MUSCULOSKELETAL SYSTEM March 2019

Historical Perspective of ORTHOPAEDICS Orthopedik adalah cabang ilmu bedah, berhubungan dengan pemeliharaan dan pemulihan fungsi sistem rangka, persendian, dan struktur yang berkaitan. Bedah orthopedi adalah suatu tindakan bedah untuk memulihkan kondisi disfungsi muskuloskeletal Berhubungan dengan koreksi deformitas sistem muskuloskeletal berhubungan dengan orthopedik seperti, fraktur yang tidak stabil, deformitas, dislokasi sendi, jaringan nekrosis dan terinfeksi, sindrom kompartemen, serta sistem muskuloskeletal.

Derived from two Greek words, orthos= straight and paidos= child. “The art of Correcting and Preventing Deformities in Children” Was introduced in 1741 by Nicolas Andre. First Orthopaedic Institute was founded in Switzerland in 1780 Orthopaedic practitioners were known as “strap-and-buckle” as they use the appliances to straighten body and limbs Spesialisasi medis yang berkaitan dengan koreksi cacat yang disebabkan oleh penyakit atau kerusakan (termasuk trauma) tulang dan sendi Keperawatan Ortopedi Praktisi Ortopedi dikenal sebagai "tali-dan-gesper" karena mereka menggunakan peralatan untuk meluruskan tubuh dan anggota badan

HUGH OWEN THOMAS (1834-1891) was known for his ability to set broken bones and reduce dislocated joints

AGNES HUNT (1862-1948) “The Florence Nightingale of Orthopaedic Nursing” AGNES HUNT suffered from an orthopaedic deformity in childhood but she went to open a home called the “Baschurch Home” in Oswestry, England. IT then grew into a large orthopaedic hospital with a school for training orthopaedic nurses.

What is musculoskeletal? Muscle Otot Tendon Ligamen Skeletal/ rangka Tulang Sendi Musculoskeletal system enables changes in movement (pergerakan) and position (bentuk tubuh) penunjang bentuk tubuh dan mengurus pergerakan Tendon: fibrous connective tissue, tie bones to muscles-struktur dalam tubuh yang lentur tapi kuat yang menghubungkan otot ke tulang Ligamen: fibrous connective tissue, tie bones to bones Sendi: part of skeleton where two or more bones are connected-penghubung antar 2 tulang agar bisa digerakkan Tulang rawan: fungsi: menyokong jaringan lunak, memberi kekuatan dan kelenturan, memungkinkan fleksibilitas 3 macam tulang rawan: hialin (ketika dewasa, tl rawan di ganti tl keras), elastis (lentur: auricular, epiglotis, larings), fibrokartilago (mengandung serat kolagen)

penunjang bentuk tubuh dan mengurus pergerakan ROM= limited

Review of the Skeletal System Functions of the Bones Primary function is to produce : skeletal movements (pergerakan) 1. Locomotion- memberikan pergerakan (otot  berhubungan dengan kontraksi dan pergerakan). 2. Protection- melindungi organ tubuh  (jantung, otak, paru-paru, dan jaringan lunak). 3. Support- mendukung jaringan tubuh dan memberikan bentuk tubuh (give form to the body)-memberikan bentuk tubuh (skull- to protect the brain, rib cage- to protect the heart and lungs)

4. Blood production- membentuk sel-sel darah merah di dalam sumsum tulang  (hematopoesis) 5. Mineral deposition- menyimpan garam-garam mineral (kalsium, fosfor, magnesium dan fluor).

SKELETAL SYSTEM Tulang adalah jaringan yang paling keras diantara jaringan ikat lainnya yang terdiri atas: hampir 50 % air dan bagian padat, selebihnya mineral (calcium) kurang lebih 67 % dan bahan seluler 33%.

