CHAPTER I

INTRODUCTION

1.1 Background
The musculoskeletal system is one system of the body that was instrumental to the function of a
person's movement and mobility. Supporting the most dominant component in this system is the
bone. Problems or disorders of the bone will be able to affect the movement of a person's system,
ranging from infants, children, adolescents, adults, and the elderly. One of the musculoskeletal
problems that often we find around us is a fracture or fractures.
Usman (2012) mentions that the results of the data Basic Health Research (RISKESDAS) in
2011, in Indonesia fracture caused by the injuries are due to falls, traffic accidents and trauma sharp /
blunt. Of 45 987 events fell fracture as much as 1,775 persons (3.8%), from 20 829 cases of traffic
accidents, fractures as much as 1,770 persons (8.5%), from 14 127 trauma sharp / blunt, which is
fractured as many as 236 people (1.7%). (MOH 2009) And according to the data department of health
2005 East Kalimantan victim fractures resulting from accidents range from 10.5%, while based on
data obtained from medical records at the hospital record islam samarinda, data on the year 2012 (the
period of January - June) found 14 cases fracture, while for the month of July there were 7 cases of
fracture.
Bone fracture is a break of continuity is determined according to the type and extent of (Smeltzer,
2001). Management of fracture is common action (Handerson, 1997, p.222) namely Repositoning is
each shift or angulation of the fracture ends must be repositioned carefully through manipulation
which usually under general anesthesia, consist of (1) immobilization is to allow the necessary
healing fragment;and (2) Physiotherapy and mobilization is to improve the muscles that can quickly
shrink when not in use.

The integumentary system is composed of the skin, hair, nails, sebaceous glands, and sweat
glands. The skin has four main functions: protection, temperature regulation, secretion of sweat or oil, and
sensation of pain, touch, temperature, and pressure (Jahangir Moini. The Pharmacy Technican.2005).
Supporting the most dominant component in this system is the skin. There are some problems or
disruption of the skin. One of the integument system problem is scabies.

The results of the statistical test using the Spearman Rho test with p 0.05. The results showed that
as many as 16 respondents (55.25) with moderate scabies have less personal hygiene. In scabies with a
mild degree of personal hygiene that have as many as 13 respondents (44.8%). Spearman Rho test results
showed P: 0.013 with a significance level of p 0.05 means that H0 is rejected which means that there is a

1
relationship between personal hygiene with the incidence of scabies in adolescents at boarding school Al-
Hidayah Ketegan Tanggulangin Sidoarjo.

Scabies is a contagious skin infection that spreads rapidly in crowded conditions and is found
worldwide. Personal hygiene is an important preventive measure and access to adequate water supply is
important in control (WHO, 2015).Scabies is identical to the boarding school childhood diseases, the
cause is less maintained sanitary conditions, poor sanitation, malnutrition and too humid room conditions
and receive less direct sunlight. Contagious skin disease scabies quickly in a community living together
so that the treatment should be carried out simultaneously and comprehensively on all the people and the
environment in communities afflicted by scabies, because if the treatment is done on an individual basis it
will be easy to catch back the disease scabies (Yosefw, 2007).

The incidence of scabies are common in people who live together in certain facilities, such as
dormitories, boarding schools, nursing homes, hospitals, hospitalization, prison and other facilities. This
is caused by the high density of occupants that may affect the development of scabies. The incidence of
scabies has been estimated at 300 million cases of scabies occur in epidemics in nursing homes, hospitals,
inpatient facilities, and other institutions (Makigami, 2009).

Boarding school is an institution that provides some boarding facilities are used jointly, therefore
students vulnerable to contracting the scabies disease. Against 70 students, obtained 62.9% of students
were exposed to the scabies. This is because the exchange of clothing, blankets, towels and bed together
and habits of students ablution not use tap water (Handajani, 2007).

