1. Skeletal Fixation Devices

2. Skeletal Fixation Devices
External fixation
Casts
Traction

3. 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

4. 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

5. Skeletal Fixation Devices

6. Non-surgical Interventions

7. 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

8. 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

9. 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

10. 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.

11. 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!

12. TRACTION

13. 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

14. 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

15. 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

18. 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

19. Traction

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

21. 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

22. 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

23. Orthopedic Devices

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

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

26. Orthopedic Devices
Stryker Frame

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

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

30. Splints
Along with casts, used to secure the position of the body part being treated
Immobilize 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 crutches
Requires good upper body strength
In most cases, PT measures pt for proper fit and instructs in proper crutch walking

32. 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

33. 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

34. 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.

35. 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 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 it
One foot brought forward at a time

37. 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

38. 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