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GADGETSMost common gadgets used at Philippine Orthopedic Center

are :

1. Cast2. Braces

3. Traction

4. Canvass

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. Functions-

1. to immobilize

2. to prevent or correct deformity

3. to support, maintain and protect realigned

bone

4. to promote healing and early weight-bearing

C. Casting Materials:

1. Plaster of Paris others made of:

As synthetic materials:a. Fiberglass

b. Polyester / cotton knit

c. Thermoplast

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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 compromise - it

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 vomitingd. COMPARTMENT SYNDROME ( IS A

CONDITION WHICH INCREASED

PRESSURE WITHIN A LIMITED

SPACE, COMPROMISES THE

CIRCULATION AND FUNCTION OF

THE TISSUES WITHIN THE

SPACE.

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F. Principles in Applying Plaster cast

I. Provide for maximal comfort and alleviation

of complications.

II. Maintain desired position throughout thecast 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

G. Applying a Plaster cast ( circular Cast

application)

a. Check for the doctors 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

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h. Apply cast in circular motion until the

whole area is covered and molding it,

during the process of application.

i. Handle the cast with care.

H. 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 affectedc. 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 checksb. 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.

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INSTRUMENTS FOR CAST REMOVAL:

1.CAST CUTTER ( MANUAL,

ELECTRIC)

2.CAST SPREADER3.TRIMMING KNIFE

4.BANDAGE SCISSORS

5.PLASTER SHEARS

CASTS INDICATIONS

1. Collar cast Cervical spine affection

2. PhiladelphiaCervical spine affection / injury

3. Minerva cast Upper dorsal spine for potts

dis. and scoliosis

4. Rizzer Jacket castFor Scoliosis

5. Body Cast Lower lumbar spine

6. Pantalon Cast For pelvis #

7. Double Hip Spica

Cast

Bilateral affection of Hip and

femur

8. Double Hip spica moldBil. Affection of hip and femur w/

infection, swelling and open

wound

9. 1 Hip Spica cast Pelvis and hip affection

10. 1 Hip Spica mold Pelvis and hip affection

w/ infection, swelling and open

wound

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11. Single Hip SpicaHip and femur affection w/

infection, swelling and openwound

12. Frog castCongenital hip dislocation

13. Hanging CastFx shaft of Humerus

14. Functional Cast Fx of shaft of humerus w/c

allows flexion and extension of

upper extremity

15. Shoulder Spica CastAffection of upper portion of

humerus (recurrent dis.)

16. Airplane CastFx neck of humerus / for

abduction splint ( recurrent

shoulder dislocation)

17. Cylinder CastAffection of the patella

18. Cylinder MoldAffection of the patella w/

infection, swelling and openwound

19. Long Leg circular cast( LLCC)

For tibia and fibula

20. Long Leg posterior mold

( LLPM)For tibia and fibula w/ infection,

swelling and open wound

21. Patella Tendon Bearing

Cast ( PTB cast)Affection of tibia and fibula

22. Quadrilateral Cast

Affection of # femur23. Short leg circular cast

Ankle and toes

24. Short leg posterior moldAnkle and toes w/ infection,

swelling and open wound

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25. Boot CastPost polio w/ residual

26. Brace castFor # of the patella / fx distal 3rd

femur27. Basket Cast

For sever or massive bone injury

28. Delvit castAffection of the distal 3rd of tibia

and fibula

29. Internal rotatorFor pt who is udergone HIP

surgery / prosthesis,maintain abduction nad

prevent internal rotation30. Short Arm Circular cast

Affection of wrist andfinger( Wrist , carpals,matacarpals andphallenges)

31. Short Arm posterior mold Affection of wrist and

finger( Wrist , carpals,matacarpals andphallenges) w/ openwound , infection, andswelling

32. Long Arm Circular CastAffection of radius, ulna and wrist

33. Long Arm posterior moldAffection of radius, ulna and wrist

w/ open wound , infection,and swelling

34. Walking castAffection of ankle and toes w/

callus formation

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35. Night splintFor post polio w/ residual

36. Sugar tong

Affec tion of the shoulder , upperportion of the humerus w/open wound , infection andswelling

37. Fuenster ( Munster Cast)Fx of the radius and ulna w/

callus formation

38. U moldShaft of the humerus

39. Thumb Spica castAffection of the 1st metacarpals

bone

40. Petri castIndicated for legg perthes dis.

41. Bohler Braun splintTibia plateau pin inserted at the

calcaneous bone

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Traction

1. Traction is the act of pulling or drawing which isassociated 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 tothe 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 directlyto the bone using pins and wires such as KIRSHNERS

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WIRE, STEINMANS PIN, VINKIS SKULL RETRACTOR,

AND CRUTCHFIELD TONGS.

