casts and traction

8/8/2019 Casts and Traction

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Emillie Grace D. Tombucon



The branch of surgery concernedwith conditions involving

the musculoskeletal system.Orthopedic surgeons use bothsurgical and nonsurgical means totreat musculoskeletal trauma, sports

injuries, degenerative diseases,infections, tumors, and congenitaldisorders.



A cast holds a broken bone in place as it heals.Casts also help to prevent or decrease muscle

contractions, and are effective at providing

immobilization, especially after surgery.Casts immobilize the joint above and the jointbelow the area that is to be kept straight andwithout motion.

For example, a child with a forearm fracture

will have a long arm cast to immobilize thewrist and elbow joints.



The outside, or hard part of the cast, is madefrom two different kinds of casting materials.

plaster - white in color. fiberglass - comes in a variety of colors,

patterns, and designs. Cotton and other synthetic materials are used to

line the inside of the cast to make it soft and toprovide padding around bony areas, such as thewrist or elbow.

Special waterproof cast liners may be used undera fiberglass cast, allowing the child to get thecast wet. Consult your child's physician forspecial cast care instructions for this type of cast.



Type of Cast1. Short arm cast: Applied below the elbow to the hand. Forearm or wrist fractures. Also used to hold the

forearm or wrist muscles and tendons in placeafter surgery.2. Long arm cast: Applied from the upper arm to the hand. Upper arm, elbow, or forearm fractures. Also used

to hold the arm or elbow muscles and tendons in

place after surgery.3. Arm cylinder cast: Applied from the upper arm to the wrist. To hold the elbow muscles and tendons in place

after a dislocation or surgery.



4. Shoulder spica cast: Applied around the trunk of the body to the shoulder,

arm, and hand. Shoulder dislocations or after surgery on the shoulder

area.

5. Minerva cast: Applied around the neck and trunk of the body. After surgery on the neck or upper back area.6. Short leg cast: Applied to the area below the knee to the foot. Lower leg fractures, severe ankle sprains/strains, or

fractures. Also used to hold the leg or foot muscles andtendons in place after surgery to allow healing.7. Leg cylinder cast: Applied from the upper thigh to the ankle. Knee, or lower leg fractures, knee dislocations, or after

surgery on the leg or knee area.



7. Unilateral hip spica cast: Applied from the chest to the foot on one leg. Thigh fractures. Also used to hold the hip or thigh muscles and

tendons in place after surgery to allow healing.8. One and one-half hip spica cast:

Applied from the chest to the foot on one leg to the knee of theother leg. A bar is placed between both legs to keep the hipsand legs immobilized.

Thigh fracture. Also used to hold the hip or thigh muscles andtendons in place after surgery to allow healing.

9. Bilateral long leg hip spica cast: Applied from the chest to the feet. A bar is placed between both

legs to keep the hips and legs immobilized. Pelvis, hip, or thigh fractures. Also used to hold the hip or thigh

muscles and tendons in place after surgery to allow healing.



Short leg hip spica cast:Applied from the chest to the thighs

or knees.

To hold the hip muscles and tendonsin place after surgery to allowhealing.



Abduction boot cast:Applied from the upper thighs to the

feet. A bar is placed between both legs

to keep the hips and legs immobilized. To hold the hip muscles and tendons inplace after surgery to allow healing.



crutcheswalkers

wagonswheelchairs reclining wheelchairs



Keep the cast clean and dry. Check for cracks or breaks in the cast. Rough edges can be padded to protect the skin from

scratches. Do not scratch the skin under the cast by inserting

objects inside the cast. Can use a hairdryer placed on a cool setting to blow air

under the cast and cool down the hot, itchy skin. Neverblow warm or hot air into the cast.

Do not put powders or lotion inside the cast. Cover the cast while your child is eating to prevent

food spills and crumbs from entering the cast.



Prevent small toys or objects from being put inside the cast.

Elevate the cast above the level of the heart to decrease swelling. Encourage your child to move his/her fingers or toes to promote circulation.

Do not use the abduction bar on the cast to lift or carry the child.

Older children with body casts may need to use a bedpan or urinal in order to go to thebathroom. Tips to keep body casts clean and dry and prevent skin irritation around thegenital area include the following:

Use a diaper or sanitary napkin around the genital area to prevent leakage or splashing

of urine. Place toilet paper inside the bedpan to prevent urine from splashing onto the cast or bed.

Keep the genital area as clean and dry as possible to prevent skin irritation.



Contact your child's physician or healthcareprovider if your child develops one or moreof the following symptoms:

fever greater than 101° F increased pain increased swelling above or below the castcomplaints of numbness or tinglingdrainage or foul odor from the castcool or cold fingers or toes



refers to the set of mechanisms forstraightening broken bones orrelieving pressure on the spine

and skeletal system. There are twotypes of traction: skin traction andskeletal traction.