To study and know the changes that occur in the human body, first we must understand the
structure and function of each means from a healthy human body composition in life. Knowledge of the
anatomy and physiology of the human body is an important basis in implementing nursing care. By
knowing the structure and function of the human body, a professional care can be more clearly known
changes contained in the body of the means. After we know the anatomy and physiology of
musculoskeletal and integumentary system, we also know about the disease in the system organ include
fracture and scabies.
1.2 Problem Formulation
1. What is anatomy and physiology of musculoskeletal and integumentary system ?
2. What are types and classification of fractures and scabies ?
3. What is the etiology of fractures and scabies ?
4. How is the clinical appearances of fractures and scabies ?
1.3 Purpose

2
 1. Knowing and understanding the anatomy and physiology of musculoskeletal and integumentary
system.
2. Knowing and understanding the types and classification of fractures and scabies.
3. Knowing understanding etiology of Fractures and Scabies.
4. Knowing clinical appearances of Fractures and Scabies.
1.4 Benefits
1. Adding to students about the musculoskeletal and integumentary system.
2. Increase student knowledge about the clinical appearances of musculoskeletal and integumentary
system.

3

2.1 Anatomy and Physiology of Musculoskeletal and Integumentary System
2.1.1 Anatomy of Musculoskeletal System
1. BONE
1.1 Axial Skeleton
a. Bones of the Skull
Table 1.1 Bone of the skull in human body
Name
Cranial Bones
Frontal (Brow bone)
Parietal ( Cantle bone)
Temporal (Temple bone)
Occipital (Rear head bone)
Sphenoid (Wedge bone)
Ethmoid
CHAPTER 2
CONTENTS
Number Description
1 Forehead bone; also forms front part of floor
of cranium and most of upper part of eye
sockets; cavity inside bone above upper
margins of eye sockets (orbits) called frontal
sinus; lined with mucous membrane
2 Forms bulging topsides of cranium
2 Form lower sides of cranium; contain middle
and inner ear structures; mastoid sinuses are
mucosa-lined spaces into mastoid process
1 Forms back of skull; spinal cord enters
cranium through large hole (foramen
magnum) in occipital bone
1 Forms central part of floor of cranium;
pituitary gland located in small depression in
sphenoid called sella turcica (Turkish saddle)
1 Uniwuely shaped bone that helps form floor
of cranium; side walls, root of nose, and part
4

Face Bones
Nasal (Nose bone)
Maxilla (Upper Jawbone)
Zygomatic (Cheek bone)
Mandible (Lower
jawbone)
Lacrimal (Tears bone)
b. Bones of Vertebra Column
Table 1.2 Bones of vertebra column in human
Name
Cervical (Spine bone)
Thoracic vertebrae (Back 12
bone)
1
Thibodeau, A. Garry. 2012. Structure and Function of The Body. USA: Elsevier Mosby
of its middle partition (nasal septum-made up
of the vomer bone and the perpendicular plate
of the ethmoid bone
2 Small bones that form upper part of bridge of
nose
2 Help form roof of mouth, floor, and side walls
of nose and floor of orbit; large cavity in
maxillary bone is maxillary sinus
2 Help form orbit
1 Only bone of skull that moves freely; mental
foramen is hole for blood vessels and nerves
2 Small bones; help form medial wall of eye
socket and side wall of nasal cavity1
Number Description
7 Upper seven vertebrae, in neck region; first
cervical vertebra called atlas; second, axis
Next 12 vertebrae; ribs attach to these
5
 Lumbar vertebrae (Pelvis) 5 Next five vertebrae; located in small of back
Sacrum 1 In child, five separate vertebrae; in adult,
fused into one
Coccyx 1 In child, three to five separate vertebrae; in
adult, fused into one2

c. Bones of Thorax

Table 1.3 Bones of thorax in human body

Name Number Description

True ribs 14 Upper seven pairs; attached to sternum by
costal cartilages
False ribs 10 Lower five pairs; first three pairs attached to
sternum by costal cartilage of seventh ribs;
lowest to pairs do not attach to sternum,
therefore called floating ribs
Sternum 1 Breast bone; shaped like a dagger; piece of
cartilage at lower end of bone called xipoid
process; superior portion called the
manubrium3

