malnutrition impair repair

🔷 Complications include bleeding, infection, nonunion

🔎 Clinical Manifestations & Diagnostics

🔷 Pain, swelling, deformity, loss of function

🔷 Crepitus may occur with bone movement

🔷 Shortening/rotation suggests displaced fracture

🔷 X-ray confirms location and fracture pattern

🔷 CT scan evaluates complex joint fractures

🔷 CBC monitors blood loss if major trauma

💊 Medical / Surgical Management

🔷 Closed reduction realigns bone without surgery

🔷 Open reduction internal fixation uses plates/screws

🔷 External fixation stabilizes severe/open fractures

🔷 Analgesics: morphine, ketorolac, acetaminophen

🔷 Calcium/vitamin D support bone healing

🔷 Antibiotics for open contaminated fractures

🩺 Nursing & Collaborative Management

🔷 Immobilize limb before movement or transport

🔷 Monitor neurovascular status distal to injury

🔷 Manage pain before repositioning or therapy

🔷 Monitor cast/splint tightness and swelling

🔷 Teach no weight-bearing until cleared

🔷 Collaborate orthopaedics/PT for mobility plan

3️⃣ 🦴 Open vs Closed Fractures

🧬 Pathophysiology & Risk Factors

🔷 Closed fracture: skin intact over injury

🔷 Open fracture: bone communicates with environment

🔷 Open fractures ↑ infection/osteomyelitis risk

🔷 High-energy trauma often causes open injury

🔷 Soft tissue damage worsens healing prognosis

🔷 Contamination requires urgent surgical management

🔎 Clinical Manifestations & Diagnostics

🔷 Closed: swelling, deformity, bruising, pain

🔷 Open: visible wound, bleeding, exposed bone possible

🔷 Assess distal pulses, sensation, movement

🔷 X-ray confirms fracture type and alignment

🔷 Wound culture if infection suspected later

🔷 Tetanus status must be assessed immediately

💊 Medical / Surgical Management

🔷 Cover open wound with sterile dressing

🔷 IV antibiotics: cefazolin, gentamicin if severe

🔷 Tetanus prophylaxis based on immunization history

🔷 Surgical irrigation and debridement urgently

🔷 External fixation often used initially

🔷 Delayed closure if contamination severe

🩺 Nursing & Collaborative Management

🔷 Do not push exposed bone back inside

🔷 Control bleeding with sterile pressure dressing

🔷 Maintain immobilization and limb alignment

🔷 Monitor for compartment syndrome signs

🔷 Educate infection warning signs after discharge

🔷 Coordinate urgent OR preparation and antibiotics

4️⃣ 🦴 Compartment Syndrome

🧬 Pathophysiology & Risk Factors

🔷 Increased pressure within closed muscle compartment

🔷 Pressure ↓ capillary perfusion → tissue ischemia

🔷 Fractures, crush injury, tight casts common causes

🔷 Irreversible nerve/muscle damage within hours

🔷 Bleeding/edema increases compartment pressure

🔷 Most common in forearm and lower leg

🔎 Clinical Manifestations & Diagnostics

🔷 Pain out of proportion = earliest key sign

🔷 Pain worsens with passive stretch

🔷 Paresthesia, pallor, paralysis, pulselessness late

🔷 Tight shiny skin over affected compartment

🔷 Compartment pressure >30 mmHg concerning

🔷 Pulses may remain present until late stage

💊 Medical / Surgical Management

🔷 Remove tight cast/dressing immediately

🔷 Keep limb at heart level, not elevated high

🔷 Fasciotomy definitive emergency treatment

🔷 Analgesics may not relieve ischemic pain

🔷 IV fluids support renal perfusion if rhabdomyolysis

🔷 Treat fracture/swelling source urgently

🩺 Nursing & Collaborative Management

🔷 Report severe unrelieved pain immediately

🔷 Perform frequent neurovascular assessments

🔷 Avoid ice/elevation above heart if suspected

🔷 Prepare patient for emergency fasciotomy

🔷 Monitor urine color for myoglobinuria

🔷 Document pain, pulses, sensation, movement

