internal, external fixation and traction
TRANSCRIPT
INTERNAL, EXTERNAL FIXATION AND TRACTION
Orthopedic Hardwares, Casts, Molds, Braces, Traction
INTERNAL FIXATION
A way of immobilizing fractures involving the surgical insertion of a metal nail, pins screws, sometimes in conjunction with a plate, to bind the fractured bones together– e.g. ORIF (open reduction internal fixation)
EXTERNAL FIXATION
A way of stabilizing fractures that are difficult to immobilize, with casts, traction, pins or plates – e.g. RAEF ( roger anderson
external fixator)
CAST and MOLD
A rigid immobilizing device made up of layers of Plaster of Paris (anhydrous calcium sulfate) or synthetic materials
Purposes– Immobilization of bone fragments during fracture
healing– Prevent and correct deformity– Support; easier elevation of the affected part– Obtaib a model of limb to serve as a model for
making artificial limb
Materials for casts and molds
Plaster of Paris or fiber glass
Stockinette Wadding sheet
Bucket of tepid water
Steps in Making Casts
Inspect skin for presence of wounds. Place extremity in desired position. Wrap extremity with wadding sheet. Place stockinette over extremity. Immerse Plaster of Paris in water. Roll Plaster of Paris on the extremity and mold to
contours of the skin. Trim edges to desired margin and roll back to the
cast. Clean excess plaster off the patient.
Principles in Cast Application
The cast must be applied closely conform the contour of the extremity.
Immobilize the joints above and below the fracture.
During the drying process, the cast must be handled with palms rather than finger.
The cast should be left open to the air for drying and this is best accomplished by natural evaporation.
Immediate Care
Avoid covering the cast with blanket or towel. Handle with palms not fingers. Avoid resting cast on hard surfaces and sharp
edges. Avoid putting powder or lotion. Avoid putting anything inside the cast. Maintain dryness of cast. Keep affected limb elevated above heart level; place
on soft surface until dry, don’t use heat lamp. Check 5 P’s: Pain, Paralysis, Pulselessness,
Paresthesia, Poikilothermia
After Cast Care
Wash the skin gently.Apply powder, cornstarch or baby oil.Have patient gradually adjust to
movement without support of cast. Inform patient that swelling is common.
– Elevate limb and apply elastic bandage.
Nursing Care
Potential for altered tissue perfusion related to trauma and vascular injury.
Pain related to trauma and muscle spasms. Potential for infection related to break in
tissue integrity. Potential for impaired skin integrity related to
immobility.
Nursing Care
Potential for impaired physical mobility related to muscle atrophy.
Potential for ineffective airway clearance related to accumulation of secretions secondary to pneumonia.
Potential for altered bowel elimination– Constipation related to immobility
Potential for injury related to renal calculi secondary to immobility
BRACE
An orthopedic device providing mechanical support to weakened muscles, joints and bones
Purposes:1. Immobilization2. Control involuntary movements3. Support voluntary muscles4. Permit patient to walk without fatigue5. Prevent and correct deformity6. Maintain body alignment
PRECAUTIONS
1. Check the nature of accident/cause2. Apply the brace before rising3. Applied by a doctor with specialty4. May be cleaned with soap and water but
need not to be exposed under the sun5. Should be applied correctly6. Padding material should be worn before
putting on the braces, especially with back braces
NURSING CONSIDERATIONS
Check skin 2-3 times daily.Massage skin under straps to stimulate
circulation.Avoid putting on lotion or powder.Do not let the patient adjust straps
without supervision.Assess neurovascular status.
TRACTION
The act of pulling or drawing body part associated with countertraction
Purposes:– Immobilization– Support– Reduce fracture– Prevent and correct deformity– Reduce muscle spasm
Types of Traction
Manual tractionMechanical traction
Skin tractionSkeletal traction
PRINCIPLES OF SKELETAL TRACTION
Have an opposite pull or countertraction. Line of pull should be in line with the deformity. Traction should be continuous. Position of the patient should be in dorsal recumbent
position. Avoidance of friction:
– Weights should be hanging freely.– Observe for sifns of wear and tear on the ropes and bags.– Rope should run freely along the grove of the puley.– Knots should be away from the pulley.
Nursing Care
Potential for altered tissue perfusion related to trauma and vascular injury.
Pain related to trauma and muscle spasms. Potential for infection related to break in
tissue integrity. Potential for impaired skin integrity related to
immobility.
Nursing Care
Potential for impaired physical mobility related to muscle atrophy.
Potential for ineffective airway clearance related to accumulation of secretions secondary to pneumonia.
Potential for altered bowel elimination– Constipation related to immobility
Potential for injury related to renal calculi secondary to immobility