Compile by

ORTHOPEDIC NURSING Fida Ur Rahman

RN, DPN, BScN
Nursing lecturer
OBJECTIVES
Define bone tumor and bone tuberculosis
Describe etiology of bone tumor and TB
Discuss sign and symptoms of bone tumor and TB
Enlist investigation for bone tumors and TB
Describe management (nursing, medical)
Apply nursing process for the patient of above diseases
 BONE TUMORS
Neoplasms of the musculoskeletal system are of various types,
including osteogenic, chondrogenic, fibrogenic, muscle
(rhabdomyogenic), and marrow (reticulum) cell tumors as well
as nerve, vascular, and fatty cell tumors.
They may be primary tumors or metastatic tumors from
primary cancers elsewhere in the body (eg, breast, lung, prostate,
kidney).
Metastatic bone tumors are more common than primary bone
tumors
 BENIGN BONE TUMORS
Benign tumors of the bone and soft tissue are more common than
malignant primary bone tumors.
Benign bone tumors generally are slow growing, well
circumscribed, and encapsulated; present few symptoms;
Benign primary neoplasms of the musculoskeletal system include
osteochondroma, enchondroma, bone cyst (eg, aneurysmal bone
cyst), osteoid osteoma, rhabdomyoma, and fibroma.
Some benign tumors, such as giant cell tumors, have the potential
to become malignant.
 TYPES
Osteochondroma is the most common benign bone tumor. It usually occurs as a large
projection of bone at the end of long bones (at the knee or shoulder).
Enchondroma is a common tumor of the hyaline cartilage that develops in the hand, femur,
tibia, or humerus. Usually, the only symptom is a mild ache. Pathologic fractures may occur.
Bone cysts are expanding lesions within the bone. Aneurysmal (widening) bone cysts are
seen in young adults, who present with a painful, palpable mass of the long bones,
vertebrae, or flat bone.
Osteoid osteoma is a painful tumor that occurs in children and young adults. The neoplastic
tissue is surrounded by reactive bone formation that can be identified by x-ray.
Giant cell tumors (osteoblastomas) are benign for long periods but may invade local tissue
and cause destruction. They occur in young adults and are soft and hemorrhagic. Eventually,
giant cell tumors may undergo malignant transformation and metastasize
 MALIGNANT BONE TUMORS
Primary malignant musculoskeletal tumors are relatively rare and arise from connective and
supportive tissue cells (sarcomas) or bone marrow elements (multiple myeloma)
Osteosarcoma (ie, osteogenic sarcoma) is the most common and most often fatal primary
malignant bone tumor.
Osteosarcoma appears most frequently in children, adolescents and young adults (in bones that
grow rapidly), in older people with Paget’s disease of the bone, and in people with a prior
history of radiation exposure.
Malignant tumors of the hyaline cartilage are called chondrosarcomas. These tumors are
the second most common primary malignant bone tumor. They are large, bulky, tumors that
may grow and metastasize slowly or very fast, depending on the characteristics of the tumor
cells involved (ie, grade).
Metastatic bone disease (secondary bone tumor) is more common than primary bone
tumors. Tumors arising from tissues elsewhere in the body may invade the bone and produce
localized bone destruction (lytic lesions) or bone overgrowth (blastic lesions).
 PATHOPHYSIOLOGY
A tumor in the bone causes the normal bone tissue to react by osteolytic
response (bone destruction) or osteoblastic response (bone formation).
Primary tumors cause bone destruction, which weakens the bone,
resulting in bone fractures. Adjacent normal bone responds to the tumor
by altering its normal pattern of remodeling. The bone’s surface changes
and the contours enlarge in the tumor area.