2
Thibodeau, A. Gary. 2012. Structure and Function of The Body. USA: Elsevier Mosby
3
Thibodeau, A. Gary. 2012. Structure and Function of The Body. USA: Elsevier Mosby

6
 1.2 Appendicular Skeleton
a. Upper Extremities

Table 2.1 Upper extremities in human body

Name Number Description

Clavicle (Collar bones) 2 Only joints between pectoral (shoulder) and
axial skeleton are those between each clavicle
and sternum (sternoclavicular joints)
Scapula 2 Shoulder blades; scapula plus clavicle forms
pectoral (shoulder); glenoid cavity-arm socket
Humerus (Arm bones) 2 Muscles are attached to the greater tubercle
and to the medial and lateral epicondytes
Radius 2 Bone on thumb (lateral) side of forearm
Ulna 2 Bone on little finger (medial) side of forearm
Carpal bones 16 Short bones at upper end of hand; anatomical
wrist
Metacarpals 10 Form framework of palm of hand
Phalanges (Finger bones) 28 Finger bones; three in each finger, two in each
thumb4

4
Thibodeau, A. Gary. 2012. Structure and Function of The Body. USA: Elsevier Mosby

7
 b. Lower Extremity

Table 2.2 Lower extremities in human body

Name Number Description

Coxal (Hip) bone 2 Consist of Ilium, Ischium, Pubic bone,
Acetabulum, Pubis, Pelvic inlet
Femur (Thigh bone) 2 Head of femur-ball shaped upper end of
bone; fits into acetabulum
Patella 2 Kneecap
Tibia (Shin bone) 2 Medial malleolus-rounded projection at lower
end of tibia commonly called inner anklebone
Fibula 2 Long slender bone of lateral side of leg
Tarsal bones 14 Form heel and back part of foot; anatomical
ankle; largest in the calcaneus
Metatarsals 10 Form part of foot to which toes are attached;
tarsal and metatarsal bones arranged so that
they form three arches in foot
Phalanges (Toe bone) 28 Three in each of the smaller toes, two in each
great toe5

5
Thibodeau, A. Gary. 2012. Structure and Function of The Body. USA: Elsevier Mosby

8
 2. MUSCLE
a. Types of Muscle

1. Skeletal Muscle

Voluntary striated muscle that is usually attached to one or more bones. Because of
their extraordinary length, skeletal muscle cells are usually called muscle fibers or
myofibers. A skeletal muscle fiber is packed with protein microfilaments that overlap each
other in such a way as to produce alternating light and dark bands, or striations. Skeletal
muscle is called voluntary because it is usually subject to conscious control.

2. Cardiac Muscle
Cardiac muscle is also striated, but it is involuntary-not normally under conscious
control. Its cells are not fibrous in shape, and are therefore called myocytes or cardiocytes.6
3. Smooth Muscle
Smooth muscle contains the same contractile proteins as skeletal and cardiac muscle,
but they are not arranged in a regularly overlapping way, so there are no striations in
smooth muscle. Its cells, also called myocytes, are relatively short and fusiform in shape-that
is, thick in the middle and tapered at the ends. Smooth muscle, like cardiac muscle, is
involuntary7.

Function of Muscle

6
Saladin, Kenneth. 2007. Human Anatomy. Philipines: Mc Graw Hills
7
Saladin, Kenneth. 2007. Human Anatomy. Philipines: Mc Graw Hills

9
The function of muscular tissue are as follows:

a. Movements. Most obviously, the muscles enable us to move from place to palce
and to move indibidual body parts.
Muscular contraction also move body contents in the course of respiration,
circulation, digestion, defecation, urination, and childbirth.
b. Stability. Muscle maintain posture by resisting the pull of gravity snd preventing
unwanted movements. They also hold some articulating bones in place by
maintaining tension on the tendons.
c. Control of body openings and passages. Ringlike sphincter muscle around the
eyelids, pupils, and mouth control the admission of light, food, and drink into the
body; others that encircle the urethral and anal orifices control elimination of waste,
and other sphincters control the movement of food, bile, and other materials
through the body.
d. Heat production. The skeletal muscles produce as much as 85% of our body heat,
which is vital to the functioning of enzymes and therefore to all of our metabolism.
3. JOINTS
a. The Articulation
Table 3.1 The articulation of human body

