Skeletal Fixation Devices

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 • Skin breakdown • 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. 4-33 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 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