Orthopedic Technologies

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Orthopedic Technologies

• Purpose of Casting
• 1. Maintain immobilization
• 2. Prevent neurovascular impairment
• 3. Prevent infection
• Indications for Casting
• 1. Immobilize for healing
• 2. Prevent contractures
• Type of casts
• 1. Cylinder- extremities
• 2. Body- all of trunk
• 3. Spica- enclose part of trunk and/or
  extremities.
• Materials used for Casting
• 1. Plaster of Paris
• 2. Fiberglass
• 3. Splint or molded plastic

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• Nursing responsibilities
• Positioning of casted limbs
• Elevate
• Alignment
• Facilitating drying of the cast
• Handle palm of hands for first 24-36 hours
• Elevate
• Petaling edges of the cast- if edges are not
  finished with stockinette, edges should be
  covered with pieces of tapes once cast has dried
  to protect against rough edges.
• Assessment
• NV checks hourly for first 24 hours then q 4
  hours
• Documentation

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• Complications
• 6Ps- Pain, Paresthesia, Pallor, Pulselessness,
  Paresis, and Puffiness. Elevate area have
  client wiggle toes and fingers ask about
  sensation capillary refill observe for edema
  check pulses distal to cast. (pg 310)
• Infection odor, warm spots, drainage,
  temperature, restlessness. MD may cut out a
  window over hot spot.
• Pressure sores- same symptoms as infection and
  pain. Turn frequently, skin care and check edges
  of cast.
• Drainage- breakthrough bleeding. Draw a circle
  around area with date and time.
• Immobility- turn, cough and deep breath. ROM
  with other extremities.

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• Cast Removal
• Explain procedure to client
• Cover immediate area to protect from particles of
  cast material.
• Obtain cast cutter, bivalve cast spreader and
  scissors
• Assess clients NV status, mobility and skin
  condition after removal.

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• Traction
• Traction is the force or pull applied to limbs,
  bones or other
• tissues to pull the tissues apart , often for
  realignment (pg
• 317)
• Relieve muscle spasm
• Alignment of a fracture
• Immobility or rest a joint
• Reduce contractures
• Treat deformities
• Counter-traction is used for effective traction.
  Client needs to slide away from traction pull.
  Counter traction may be provided by
• Clients own weight
• Position of bed

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TRACTION Force or pull applied to limbs, bones,
or other tissues to pull the tissues apart, often
for realignment Principles of traction
Care 1. Maintain the established line of
pull-weights must hang freely, not resting
against the bed or floor. 2. Maintain
traction equipment- traction rope rest in the
groove and not outside the groove so it does
not move freely. Knots that hold the weights
must be secure and have a double knot and
maybe taped to hold in place 3. Maintain
countertraction-the countertraction
is maintained by the weight of the clients
body, elevation of the bed and the pull of
the
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4. Maintain continuous traction unless
ordered otherwise- changing position of client,
the nurse will not lift or adjust traction if
(continu- our) if (intermittent) will gently
adjust or remove if needed 5. Maintain
correct body alignment-client has to be in
constant correct alignment 6. Prevent friction
to skin- skin traction must be removed and
reapplied daily. Skin needs to be checked for
redness, bruising, or skin breakdown. Types of
traction A. Skin traction- used to
treat fractured bones and correction of
orthopedic abnormalities
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1. Bryant traction- vertically held type of
bilateral traction to legs (pg 317) 2. Bucks
traction-horizontally applies unilateral or
bilateral traction (pg 318) 3. Dunlops
traction-simultaneous horizontal form of Bucks
extension to humerus with an accompanying
vertical Bucks extension to the forearm ( pg
318) 4. Cervical ( head Halter) traction
involving a specially shaped halter with cutout
areas for the ears, face and top of head (pg
319) 5. Pelvic Belt-traction consisting of a
girdlelike belt that fits around the lumbosacral
and abdominal areas, fastening in the middle of
the abdomen with pressure-sensitive straps or
buckles (pg 319)
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6. Pelvic sling ( Weil sling) traction
consisting of ham-mocklike belt wherein the
sling cradles the pelvis in its boundaries for
treatment of one or more fractures of the pelvic
bones. (pg 319) 7. Russells traction-
modification of Bucks extension using Newtons
third law of motion. (pg 319) B. Skeletal
Traction- used for the treatment of fractures
or correction of orthopedic abnormalities. 1. Ba
lances-suspension skeletal traction-used for
displaced or overriding fractures of the
femur. Kirschner wire or Steinmann pin
supplying the traction
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2. Upper extremity traction- a. Side-arm
traction ( pg 327) b. Overhead 90-90 traction
(pg 327) c. External fixation (pg
328) d. Skull tong traction (pg 329) Nursing
Responsibilities for clients in Traction 1.
Care of immobilized patient 2. Assess and
treat pain 3. Maintain alignment/position 4.
Assess status of ropes, pulleys,
weights 5. Pin care a. follow
institutions policy b. clean with antiseptic
solution
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• c. assess for infection
• d. protect ends of pins with corks or rubber
  stoppers
• 6. Bedmaking- top to bottom easier than
  side to side, have client use trapeze bar
  to raise self
• Complications
• 1. NV checks- pain, palor, pulselessness,
  parasthesia, paralysis, pressure p. 310
• 2. Skin breakdown