Structural Description Subtypes Subtypes Examples Functional

Category Description Category
Bony Joints Bone directly Synostosis One type only The Synarthrosis
meeting epiphyseal
bone line
Fibrous Bones are Suture Very thin The skull Synarthrosis
hold interfocking suture
together by joints
fibrous C.T Syndesmosis Less tight with Distal Amphiarthrosis
more C.T articulation
of tibia and
fibula
Comphosis Fibrous C.T in Ligament Synarthrosis

10
 the form of a holding
peg in a hole of teeth in
bone jaw
Cartilaginous Bones are Synchondrosis Hyaline Epiphyseal Synarthrosis
held cartilage is plate
together by present
cartilage Symphisis Fibrocartilage Symphisis Amphiarthrosis
pubis
Synovial Bones are Based on Based on All freely Diarthrosis8
separated by structure and structure and movable
synovial movement movement joints
space
C.T = Connective Tissue

b. A Typical Synovial Joint

8
Clark, K. Robert. 2005. Anatomy and Phisiology:Understanding the Human Body. USA: Jones and Bartlett
Publisher Inc

11
Table 3.2 Terminology Describing Movements of The Human Body

Name of Movement Description

Flexion Decrease the angle of a joint to move bones closer together (bend
your elbow)
Extension Increase the angle of a joint to move bone apart (straighten your
elbow)
Hyperextension Extend a joint past the straight position (head backwards)
Abduction Move a limb away from the midline (lift your leg laterally from the
anatomical position)
Adduction Move a limb toward the midline (return your leg in the anatomical
position)
Circumduction A complex movements in which a limb describes a cone in the air (with
your arm or leg stiff, move that limb so your hand or foot completes a
circle)
Lateral Rotation Turn a structure away from the midline (from the anatomical position,
turn your head to one side)
Medial Rotation Turn a structure toward the midline (return your head to the
anatomical position)
Elevation Move a structure superiorly (shrug your shoulders)
Depression Move a structure inferiorly (pull your shoulders down)
Protraction Move a structure anteriorly (jut out your jaw)
Retraction Move a structure posteriorly (put your jaw in)
Dorsiflexion Specific for the ankle and foot, move superiorly (arch your foot up)
Plantar Flexion Specific for the ankle and foot, move inferiorly (arch your foot down)
Inversion Specific for the ankle and foot, rotate soles medially (face soles toward
each other)
Eversion Specific for the ankle and foot, rotate soles laterally (make soles face
outward)
Supination Specific for forearm, rotate palms anteriorly or superiorly (flex elbow,
then rotate forearm as if to collect money in your arm
Pronation Specific for forearm, rotate palms posteriorly or inferiorly (flex elbow,

12
 as if to dumb dust from your hand)
Opposition Move one digit across the hand (place your thumb across your palm, as
if to hold onto a rope9

2.1.2 Physiology of Musculoskeletal System

1. Axial Skeleton

The axial skeleton provides a framework that support and protects organs in the dorsal and
ventral body cavities. It also provides an extensive surface area for the attachment of muscles
that (1) adjust the positions of the head, neck, and trunk; (2) perform respiratory movements;
and (3) stabilize or position parts of the appendicular skeleton. The joints of the axial skeleton
permit limited movement, but they are very strong and heavily rein forced with ligaments.

