NURS 643 Week 8: Orthopedics Questions With Complete
Solutions
Benign Bony Tumors
conditions like osteochondroma, non-ossifying fibroma, &
aneurysmal bone cyst
- S/S - painful/painless mass at time of pathologic fx (no S/S
prior)
- Dx - incidental findings
Benign Tumor Tx
includes:
- Ortho referral & observation if no S/S & stable
- Some spontaneously resolve
- Biopsy if uncertain
- Fracture tx - consider preventative care
- ABCs - d/t growth & can recur
- Often need curettage & grafting
Osteosarcoma
most common bone malignancy that often presents in
adolescence
- Most common locations - distal femur, prox tibia, & prox
humerus
Osteosarcoma S/S
includes:
- Several months of 'strain-like' pain that wakes them up at night
,- Palpable mass or localized swelling
- Limp or dec ROM
Osteosarcoma Dx
includes:
- Xray & then MRI - "Sunburst sign" or "bone in bone"
formation
- Bloodwork - not helpful in dx but likely part of initial eval
- Biopsy for definitive diagnosis
Ewing's Sarcoma
malignant, distinctive small round cell sarcoma associated w/
translocation
- Most commonly occurs in the diaphysis of long bones
- Axial skeleton - more common in diaphysis of bones
- S/S - regional pain, swelling, wt loss, & fevers
- Dx - Xrays, MRI, & biopsy
- Xray - "Onion peel" appearance
- Tx - chemo, surgery, & +/- radiation
Malignant Tumor Surgery
includes:
- Amputation
- Limb Salvage - endoprosthesis (joint replacement) or free
tibial graft
- Rotationplasty - good procedure for kids w/ tumors, both osteo,
& ES around the knee area
- Their ankle becomes a new functional knee
Osteomyelitis
, infection of the bone, commonly in the femur & tibia, that may
be acute, subacute, or chronic & can be caused by:
- Hematogenous spread from bacteremia
- Local invasion from a contiguous infection
- Direct inoculation from trauma or surgical procedure
Osteomyelitis S/S
includes:
- Discrete tenderness w/ focal S/S at the affected site
- Pain, swelling, warmth, & erythema
- Constitutional S/S - fever, malaise, chills, & vomiting
- Limitation of function
Osteomyelitis Dx
includes:
- CBC, CRP, ESR, & blood cx
- X-rays
- MRI best technique for imaging soft tissue vs. bone
- Assess any periosteal abscess
OSteomyelitis Tx
includes:
- IV empiric abx to cover staph (Ex. cefazolin, oxacillin)
- MRSA coverage when needed
- Transition to PO abx once afebrile & labs improved (neg blood
cx x2-3 days)
- Lengthy PO abx after discharge (6-8wks)
- Bony Abscess? >> need surgical washout
- If delayed improvement, may require reimaging
Solutions
Benign Bony Tumors
conditions like osteochondroma, non-ossifying fibroma, &
aneurysmal bone cyst
- S/S - painful/painless mass at time of pathologic fx (no S/S
prior)
- Dx - incidental findings
Benign Tumor Tx
includes:
- Ortho referral & observation if no S/S & stable
- Some spontaneously resolve
- Biopsy if uncertain
- Fracture tx - consider preventative care
- ABCs - d/t growth & can recur
- Often need curettage & grafting
Osteosarcoma
most common bone malignancy that often presents in
adolescence
- Most common locations - distal femur, prox tibia, & prox
humerus
Osteosarcoma S/S
includes:
- Several months of 'strain-like' pain that wakes them up at night
,- Palpable mass or localized swelling
- Limp or dec ROM
Osteosarcoma Dx
includes:
- Xray & then MRI - "Sunburst sign" or "bone in bone"
formation
- Bloodwork - not helpful in dx but likely part of initial eval
- Biopsy for definitive diagnosis
Ewing's Sarcoma
malignant, distinctive small round cell sarcoma associated w/
translocation
- Most commonly occurs in the diaphysis of long bones
- Axial skeleton - more common in diaphysis of bones
- S/S - regional pain, swelling, wt loss, & fevers
- Dx - Xrays, MRI, & biopsy
- Xray - "Onion peel" appearance
- Tx - chemo, surgery, & +/- radiation
Malignant Tumor Surgery
includes:
- Amputation
- Limb Salvage - endoprosthesis (joint replacement) or free
tibial graft
- Rotationplasty - good procedure for kids w/ tumors, both osteo,
& ES around the knee area
- Their ankle becomes a new functional knee
Osteomyelitis
, infection of the bone, commonly in the femur & tibia, that may
be acute, subacute, or chronic & can be caused by:
- Hematogenous spread from bacteremia
- Local invasion from a contiguous infection
- Direct inoculation from trauma or surgical procedure
Osteomyelitis S/S
includes:
- Discrete tenderness w/ focal S/S at the affected site
- Pain, swelling, warmth, & erythema
- Constitutional S/S - fever, malaise, chills, & vomiting
- Limitation of function
Osteomyelitis Dx
includes:
- CBC, CRP, ESR, & blood cx
- X-rays
- MRI best technique for imaging soft tissue vs. bone
- Assess any periosteal abscess
OSteomyelitis Tx
includes:
- IV empiric abx to cover staph (Ex. cefazolin, oxacillin)
- MRSA coverage when needed
- Transition to PO abx once afebrile & labs improved (neg blood
cx x2-3 days)
- Lengthy PO abx after discharge (6-8wks)
- Bony Abscess? >> need surgical washout
- If delayed improvement, may require reimaging
