CAST AND TRACTION
CAST TYPES
• Used for immobilization to aid in healing
• Cast wet handle with palm of hands
• 24-48 hours to dry completely - May elevate on pillows
o Forearm Cast
o Long Arm Cast
Will have some flexion – muscle atrophy
o Short Leg cast
NV assessment
o Long leg cast
May have heal added to be able to put weight
o Body Cast
o Full Spica Cast
o May see the Spica in the pediatric setting
CARE
• Elevate
• Monitor Drainage
• Itch use “cool” blow dryer
• Check pulses
• Instruct not to pull padding under cast
• Circulate air around promote drying
• Isometric exercises
EXTERNAL FIXATORS
• Pin setting
• Used for usually a comminuted fracture or a bad open fracture
• Ambulatory or Immobilized with traction bar
• Open fracture with soft tissue damage
• Clean daily every shift (without osteomylitis)
• ½ / ½ with 4x4, betadine(allergies??), 2x2 with split
• Notify MD of any drainage, assess redness, edema
• Clear drainage is OK
CPM: CONTINOUS PASSIVE MOTION
• Used after Total Knee Replacement
• Can be set from a 0o to a 90o Flexion
• Post op 30-35o flexion, put on in the recovery room
• Increase Flexion by 10o each day with no complications
• May say extension –10o to make sure it is totally extended
• Promote mobility, circulation, healing
CRUTCH WALKING
• Patient Teaching with nurse reinforces education
• Several gaits rotate strain on muscles
• Bear the weight through the Palm of the hands
• Check height of crutch
• Stand up with tripod position
o 4pt gait: opposite side with crutch / leg rotation
o 2pt gait: opposite side crutch / leg together
o Swing to gait: Feet land at tip of crutches
o Swing through: Feet land ahead of crutches
o 3pt gait: You will not bear weight on the affected extremity. Never put weight on
injured extremity
• Down Movement: Walk forward as far as possible advance crutch lower step weaker leg
first, then stronger leg
• Movement Upstairs: Stronger leg 1st, with crutch to step then bring weaker of affected
side first
TRACTION
• Pulling force to part of body
• Purpose: Reduce, alignment, mobilize fracture
• Minimize muscle spasms to decrease pain
• Increase spaced between opposing surface within joint
o Example: Vertebrae to prevent cervical nerve
• Prevent further soft tissue damage in and around area
• Apply more than one direction achieves life of pull desired counter traction
o 2 Types
Skin
• To skin transmit traction to skeletal muscle underneath. Up to 5
pounds
• Bucks and Russell’s
Skeletal
• Pin Placement. Up to 20 pounds of weight
• Skeletal with Thomas splint and person attachment
Straight Traction
• Looking at the line of pull
• Bucks, Pelvic
Suspended Traction:
PRINCIPELS
• Counter traction through body weight of patient
o Increase part of bed with traction
• Traction must be maintained for treatment
• Remove Buck but with assistance to support extremity
o Align in bed and in center
o Can remove for skin care to provide skin care
o Do not remove from skeletal traction
• Traction neck / back pain intermittent
• Maintain good body alignment
• Weights off ground, no frayed ropes
TYPES OF TRACTION
• Bucks Traction
o Used for a broken hip
o About 3-5pounds of weight on bucks
• Pelvic traction: Increase oppose surface of lumbar area: Straight Txn
o For chronic low back pain. Intermittent traction
o Done at home. Not hospitalized for lower back pain
o Can be done sitting or lying
o Home sitting (assess airway, skin breakdown at pressure points, Make sure it
fits)
• Dunlop’s: Fracture of humorous / forearm; elbow
• Balanced Suspension with Skeletal Traction: Used for a Fracture of femur (extremity
balance between weights) Person attachment????
• Balanced Suspension without Skeletal: Can be done to abduct a hip - FYI
• Russell’s: Fracture of tibial; Same as bucks but has a sling under the knee; Somewhat
suspended
•
• Cervical: relieve pain Increases extremity cervical area (intermittent tx). Straight Txn
• Cervical Skeletal: Relieve muscle spasm, compression
o FX of C5-C6 - Crutchfield, Binky - Prevent spinal cord injury
o Log roll
o Pin site care
May be skin or skeletal
Little small pillow
There body must be in good alignment
Log roll with 3 people
• Halo Vest: Immobilize neck
o For a cervical neck injury
o Pin site care
COUNTER TRACTION
• If they are flat in the bed with skeletal cervical traction, you would increase counter
traction by raising the HOB. In bucks you would elevate the Foot of the bed
• To increase counter traction you would lift the area that is in traction
NURSING MANAGEMENT
• Can they move while in traction: Yes with a trapeze bar
• Maintain affective traction
• Neuro Checks
• Position with body alignment
• Support extremity with movement
• Skin Traction – Remove before surgery, care: neuro check Q2o
• Foot drop suggest nerve damage
• ROM to the extremities than can be done and isometric to the extremities that cannot.
