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GADGETS

Most common gadgets used at Philippine Orthopedic Center


are :
1. Cast
2. 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 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.

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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

G. 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

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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 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.

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INSTRUMENTS FOR CAST REMOVAL:
1.CAST CUTTER ( MANUAL,
ELECTRIC)
2.CAST SPREADER
3.TRIMMING KNIFE
4.BANDAGE SCISSORS
5.PLASTER SHEARS

CASTS INDICATIONS
1. Collar cast Cervical spine affection

2. Philadelphia
Cervical spine affection / injury

3. Minerva cast Upper dorsal spine for pott’s


dis. and scoliosis
4. Rizzer Jacket cast
For Scoliosis

5. Body Cast Lower lumbar spine

6. Pantalon Cast For pelvis #

7. Double Hip Spica Bilateral affection of Hip and


Cast femur
8. Double Hip spica mold
Bil. Affection of hip and femur w/
infection, swelling and open
wound

9. 1½ Hip Spica cast Pelvis and hip affection

10. 1½ Hip Spica mold Pelvis and hip affection


w/ infection, swelling and open
wound

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11. Single Hip Spica
Hip and femur affection w/
infection, swelling and open
wound
12. Frog cast
Congenital hip dislocation

13. Hanging Cast


Fx shaft of Humerus

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


allows flexion and extension of
upper extremity
Affection of upper portion of
15. Shoulder Spica Cast humerus (recurrent dis.)
Fx neck of humerus / for
16. Airplane Cast abduction splint ( recurrent
shoulder dislocation)
17. Cylinder Cast
Affection of the patella
18. Cylinder Mold
Affection of the patella w/
infection, swelling and open
wound
19. Long Leg circular cast
For tibia and fibula
( LLCC)
20. Long Leg posterior mold
For tibia and fibula w/ infection,
( LLPM) swelling and open wound

21. Patella Tendon Bearing


Affection of tibia and fibula
Cast ( PTB cast)
22. Quadrilateral Cast
Affection of # femur
23. Short leg circular cast
Ankle and toes
24. Short leg posterior mold
Ankle and toes w/ infection,
swelling and open wound

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25. Boot Cast
Post polio w/ residual

26. Brace cast


For # of the patella / fx distal 3rd
femur
27. Basket Cast
For sever or massive bone injury
28. Delvit cast
Affection of the distal 3rd of tibia
and fibula
29. Internal rotator
For pt who is udergone HIP
surgery / prosthesis,
maintain abduction nad
prevent internal rotation
30. Short Arm Circular cast
Affection of wrist and
finger( Wrist , carpals,
matacarpals and
phallenges)

31. Short Arm posterior mold Affection of wrist and


finger( Wrist , carpals,
matacarpals and
phallenges) w/ open
wound , infection, and
swelling
32. Long Arm Circular Cast
Affection of radius, ulna and wrist

33. Long Arm posterior mold


Affection of radius, ulna and wrist
w/ open wound , infection,
and swelling
34. Walking cast
Affection of ankle and toes w/
callus formation

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35. Night splint
For post polio w/ residual

36. Sugar tong


Affec tion of the shoulder , upper
portion of the humerus w/
open wound , infection and
swelling
37. Fuenster ( Munster Cast)
Fx of the radius and ulna w/
callus formation
38. U mold
Shaft of the humerus

39. Thumb Spica cast


Affection of the 1st metacarpals
bone
40. Petri cast
Indicated for legg perthes dis.

41. Bohler Braun splint


Tibia plateau pin inserted at the
calcaneous bone

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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

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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 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 A
HARLINGTON 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 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. 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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TRACTION
Kinds of Traction Indication Classification

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1. Head halter Cervical spine Skin traction /non –
affection adhesive type

2. Pelvic Girdle Lumbo-sacral Skin traction / non


affection(HN adhesive type
P)

3. Halo-Pelvic For scoliosis Skeletal traction

4. Halo-femoral For severe Skeletal traction


scoliosis

5. Overhead # of the humerus/ Skeletal traction


supra
condylar # of
the humerus
6. Buck Extension Femur and hip Skin traction /
affection adhesive-
adhesive type
7. Dunlop traction Supracondylar # Skin adhesive type
of the
humerus
8. Bryant’s Cogenital hip Skin traction /
traction disloc. # adhesive type
femur for ↓ 6
y.old
9. Boot Cast ( leg) Post polio w/ Special type of
residual traction
paralysis

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Ninety-ninety Fx of the femur Skeletal traction
degrees(steinman
pin)

11. Hammock Pelvic affection Skin traction


suspension

For scoliosis Skin traction /


Cotrel traction comb. adhesive type
of head halter
and pelvic
traction
12.Balance Hip and femur Skeletal traction
skeletal affection
traction

13.Zero degree Neck of the Skin traction /


traction humerus adhesive type

14.Stove in Chest Multiple ribs # Special type


traction traction

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

Braces Indications

1. Shuntz collar / cervical Cervical affection


Collar
2. Philadelphia brace Cervical affection

3. Taylor brace Upper thoracic spine affection


( pott’s 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 or Cervical thoraco spine


Walker affection

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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For Pott’s disease( sterno
12. SOMI Brace 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 Anderson Affection of Tibia-Fibula, Long
External Fixator bones, for humerus, Mal-
union, communited #
20. Tower’s 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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