Most common gadgets used at Philippine Orthopedic Center are : 1. Cast 2. Braces 3. Traction 4.Canvass GADGETS Care of Patient in Cast Cast- is a temporary immobilization device which is made up of gypsum sulfate anhydrous by calcinations when mixed with water swells and forms into cement. A. Functions1. to immobilize 2. to prevent or correct deformity 3. to support, maintain and protect realigned bone 4. to promote healing and early weight-bearing Casting Materials: 1. Plaster of Paris others made of: As synthetic materials: a. Fiberglass b. Polyester / cotton knit c. Thermoplast C. 1 D. CAST CAN BE APPLIED IN THE EXTREMITIES, TO THE TRUNK AND TO EXTREMITY AND TRUNK , IT CAN ALSO BE APPLIED IN WHOLE BODY, OR APPLIED AS A SPLINT OR MOLD. E. Complications of Cast 1. neurovascular compromiseit compromises the circulation and function of the tissues within that space. 2. incorrect fracture alignment 3. cast syndrome: a. superior mesenteric artery syndrome occurs with the body casts b. traction on superior mesenteric artery causes decrease in supply to bowel c. signs and symptoms: abdominal pain nausea, and vomiting d. COMPARTMENT SYNDROME ( IS A CONDITION WHICH INCREASED PRESSURE WITHIN A LIMITED SPACE, COMPROMISES THE CIRCULATION AND FUNCTION OF THE TISSUES WITHIN THE SPACE. 2 F. Principles in Applying Plaster cast I. Provide for maximal comfort and alleviation of complications. II. Maintain desired position throughout the cast application. Use caution in handling of the cast until has set or become hardened. Support it with palm. III. Prepare the patient for the cast application by providing appropriate education. IV. Provide the patient with privacy, before and during the cast application. F. Contraindications of Plaster Cast Application I. Pregnancy II. Skin Disease Applying a Plaster cast ( circular Cast application) a. Check for the doctor’s Order b. Inform and prepare the patient for the procedures. c. Ready all things needed. d. Position by the doctor e. Apply padding 1st f. Soak into the bucket with water g. When bubbles cease, without squeezing it G. 3 h. i. H. Apply cast in circular motion until the whole area is covered and molding it, during the process of application. Handle the cast with care. Care of Patient on Cast A. The duration is at least one month .It varies among patients. Factors that influences the duration are: a. Age b. Part of the body affected c. the degree of injury or affection of the part. B. During the entire period that the patient is in Cast the nurse responsibility is focused on the following: a. Neuro-vascular checks b. Preservation of the efficiency of the cast c. Maintenance /promotion of the integrity of he system of the body d. Maintenance of the cleanliness of the cast. 4 INSTRUMENTS FOR CAST REMOVAL: 1.CAST CUTTER ( ELECTRIC) 2.CAST SPREADER 3.TRIMMING KNIFE 4.BANDAGE SCISSORS 5.PLASTER SHEARS MANUAL, CASTS 1. Collar cast 2. Philadelphia 3. Minerva cast 4. Rizzer Jacket cast 5. Body Cast 6. Pantalon Cast 7. Double Hip Spica Cast 8. Double Hip spica mold INDICATIONS Cervical spine affection Cervical spine affection / injury Upper dorsal spine for pott’s dis. and scoliosis For Scoliosis Lower lumbar spine For pelvis # Bilateral affection of Hip and femur Bil. Affection of hip and femur w/ infection, swelling and open wound Pelvis and hip affection Pelvis and hip affection 9. 1½ Hip Spica cast 10. 