5️⃣ 🦴 Fat Embolism Syndrome

🧬 Pathophysiology & Risk Factors

🔷 Fat globules enter bloodstream after long-bone fracture

🔷 Common after femur, pelvis, tibia fractures

🔷 Fat emboli lodge in pulmonary/cerebral circulation

🔷 Inflammatory response causes ARDS-like lung injury

🔷 Usually develops 24–72 hrs after injury

🔷 Risk ↑ with delayed fracture stabilization

🔎 Clinical Manifestations & Diagnostics

🔷 Triad: respiratory distress, neurologic change, petechiae

🔷 Hypoxemia, tachypnea, dyspnea early signs

🔷 Confusion, restlessness, decreased LOC possible

🔷 Petechial rash chest, axilla, conjunctiva

🔷 ABG: PaO₂ ↓, respiratory alkalosis early

🔷 Chest x-ray may show diffuse infiltrates

💊 Medical / Surgical Management

🔷 Supportive oxygen therapy main treatment

🔷 Mechanical ventilation if severe hypoxemia

🔷 Early fracture stabilization reduces risk

🔷 IV fluids maintain hemodynamic stability

🔷 Corticosteroid use controversial/not routine

🔷 Treat shock/ARDS in critical care setting

🩺 Nursing & Collaborative Management

🔷 Monitor SpO₂ frequently after long-bone fracture

🔷 Report sudden confusion or respiratory distress

🔷 Assess petechiae in chest/axilla/conjunctiva

🔷 Maintain immobilization before surgical fixation

🔷 Encourage pulmonary hygiene when stable

🔷 Collaborate trauma/ICU/orthopaedic teams

6️⃣ 🦴 Traction Principles

🧬 Pathophysiology & Core Concepts

🔷 Traction applies pulling force for bone alignment

🔷 Reduces muscle spasm and fracture displacement

🔷 Skin traction temporary, lighter pulling force

🔷 Skeletal traction uses pins/wires into bone

🔷 Continuous force required for effectiveness

🔷 Incorrect alignment may cause neurovascular injury

🔎 Clinical Manifestations & Diagnostics

🔷 Assess pain, alignment, muscle spasm improvement

🔷 Neurovascular checks distal to traction site

🔷 Pin sites inspected for redness/drainage

🔷 X-ray confirms fracture alignment effectiveness

🔷 Monitor skin breakdown under traction devices

🔷 Assess for DVT due prolonged immobility

💊 Medical / Surgical Management

🔷 Analgesics: morphine, acetaminophen, NSAIDs PRN

🔷 Antibiotics if pin-site infection develops

🔷 Bucks traction common temporary skin traction

🔷 Skeletal traction used severe/unstable fractures

🔷 Surgical fixation may replace prolonged traction

🔷 Anticoagulants prevent thromboembolic complications

🩺 Nursing & Collaborative Management

🔷 Keep weights hanging freely at all times

🔷 Never remove weights unless specifically ordered

🔷 Maintain body alignment with traction line

🔷 Provide pin-site care using sterile technique

🔷 Encourage ROM unaffected extremities frequently

🔷 Prevent pressure injuries and constipation immobility

7️⃣ 🦴 Cast Care & Neurovascular Assessment

🧬 Pathophysiology & Risk Factors

🔷 Cast immobilizes fracture for proper healing

🔷 Swelling inside cast may impair circulation

🔷 Tight casts increase compartment syndrome risk

🔷 Moisture weakens cast integrity and skin

🔷 Pressure points may cause skin breakdown

🔷 Neurovascular compromise threatens limb viability

🔎 Clinical Manifestations & Diagnostics

🔷 Assess 6 Ps: pain, pallor, pulse, paresthesia, paralysis, poikilothermia

🔷 Capillary refill >2 sec concerning finding

🔷 Severe unrelieved pain may indicate ischemia

🔷 Foul odor/drainage suggests infection under cast

🔷 Cool pale extremity suggests poor circulation

🔷 X-ray monitors fracture alignment and healing

💊 Medical / Surgical Management

🔷 Bivalving cast relieves swelling pressure

🔷 Analgesics for fracture/cast discomfort

🔷 Fiberglass casts lighter and dry faster

🔷 Surgery required if reduction unsuccessful