3. Appendicular Skeleton
The appendicular skeleton conist of 126 bones. This division includes the bones of the limbs
and of the pectoral and pelvic girdles that attach the limbs to the trunk.10

9
Clark, K. Robert. 2005. Anatomy and Phisiology:Understanding the Human Body. USA: Jones and Bartlett
Publisher Inc
10
Martini, H. Frederic. 2005. Anatomy and Physiology. Singapore: Pearson Education South Asia Pte, Ltd

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 2.1.3 Anatomy and Phisiology of Integumentary System

Integumentary System
The Integumentary system is an organ that consist of the skin, its derivatives (sweat and oil glands),
nails and hair. The basic function of the skin is protection. The skin consists of epidermis and dermis.

Anatomy and Physiology of Skin

1. Epidermis

Cells of epidermis consist of :

Table 4.1 Cells of Epidermis
Name Describtion
Keratinocytes Tightly packed and connected to desmosomes; originate from stratum
basale; produce keratin
Melanocytes Spider-like cells that produce melanin (forms a pigment shield that
protects the nucleus from the UV rays).
Langerhans Star-shaped cells from bone marrow. Function to activate the immune
system as macrophages.
Merkel cells Function as sensory receptors.11

11
Lescher, Penelope J. 2011. Pathology for The Physical Therapist Assistant. USA: F.A Davis

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 Layer of Epidermis consist of :

a. Stratum basale: consist of predominantly single row of keratinocytes; some melanocytes (10-25%) and
Merkel cells.
b. Stratum spinosum: several layers thick; Contains flattened irregularly-shaped keratinocytes, pre-keratin
intermediate filaments.
c. Stratum granulasum: consist of flattened keratinocytes which accumulate keratohyaline granules
(granules form keratin) and lamellated granules (produce water-resistant chemical).
d. Stratum lucidum: present only in thick skin and made up of a few rows of clear, flat, dead
keratinocytes.
e. Stratum corneum: outermost layer, conts many layers of cells (cornified or horny cells). Dead skins
slough off.12
2. Dermis
Richly supplied with nerves (sensory receptors), blood vessels, lymphatic vessels, sweat and sebaceous
glands derived from the epidermis. Contains two layers: papillary and reticular

Figure 2.2: Journal of Sciamsurgery

Cross-sectional diagram shows the two distinct layers of the skin—the epidermis and the dermis (papillary and
reticular)—and the underlying subcutaneous fat.

12
Lescher, Penelope J. 2011. Pathology for The Physical Therapist Assistant. USA: F.A Davis

15
 a. Papillary layer: Consists of areolar connective tissue made up of loose collagen and elastic
fibers, projections called papillae which contain touch and pain receptors (Messsner’s
corpusles). The papillae also form epidermal ridges found on the surfaces of palms, fingers
and feet. On the palm and fingers they form the fingerprints (genetic markers of
individualilty).13
b. Reticular layer: account for about 80% of thickness of dermis; consist of dense irregular
connective tissue. The ECM of this layer consist of bundles of collagenous fibers which run
in parallel and opposite directions. The fibers give strength and resilience (toughness) and
recoil, while collagen absorbs water and keep the skin hydrated. Stretch marks found on the
buttocks, thighs, abdomen and breast are due to these fibers.14
3. Subcutaneous or Hypodermis
The subcutaneous layer, although not actually part of the skin, is an important layer that lies
deep to the dermis. It is largerly composed of connective tissue, which is interwoven with the
connective tissue of the dermis. This layer stabilizes the skin, connecting it to underlying
structures, while allowing some independent movement. At the same time, the subcutaneous
tissue separates the deep fascia that surrounds muscles and organ from the skin. Therefore,
this layer is also known as the superficial fascia. The subcutaneous layer has a deposit of
adipose (fat) tissue and serves as an energy reservoir and insulator. The adipose tissue also
protects the underlying structures by serving as shock absorbers. Te distribution of fat in the
subcutaneous layer changes in adulthood. In men, it tend to accumulate in the neck, arm,
along the lower back, and buttocks; in women, it accumulates primarily in the breasts, hips,
and thighs.15
ACCESSORY STRUCTURES

Accessory structures include hair, nail, and glands.

a. Hair: formed of keratinized cells and consist of two parts: a shaft and root. The shaft is above the skin
and root embedded in the dermis, in a hair follicle connected to blood supplies and arrector muscle.
b. Nail: they are formed of keratinized epidermal cells and occur on the finger and toes. Consist of a
visible area (body) and the root (embedded in the dermis).

