3 External Fixation Devices Skeletal Pin FixationImmobilizes fractures by the use of pins inserted through the bone and attached to a rigid external metal frameExamples pg. 156, 157Patient can use muscles above and below the fixationGood visibility of fx. Site and accessibility for wound care
4 External Fixation Devices Nursing care:Assess pin sites/pin careMaintain alignmentEnsure that weights hang free/correct weightCMS checks frequentlyPt. understandingMay shower when wounds have healedAvoid salt or chlorinated water
7 CastsCastsMade of layers of plaster of Paris, fiberglass, or plastic roller bandagesStockinete applied, then a sheet of wadding, and casting materialApplied after MD has properly aligned the bone
8 Casts Cast Brace – alternative appliance to traditional leg cast Has additional support and mobility provided by a hinge braceMost effective for fx. of the femurPermits early ambulation and weight bearingBased on the concept that limited weight bearing promotes formation of boneMost common problem – edema around the knee
9 Casts Nursing Assessment/Interventions Neurovascular assessment -7 P’s, CMS chks.S/sx. of infectionAssess cast for rough edges; petal castSuperficial burns may occur as cast sets up – observe skin and perform skin careCoordinate with PT for ambulation/equipment use
10 Cast Care Patient Education Prevention of infection, irritation, neurovascular pressure, misalignment of bone endsWet cast handled gently until it sets upElevate casted extremity for 24-48h ON PILLOWSCast syndrome may occur with hip spica-acute obstruction of the duodenumChief symptom: nauseaAction: prone the patient; report to charge nurseMay need gastric decompressionDo not use the bar in the spica cast to turn pt.
11 Cast CareClean around cast with mild soap/water; prevent soap build upItching can/does occur- diversional activities, rub area above and below castNEVER PUT ANYTHING INTO CAST TO RELIEVE PRURITIS!
13 TractionThe process of putting an extremity, bone, or group of muscles under tension by means of weights and pulleys to:Align and stabilize a fracture siteRelieve pressure on nervesMaintain correct positioningPrevent/correct deformitiesRelieve muscle spasms
14 Skeletal Traction Applied directly to bone Wires/pins inserted distal to fracture siteWeights attached to rope tied to spreader barStrong, steady continuous pullUsed for fractures of femur, humerus and cervical spine
15 Skeletal TractionCrutchfield traction/Halo vest-pins inserted into skull on either sideUsed for reduction and immobilization of fractures of cervical or high thoracic vertebrae
18 Skin TractionWeights pulls on some type of padding attached to skin below site of fractureBuck’s (4-32C) temporary, provide support until more definitive tx. initiated. Frequently used to maintain reduction of hip fx before surgeryRussell’s-similar to Buck’s with a knee sling added for more support (B)Bryant’s –used in pediatrics for fx of femur
21 Traction Points to Remember! Weights must always hang freely Amount of weight used is correct, clamps are tight, ropes move freely over pulleysGood body alignment so line of pull correctPadding to prevent trauma to skin where traction applied
22 Traction More Points to Remember! Assess affected extremities for Temperature, pain, sensation, motion, capillary refill time, pulsesWith skeletal traction-assess pin sites for redness, drainage, odor
29 Other Orthopedic Devices SplintsCrutchesBracesCanesWalkersSafety: proper application and use of each
30 SplintsAlong with casts, used to secure the position of the body part being treatedImmobilize and assist with ambulation
31 Crutches Increase mobility, assist with ambulation Success depends on patient’s motivation, age, interests, activities and ability to adjust to crutchesRequires good upper body strengthIn most cases, PT measures pt for proper fit and instructs in proper crutch walking
32 CrutchesProper fit-3 fingerbreadths below axilla to avoid pressure on axilla and nervesWhen walking, weight should be put in hand gripsHand grips adjusted so elbow flexed no more than 30 degrees when pt. standing in tripod position
33 Crutches2 point gait: crutch on one side and the opposite foot advanced at same time; partial weight bearing and lower extremity prosthesis3 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
34 Crutches4 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 otherSwing-to gait: Both crutches advanced together then both legs lifted, placed down on spot behind the crutches.
35 CrutchesSwing-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 availableFor further information: Fig p. 158 AHN
36 Walkers Used for support and balance Modified swing-to-gait used Walker is pushed or lifted forward and then legs are brought up to itOne foot brought forward at a time
37 Canes Used to provide minimal support and balance Help relieve pressure on weight bearing jointsPlaced on unaffected side with top of cane even with patient’s greater trochanterCane held close to body on unaffected side and advanced along with affected leg
38 Continuous Passive Motion Machine CPM Used after joint replacement surgeryMoves the joint through a set ROM at a set rate of movements per minutePrevents scar tissue formation; promotes flexibilityAffected extremity may be placed in CPM in PACU or after first post op dayUsed at specific intervals, degree of flexion/extension gradually increasedMaintain limb alignment, watch skin for pressure or abrasions