🔷 Antibiotics if skin infection develops

🔷 Splints initially used during acute swelling phase

🩺 Nursing & Collaborative Management

🔷 Elevate extremity first 24–48 hrs

🔷 Handle wet plaster cast with palms only

🔷 Keep cast dry and intact always

🔷 Never insert objects inside cast

🔷 Encourage finger/toe movement regularly

🔷 Report numbness, burning, increasing pain immediately

8️⃣ 🦴 Sprains and Strains

🧬 Pathophysiology & Risk Factors

🔷 Sprain = ligament overstretching or tearing

🔷 Strain = muscle/tendon overstretching injury

🔷 Sports, falls, improper lifting common causes

🔷 Weak muscles increase strain injury risk

🔷 Ankle sprains most frequent ligament injury

🔷 Recurrent injury possible without rehabilitation

🔎 Clinical Manifestations & Diagnostics

🔷 Pain, swelling, bruising common findings

🔷 Limited ROM and weakness present

🔷 Joint instability suggests severe sprain

🔷 Muscle spasm common strain manifestation

🔷 X-ray rules out associated fracture

🔷 MRI evaluates ligament/tendon severity injury

💊 Medical / Surgical Management

🔷 RICE: rest, ice, compression, elevation

🔷 NSAIDs: ibuprofen, naproxen pain control

🔷 Splints/braces support injured structures

🔷 Physical therapy restores flexibility/strength

🔷 Severe tears may require surgery

🔷 Gradual return-to-activity recommended

🩺 Nursing & Collaborative Management

🔷 Apply ice first 24–48 hrs

🔷 Encourage elevation reduce swelling

🔷 Assess distal circulation and sensation

🔷 Teach proper brace/crutch use

🔷 Reinforce rehabilitation exercise compliance

🔷 Educate prevention warm-up/stretching techniques

9️⃣ 🦴 Dislocations

🧬 Pathophysiology & Risk Factors

🔷 Dislocation = bone displaced from joint socket

🔷 Trauma commonly forces joint out alignment

🔷 Ligament/tendon injury often accompanies dislocation

🔷 Shoulder dislocation most common major joint

🔷 Neurovascular damage risk if untreated

🔷 Recurrent instability possible after initial injury

🔎 Clinical Manifestations & Diagnostics

🔷 Severe pain and visible deformity present

🔷 Inability to move affected joint normally

🔷 Swelling and muscle spasm common

🔷 Numbness/weakness may indicate nerve compression

🔷 X-ray confirms dislocation and associated fracture

🔷 Assess distal pulses and sensation immediately

💊 Medical / Surgical Management

🔷 Closed reduction restores joint alignment

🔷 Procedural sedation often required during reduction

🔷 Immobilization sling/splint after reduction

🔷 NSAIDs/opioids manage pain and inflammation

🔷 Surgery required unstable/recurrent dislocations

🔷 Physical therapy restores ROM and strength

🩺 Nursing & Collaborative Management

🔷 Immobilize joint before reduction procedure

🔷 Frequent neurovascular checks after reduction

🔷 Apply ice to reduce swelling/pain

🔷 Educate avoid reinjury during healing period

🔷 Encourage rehabilitation exercises gradually

🔷 Teach sling/immobilizer proper positioning use

🔟 🦴 Trauma-Related Musculoskeletal Injuries

🧬 Pathophysiology & Risk Factors

🔷 Trauma damages bones, muscles, ligaments, vessels

🔷 High-energy injuries may cause multisystem involvement

🔷 Crush injuries risk rhabdomyolysis and compartment syndrome

🔷 Pelvic fractures may cause massive hemorrhage

🔷 Elderly patients higher fracture susceptibility

🔷 Motor vehicle crashes major trauma cause

🔎 Clinical Manifestations & Diagnostics

🔷 Pain, deformity, swelling, impaired mobility common

🔷 Open wounds may expose bone/tissue

🔷 Hypotension/tachycardia suggest hemorrhagic shock

🔷 Neurovascular deficits indicate severe injury

🔷 X-ray identifies fractures/dislocations rapidly

🔷 CT scan evaluates complex pelvic/spinal trauma

