MEDSTUDY.COM
The Canadian Orthopaedic Nurses Association
Association Canadienne des Infirmières
et Infirmiers en Orthopédie
ORTHOPEDIC
REVIEW FOR
NURSING
PRACTICE
The Rapid Reviews have been revised with permission from the Orthopaedic
Specialty Preparation Program at Vancouver Coastal Health. They provide a synopsis
of key information versus a comprehensive coverage of the topics.
Dedicated to orthopaedic nurses who strive to gain further knowledge and
understanding of Reconstructive Orthopaedics in a rapid paced environment.
Orthopedic Review for Nursing Practice
This document is considered one of several tools available to assist orthopaedic
nurses to prepare for certification for orthopaedic nursing through CNA. Note: this
document contains summary information versus comprehensive coverage.
,MEDSTUDY.COM
TABLE OF CONTENTS
OVERVIEW
ANATOMY & PHYSIOLOGY
Bone structure, Development, and Function ............................................................................ 6
Joints ............................................................................................................................ 8
Muscle, Tendons & Ligaments ............................................................................................ 12
Neurovascular System .................................................................................................... 13
The Integumentary System, Development, and Function ...........................................................14
ORTHOPEDIC CONDITIONS
Congenital
Cerebral Palsy ................................................................................................................ 16
Development Dysplasia of the Hip ........................................................................................ 17
Hemophilia A (Factor VII) & B (Factor IX) ............................................................................... 19
Osteogenesis Imperfecta (Brittle Bone Disease) ....................................................................... 22
Scoliosis ..................................................................................................................... 25
Spina Bifida .................................................................................................................. 25
Talipes Equinovarus (Club Foot) .......................................................................................... 27
Degenerative Conditions
Chondromalacia Patella (Patellofemoral Pain Syndrome) ........................................................... 30
Degenerative Disc Disease ................................................................................................. 33
Osteoarthritis (OA) ........................................................................................................... 33
Spinal Stenosis............................................................................................................... 36
Spondylolisthesis ........................................................................................................... 38
Developmental Conditions
Osgood-Schlatter........................................................................................................... 41
Legg-Calve-Perthes Disease ............................................................................................. 42
Slipped Capital Femoral Epiphysis ...................................................................................... 43
Inflammatory and Autoimmune disorders
Ankylosing Spondylitis (AS)................................................................................................ 45
Chronic Childhood Arthritis............................................................................................................. 47
Psoriatic Arthrititis ........................................................................................................... 49
Rheumatoid Arthritis (RA) ................................................................................................... 51
Systemic Lupus Erythematosus (SLE) ................................................................................... 57
Systemic Sclerosis ......................................................................................................... 61
Metabolic disorders
Gout ............................................................................................................................ 63
Hyperparathyroidism ..................................................................................................... 64
Osteitis Deformans (Paget’s Disease)................................................................................... 65
Osteomalacia ................................................................................................................ 67
Osteoporosis ................................................................................................................. 68
Rickets........................................................................................................................ 72
Oncology disorders
Soft Tissue Sarcoma ......................................................................................................... 73
Bone Sarcoma ............................................................................................................... 75
Orthopaedic Injuries
Fractures ..................................................................................................................... 78
Page 2 of 196
,MEDSTUDY.COM
Herniated Disc ............................................................................................................... 87
Overuse of Joints (Carpal Tunnel, Impingement Syndrome, Rotator Cuff Tears) ................................. 90
Joint and Soft Tissue Injuries .............................................................................................. 93
SURGERIES & NON-SURGICAL INTERVENTIONS
Amputations for Oncological Conditions ................................................................................. 95
Anterior Cervical Discectomy and Fusion.............................................................................. 102
Hip Arthroplasty............................................................................................................. 105
Knee Arthroplasty ......................................................................................................... 111
Lumbar Laminectomy ..................................................................................................... 116
Lumbar Laminectomy and Spinal Fusion .............................................................................. 119
Pelvic Acetabular Osteotomy ............................................................................................. 121
Principles of Cast Care..................................................................................................... 124
Prostalac .................................................................................................................... 125
Resection Arthroplasty – (Girdlestone) ................................................................................. 128
Traction ...................................................................................................................... 130
COMPLICATIONS
Anemia ....................................................................................................................... 131
Compartment Syndrome ................................................................................................. 134
Contractures................................................................................................................ 140
Deep Vein Thrombosis (DVT) & Pulmonary Embolism (PE) ...................................................... 141
Fat Embolism (FE) Syndrome ............................................................................................ 146
Fracture Blisters ............................................................................................................ 149
Infection – Post Arthroplasty .............................................................................................. 150
Osteomyelitis ........................................................................................................... 151
Necrotizing Faciitis.........................................................................................................154
Pain ........................................................................................................................... 154
Neuropathic Pain (NP) ................................................................................................. 155
Post-Polio Disease ......................................................................................................... 158
Pressure Injuries ........................................................................................................... 160
Septic Joint Arthritis ........................................................................................................ 161
Substance Withdrawal ...................................................................................................162
FRAIL ELDERLY
Constipation in Older Adults .............................................................................................. 163
Delirium ...................................................................................................................... 166
Falls: The Frail Elderly ..................................................................................................... 168
Malnutrition in the Frail Older Adult ..................................................................................... 172
Avoiding Restraints........................................................................................................ 174
MEDICATIONS
Anticoagulation ............................................................................................................ 178
Biologics & Disease Modifiers ........................................................................................... 183
Biphosphonates .......................................................................................................... 185
Corticosteroids ........................................................................................................... 185
Answers ......................................................................................................................... 187
ACKNOWLEDGEMENTS ................................................................................................. 191
Page 3 of 196
, MEDSTUDY.COM
OVERVIEW
Reconstructive-orthopaedic nurses care, support and educate people and their
families who are coping with orthopaedic conditions and surgeries. Conditions that afflict
the orthopaedic population may be degenerative, traumatic, inflammatory,
neuromuscular, congenital, or oncologic in nature. Reconstructive surgery may be
performed to relieve pain, restore function, reconstruct limbs and eradicate disease or
infection. While the adult reconstructive population represents the full spectrum of ages
from adolescence onwards, the majority of patients are older and many have complex
health problems. Pre-existing illness, social and emotional conditions may have a
profound effect on the person’s coping style, recovery and maintenance of health.
