Care of patient with

orthopedic devices
Orthopedic devices
• Splints
• Braces
• Plaster casts
• Types of tractions
• Orthopedic bed
• Ripple mattress
 Splints and braces
Splints
• These are devices that are used to immobilize and support the body part in a
functional position and it must be well padded to prevent pressure, skin abrasion,
and skin breakdown
• The splint is overwrapped with an elastic bandage applied in a spiral fashion and
with pressure uniformly distributed so that circulation is not restricted.
• Splints are generally indicated for short-term use
Braces (ie, orthoses)
• These devices are used to provide support, control movement, and prevent
additional injury
• They are custom fitted to various parts of the body.
• The orthotist adjusts the brace for fit, positioning, and motion so that movement
is enhanced, any deformities are corrected, and discomfort is minimized.
• Braces are generally indicated for longer use than splints

• The splints and braces can be made from materials such as cloth, leather, metal,
elastic
Care of a patient with a brace and splint
• The nurse observes the patient for systemic signs of infection; odors from the
cast, brace, or splint; and purulent drainage staining the cast.
• Monitors circulation, motion, and sensation of the affected extremity, assessing
the fingers or toes of the affected extremity and comparing them with those of
the opposite extremity
• Encourages the patient to move all fingers or toes hourly when awake to
stimulate circulation.
• It is important to perform frequent, regular assessments of neurovascular status.
• The nurse adjusts the extremity so that it is no higher than heart level to enhance
arterial perfusion and control edema and notifies the physician at once if signs of
compromised neurovascular status are present
• Potential complications related to casts, braces, and splints include compartment
syndrome, pressure ulcer formation, and disuse syndrome.
• Pressure of a cast or an inappropriately applied brace on soft tissues may cause
tissue anoxia and pressure ulcers.
• Usually, the patient with a pressure ulcer reports pain and tightness in the area. A
warm area on the cast or brace suggests underlying tissue erythema
 Plaster casts
• Plaster casts are used to immobilize bones and joints into correct alignment after
a fracture or injury
• Casting is a common treatment often closed reductions has been performed
• Casts may include short leg casts, extending to the knees, or long-leg casts,
extending to the groin
• Casts that encase the trunk (body cast) and portions of one or two extremities
(spica cast) require special nursing strategies.
• Body casts are used to immobilize the spine.
• Hip spica casts are used for some femoral fractures and after some hip joint
surgeries, and shoulder spica casts are used for some humeral neck fractures.
Care of a patient with a cast
• Keep the cast and extremity elevated
• Allow a wet plaster cast 24 to 72 hours to dry (synthetic casts dry in 20 minutes)
• Handle a wet plaster cast with the palms of the hands (not fingertips) until dry
• Turn the extremity every 1 to 2 hours, unless contraindicated, to allow air
circulation and promote drying of the cast
• A hair dryer can be used on a cool setting to dry a plaster cast (heat cannot be
used on a plaster cast, because the cast heats up and burns the skin)
• Monitor closely for circulatory impairment; prepare for bivalving or cutting the
cast if circulatory impairment occurs
• Petal the cast or apply moleskin to the edges to protect the client’s skin; maintain
smooth edges around the cast to prevent crumbling of the cast material
• Monitor for signs of infection such as increased temperature, hot spots on the
cast, foul odor, or changes in pain
• If an open draining area exists on the affected extremity, the health care provider
will make a cutout portion of the cast known as a window, for assessment and
wound care purposes.
• Instruct the client not to stick objects inside the cast because it may abrade the
skin and lead to infection
• Teach the client to keep the cast clean and dry
• Instruct the client in isometric exercises to prevent muscle atrophy.
• Monitor a casted extremity for circulatory impairment such as pain, swelling,
discoloration, tingling, numbness, coolness, or diminished pulse. Notify the
Doctor immediately if circulatory compromise occurs.
 Tractions
• Traction is the exertion of a pulling force applied in 2 directions to reduce and
immobilize a fracture
• It provides proper bone alignment and reduces muscle spasms.
• Traction must be applied in the correct direction and magnitude to obtain its
therapeutic effects
• Traction is used primarily as a short-term intervention until other modalities, such
as external or internal fixation, are possible.
• These modalities reduce the risk of disuse syndrome and minimize the length of
hospitalization, often allowing the patient to be cared for in the home setting
 Principles of effective traction
• Whenever traction is applied, counter traction must be used to achieve effective
traction. Counter traction is the force acting in the opposite direction.
• Traction must be continuous to be effective in reducing and immobilizing
fractures
• Skeletal traction is never interrupted
• Weights are not removed unless intermittent traction is prescribed
• Any factor that might reduce the effective pull or alter its resultant line of pull
must be eliminated
• The patient must be in good body alignment in the center of the bed when
traction is applied
• Ropes must be unobstructed.
• Weights must hang freely and not rest on the bed or floor
• Knots in the rope or the footplate must not touch the pulley or the foot of the
bed
• Do not remove or lift the weights without a Doctor’s prescription
 Types of traction
• Skin traction
• Skeletal traction
Skin traction
• Skin traction is used to control muscle spasms and to immobilize an area before
surgery and is accomplished by using a weight to pull on traction tape or on a
foam boot attached to the skin
• No more than 2 to 3.5 kg of traction can be used on an extremity. Pelvic traction
is usually 4.5 to 9 kg depending on the weight of the patient.
• Types of skin traction used for adults include Buck’s extension traction (applied
to the lower leg) ,the cervical head halter (occasionally used to treat neck pain),
and the pelvic belt (sometimes used to treat back pain).
• Skin traction is applied by using elastic bandages or adhesive, foam boot, or
sling.
• Cervical skin traction relieves muscle spasms and compression in the upper
extremities and neck
• Cervical skin traction uses a head halter and chin pad to attach the traction
Indication of traction
• Reduction of fracture
• Maintain correct alignment of the bone during healing
• Immobilize a limb while soft tissue healing takes place
• Overcome muscle spasm
• Correct deformities
 Cervical
traction(head
halter)
Bucks Traction