💊 Medical / Surgical Management

🔷 ABC stabilization first trauma priority

🔷 IV fluids/blood products manage shock

🔷 Analgesics and immobilization reduce pain

🔷 Surgical fixation stabilizes unstable fractures

🔷 Fasciotomy if compartment syndrome develops

🔷 Broad-spectrum antibiotics for open injuries

🩺 Nursing & Collaborative Management

🔷 Maintain cervical spine precautions if indicated

🔷 Frequent neurovascular and bleeding assessments

🔷 Monitor urine output and renal perfusion

🔷 Prevent hypothermia in trauma patients

🔷 Prepare patient for imaging/surgery rapidly

🔷 Coordinate multidisciplinary trauma rehabilitation care

1️⃣1️⃣ 🦴 Osteoporosis

🧬 Pathophysiology & Risk Factors

🔷 Decreased bone density → fragile porous bones

🔷 Bone resorption exceeds bone formation process

🔷 Postmenopausal estrogen loss accelerates bone loss

🔷 Aging, inactivity, smoking ↑ osteoporosis risk

🔷 Long-term corticosteroid use weakens bone matrix

🔷 Hip, vertebral, wrist fractures commonly occur

🔎 Clinical Manifestations & Diagnostics

🔷 Often asymptomatic until fracture develops

🔷 Back pain from vertebral compression fractures

🔷 Loss of height and kyphosis possible

🔷 Fragility fractures after minimal trauma hallmark

🔷 DEXA scan T-score ≤ −2.5 diagnostic

🔷 Serum calcium usually normal finding

💊 Medical / Surgical Management

🔷 Calcium + vitamin D supplementation recommended

🔷 Bisphosphonates: alendronate, risedronate common therapy

🔷 Denosumab inhibits osteoclast bone resorption

🔷 Teriparatide stimulates bone formation

🔷 Weight-bearing exercise improves bone strength

🔷 Hip fracture repair/replacement if severe injury

🩺 Nursing & Collaborative Management

🔷 Implement strict fall-prevention strategies

🔷 Encourage weight-bearing and resistance exercises

🔷 Teach smoking/alcohol cessation importance

🔷 Promote calcium-rich diet and sunlight exposure

🔷 Monitor medication adherence and side effects

🔷 Educate proper body mechanics during movement

1️⃣2️⃣ 🦴 Osteomalacia

🧬 Pathophysiology & Risk Factors

🔷 Defective bone mineralization from vitamin D deficiency

🔷 Soft weakened bones prone to deformity

🔷 Malabsorption disorders impair vitamin D absorption

🔷 Chronic kidney/liver disease affects metabolism

🔷 Limited sunlight exposure increases deficiency risk

🔷 Adults affected; rickets pediatric equivalent

🔎 Clinical Manifestations & Diagnostics

🔷 Diffuse bone pain and tenderness common

🔷 Muscle weakness especially proximal muscles

🔷 Difficulty walking/waddling gait possible

🔷 Pathologic fractures may occur

🔷 Vitamin D ↓, calcium/phosphate ↓ possible

🔷 X-ray may show Looser zones pseudofractures

💊 Medical / Surgical Management

🔷 Vitamin D replacement primary treatment

🔷 Calcium supplementation supports remineralization

🔷 Treat underlying malabsorption/kidney disorder

🔷 Sunlight exposure improves vitamin D synthesis

🔷 Analgesics relieve bone discomfort

🔷 Orthopedic repair for severe fractures/deformities

🩺 Nursing & Collaborative Management

🔷 Encourage compliance vitamin D therapy

🔷 Promote safe sunlight exposure regularly

🔷 Assess gait instability and fall risk

🔷 Encourage calcium-rich nutritious diet

🔷 Monitor pain and mobility improvement

🔷 Teach prevention through nutrition and exercise

1️⃣3️⃣ 🦴 Osteomyelitis

🧬 Pathophysiology & Risk Factors

🔷 Bone infection usually caused Staphylococcus aureus

🔷 Infection spreads hematogenous or direct contamination

🔷 Open fractures increase osteomyelitis risk greatly

🔷 Diabetes and poor circulation impair healing

🔷 Bone necrosis may form sequestrum tissue

🔷 Chronic infection difficult to eradicate completely