13
Lescher, Penelope J. 2011. Pathology for The Physical Therapist Assistant. USA: F.A Davis

15
Premkumar, Kalyani. 2004. The Message Connection : Anatomy and Physiology. USA : Lippincott Williams &
Wilkins

16
 c. Glands: There are there exocrine (conts ducts) glands: sebaceous, sudoriferous and ceruminous
glands. These glands secrete their contents to the exterior unlike endocrine which secrete their contents
directly into blood.
- Sebaceous glands: produce oil (sebaum) which keeps the skin oily. The glands are branched and
attached to the hair follicle. Blockage of the gland causes acne.
- Sudoriferous(sweat) gland: produce sweat or perspiration composed of water, salt, urea and uric acid.
They are coiled and tubular shaped and of two types: Eccrine (found on forehead, back of palm and
soles), and Apocrine (larger that eccrine, found in pubic regions and secrete into hair follicles).
Mammary glands: are specialized form of sudoriferous gland secrete milk.
- Ceruminous glands: found only in the external auditory canal where they secrete cerumen (earwax).
Cerumen is an insect repellant and also keep the eardrum (tympanic membrane) from drying out.
Excess amount may block.16
2.2 Types and Classification of Fractures and Scabies
2.2.1 Types and Classification of Fractures
Table 5.1 Classification and types of Fractures
Classification of Fractures
Type Description
Closed Skin is not broken (formerly called a simple fracture)
Open Skin is broken; bones protrudes through skin or wound extent to fractured bone
Complete Bone is broken into two or more pieces
Incomplete Parsial fracture that extends only partway across bone; pieces remain joined
Greenstick Bone is bent on one side and has incomplete fracture on opposite side
Hairline Fine crack in which sections of bone remain aligned, common in skull
Comminuted Bone is broken into three or more pieces
Displaced The portions of fractured bone are out on anatomical alignment
Nondisplaced The portions of bone are still in correct anatomical alignment
Impacted One bone fragment is driven into the medullary space or spongy bone of other
Depressed Broken portions of bone forms a concavity, as in skull fractures
Linear Fractures parallel to long axis of bone
Transverse Fractures perpendicular to long axis of bone
Oblique Diagonal fracture, between linear and transverse
Spiral Fracture spirals around axis of long bone, the result of a twisting stress, often

16
Lescher, Penelope J. 2011. Pathology for The Physical Therapist Assistant. USA: F.A Davis

17
 produced when an abusive adult roughly picks a child up by the arm17
2.2.2 Types and Classification of Scabies
There are 3 clinical forms of scabies: 1) Papulovesicular lesions, 2) Persistent
nodules, 3) Norwegian (crusted) scabies.
a. Scabies: Distribution of characteristic Lesions
Naïve individuals may be asymptomatic for up to 4-6 weeks, while those who
have. The distinctive scabies lesions are roughly symmetrical and their locatios are
highly predictable. The hands are often the first body part to demonstrate cutaneous
lesions, especially in the webbing and the sides of the fingers. Hand eczema may
follow. Lesions are also found on the skin folds under the wrist, elbow, knee, penis,
breasts, shoulder blades, and abdomen. (Orkin 14)
b. Burrows: Classic Lesions
Scabies causes more than 4 types of lesions, of which the burrow best
characterizes the disease. Burrows can be linear, curved, or S-shaped, and are
generally 1-2 mm wide, less than 15 mm long, pink-white, and slightly raised. They
are often V-shaped at one end (the burrow opening in the stratum corneum) and have
a small black dot at the other end, which is where the mite resides. Burrows are most
common on the fingers, wrist, penis, and feet. (Scabies, CDC)
c. Inflammation and Rush
Scabies is intensely pruritic, principally at night. Excessive scratching render the
body vulnerable to secondary bacterial infecton and corresponding secondary
lesions. Inflammatory pruritic papules are found at most sites of infection. The
popular scabies rash is often times seen in areas of the body that actually lack adult
female mites (buttocks, scapular region, abdomen), suggesting that the rash may be a
result of both sensitization from previous infection and a reaction to immature mite
stages.
d. Nodular Scabies
Persistent nodular scabies is found in 7% of infested individuals. This clinical
variety is most likely to be manifest in children and young adults. Red-brown pruritic
nodules develop primarily on the lower trunk, scrotum, and thighs. Mites are rarely
found, implying that this variety represents a delayed hypersensitivity reaction to the
scabies mite. (Weedon, 624).
e. Norwegian Scabies (Crusted Scabies)