Patients are viewed in the context of their unique biological, social, family,
psychological, cultural and spiritual dimensions.
Reconstructive-orthopaedic nurses are attuned to the complex needs of this
population and are prepared to prevent, detect and effectively intervene with clinical
problems. They provide expert care, comfort and support. They promote healing, self-
care, optimal health and the prevention of illness and injury. They assess the person’s
unique health and social needs and coordinate care with the interdisciplinary team and
community supports.
Anatomy & Physiology
Understand the structure, development & function of different components of the body
and how they affect mobility and healing for an orthopaedic patient.
Knowledge of Underlying Conditions
Describe/define the condition; identify characteristics of the population at risk. Describe
the prevention, detection and/or management of the condition. Identify pertinent
assessments, interventions and patient teaching strategies for reconstructive-
orthopaedic nurses.
Surgeries
Specify for each surgical procedure: indications for surgery, population characteristics,
description of surgery/prosthesis, common clinical problems and why they occur, and
postoperative care considerations.
Clinical Problems & Complications
Identify who is at risk and why and how to prevent, detect and manage.
Psycho-Social Support
Page 4 of 196
The Canadian Orthopaedic Nurses Association
Association Canadienne des Infirmières
et Infirmiers en Orthopédie
ORTHOPEDIC
REVIEW FOR
NURSING
PRACTICE
The Rapid Reviews have been revised with permission from the Orthopaedic
Specialty Preparation Program at Vancouver Coastal Health. They provide a synopsis
of key information versus a comprehensive coverage of the topics.
Dedicated to orthopaedic nurses who strive to gain further knowledge and
understanding of Reconstructive Orthopaedics in a rapid paced environment.
Orthopedic Review for Nursing Practice
This document is considered one of several tools available to assist orthopaedic
nurses to prepare for certification for orthopaedic nursing through CNA. Note: this
document contains summary information versus comprehensive coverage.
,MEDSTUDY.COM
TABLE OF CONTENTS
OVERVIEW
ANATOMY & PHYSIOLOGY
Bone structure, Development, and Function ............................................................................ 6
Joints ............................................................................................................................ 8
Muscle, Tendons & Ligaments ............................................................................................ 12
Neurovascular System .................................................................................................... 13
The Integumentary System, Development, and Function ...........................................................14
ORTHOPEDIC CONDITIONS
Congenital
Cerebral Palsy ................................................................................................................ 16
Development Dysplasia of the Hip ........................................................................................ 17
Hemophilia A (Factor VII) & B (Factor IX) ............................................................................... 19
Osteogenesis Imperfecta (Brittle Bone Disease) ....................................................................... 22
Scoliosis ..................................................................................................................... 25
Spina Bifida .................................................................................................................. 25
Talipes Equinovarus (Club Foot) .......................................................................................... 27
Degenerative Conditions
Chondromalacia Patella (Patellofemoral Pain Syndrome) ........................................................... 30
Degenerative Disc Disease ................................................................................................. 33
Osteoarthritis (OA) ........................................................................................................... 33
Spinal Stenosis............................................................................................................... 36
Spondylolisthesis ........................................................................................................... 38
Developmental Conditions
Osgood-Schlatter........................................................................................................... 41
Legg-Calve-Perthes Disease ............................................................................................. 42
Slipped Capital Femoral Epiphysis ...................................................................................... 43
Inflammatory and Autoimmune disorders
Ankylosing Spondylitis (AS)................................................................................................ 45
Chronic Childhood Arthritis............................................................................................................. 47
Psoriatic Arthrititis ........................................................................................................... 49
Rheumatoid Arthritis (RA) ................................................................................................... 51
Systemic Lupus Erythematosus (SLE) ................................................................................... 57
Systemic Sclerosis ......................................................................................................... 61
Metabolic disorders
Gout ............................................................................................................................ 63
Hyperparathyroidism ..................................................................................................... 64
Osteitis Deformans (Paget’s Disease)................................................................................... 65
Osteomalacia ................................................................................................................ 67
Osteoporosis ................................................................................................................. 68
Rickets........................................................................................................................ 72
Oncology disorders
Soft Tissue Sarcoma ......................................................................................................... 73
Bone Sarcoma ............................................................................................................... 75
Orthopaedic Injuries
Fractures ..................................................................................................................... 78
Page 2 of 196
,MEDSTUDY.COM
Herniated Disc ............................................................................................................... 87
Overuse of Joints (Carpal Tunnel, Impingement Syndrome, Rotator Cuff Tears) ................................. 90