🔎 Clinical Manifestations & Diagnostics

🔷 Localized bone pain, warmth, swelling present

🔷 Fever and malaise common systemic findings

🔷 Purulent drainage possible chronic cases

🔷 WBC, ESR, CRP often elevated

🔷 MRI highly sensitive early infection detection

🔷 Bone biopsy/culture definitive diagnostic method

💊 Medical / Surgical Management

🔷 IV antibiotics prolonged 4–6 weeks therapy

🔷 Vancomycin common MRSA coverage option

🔷 Surgical debridement removes necrotic tissue

🔷 Drainage of abscess if present

🔷 Hyperbaric oxygen selected chronic refractory cases

🔷 Glycemic control improves healing outcomes

🩺 Nursing & Collaborative Management

🔷 Monitor wound drainage and fever trends

🔷 Administer IV antibiotics exactly scheduled

🔷 Maintain sterile dressing changes technique

🔷 Encourage high-protein diet for healing

🔷 Assess pain and limb function regularly

🔷 Educate complete antibiotic course importance

1️⃣4️⃣ 🦴 Osteoarthritis

🧬 Pathophysiology & Risk Factors

🔷 Degenerative joint disease with cartilage breakdown

🔷 Weight-bearing joints commonly affected

🔷 Aging and obesity major risk factors

🔷 Repetitive joint stress accelerates degeneration

🔷 Osteophyte formation limits joint mobility

🔷 Inflammation mild compared rheumatoid arthritis

🔎 Clinical Manifestations & Diagnostics

🔷 Joint pain worsens with activity/use

🔷 Morning stiffness usually <30 minutes

🔷 Crepitus during joint movement common

🔷 Decreased ROM and functional mobility

🔷 X-ray: joint-space narrowing, osteophytes

🔷 Weight-bearing joints often asymmetrically involved

💊 Medical / Surgical Management

🔷 Acetaminophen first-line mild pain control

🔷 NSAIDs: ibuprofen, celecoxib reduce inflammation

🔷 Intra-articular corticosteroid injections temporary relief

🔷 Weight reduction decreases joint stress

🔷 Joint replacement severe debilitating disease

🔷 Exercise strengthens supporting muscles/joints

🩺 Nursing & Collaborative Management

🔷 Encourage low-impact exercise and ROM

🔷 Apply heat for stiffness relief

🔷 Promote weight management strategies

🔷 Teach joint-protection/body mechanics techniques

🔷 Assess pain before and after activity

🔷 Coordinate PT/OT mobility support

1️⃣5️⃣ 🦴 Rheumatoid Arthritis

🧬 Pathophysiology & Risk Factors

🔷 Autoimmune inflammatory disease affecting synovial joints

🔷 Synovial inflammation destroys cartilage and bone

🔷 Symmetric joint involvement characteristic finding

🔷 Women affected more commonly than men

🔷 Genetic and environmental triggers contribute

🔷 Chronic inflammation causes deformities/disability progression

🔎 Clinical Manifestations & Diagnostics

🔷 Morning stiffness >1 hour hallmark

🔷 Painful swollen warm joints bilaterally

🔷 Fatigue, weight loss, low-grade fever possible

🔷 Rheumatoid nodules may develop

🔷 Rheumatoid factor/anti-CCP often positive

🔷 X-ray shows erosions and joint destruction

💊 Medical / Surgical Management

🔷 Methotrexate cornerstone DMARD therapy

🔷 Biologics: adalimumab, etanercept reduce inflammation

🔷 NSAIDs/corticosteroids manage acute flares

🔷 Physical therapy preserves mobility/function

🔷 Joint replacement severe deformity cases

🔷 Monitor infection risk immunosuppressive therapy

🩺 Nursing & Collaborative Management

🔷 Encourage balanced rest and activity periods

🔷 Apply warm compresses for stiffness relief

🔷 Assess medication side effects routinely

🔷 Promote joint-protection and energy conservation

🔷 Monitor fatigue and psychosocial coping

🔷 Reinforce adherence DMARD monitoring labs

1️⃣6️⃣ 🦴 Gouty Arthritis

🧬 Pathophysiology & Risk Factors

🔷 Hyperuricemia causes urate crystal joint deposition

🔷 Inflammatory response triggers sudden severe arthritis