17
Saladin, Kenneth. 2007. Human Anatomy. Philippines: McGraw Hill Education

18
 Found in the immunocompromised and elderly, and may be related to failure of
sensitization to mite antigen. Highly contagious, with honeycombed cavities in the
skin containing many thousands of mites. Extensive crusted lesions with thick
hyperkeratotic scales (‘bread-crumb’) develop over the elbows, palms, knees, and
soles of the feet. (Patman, Richard., Nathan, Sankar., et al. 2010).18

2.3 Etiology of Fractures and Scabies

2.3.1 Etiology of Fractures

Based on etiology, fractures may be of three types:
 Trauma or injury: a fracture sustained due to trauma is called traumatic fracture. It
can be caused by a direct injury as in a road traffic accident or a blow, etc. indirect,
injury can cause fracture by a force transmitted along the bone, e.g a fall on
outstretched hand can cause fracture of head of the radius.
 Fatigue fracture: these fracture occur from repetitive metals. These fracture are
mostly confined to the bones of lower limb and ascribed to prolonged walking,
running, or athletic activities. Some of the common fatigue fractures are fracture of
2nd metatarsal, fibula, tibia, or of neck of femur.
 Pathological fracture: this term is applied to a fracture through a bone already
weakened by disease. Often the bones get fracture spontaneously or from a trival
trauma. In contrast to the traumatic fractures, these fractures are minimally displaced
and often go into non union. The various pathological conditions responsible for
pathological fractures may be osteoporosis, osteomalacia, osteopenia, Paget’s
disease, osteogenesis imperfect, fibrous dysplasia, primary benign or malignant bone
tumors or secondaries of a carcinoma.19
2.3.2 Etiology of Scabies
Scabies is a highly contagious skin infections cause by the scabies mite Sarcoptes
scabiei (a member of the spider family with eight legs), sometimes called the “itch mite”.
The might is only about a third of a millimeter in size and cannot be seen without using a
magnifying glass. The spread of the might that causes the skin disease can occur before

18
Patman, Richard., Nathan, Sankar., et al. 2010. Oxford Handbook of Genitourinary Medicine, HIV, and Sexual
Health. Newcastle: OUP Oxford
19
M.S Dhillon, et al. 2012. First Aid and Emergency Management in Orthopedic Injuries. Panama: Jaypee Brothers
Medical Publisher (P) Ltd

