Skeletal Fixation Devices

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

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

Skeletal Fixation Devices

Non-surgical Interventions

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

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

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

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.

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!

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

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

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

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

Traction

Complications of Traction Impaired circulation Inadequate fracture alignment Skin breakdown Soft tissue injury Pin track infection Osteomyelitis

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

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

Orthopedic Devices

Orthopedic Devices Balkan frame Wooden or steel frame attached to hospital bed Adjustable pulleys and trapeze bar attached to overhead bar

Orthopedic Devices Stryker frame Assists patient to change position from supine to prone Patients become apprehensive about turning-fear of falling

Orthopedic Devices Stryker Frame

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

Other Orthopedic Devices Splints Crutches Braces Canes Walkers Safety: proper application and use of each

Splints Along with casts, used to secure the position of the body part being treated Immobilize and assist with ambulation

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

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

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

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.

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

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

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

Continuous Passive Motion Machine CPM 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