Byrant Traction
Care of a patient with skin traction
• Before the traction is applied, the nurse inspects the skin for abrasions and
circulatory disturbances.
• The skin and circulation must be in healthy condition to tolerate the traction.
• The extremity should be clean and dry before the foam boot or traction tape is
applied.
• To apply Buck’s traction, one nurse elevates and supports the extremity under the
patient’s heel and knee while another nurse places the foam boot under the leg,
with the patient’s heel in the heel of the boot
• Avoid wrinkling and slipping of the traction bandage and to maintain counter
traction
• Proper positioning must be maintained to keep the leg in a neutral position
• Patient should not turn from side to side
• Monitors the status of the skin in contact with tape or foam to ensure that
shearing forces are avoided.
• The nurse performs the following procedures to monitor and prevent skin
breakdown: •
• Inspect the skin, the ankle, and the achilles tendon three times a day
• Palpates the area of the traction tapes daily to detect underlying tenderness
• Provides back care at least every 2 hours to prevent pressure ulcers. The patient who must
remain in a supine position is at increased risk for development of a pressure ulcer
• Uses special mattress overlays (eg, air-filled, high density foam) to prevent pressure ulcers
• Regularly question the patient about sensation and asks the patient to move the
toes and foot.
• Dorsiflexion of the foot demonstrates function of the peroneal nerve.
• Assess the circulation of the foot within 15 to 30 minutes and then every 1 to 2
hours
• Circulatory assessment consists of the following;
• Peripheral pulses, color, capillary refill, and temperature of the fingers or toes
• Indicators of deep vein thrombosis (DVT), including unilateral calf tenderness, warmth,
redness, and swelling
 Skeletal traction
• Its applied directly to the bone and placed for a longer period of time
• This method of traction is used occasionally to treat fractures of the femur, the
tibia, and the cervical spine.
• The physician inserts a pin or wire into the bone either partially or completely to
align and immobilize the injured part, the pin is inserted through the bone distal
to the fracture, avoiding nerves, blood vessels, muscles, tendons, and joints
• Tongs applied to the head are fixed to the skull to apply traction that immobilizes
cervical fracture
• The weights are attached to the pin or wire bow by a rope-and pulley system that
exerts the appropriate amount and direction of pull for effective traction.
• Skeletal traction frequently uses 7 to 12 kg to achieve the therapeutic effect.
• As the muscles relax, the traction weight is reduced to prevent fracture
dislocation and to promote healing.
• When skeletal traction is discontinued, the extremity is gently supported while
the weights are removed.
• The pin is cut close to the skin and removed by the physician.
• Internal fixation, casts, or splints are then used to immobilize and support the
healing bone.
Care of patient with skeletal traction
• Explain amount of movement permitted and how to achieve by using the
trapeze to assist with movement; trapeze can be suspended overhead within
easy reach of the patient so as to prevent using the elbows or heel during
movement
• Maintain body alignment and positioning to promote an effective line of pull.
• The nurse checks the traction to see that the ropes are in the wheel grooves
of the pulleys, that the ropes are not frayed, that the weights hang freely,
and that the knots in the rope are tied securely
• This digging of the heel into the mattress may injure the tissues, the nurse
should protect the elbows and heels and inspect them for pressure ulcers.
• The nurse assesses the neurovascular status of the immobilized extremity at
least every hour initially and then every 4 hours.
• The nurse encourages the patient to do active flexion–extension ankle
exercises and isometric contraction of the calf muscles 10 times an hour while
awake to decrease venous stasis
• Anti-embolism stockings, compression devices, and anticoagulant therapy
may be prescribed to help prevent thrombus formation.
• Pin insertion site require care to avoid infection and development of
osteomyelitis, Pin site care is performed initially two or three times a day.
• Monitor the pin for signs of infection i,.e swelling , purulent drainage,
erythema, tenderness
• The nurse must consider the psychological and physiologic impact of the
musculoskeletal problem, traction device, and immobility
• Initially, the patient may require assistance with self-care activities.
• The nurse auscultates the patient’s lungs every 4 to 8 hours to assess
respiratory status and teaches the patient deep breathing and coughing
exercises to aid in fully expanding the lungs and clearing pulmonary
secretions.
• A high fiber diet and fluids may help stimulate gastric motility to prevent
constipation
• Incomplete emptying of the bladder related to positioning in bed can
result in urinary stasis and infection, the nurse teaches the patient to
consume adequate amounts of fluid and to void every 3 to 4 hours.
 Special orthopedic beds and mattress
• There are different orthopedic beds used for different purpose in musculoskeletal
disorders
Special orthopedic bed for positioning the patient
• Its indication is to promote turning of the patient and promote skin integrity
• The beds have frames that promote turning of patient
• The frame is rigid for giving support to or immobilizing a part
• Balkan frame – its an apparatus for continuous extension in treatment of fracture of the
femur, consisting of an overhead bar with pulleys attached by which the leg is supported in
a sling
• Bradford frame – it’s a canvas covered rectangular frame used as a bed frame in spine or
thigh disease
• Beds that promote turning have the turning frame
• Stryker or foster frame ;
• It immobilizes the vertebral column
• Facilitates turning
• Promotes body function(circulation, respiration and elimination)
• They have perineal openings in the frame for use of bedpan
Beds that promote skin integrity
• These are beds with mattresses filled with either fluid or air
• There purpose is to distribute body weight
• Limits friction and reduces bedsore
• Promotes circulation of air under patient.