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• Continuous passive motion machine p. 273
• Sequential compression device and TED hose p. 276
• Immobilization devices p. 335
• Binders Bandages p. 1292
• Crutches
• To facilitate mobility and activity (chap. 11)
• Increase self- esteem by reducing dependence
• Decrease physical stress on weight bearing joints
  and unhealed skeletal injuries.
• .

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• Nursing Responsibilities relating to Crutches
• Measuring for crutches p. 286
• Have client flat in bed- measure from axilla
  downward to 6-8 inches from side of heel
• Have client standing with elbows slightly flexed
  and measure distance between axillary pit an top
  of crutch, be sure a space of at least the width
  of 2-3 fingers exists
• Crutch safety
• Prevent pressure on brachial and radial nerves
• prevent falls by correctly measuring and use of
  sturdy non slip shoes
• use of safety belt like physical therapy uses
  when first trying to use crutches
• assess living area for rugs, furniture, etc
• teach client how to use stairs

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• Types of gaits p. 289, 295, and 296
• A. 4 point- can bear weight on legs. Advance
  Right crutch
• then left foot, then left crutch and right
  foot- alternate.
• B. 3 point- cannot bear weight on affected leg so
  place
• weight on unaffected leg and crutches. Advance
  both
• crutches and affected extremity at same time.
• C. 2 point- partial weight bearing allowed on
  both legs so
• advance right crutch and left foot together and
  then left
• crutch and right foot together. Similar to
  walking (referred to as assisted walking)

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Swing to or swing through- sometimes referred to
as 2 point, this gait provides additional
stability for client with bilateral leg
disability. Advance both crutches at the same
time and swing body forward to crutches or
past. Stairs- ascending good leg and crutches
up descending bad leg and crutches down.
Remember this way, angels go up and devils go
down.
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• Level of Consciousness (LOC)
• Purpose-often clients with fractures in traction
  or cast
• have had accidents which also resulted in head
  injuries. The LOC is the most reliable indicator
  of cerebral functioning.
• The Glascow Coma Scale- record best patient
  response to
• 1. Eye opening-on command, with speaking
  loudly or only with response to pain
• 2. Pupil check with penlight- PERRLA pupils
  equal, round, reactive to light and
  accommodation
• 3. Motor response-equality of grips and foot
  pushes
• 4. Verbal response-alert and oriented x3
  (person, place, and time), drowsy, confused,
  unable to arouse

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• Respiratory Assessment
• Be aware that broken bones can lead to fat
  embolus.
• Thrombosis and Pulmonary Embolism (PE) is a
  potential complication of immobilized patients.