1½ Hip Spica mold w/ infection, swelling and open wound 5 11. Single Hip Spica Hip and femur affection w/ infection, swelling and open wound Congenital hip dislocation Fx shaft of Humerus 12. Frog cast 13. Hanging Cast 14. Functional Cast 15. Shoulder Spica Cast 16. Airplane Cast 17. Cylinder Cast 18. Cylinder Mold Fx of shaft of humerus w/c allows flexion and extension of upper extremity Affection of upper portion of humerus (recurrent dis.) Fx neck of humerus / for abduction splint ( recurrent shoulder dislocation) Affection of the patella Affection of the patella w/ infection, swelling and open wound For tibia and fibula For tibia and fibula w/ infection, swelling and open wound Affection of tibia and fibula Affection of # femur Ankle and toes Ankle and toes w/ infection, swelling and open wound 19. Long Leg circular cast ( LLCC) 20. Long Leg posterior mold ( LLPM) 21. Patella Tendon Bearing Cast ( PTB cast) 22. Quadrilateral Cast 23. Short leg circular cast 24. Short leg posterior mold 6 25. Boot Cast 26. Brace cast 27. Basket Cast 28. Delvit cast 29. Internal rotator Post polio w/ residual For # of the patella / fx distal 3rd femur For sever or massive bone injury Affection of the distal 3rd of tibia and fibula For pt who is udergone HIP surgery / prosthesis, maintain abduction nad prevent internal rotation Affection of wrist and finger( Wrist , carpals, matacarpals and phallenges) 30. Short Arm Circular cast 31. Short Arm posterior mold Affection of wrist and finger( Wrist , carpals, matacarpals and phallenges) w/ open wound , infection, and swelling Affection of radius, ulna and wrist 32. Long Arm Circular Cast 33. Long Arm posterior mold Affection of radius, ulna and wrist w/ open wound , infection, and swelling Affection of ankle and toes w/ callus formation 34. Walking cast 7 35. Night splint 36. Sugar tong For post polio w/ residual Affec tion of the shoulder , upper portion of the humerus w/ open wound , infection and swelling Fx of the radius and ulna w/ callus formation Shaft of the humerus 37. Fuenster ( Munster Cast) 38. U mold 39. Thumb Spica cast 40. Petri cast 41. Bohler Braun splint Affection of the 1st metacarpals bone Indicated for legg perthes dis. Tibia plateau pin inserted at the calcaneous bone 8 Traction 1. Traction – is the act of pulling or drawing which is associated with countertraction. Traction means that a pulling force is applied to a part of the body while countertraction pulls in the opposite direction. The basic type of traction / Classification of traction: 1. Skin traction – is the application of a pulling force to the skin from where it is transmitted to the muscle and then to the bones by the use of: a. ADHESIVE TYPE / TAPE MATERIALS; Ex. Bryan traction, Dunlop traction b. NON- ADHESIVE TYPE – LIKE: Ex. Canvass, slings, leather and strap with buckles and laces/ Ex of traction : Pelvic traction, Head Halter, Hammock suspension. 2. Skeletal Traction- the pulling force is applied directly to the bone using pins and wires such as KIRSHNER’S 9 WIRE, STEINMAN’S PIN, VINKI’S SKULL RETRACTOR, AND CRUTCHFIELD TONGS. EX. affection of the femur, cervical spine or hip. 3. Manual Traction the pulling force is applied by hands of the operator. In accident sometimes hands applied first the EMS arrived, cervical collar applied, pulling force during casting esp. in extremity Purpose of Traction 1.IS OFTEN USED IN THE TREATMENT OR FRACTURED EXTREMITIES. A. to B. to C. to D. to lessen muscle spasm reduce # provide immobilization maintain alignment / support 2. IS ALSO USED TO CORRECT, OR PREVENT DEFORMITIES AS IN CASE OF ARTHRITIS PATIENT WITH FLEXION CONTRACTION. A CHILD WHO HAS SCOLIOSIS AND IS PLACED IN TRACTION TO HELP LESSEN THE CURVATURE OF THE SPINE BEFORE CORRECTION SURGERY IS CARRIED OUT BUT TO INSERT A HARLINGTON ROD. PRIOR TO TOTAL HIP REPLACEMENT, SURGEON MAY APPLY SKELETAL TRACTION, IN AN 3. 