🔷 Great toe commonly affected first joint

🔷 High-purine diet increases uric acid levels

🔷 Alcohol, obesity, CKD ↑ gout risk

🔷 Diuretics may precipitate acute gout attacks

🔎 Clinical Manifestations & Diagnostics

🔷 Sudden severe joint pain often nighttime onset

🔷 Red hot swollen tender joint classic finding

🔷 Limited ROM due intense inflammation

🔷 Tophi = urate crystal deposits chronic gout

🔷 Serum uric acid often elevated >7 mg/dL

🔷 Synovial fluid shows needle-shaped urate crystals

💊 Medical / Surgical Management

🔷 Colchicine reduces acute inflammatory response

🔷 NSAIDs: indomethacin common acute treatment

🔷 Prednisone alternative if NSAIDs contraindicated

🔷 Allopurinol lowers uric acid long-term

🔷 Febuxostat alternative xanthine oxidase inhibitor

🔷 Avoid alcohol/high-purine foods prevention strategy

🩺 Nursing & Collaborative Management

🔷 Elevate affected joint during acute attack

🔷 Encourage hydration reduce uric acid stones

🔷 Avoid aspirin, may retain uric acid

🔷 Teach low-purine diet modifications

🔷 Monitor medication adherence and side effects

🔷 Educate attacks may recur without treatment

1️⃣7️⃣ 🦴 Total Hip Replacement

🧬 Pathophysiology & Risk Factors

🔷 Damaged hip joint replaced prosthetic components

🔷 Severe OA common indication for surgery

🔷 RA, fractures, avascular necrosis also indications

🔷 Prosthesis restores mobility and pain reduction

🔷 Dislocation risk highest early postoperative period

🔷 DVT/infection major postoperative complications

🔎 Clinical Manifestations & Diagnostics

🔷 Severe hip pain and limited mobility pre-op

🔷 Post-op swelling and discomfort expected initially

🔷 Leg shortening/rotation may suggest dislocation

🔷 Neurovascular assessment essential after surgery

🔷 X-ray confirms prosthesis alignment placement

🔷 Monitor CBC for blood loss anemia

💊 Medical / Surgical Management

🔷 Opioids/NSAIDs manage postoperative pain

🔷 Enoxaparin prevents postoperative DVT formation

🔷 Antibiotics prevent surgical-site infection

🔷 Hip arthroplasty replaces femoral head/socket

🔷 Early ambulation improves recovery outcomes

🔷 Abduction pillow prevents hip dislocation

🩺 Nursing & Collaborative Management

🔷 Avoid hip flexion >90° postoperatively

🔷 Do not cross legs or internally rotate

🔷 Use elevated toilet seat/chair support

🔷 Encourage deep breathing and early ambulation

🔷 Monitor incision drainage and infection signs

🔷 Teach lifelong hip precaution adherence initially

1️⃣8️⃣ 🦴 Total Knee Replacement

🧬 Pathophysiology & Risk Factors

🔷 Damaged knee joint replaced artificial prosthesis

🔷 Severe osteoarthritis common surgical indication

🔷 RA and trauma may require replacement

🔷 Prosthesis improves mobility and pain control

🔷 Stiffness and DVT common postoperative concerns

🔷 Obesity increases prosthesis stress complications

🔎 Clinical Manifestations & Diagnostics

🔷 Chronic knee pain and stiffness pre-op

🔷 Post-op edema and limited ROM expected

🔷 Warmth mild swelling normal early recovery

🔷 Severe calf pain may indicate DVT

🔷 X-ray confirms prosthesis alignment/function

🔷 Monitor Hgb/Hct for blood loss trends

💊 Medical / Surgical Management

🔷 Analgesics: morphine, ketorolac, acetaminophen PRN

🔷 Anticoagulants prevent thromboembolic complications

🔷 CPM machine may improve ROM recovery

🔷 Physical therapy essential postoperative rehabilitation

🔷 Antibiotics reduce surgical infection risk

🔷 Ice therapy decreases swelling and pain

🩺 Nursing & Collaborative Management

🔷 Encourage early ambulation with assistance

🔷 Perform neurovascular checks regularly

🔷 Promote ROM and strengthening exercises