EX. affection of the femur, cervical spine or hip.

3. Manual Traction - the pulling force is applied byhands 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 lessen muscle spasm

B. to reduce #

C. to provide immobilization

D.to 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 AHARLINGTON ROD.

3. PRIOR TO TOTAL HIP REPLACEMENT, SURGEON

MAY APPLY SKELETAL TRACTION, IN AN

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ATTEMPT TO STRECH MUSCLES AND OBTAIN

MORE WORKING SPACE WITH THE JOINTS.

4.IT LESSEN MUSCLE SPASM IN BACK PAIN ANDIN 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 traction5. Be applied to a patient in a supine

position.

NURSING IMPLICATION IN VARIOUS TRACTIONS

APPLICATION

1. PHYSICIAN HAVE PRACTICED AND VERY

EFFICIENT AND EFFECTIVE.

2. NURSE MUST KNOW ALL BY MEANS MUST

BE KNOWLEDGEABLE ABOUT THE

PRINCIPLES OF TRACTION, UNDERSTAND

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THE ROUTINES OF THE HOSPITALS STAFF

& PHYSICIANS.

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TRACTIONKinds of Traction Indication Classification

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1. Head halter Cervical spine

affection

Skin traction /non

adhesive type

2. Pelvic Girdle Lumbo-sacral

affection(HN

P)

Skin traction / non

adhesive type

3. Halo-Pelvic For scoliosis Skeletal traction

4. Halo-femoral For severescoliosis

Skeletal traction

5. Overhead # of the humerus/

supra

condylar # of

the humerus

Skeletal traction

6. Buck Extension Femur and hip

affection

Skin traction /

adhesive-

adhesive type

7. Dunlop traction Supracondylar #

of the

humerus

Skin adhesive type

8. Bryants

traction

Cogenital hip

disloc. #

femur for 6

y.old

Skin traction /

adhesive type

9. Boot Cast ( leg) Post polio w/residual

paralysis

Special type oftraction

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Ninety-ninety

degrees(steinman

pin)

Fx of the femur Skeletal traction

11. Hammock

suspension

Pelvic affection Skin traction

Cotrel traction comb.

of head halterand pelvic

traction

For scoliosis Skin traction /

adhesive type

12.Balance

skeletal

traction

Hip and femur

affection

Skeletal traction

13.Zero degreetraction Neck of thehumerus Skin traction /adhesive type

14.Stove in Chest

traction

Multiple ribs # Special type

traction

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ORTHO-BRACES= a mechanical support for neck, muscle, bones and joints.

Braces Indications

1. Shuntz collar / cervical

Collar

Cervical affection

2. Philadelphia brace Cervical affection

3. Taylor brace Upper thoracic spine affection

( potts disease)

4. Jewette brace Lower thoracic affection

5. Milwaukee Brace For scoliosis ( thoracic T-9)

6. Yamamoto Brace For Scoliosis

7. Chair-Back Brace Affection of lumbo-sacral spine

8. Four foster Brace orWalker

Cervical thoraco spineaffection

9. Forester Brace Cervico-thoraco-lumbar spine

affection

10. Bilateral Leg Brace For Polio

11. Unilateral Leg Brace For Polio ( one leg)

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12. SOMI Brace

For Potts disease( sterno

occipito mandibular

Immobilizer / For cervico

upper dorsal spine affection

13. Dennis Brown Splint For clubfoot

14. Banjo Splint For Peripheral nerve injury

15. Cock-up Splint For wrist drop

16. Lively Finger splint For Fracture of finger

17. Abduction walking Brace For legg Perthess Disease

18. Bohler Braun Splint For tibia plateau pin inserted

at the calcaneum bone

19. RAEF- Roger AndersonExternal Fixator

Affection of Tibia-Fibula, Longbones, for humerus, Mal-

union, communited #

20. Towers External Fixation For # of the mandible

21. Hoffman fixator For # of the pelvis

22. Spanning fixator For Long bones ex. femur and

tibia-fibula communited #cannot flex.

23. Delta fixator

24. Hybrid fixator

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