19
 the rash appears on the skin because the incubation period of the larvae to emerge from the
egg is 4 to 6 weeks. The parasite is transmitted trough close and prolonged contact with an
infected person. The sharing of clothing, bedding, and towels can increase the likelihood
of infection.20
2.4 Clinical Appearances of Fractures and Scabies
2.4.1 Clinical Appearances of Fractures
The clinical appearances of fractures differ depending on the location and type of
fracture and associated with soft-tissue injuries. The common signs and symptoms include
the following.
1. Oedema and swelling: Disruption of the soft tissues or bleeding into surrounding
tissues. Unhecked oedema in closed space can occlude circulation and damage
nerves (i.e there is risk of acute compartement syndrome).
2. Pain and tenderness: Muscle spasm as a result of involuntary reflex action of
muscle, direct tissue trauma, increased pressure on sensory nerve, movement of the
fractures parts. Pain caused by swelling at the site, muscle spasm, damage to
periosteum. It may be immediate, severe and aggravaled by pressure at the site of
injury and attempted motion.
3. Loss of normal function: Due to disturption of bone, preventing functional use, the
injured part is is incaple of movement. Fracture must be managed properly to
ensure restoration of function.
4. Deformity: Obvious deformity resulting from loss of bone continuity. Abnormal
position of bone as a result of original forces of injury and action of muscles
pulling fragment into abnormal position seen as a loss of normal bony contours.
Deformity is cardinal sign of fracture. If incorrected, it may result in problem with
bony union and restoration of function of injured part.
5. Excessive motion at site: e.g motion when motion does not usually occur.
6. Creptation: Crepitus or grating sound occurs if limb is moved gently. Grating or
crunching together of bony fragments producing palpableor audible cruching
sensation.
7. Self-tissue: Oedema in area of injury resulting from extravasation of blood and
tissue fluid.
8. Warmth over injured area resulting from increases blood flow to the area.

20
Lescher, Penelope J. 2011. Pathology for The Physical Therapist Assistant. USA: F.A Davis

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 9. Ecchymosis: of skin surrounding injured area (may not be apparent for several
days). This is discoloration of skin as a result of extravasation of blood in
subcutaneous tissue.
10. Impairment or loss of sensation or paralysis distal to injury is resulting from nerve
entrapment or damage.
11. Signs of shock related to severe tissue injury, blood loss or intense pain.
12. Evidence of fracture on X-Ray film.21
2.4.2 Clinical Appearances of Scabies
Scabies presents with a pruritic, pleumorphic rash. It has an insidious onset and a
characteristic pattern of involvement that includes wrist, finger webs, elbows, axillae,
genitals, and buttocks. Patients report a gradual onset of pruritus and rash over 3 to 4
weeks after the initial infestations. With repeat infestation, the onset of symptoms is
relatively prompt within hours. Much of the symptomatology of scabies is the result of the
host immune response to S. scabiei.
Pruritus is the predominant symptom and may be intens. Tipically, the itching is
worse at night. The physical findings include the presence of the burrows, a papuler
erythematous rash, and persistent pruritic nodules. The burrows are 5-10 mm long, and the
organism may be seen as a tiny brown and white speck at the inner end of the burrow.22
CHAPTER 3
CLOSING
2.3 Conclusion
The human musculoskeletal system (also known as the locomotor system, and
previously the activity system) is an organ system that gives humans the ability to move
using their muscular and skeletal systems. The musculoskeletal system provides form,
support, stability, and movement to the body.
It is made up of the bones of the skeleton, muscles, cartilage, tendons, ligaments, joints,
and other connective tissue that supports and binds tissues and organs together. The
musculoskeletal system’s primary function include supporting the body, allowing motion,
and protecting vital organs. The skeletal portion of the system serves as the main storage

21
Basavanthappa, BT. 2003. Medical- Surgical Nursing. New Delhi: aypee Brothers Medical Publishers (P) Ltd

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Bieber, Erik, et al. 2015. Clinical Gynecology, second edition. Spain: Cambridge University Press

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 system for calcium and phosphorus and contains critical components of the hematopoietic
system.
The integumentary system is the largest organ system in the human body, and is
responsible for protecting the body from most physical and environment factors. The largest
organ in the body, is skin. The integument also includes appendages, primarily the sweat and
sebaceous glands, hair, nails, and arrectores pili (tiny muscles at the root of each hair that
cause goose bumps).
The disease of musculoskeletal system is fractures, and the disease of integumentary
system is scabies.
2.4 Suggestion
With the existence of this paper is expected to increase the knowledge of the readers,
especially students majoring in nursing. A nurse or a nurse candidate is expected to have a
good understanding in musculoskeletal and integumentary system, and a nurse candidate
must have a good skill, so they can give a right nursing care plan to the patient.

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