Malignant bone tumors invade and destroy adjacent bone tissue. Benign
bone tumors, in contrast, have a symmetric, controlled growth pattern
and place pressure on adjacent bone tissue. Malignant bone tumors
invade and weaken the structure of the bone until it can no longer
withstand the stress of ordinary use; pathologic fracture commonly result
 SIGN AND SYMPTOMS
Patients with metastatic bone tumor may have a wide range of
associated clinical manifestations. They may be symptom-free or
have pain that ranges from mild and occasional to constant and
severe, varying degrees of disability, and, at times, obvious bone
growth. Weight loss, malaise, and fever may be present. The tumor
may be diagnosed only after pathologic fracture has occurred.
Metastasis, spinal cord compression may occur. It can progress
rapidly or slowly. Neurologic deficits (eg, progressive pain,
weakness, gait abnormality, paresthesia, paraplegia, urinary retention,
loss of bowel or bladder control) must be identified early and treated
 INVESTIGATIONS
Diagnosis is based on the history, physical examination, and diagnostic
studies, including CT, bone scans, myelography, arteriography, MRI,
biopsy, and biochemical assays of the blood and urine.
Serum alkaline phosphatase levels are frequently elevated with osteogenic
sarcoma.
Hypercalcemia is present with bone metastases from breast, lung, or
kidney cancer.
A surgical biopsy is performed for histologic identification.
Chest x-rays are performed to determine the presence of lung metastasis.
Staging is used for planning treatment.
 MANAGEMENTS
The goal of primary bone tumor treatment is to destroy or remove the tumor.
This may be accomplished by surgical excision (ranging from local excision to
amputation and disarticulation),
Radiation therapy if the tumor is radiosensitive, and
Chemotherapy
Chemotherapy may be delivered intra-arterially for patients with osteosarcoma;
Limb-sparing (salvage) procedures are used to remove the tumor and adjacent tissue.
Surgical removal of the tumor may require amputation of the affected extremity, with the
amputation extending well above the tumor to achieve local control of the primary lesion
The treatment of metastatic bone cancer is palliative. The therapeutic goal is to relieve
the patient’s pain and discomfort while promoting quality of life
 NURSING MANAGEMENT
The nurse asks the patient about the onset and course of symptoms.
During the interview, the nurse assesses the patient’s understanding of the disease process, how the patient
and the family have been coping, and how the patient has managed the pain.
On physical examination, the nurse gently palpates the mass and notes its size and associated soft tissue
swelling, pain, and tenderness.
Assessment of the neurovascular status and range of motion of the extremity provides baseline data for
future comparisons.
Assessing for undergoing or post operative complication Vital signs are monitored; blood loss is assessed;
and observations are made to assess for the development of complications such as DVT, pulmonary
embolism, infection, contracture, and disuse atrophy.
The affected part is elevated to reduce edema, and the neurovascular status of the extremity is assessed.
Patient and family teaching about the disease process and diagnostic and management regimens is essential.
Accurate pain assessment and use of pharmacologic and nonpharmacologic pain management techniques are
used
BONE TUBERCULOSIS
oBone tuberculosis, also known as skeletal tuberculosis or
osteoarticular tuberculosis,
ois a form of tuberculosis (TB) that primarily affects the bones,
joints, and surrounding tissues.
oIt is caused by the bacteria Mycobacterium tuberculosis, which
usually enters the body through the respiratory system and can
spread to other parts, including the bones and joints.
GLOBAL PREVALENCE
oBone TB is relatively rare compared to pulmonary
tuberculosis, accounting for only about 1-3% of all cases
of TB worldwide.
oHowever, it is more common in areas with a higher
burden of TB,
RISK FACTORS
oCertain factors increase the risk of developing bone TB.
oThese include having a weakened immune system (such
as in HIV/AIDS or malnutrition), close contact with an
active TB patient, living in crowded and poorly ventilated
conditions, and having a history of previous TB infection.