Komponen utama dari sistem muskuloskeletal adalah tulang dan jaringan ikat yang menyusun kurang lebih 25 % berat badan dan otot menyusun kurang lebih 50% (muscle plays a major role in metabolism and temperature regulation)

GROSS ANATOMY OF THE BONES A. Axial= 80 B. Appendicular= 126 AXIAL: 80 APPENDICULAR: 126 Total: 206

A. AXIAL Skull Cranium 8 Face 14 Hyoid 1 Auditory ossicles 6 Vertebral column 26 Thorax Sternum 1 Ribs 24 TOTAL 80 Skull (kepala) – Cranium (brain box)

I. SKULL - (Brain box) CRANIUM Frontal 1 bone of the forehead Parietal 2 roof Temporal 2 sides of the cranium Occipital 1 back of the head Ethmoid 1 anterior floor of cranium Sphenoid 1 posterior floor of cranium Anterior: bagian depan cranium Posterior: bagian belakang cranium

Temporal= where TMJ is found (Temporo Mandibular Joint)- sendi Occipital= connect dengan atlas to form atlanto-occipital joint allows us to nod, say YES

II. FACE Maxilla 2 upper jaw Mandible 1 lower jaw Zygomatic 2 cheek bones Nasal 2 sides of the nose Vomer 1 nasal septum Lacrimal 2 help form orbit Inferior conchae 2 sides, nasal cavity Palatine 2 mouth, interior Skull= tulang tengkorak Palatine= roof of the mouth, separate the nasal & mouth cavity Cleft lip and cleft palate

Every bone is connected to another bone , with one exception “Hyoid” It is also at the base of the mandible, near the thyroid. Attachment and protection for many muscles associated with the mouth's floor, as well as the larynx, pharynx, and epiglottis. Support the tongue and elevate the larynx when talk or swallow. May fracture. A broken hyoid results from strangulation (cekik). The only bones that does not articulate with any other bones

Auditory ossicles Malleus 2 Incus 2 Stapes 2

III. BONES OF THE TRUNK (Anterior) Sternum (Breastbone) A. Manubrium B. Body C. Xyphoid process Where we do CPR. Place two fingers above the xyphoid process and start cpr

RIBS (Antero-posterior) True 7 pairs Attached to the sternum FALSE Ribs: False 3 pairs Attached to the true ribs Floating 2 pairs Attached to the vertebra Part of the bones of the trunk, the ribs

TRUE ribs- anteriorly attached to the sternum, posteriorly attached to vertebra FALSE ribs- anteriorly attached to the true ribs, posteriorly attached to vertebra FLOATING- posteriorly to vertebra but not to sternum

VERTEBRAL COLUMN Cervical (7) Atlas- 1st cervical vertebra (occipital condyle rests on the surface of the atlas “YES”) Axis- 2nd cervical vertebra (connects with atlas by odontoid process “NO”) “neural foramen”

Thoracic vertebra (12) Connect to vertebral end of ribs

Lumbar vertebrae 5 Sacrum 1 Coccyx 1 Coccyx- supports the trunk when in sitting position Lumbar vertebrae 5 Sacrum 1 Coccyx 1

B. APPENDICULAR I. Pectoral Girdle: bones attach arms to the trunk Clavicle (shoulder) 2 Scapula (shoulder blade) 2

II. Upper Extremities Humerus (upper arm bone) 2 Radius (lateral bone of lower arm) 2 Ulna (medial arm bone) 2 Carpals (wrist bones) 14 Metacarpals (palm bones) 10 Phalanges (finger bones) 28

Humerus (upper arm bone) 2 Radius (lateral bone of lower arm) 2 Ulna (medial arm bone) 2 Carpals (wrist bones) 14 Metacarpals (palm bones) 10 Phalanges (finger bones) 28

III. Lower Limb Pelvic Girdle (2) (attaches lower extremities to the trunk) 1. Ilium 2. Ischium 3. Pubis

Lower Extremities 1. Femur (upper leg bone) 2 2. Patella (knee bone) 2 3. Tibia (lower leg bone, medial) 2 4. Fibula (lower leg bone, lateral) 2 5. Tarsal bones 14 6. Metatarsals 10 7. Phalanges 28

Tibia (lower leg bone, medial) – medial malleolus 2 Fibula (lower leg bone, lateral) – lateral malleolus 2

DID YOU KNOW? Olecranon process Medial malleolus Lateral malleolus

CLASSIFICATION Long bones: long, wide, found in the upper and lower extremities (humerus, radius, ulna, femur, tibia, fibula, metatarsals, metacarpals, phalanges) Short bones: do not have long axis, cubical (carpals, tarsals) Flat bones: provide soft body parts, provide large surfaces for muscle attachments (ribs, cranium, scapula, portion of pelvic girdle) Irregular bones: have various shapes (vertebrae, ear ossicles, facial bones, pelvis) There are also bones in the fingers that are classified as "long bones," even though they are short in length. This is due to the shape of the bones, not the actual size.