skeletal fixation devices. external fixation casts traction

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Skeletal Fixation Devices

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Page 1: Skeletal Fixation Devices. External fixation Casts Traction

Skeletal Fixation Devices

Page 2: Skeletal Fixation Devices. External fixation Casts Traction

Skeletal Fixation Devices

• External fixation• Casts• Traction

Page 3: Skeletal Fixation Devices. External fixation Casts Traction

External Fixation Devices

• Skeletal Pin Fixation– Immobilizes fractures by the use of pins inserted

through the bone and attached to a rigid external metal frame• Examples pg. 156, 157

– Patient can use muscles above and below the fixation

– Good visibility of fx. Site and accessibility for wound care

Page 4: Skeletal Fixation Devices. External fixation Casts Traction

External Fixation Devices

– Nursing care:• Assess pin sites/pin care• Maintain alignment• Ensure that weights hang free/correct weight• CMS checks frequently• Pt. understanding• May shower when wounds have healed

Avoid salt or chlorinated water

Page 5: Skeletal Fixation Devices. External fixation Casts Traction

Skeletal Fixation Devices

Page 6: Skeletal Fixation Devices. External fixation Casts Traction

Non-surgical Interventions

Page 7: Skeletal Fixation Devices. External fixation Casts Traction

Casts

• Casts– Made of layers of plaster of Paris, fiberglass, or

plastic roller bandages– Stockinete applied, then a sheet of wadding, and

casting material– Applied after MD has properly aligned the bone

Page 8: Skeletal Fixation Devices. External fixation Casts Traction

Casts

• Cast Brace – alternative appliance to traditional leg cast– Has additional support and mobility provided by a

hinge brace– Most effective for fx. of the femur– Permits early ambulation and weight bearing• Based on the concept that limited weight bearing

promotes formation of bone

– Most common problem – edema around the knee

Page 9: Skeletal Fixation Devices. External fixation Casts Traction

Casts• Nursing Assessment/Interventions– Neurovascular assessment -7 P’s, CMS chks.– S/sx. of infection– Assess cast for rough edges; petal cast– Superficial burns may occur as cast sets up –

observe skin and perform skin care– Coordinate with PT for ambulation/equipment

use

Page 10: Skeletal Fixation Devices. External fixation Casts Traction

Cast Care• Patient Education– Prevention of infection, irritation, neurovascular

pressure, misalignment of bone ends– Wet cast handled gently until it sets up– Elevate casted extremity for 24-48h ON PILLOWS– Cast syndrome may occur with hip spica-acute

obstruction of the duodenum• Chief symptom: nausea• Action: prone the patient; report to charge

nurse• May need gastric decompression

– Do not use the bar in the spica cast to turn pt.

Page 11: Skeletal Fixation Devices. External fixation Casts Traction

Cast Care

• Clean around cast with mild soap/water; prevent soap build up

• Itching can/does occur- diversional activities, rub area above and below cast

• NEVER PUT ANYTHING INTO CAST TO RELIEVE PRURITIS!

Page 12: Skeletal Fixation Devices. External fixation Casts Traction

TRACTION

Page 13: Skeletal Fixation Devices. External fixation Casts Traction

Traction

• The process of putting an extremity, bone, or group of muscles under tension by means of weights and pulleys to:

• Align and stabilize a fracture site• Relieve pressure on nerves • Maintain correct positioning• Prevent/correct deformities• Relieve muscle spasms

Page 14: Skeletal Fixation Devices. External fixation Casts Traction

Skeletal Traction

• Applied directly to bone– Wires/pins inserted distal to fracture site– Weights attached to rope tied to spreader bar– Strong, steady continuous pull– Used for fractures of femur, humerus and cervical

spine

Page 15: Skeletal Fixation Devices. External fixation Casts Traction

Skeletal Traction

• Crutchfield traction/Halo vest-pins inserted into skull on either side–Used for reduction and immobilization of

fractures of cervical or high thoracic vertebrae

Page 16: Skeletal Fixation Devices. External fixation Casts Traction
Page 17: Skeletal Fixation Devices. External fixation Casts Traction
Page 18: Skeletal Fixation Devices. External fixation Casts Traction

Skin Traction

• Weights pulls on some type of padding attached to skin below site of fracture

• Buck’s (4-32C) temporary, provide support until more definitive tx. initiated. Frequently used to maintain reduction of hip fx before surgery

• Russell’s-similar to Buck’s with a knee sling added for more support (B)