🔷 Monitor for DVT/PE warning signs

🔷 Reinforce use walker/cane during recovery

🔷 Teach incision care and infection prevention

1️⃣9️⃣ 🦴 Amputation Care

🧬 Pathophysiology & Risk Factors

🔷 Surgical removal of nonviable extremity part

🔷 Diabetes/PAD common lower-limb amputation causes

🔷 Trauma and severe infection also indications

🔷 Phantom pain occurs from nerve pathway changes

🔷 Contractures may develop without positioning exercises

🔷 Psychological distress common after limb loss

🔎 Clinical Manifestations & Diagnostics

🔷 Postoperative pain and edema expected initially

🔷 Phantom limb sensation commonly reported

🔷 Residual limb redness/drainage infection warning signs

🔷 Assess circulation and wound healing regularly

🔷 Fever/WBC elevation may suggest infection

🔷 Evaluate emotional adaptation and coping status

💊 Medical / Surgical Management

🔷 Opioids and gabapentin manage phantom pain

🔷 Antibiotics if postoperative infection develops

🔷 Compression wrapping shapes residual limb

🔷 Prosthesis fitting after wound healing complete

🔷 PT strengthens mobility and balance training

🔷 Psychological counseling supports emotional adjustment

🩺 Nursing & Collaborative Management

🔷 Position prone periodically prevent hip contractures

🔷 Avoid pillow under residual limb continuously

🔷 Perform stump care using sterile technique

🔷 Encourage ROM and strengthening exercises

🔷 Support grief process and body-image adaptation

🔷 Teach prosthesis and skin-care maintenance

2️⃣0️⃣ 🦴 Orthopaedic Emergencies Overview

🧬 Pathophysiology & Risk Factors

🔷 Emergencies threaten limb viability or life rapidly

🔷 Severe trauma may impair circulation/oxygenation

🔷 Compartment syndrome causes tissue ischemia necrosis

🔷 Fat embolism causes respiratory/cerebral compromise

🔷 Pelvic fractures risk massive hemorrhage

🔷 Open fractures increase sepsis/infection risk

🔎 Clinical Manifestations & Diagnostics

🔷 Severe pain, deformity, swelling major findings

🔷 Absent pulse/cool extremity vascular emergency

🔷 Dyspnea/confusion after fracture suggests fat embolism

🔷 Severe pain with passive stretch compartment syndrome

🔷 X-ray/CT identifies fracture severity rapidly

🔷 CK ↑ may indicate rhabdomyolysis muscle injury

💊 Medical / Surgical Management

🔷 ABC stabilization first emergency priority

🔷 Splinting/immobilization prevents further injury

🔷 IV fluids/blood products treat shock

🔷 Fasciotomy emergency compartment syndrome treatment

🔷 Surgical fixation stabilizes unstable fractures

🔷 Broad-spectrum antibiotics for open trauma injuries

🩺 Nursing & Collaborative Management

🔷 Perform rapid neurovascular assessments repeatedly

🔷 Monitor airway, breathing, circulation continuously

🔷 Prepare patient for emergency surgery quickly

🔷 Prevent hypothermia in trauma situations

🔷 Assess pain and response to interventions

🔷 Coordinate trauma, ortho, rehab multidisciplinary care

Orthopaedic disorders and injuries can significantly impair mobility, circulation, sensation, independence, and quality of life, requiring rapid assessment and timely intervention to prevent permanent disability or limb loss. Nurses play a vital role in neurovascular monitoring, pain management, immobilization care, postoperative rehabilitation, complication prevention, and patient education. Effective orthopaedic nursing integrates focused musculoskeletal assessment, pharmacologic and surgical management, mobility support, rehabilitation strategies, and interdisciplinary collaboration. Mastery of orthopaedic nursing principles strengthens patient safety, functional recovery, mobility preservation, and holistic long-term care.