ORTHOPEDIC NURSING(IMMOBILIZATION DEVICES)BY:SUSIE MAY D. JARDIO RN, RM, MSN

TRACTION Is the act of pulling and drawing which is associated with counter traction.

TYPES OF TRACTION1. FIXED the traction is applied against a counter force while the pull is continuous and intact. ex. HARE traction used by paramedics during rescues. 2. SLIDING - the patient's weight is balanced against an applied load making use of the gravitational pull to counter balance the applied traction. ex. Crutchfield tong while the bed is tilted by shock blocks.

TYPES OF TRACTION APPLICATION1. SKIN - adhesive straps are applied to the skin while the pull is offered by weight. 2. SKELETAL a pin is driven across the bone to provide an excellent hold while the weight is likewise attached.

BALANCED SKELETAL TRACTIONINDICATIONS: To provide immobilization. To prevent further deformity or correct deformity. To reduce pain and muscle spasm. To reduce fracture. To maintain good body alignment. For support.

1. 2. 3. 4. 5. 6.

PARTS OF AN ORTHOPEDIC BED1. 2. 3. 4. Firm Mattress Fracture Board Bed Elevator or Shock Block Balkan Frame a. 4 vertical bars b. 2 horizontal bars c. 1 diagonal bar d. 1 straight bar or cross bar 5. Pulleys 3 6. Clamps to hold the bars in place 7. Overhead Trapeze

PRINCIPLES OF TRACTION1. Patient should be on a dorsal recumbent position. 2. Line of pull should be in line with the deformity. 3. Should always be continuous, emphasize the importance of manual traction. 4. Avoid friction. 5. Provide counter traction.

TRACTION EQUIPMENTS1. 2. 3. 4. 5. Thomas Splint with Pearson Attachment Rest Splint 5 Slings of variable sizes 5 Paper clips or safety pins Cord Sash different length short for the thigh long for the traction longest for the suspension 6. Weights and Bags Suspension weight is lighter than the weight of the traction. 7. Foot Support to prevent foot drop.

APPLICATION OF TRACTION (PREPARATION PHASE)1. Verify doctors order. 2. Inform the patient about the need and purpose of procedure. 3. Preparation: a. Identify the different parts of the orthopedic bed. b. Assemble the needed equipments. c. Know the affected extremity. d. Know where to stand on the demo side look for the last pulley.

4. Mount the Thomas Splint and Pearson Attachment on the Rest Splint. Splint. 5. Tie the short rope on the medial upright of the Thomas Splint with a slip knot. 6. Attach slings to the Thomas Splint and Pearson Attachment. 7. Apply manual traction on the affected leg. 8. Instruct the patient to flex the unaffected leg and hold on to the overhead trapeze. 9. Insertion of the apparatus under the affected knee with the help of assistants. 10. Apply the Traction Weight. 11. Apply Suspension Traction. 12. Remove the Rest Splint. 13. Apply Foot Support. 14. Check the Principles of Traction

5 PRINCIPLES IN APPLICATION OF SLINGS:1. Not too tight and not too loose. 2. One (1) inch distance in between the slings to promote aeration or ventilation. 3. Popliteal and heel portion should be free from any sling. 4. Smooth and right side should come in contact with the patients skin. 5. Two (2) longer and wider slings for the thigh portion and the three (3) for the leg area.

HOW TO APPLY SLING?1. Start from the medial side to the lateral side. 2. Secure both ends together. 3. Fan fold nicely on the lateral aspect and secure with a pin or clip. 4. Observe the 5 Principles in Application of Slings. 5. Avoid hitting the patients extremity with a pin. 6. The thigh rope should be attached on the medial aspect to the lateral aspect.

APPLICATION OF TRACTION WEIGHT1. Rope to be attached to the Steinman pin holder to run along the third (3rd) pulley and attached the prescribed weight. 2. Check the principles of sling application, and make the necessary adjustments, also check the alignment.

3 MANPOWER NEEDED1. To insert the whole apparatus under the affected extremity. 2. Manual traction to be released after the completion of the traction weight on the third (3rd) pulley. 3. To lift the affected extremity, simultaneous at the count of three (3).

APPLICATION OF SUSPENSION TRACTION1. One (1) end of the thigh rope to be attached to the lateral aspect of the ischial ring with a slip knot. 2. Attach the suspension rope on the mid part of the thigh rope, to the first (1st) pulley, hang it on the first (1st) pulley pass it on the second (2nd) pulley under the rest splint, clove hitch knot on the Thomas Splint and another clove hitch knot on the Pearson, close it with a knot to secure it. 3. Be sure to maintain the traction rope inside, and the suspension weight should be outside.

REMOVAL OF TRACTION1. Apply rest splint. 2. Hang suspension weight on the first (1st) pulley. 3. Complete removal of suspension weight. Remove the knot on the Pearson attachment and Thomas splint. 4. Manual traction on the Steinman pin holder, remove the traction weight on the third (3rd) pulley, secure the traction rope on the rest splint another on the Thomas splint and Pearson attachment.

NURSING CARE OF PATIENTS WITH TRACTION1. Assessment assess the patient as to level of understanding, consciousness. 2. Provision of general comfort. a. Skin care head to toe, focus on the sponging of the affected extremity. HOW TO SPONGE? 2 basins with face towel and soap. Remove sling one by one and sponge. b. Changing of linen. c. Provide bedpan as needed - serve bedpan on unaffected side, provide pillow at the back and provide privacy. d. Perineal care

3. Potential complications: complications: a. Upper respiratory - PNEUMONIA bronchial taping and deep breathing. b. Bedsore good perineal care, proper skin care, turning left buttocks once in a while. c. Urinary and kidney problem good perineal care, increase fluid intake. d. Bowel complication fear of apparatus, no privacy, lack of fluids, perineal care. e. Pin site infection observe for s/sx of infection, loosening pin tract, pus coming out, foul smelling, fever. - aseptic technique and proper referral to DIC. f. Deformity contracted knee, atrophy of muscles, foot drop, joint contractures.