It is largely replaced now by more moderntechniques, but certain approaches are stillused today:

Bryant's traction

Buck's traction - hip fracturesDunlop's traction - humeral fractures in

childrenRussell's traction

Milwaukee brace



The purpose of traction is to: To regain normal length and alignment of

involved bone. To reduce and immobilize a fractured bone. To lessen or eliminate muscle spasms. To relieve pressure on nerves, especially

spinal. To prevent or reduce skeletal deformities or

muscle contractures.



In most cases traction is only one part of the treatment planof a patient needing such therapy. The physician’s order willcontain:

Type of traction Amount of weight to be applied Frequency of neurovascular checks if more frequent than

every four (4) hours. Site care of inserted pins, wires, or tongs The site and care of straps, harnesses and halters The inclusion of any other physical restraints / straps or

appliances (eg. mouth guard) the discontinuation of traction



an orthopedic mechanism that helpsimmobilize the upper arm in thetreatment of contracture orsupracondylar fracture of the elbow. The mechanism uses a system of traction weights, pulleys, and ropes

and may be accompanied by skintraction. Dunlop skeletal traction isusually applied unilaterally but mayalso be applied bilaterally.



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an orthopedic mechanism consisting of adhesive or nonadhesive skin traction that helps

immobilize the upper limb in the treatment of contracture or supracondylar fracture of theelbow. The mechanism uses a system of traction weights, pulleys, and ropes, usuallyapplied unilaterally but sometimes bilaterally.



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Bryant's traction is mainly used in youngchildren who have fractures of the femur or congenital abnormalities of the

hip. Both the patient's limbs are suspended inthe air vertically at a ninety degree angle fromthe hips and knees slightly flexed. Over a periodof days, the legs hips are gradually movedoutward from the body using a pulley system.

The patient's body provides the countertraction.



Orthopedics An apparatus for applying longitudinaltraction on the leg by contact between the skin andadhesive tape, for maintaining the proper alignment of aleg fracture; friction between the tape and skin permitsapplication of force through a cord over a pulley,

suspending a weight; elevation of the foot of the bedallows the body to act as a counterweight; a type of traction in which a nonconstricting boot with weights isworn by the Pt to maintain proper alignment.



a unilateral or a bilateral orthopedic mechanism thatcombines suspension and traction to immobilize,position, and align the lower extremities in thetreatment of fractured femurs, hip and kneecontractures, and disease processes of the hip andknee. Russell's traction is applied as adhesive ornonadhesive skin traction and uses a sling to relieve theweight of the lower extremities subjected to tractionpull. A jacket restraint is often incorporated to help

immobilize the patient.



The Milwaukee brace, also known as a cervico-thoraco-lumbo-sacral orthosis or CTLSO, is a backbrace used in the treatment of spinal curvatures(such as scoliosis or kyphosis) in children. It is a full-torso brace that extends from the pelvis to the baseof the skull. It was originally designed by Blount andSchmidt in 1946 for postoperative care when surgeryrequired long periods of immobilization.



Milwaukee braces are often custom-made over a mold of the

patient's torso, but in some cases, it can be made fromprefabricated parts. Three bars—two posterior and oneanterior—are attached to a pelvic girdle made of leather orplastic, as well as a neck ring. The ring has an anterior throatmold and two posterior occipital pads, which fit behind the

patient's head. Lateral pads are strapped to the bars;adjustment of these straps holds the spine in alignment.



This brace is normally used with growing adolescentsto hold a 25° to 40° advancing curve. The brace isintended to minimize the progression to anacceptable level, not to correct the curvature. For

corrective measures, special exercises or physicalactivities are used. If the curvature continues despitethe brace, surgery may be required.

The Milwaukee brace is often prescribed to be worn23 hours a day for several years.



Figure 1. Cervical halter skin traction.

Figure 2. Pelvic belt traction.

Figure 3. A pelvic sling is a traction deviceconsisting of a hammock-like belt wherein thesling cradles the pelvis in its boundaries. It is usedfor the treatment of one or more pelvic fractures.

Figure 4. Russell’s traction.



A bone fracture is a medical conditionin which there is a break in thecontinuity of the bone. A bone fracturecan be the result of high forceimpactor stress, or trivial injury as a result of certain medical conditions that weaken

the bones, such as osteoporosis,bone cancer, or osteogenesisimperfecta, where the fracture is thentermed pathological fracture.



Closed (simple) fractures arethose in which the skin is intact,

Open (compound)fractures involve wounds thatcommunicate with the fracture, orwhere fracture hematoma is

exposed, and may thus expose boneto contamination. Open injuries carrya higher risk of infection.

casts and traction

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