Joint and Soft Tissue Injuries .............................................................................................. 93
SURGERIES & NON-SURGICAL INTERVENTIONS
Amputations for Oncological Conditions ................................................................................. 95
Anterior Cervical Discectomy and Fusion.............................................................................. 102
Hip Arthroplasty............................................................................................................. 105
Knee Arthroplasty ......................................................................................................... 111
Lumbar Laminectomy ..................................................................................................... 116
Lumbar Laminectomy and Spinal Fusion .............................................................................. 119
Pelvic Acetabular Osteotomy ............................................................................................. 121
Principles of Cast Care..................................................................................................... 124
Prostalac .................................................................................................................... 125
Resection Arthroplasty – (Girdlestone) ................................................................................. 128
Traction ...................................................................................................................... 130
COMPLICATIONS
Anemia ....................................................................................................................... 131
Compartment Syndrome ................................................................................................. 134
Contractures................................................................................................................ 140
Deep Vein Thrombosis (DVT) & Pulmonary Embolism (PE) ...................................................... 141
Fat Embolism (FE) Syndrome ............................................................................................ 146
Fracture Blisters ............................................................................................................ 149
Infection – Post Arthroplasty .............................................................................................. 150
Osteomyelitis ........................................................................................................... 151
Necrotizing Faciitis.........................................................................................................154
Pain ........................................................................................................................... 154
Neuropathic Pain (NP) ................................................................................................. 155
Post-Polio Disease ......................................................................................................... 158
Pressure Injuries ........................................................................................................... 160
Septic Joint Arthritis ........................................................................................................ 161
Substance Withdrawal ...................................................................................................162
FRAIL ELDERLY
Constipation in Older Adults .............................................................................................. 163
Delirium ...................................................................................................................... 166
Falls: The Frail Elderly ..................................................................................................... 168
Malnutrition in the Frail Older Adult ..................................................................................... 172
Avoiding Restraints........................................................................................................ 174
MEDICATIONS
Anticoagulation ............................................................................................................ 178
Biologics & Disease Modifiers ........................................................................................... 183
Biphosphonates .......................................................................................................... 185
Corticosteroids ........................................................................................................... 185
Answers ......................................................................................................................... 187
ACKNOWLEDGEMENTS ................................................................................................. 191
Page 3 of 196
, MEDSTUDY.COM
OVERVIEW
Reconstructive-orthopaedic nurses care, support and educate people and their
families who are coping with orthopaedic conditions and surgeries. Conditions that afflict
the orthopaedic population may be degenerative, traumatic, inflammatory,
neuromuscular, congenital, or oncologic in nature. Reconstructive surgery may be
performed to relieve pain, restore function, reconstruct limbs and eradicate disease or
infection. While the adult reconstructive population represents the full spectrum of ages
from adolescence onwards, the majority of patients are older and many have complex
health problems. Pre-existing illness, social and emotional conditions may have a
profound effect on the person’s coping style, recovery and maintenance of health.
Patients are viewed in the context of their unique biological, social, family,
psychological, cultural and spiritual dimensions.
Reconstructive-orthopaedic nurses are attuned to the complex needs of this
population and are prepared to prevent, detect and effectively intervene with clinical
problems. They provide expert care, comfort and support. They promote healing, self-
care, optimal health and the prevention of illness and injury. They assess the person’s
unique health and social needs and coordinate care with the interdisciplinary team and
community supports.
Anatomy & Physiology
Understand the structure, development & function of different components of the body
and how they affect mobility and healing for an orthopaedic patient.
Knowledge of Underlying Conditions
Describe/define the condition; identify characteristics of the population at risk. Describe
the prevention, detection and/or management of the condition. Identify pertinent
assessments, interventions and patient teaching strategies for reconstructive-
orthopaedic nurses.
Surgeries
Specify for each surgical procedure: indications for surgery, population characteristics,
description of surgery/prosthesis, common clinical problems and why they occur, and
postoperative care considerations.
Clinical Problems & Complications
Identify who is at risk and why and how to prevent, detect and manage.
Psycho-Social Support
Page 4 of 196