• Bryant’s –used in pediatrics for fx of femur

Page 19: Skeletal Fixation Devices. External fixation Casts Traction

Traction

Page 20: Skeletal Fixation Devices. External fixation Casts Traction

Complications of Traction

• Impaired circulation• Inadequate fracture alignment• Skin breakdown• Soft tissue injury• Skin breakdown• Pin track infection• Osteomyelitis

Page 21: Skeletal Fixation Devices. External fixation Casts Traction

Traction

• Points to Remember!– Weights must always hang freely– Amount of weight used is correct, clamps are

tight, ropes move freely over pulleys– Good body alignment so line of pull correct– Padding to prevent trauma to skin where traction

applied

Page 22: Skeletal Fixation Devices. External fixation Casts Traction

Traction

• More Points to Remember!– Assess affected extremities for Temperature, pain,

sensation, motion, capillary refill time, pulses

– With skeletal traction-assess pin sites for redness, drainage, odor

Page 23: Skeletal Fixation Devices. External fixation Casts Traction

Orthopedic Devices

Page 24: Skeletal Fixation Devices. External fixation Casts Traction

Orthopedic Devices

• Balkan frame– Wooden or steel frame attached to hospital bed– Adjustable pulleys and trapeze bar attached to

overhead bar

Page 25: Skeletal Fixation Devices. External fixation Casts Traction

Orthopedic Devices

• Stryker frame– Assists patient to change position from supine to

prone– Patients become apprehensive about turning-fear

of falling

Page 26: Skeletal Fixation Devices. External fixation Casts Traction

Orthopedic Devices

• Stryker Frame

Page 27: Skeletal Fixation Devices. External fixation Casts Traction

Orthopedic Devices

• CircOlectric Bed– Vertical turning bed operated by one person– Can change patient to variety of positions

Page 28: Skeletal Fixation Devices. External fixation Casts Traction
Page 29: Skeletal Fixation Devices. External fixation Casts Traction

Other Orthopedic Devices

• Splints• Crutches• Braces• Canes• Walkers

• Safety: proper application and use of each

Page 30: Skeletal Fixation Devices. External fixation Casts Traction

Splints

• Along with casts, used to secure the position of the body part being treated

• Immobilize and assist with ambulation

Page 31: Skeletal Fixation Devices. External fixation Casts Traction

Crutches

• Increase mobility, assist with ambulation• Success depends on patient’s motivation, age,

interests, activities and ability to adjust to crutches

• Requires good upper body strength• In most cases, PT measures pt for proper fit

and instructs in proper crutch walking

Page 32: Skeletal Fixation Devices. External fixation Casts Traction

Crutches

• Proper fit-3 fingerbreadths below axilla to avoid pressure on axilla and nerves

• When walking, weight should be put in hand grips

• Hand grips adjusted so elbow flexed no more than 30 degrees when pt. standing in tripod position

Page 33: Skeletal Fixation Devices. External fixation Casts Traction

Crutches

• 2 point gait: crutch on one side and the opposite foot advanced at same time; partial weight bearing and lower extremity prosthesis

• 3 point gait: both crutches and foot of affected extremity are moved together, followed by foot of unaffected extremity; used for partial weight bearing or no weight bearing on affected leg

Page 34: Skeletal Fixation Devices. External fixation Casts Traction

Crutches

• 4 point gait: Right crutch advanced, then left foot, then left crutch, then right foot; used when weight bearing allowed and one foot can be placed in front of the other

• Swing-to gait: Both crutches advanced together then both legs lifted, placed down on spot behind the crutches.

Page 35: Skeletal Fixation Devices. External fixation Casts Traction

Crutches

• Swing-through gait: both crutches advanced together then both legs lifted through and beyond crutches and placed down again at a point in front of the crutches; used when adequate muscle power and balance available

• For further information: Fig. 4-33 p. 158 AHN

Page 36: Skeletal Fixation Devices. External fixation Casts Traction

Walkers

• Used for support and balance• Modified swing-to-gait used• Walker is pushed or lifted forward and then

legs are brought up to it• One foot brought forward at a time

Page 37: Skeletal Fixation Devices. External fixation Casts Traction

Canes

• Used to provide minimal support and balance• Help relieve pressure on weight bearing joints• Placed on unaffected side with top of cane

even with patient’s greater trochanter• Cane held close to body on unaffected side

and advanced along with affected leg

Page 38: Skeletal Fixation Devices. External fixation Casts Traction

Continuous Passive Motion MachineCPM

• Used after joint replacement surgery• Moves the joint through a set ROM at a set rate of

movements per minute• Prevents scar tissue formation; promotes flexibility• Affected extremity may be placed in CPM in PACU or

after first post op day• Used at specific intervals, degree of flexion/extension

gradually increased• Maintain limb alignment, watch skin for pressure or

abrasions