10 ATTEMPT TO STRECH MUSCLES AND OBTAIN MORE WORKING SPACE WITH THE JOINTS. 4.IT LESSEN MUSCLE SPASM IN BACK PAIN AND IN RESTING A DESEASED JOINT AS IN TUBERCULOSIS. PRINCIPLES OF TRACTION- CERTAIN PRINCIPLES MUST BE ADHERED TO IF TRACTION IS TO BE EFFECTIVE; TRACTION MUST: 1. Have an opposite pull or countertraction. 2. Be free from any friction 3. Follow and established line of pull that is the line of pull must be in line with the deformity 4. Be continuous traction 5. Be applied to a patient in a supine position. NURSING IMPLICATION IN VARIOUS TRACTIONS APPLICATION 1. 2. PHYSICIAN HAVE PRACTICED AND VERY EFFICIENT AND EFFECTIVE. NURSE MUST KNOW ALL BY MEANS MUST BE KNOWLEDGEABLE ABOUT THE PRINCIPLES OF TRACTION, UNDERSTAND 11 THE ROUTINES OF THE HOSPITALS STAFF & PHYSICIANS. 12 TRACTION Kinds of Traction Indication Classification 13 1. Head halter Cervical spine affection Skin traction /non – adhesive type 2. Pelvic Girdle Lumbo-sacral affection(HN P) For scoliosis For severe scoliosis Skin traction / non adhesive type Skeletal traction Skeletal traction Skeletal traction 3. Halo-Pelvic 4. Halo-femoral 5. Overhead # of the humerus/ supra condylar # of the humerus 6. Buck Extension Femur and hip affection 7. Dunlop traction Supracondylar # of the humerus 8. Bryant’s Cogenital hip traction disloc. # femur for ↓ 6 y.old 9. Boot Cast ( leg) Post polio w/ residual paralysis Skin traction / adhesiveadhesive type Skin adhesive type Skin traction / adhesive type Special type of traction 14 Ninety-ninety Fx of the femur degrees(steinman pin) 11. Skeletal traction Hammock suspension Pelvic affection Skin traction For scoliosis Cotrel traction comb. of head halter and pelvic traction 12.Balance skeletal traction 13.Zero degree traction 14.Stove in Chest traction Hip and femur affection Skin traction / adhesive type Skeletal traction Neck of the humerus Multiple ribs # Skin traction / adhesive type Special type traction 15 ORTHO-BRACES = a mechanical support for neck, muscle, bones and joints. Braces 1. Shuntz collar / cervical Collar 2. Philadelphia brace 3. Taylor brace 4. Jewette brace 5. Milwaukee Brace 6. Yamamoto Brace 7. Chair-Back Brace 8. Four foster Brace or Walker 9. Forester Brace 10. Bilateral Leg Brace 11. Unilateral Leg Brace Indications Cervical affection Cervical affection Upper thoracic spine affection ( pott’s disease) Lower thoracic affection For scoliosis ( thoracic T-9) For Scoliosis Affection of lumbo-sacral spine Cervical thoraco spine affection Cervico-thoraco-lumbar spine affection For Polio For Polio ( one leg) 16 12. SOMI Brace For Pott’s disease( sterno occipito mandibular Immobilizer / For cervico upper dorsal spine affection 13. Dennis Brown Splint 14. Banjo Splint 15. Cock-up Splint 16. Lively Finger splint 17. Abduction walking Brace 18. Bohler Braun Splint 19. RAEF- Roger Anderson External Fixator 20. Tower’s External Fixation 21. Hoffman fixator 22. Spanning fixator 23. Delta fixator 24. Hybrid fixator For clubfoot For Peripheral nerve injury For wrist drop For Fracture of finger For legg Perthess Disease For tibia plateau pin inserted at the calcaneum bone Affection of Tibia-Fibula, Long bones, for humerus, Malunion, communited # For # of the mandible For # of the pelvis For Long bones ex. femur and tibia-fibula communited # cannot flex. 17 18