 PATHOPHYSIOLOGY
oBone TB occurs when the bacteria Mycobacterium tuberculosis, responsible
for tuberculosis, spreads through the bloodstream or lymphatic system and
reaches the bones and joints.
oIt typically affects the spine, long bones (such as the femur and tibia), and the
hip and knee joints.
oThe migration of mycobacterium to bone or joint from primary source
colonized and causes inflammation at that area and manifestation of symptoms
occurs
oMost commonly affected parts of skeletal system are joints, spinal cord and
long bones
SIGN AND SYMPTOMS
oThe symptoms of bone TB can vary depending on the site of
infection.
oCommon symptoms include persistent pain in the affected area,
swelling, joint stiffness, limited mobility, and sometimes a visible
lump or abscess over the bone or joint.
oSystemic symptoms like fever, night sweats, and weight loss may
also be present.
DIAGNOSIS
oDiagnosis of bone TB involves a thorough medical history,
physical examination,
oimaging tests (such as X-rays, CT scans, or MRI),
olaboratory tests (such as blood tests and biopsies) to detect the
presence of TB bacteria or the characteristic bone changes caused
by the infection.
oJoint fluid examination
MANAGEMENTS
oBone TB is treated with a combination of anti-tuberculosis drugs for a
minimum of 6-9 months.
oSurgical intervention may be necessary in some cases, especially if there is
an abscess, joint destruction, or spinal cord compression.
oTreatment should be closely monitored by a healthcare professional to
ensure optimal outcomes
oWith proper diagnosis and timely treatment, the prognosis for bone TB is
generally good.
oHowever, delayed diagnosis or inadequate treatment can lead to
complications such as joint destruction, deformities, and permanent disability
 MUSCULOSKELETAL MODALITIES
Traction in the health context refers to the application of controlled forces to
specific parts of the body for therapeutic purposes.
It is commonly used to treat various musculoskeletal conditions, particularly
those involving the spine and joints.
Traction works by gently stretching the affected area, relieving pressure on the
joints, nerves, and discs.
The application of traction can help alleviate pain, improve spinal alignment,
and increase mobility.
It can be done through manual techniques, such as the hands-on manipulation
by a trained therapist, or through mechanical devices that apply the pulling
force.
USES
Traction therapy is often employed for conditions such as
herniated discs,
degenerative disc disease,
sciatica, spinal stenosis,
facet joint dysfunction.
It can also be beneficial for certain types of fractures or
joint dislocations.
 NURSING MANAGEMENTS
General principles
ALWAYS ensure that the weights hang freely and do not touch the floor
NEVER remove the weights
Maintain proper body alignment
Ensure that the pulleys and ropes are properly functioning and fastened by
tying square knot
Observe and prevent foot drop
Provide foot plate
Observe for DVT, skin irritation and breakdown
 CAST
oA cast is a rigid, protective device used to immobilize and support a broken bone or
injured limb.
oIt is typically made of fiberglass or plaster and is molded to the shape of the affected area.
oCasts are commonly used to stabilize fractures, promote proper healing, and prevent
movement that could further damage the injury.
oThey provide support to the injured bone or joint by limiting its motion, reducing pain,
and aiding in the recovery process.
oIt's important to follow the instructions provided by your healthcare professional for
proper care and maintenance of the cast to ensure the best outcome.
oCasts are usually removed by a healthcare professional once the injury has
sufficiently healed.
TYPES OF CAST
1. Long arm
2. Short arm
3. Short leg
4. Long leg
5. Spica
6. Body cast
 NURSING MANAGEMENTS
Allow the cast to air dry (usually 24-72 hours)
Handle a wet cast with the PALMS not the fingertips
Keep the casted extremity ELEVATED using a pillow
Turn the extremity for equal drying.
DO NOT USE DRYER for plaster cast
Encourage mobility and range of motion exercises
Petal the edges of the cast to prevent crumbling of the edges
Examine the skin for pressure areas and Regularly check the pulses and skin
Instruct the patient not to place sticks or small objects inside the cast
Monitor for the following: pain, swelling, discoloration, coolness, tingling or lack of
sensation and diminished pulses