4. Provision of Exercisesa. ROM exercises with the use of trapeze. b. Deep breathing exercises. c. Static quadriceps exercises, alternate contractions and relaxation of quadriceps muscles. d. Toes pedal exercises. 5. Nutritional Status depending on the status of patient. 6. Psychological Aspect fear of unknown, fear of death, fear of the apparatus, fear of losing job, financial fear. 7. Provision of supportive therapy offer book to read, something to listen radio or television, discover interest. 8. Spiritual Aspect know his religion, encourage relatives to give spiritual, communication, visiting chaplain. 9. Diversional activities divert attention.

TRACTIONS AND ITS INDICATIONS1. Head Halter Traction 2. Pelvic Girdle Traction 3. Dunlop Skin Traction 4. Bucks Extension Traction 5. Cotrel Traction Cervical Spine affection Lumbo-sacral affection Supracondylar fracture of the Humerus Hip and femur affection Combination of head halter and pelvic girdle traction

TRACTION 6. Halo-Pelvic Traction 7. Halo-Femoral Traction 8. Bryants Traction

INDICATIONS For Scoliosis For Severe Scoliosis Congenital hip dislocation, fracture of femur for children ages 0 to 6 years old. Post-poliomyelitis with residual paralysis

9. Boot Cast Traction

TRACTION 10. Ninety Degrees Traction 11. Stove-In Chest Traction 12. Hammock Suspension Traction

INDICATIONS Fracture of the femur Severe chest injury with multiple rib fracture Pelvic affection

BRACES AND ITS INDICATIONS1. Shuntz Collar/ Cervical Collar Brace 2. Milwaukee Brace 3. Forester Brace Cervical affection

4. Taylor Brace

Scoliosis Cervico-ThoracoLumbar spine affection Upper Thoracic affection

BRACES 5. Jewett Brace 6.Chair-Back Brace 7. Banjo Splint 8. Bilateral Leg Brace 9. Dennis Browne Splint

INDICATIONS Lower Thoracic affection Lumbo-Sacral affection Peripheral Nerve Injury Post-poliomyelitis with residuals Clubfoot Deformity

BRACES

INDICATIONS Wrist Drop Polio (one leg affection) Fracture of Finger Cervical Affection Scoliosis

10. Cock-up Splint 11. Unilateral Leg Brace 12. Lively Finger Sprint 13. Philadelphia Brace 14. Yamamoto Brace

CASTS AND MOLDSPLASTER CAST a temporary immobilizing device made up of gypsum sulfate rendered unhydrous by calcination when mixed with water, swells and forms into a hard cement.

CASTS AND MOLDS 1. Rizzers Jacket Cast 2. Minerva Cast 3. 4. 5. 6. 7. Collar Cast Body Cast Pantalon Cast 1 Hip Spica Cast Double Hip Spica Cast

INDICATIONS Scoliosis Upper Dorsal Cervical Spine affection Cervical Spine affection Lumbar Spine affection Pelvic Bone fracture Hip and Femur affection

CASTS AND MOLDS 8. Single Hip Spica Cast 9. 1 Hip Spica Mold 10. Double Hip Spica Mold 11. Single Hip Spica Mold

INDICATIONS Hip and one femur fracture Hip and femur with compound affection Pelvic affection with callus formation Pelvic bone fracture with callus formation

CASTS AND MOLDS 12. Frog Cast 13. Cylinder Cast 14. Short Leg Circular Cast 15. Long Leg Circular Cast

INDICATIONS Congenital Hip Dislocation Fracture of Patella Fracture of ankle, tarsals and metatarsals For affections of tibiafibula

CASTS AND MOLDS 16. Patellar Tendon Bearing Cast 17. Quadrilateral Cast (Ischial Weight Bearing Cast) 18. Long Leg Posterior Mold

INDICATIONS Fracture of tibia-fibula with callus formation. For affection of femur with callus formation. For fracture of tibiafibula with open wound, swelling and infection.

CASTS AND MOLDS 19. Night Splint 20. Basket Cast 21. Short Leg Posterior Mold

INDICATIONS Post-polio For Massive Bone Injury Fracture of ankle, tarsal, and metatarsal with open wound, swelling or infection. Fracture of the distal third of tibia. Post Hip Surgery Affection of distal third of femur with callus formation.

22. Delvit Cast 23. Internal Rotator Board 24. Brace Cast

CASTS AND MOLDS 25. Short Arm Circular Cast 26. Short Arm Posterior Mold 27. Long Arm Circular Cast 28. Long Arm Posterior Mold

INDICATIONS Fracture of wrist, carpals, and metacarpals. Wrist, carpals, and metacarpals with open wound, swelling or infection. Fracture of radius ulna Radius ulna affection with open wound, swelling or infection.

CASTS AND MOLDS 29. Munsters or Fuenters Cast 30. Hanging Cast 31. Functional Cast 32. Shoulder Spica Cast

INDICATIONS Fracture of radius ulna with callus formation. Shaft of the Humerus Shaft of the Humerus with callus formation. Affections of outer portion of humerus and shoulder joints. Neck of the humerus Affections.

33. Airplane Cast

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