INTERNAL, EXTERNAL FIXATION AND TRACTION

Orthopedic Hardwares, Casts, Molds, Braces, Traction

INTERNAL FIXATION

A way of immobilizing fractures involving the surgical insertion of a metal nail, pins screws, sometimes in conjunction with a plate, to bind the fractured bones together– e.g. ORIF (open reduction internal fixation)

EXTERNAL FIXATION

A way of stabilizing fractures that are difficult to immobilize, with casts, traction, pins or plates – e.g. RAEF ( roger anderson

external fixator)

CAST and MOLD

A rigid immobilizing device made up of layers of Plaster of Paris (anhydrous calcium sulfate) or synthetic materials

Purposes– Immobilization of bone fragments during fracture

healing– Prevent and correct deformity– Support; easier elevation of the affected part– Obtaib a model of limb to serve as a model for

making artificial limb

Materials for casts and molds

Plaster of Paris or fiber glass

Stockinette Wadding sheet

Bucket of tepid water

Steps in Making Casts

Inspect skin for presence of wounds. Place extremity in desired position. Wrap extremity with wadding sheet. Place stockinette over extremity. Immerse Plaster of Paris in water. Roll Plaster of Paris on the extremity and mold to

contours of the skin. Trim edges to desired margin and roll back to the

cast. Clean excess plaster off the patient.

Principles in Cast Application

The cast must be applied closely conform the contour of the extremity.

Immobilize the joints above and below the fracture.

During the drying process, the cast must be handled with palms rather than finger.

The cast should be left open to the air for drying and this is best accomplished by natural evaporation.

Immediate Care

Avoid covering the cast with blanket or towel. Handle with palms not fingers. Avoid resting cast on hard surfaces and sharp

edges. Avoid putting powder or lotion. Avoid putting anything inside the cast. Maintain dryness of cast. Keep affected limb elevated above heart level; place

on soft surface until dry, don’t use heat lamp. Check 5 P’s: Pain, Paralysis, Pulselessness,

Paresthesia, Poikilothermia

After Cast Care

Wash the skin gently.Apply powder, cornstarch or baby oil.Have patient gradually adjust to

movement without support of cast. Inform patient that swelling is common.

– Elevate limb and apply elastic bandage.

Nursing Care

Potential for altered tissue perfusion related to trauma and vascular injury.

Pain related to trauma and muscle spasms. Potential for infection related to break in

tissue integrity. Potential for impaired skin integrity related to

immobility.

Nursing Care

Potential for impaired physical mobility related to muscle atrophy.

Potential for ineffective airway clearance related to accumulation of secretions secondary to pneumonia.

Potential for altered bowel elimination– Constipation related to immobility

Potential for injury related to renal calculi secondary to immobility

BRACE

An orthopedic device providing mechanical support to weakened muscles, joints and bones

Purposes:1. Immobilization2. Control involuntary movements3. Support voluntary muscles4. Permit patient to walk without fatigue5. Prevent and correct deformity6. Maintain body alignment

PRECAUTIONS

1. Check the nature of accident/cause2. Apply the brace before rising3. Applied by a doctor with specialty4. May be cleaned with soap and water but

need not to be exposed under the sun5. Should be applied correctly6. Padding material should be worn before

putting on the braces, especially with back braces

NURSING CONSIDERATIONS

Check skin 2-3 times daily.Massage skin under straps to stimulate

circulation.Avoid putting on lotion or powder.Do not let the patient adjust straps

without supervision.Assess neurovascular status.

TRACTION

The act of pulling or drawing body part associated with countertraction

Purposes:– Immobilization– Support– Reduce fracture– Prevent and correct deformity– Reduce muscle spasm

Types of Traction

Manual tractionMechanical traction

Skin tractionSkeletal traction

PRINCIPLES OF SKELETAL TRACTION

Have an opposite pull or countertraction. Line of pull should be in line with the deformity. Traction should be continuous. Position of the patient should be in dorsal recumbent

position. Avoidance of friction:

– Weights should be hanging freely.– Observe for sifns of wear and tear on the ropes and bags.– Rope should run freely along the grove of the puley.– Knots should be away from the pulley.

Nursing Care

Potential for altered tissue perfusion related to trauma and vascular injury.

Pain related to trauma and muscle spasms. Potential for infection related to break in

tissue integrity. Potential for impaired skin integrity related to

immobility.

Nursing Care

Potential for impaired physical mobility related to muscle atrophy.

Potential for ineffective airway clearance related to accumulation of secretions secondary to pneumonia.

Potential for altered bowel elimination– Constipation related to immobility

Potential for injury related to renal calculi secondary to immobility