|
Contents Definition of cast Purpose of cast Types of traction Types of cast Plaster of paris Advantages of pop Disadvantages of pop Pop material Fiber glass Special considerations Traction uses Reduction and casting Abduction brace Application of nursing process(assessment , diagnosis Evaluation Cast drying After care Factors that influence the duration of cast Cast removal Complication of cast Rehabilitation References
Cast : 1- Externally applied structure that hold bone in one position 2- Is a rigid device applied to immobilize the injured bones and promote healing . it is applied to immobilize the joint above and below the fractured bone so that the bone won't move during healing . these are applied on clients who have relatively stable fractures Purpose of cast : Immobilize parts of the body Hold bone fragments in reduction (reduction is bringing the fractured on its anatomical position) Apply uniform compression Stabilize joint Correct deformities Support weakened limb Permit early weight bearing on affected side traction DefinitionTraction is the use of a pulling force to treat muscle and skeleton disorders. PurposeTraction is usually applied to the arms and legs, the neck, the backbone, or the pelvis. It is used to treat fractures, dislocations, and long-duration muscle spasms, and to prevent or correct deformities. Traction can either be short-term, as at an accident scene, or long-term, when it is used in a hospital setting. Traction serves several purposes:
There are two main types of traction: skin traction and skeletal traction. Within these types, many specialized forms of traction have been developed to address problems in particular parts of the body. The application of traction is an exacting technique that requires training and experience, since incorrectly applied traction can cause harm. Positioning the extremity so that the angle of pull brings the ends of the fracture together is essential. Elaborate methods of weights, counterweights, and pulleys have been developed to provide the appropriate force while keeping the bones aligned and preventing muscle spasm. The patient's age, weight, and medical condition are all taken into account when deciding on the type and degree of traction. PrecautionsPeople who are suffering from skin disorders or who are allergic to tape should not undergo skin traction, because the application of traction will aggravate their condition. Likewise, circulatory disorders or varicose veins can be aggravated by skin traction. People with an inflammation of the bone (osteomyelitis) should not undergo skeletal traction. DescriptionSkin tractionSkin traction uses five-to seven-pound weights attached to the skin to indirectly apply the necessary pulling force on the bone. If traction is temporary, or if only a light or discontinuous force is needed, then skin traction is the preferred treatment. Because the procedure is not invasive, it is usually performed in a hospital bed. Weights are attached either through adhesive or nonadhesive tape, or with straps, boots, or cuffs. Care must be taken to keep the straps or tape loose enough to prevent swelling and allow good circulation to the part of the limb beyond the spot where the traction is applied. The amount of weight that can be applied through skin traction is limited because excessive weight will irritate the skin and cause it to slough off. Specialized forms of skin traction have been developed to address specific problems. Dunlop's traction is used on children with certain fractures of the upper arm, when the arm must be kept in a flexed position to prevent problems with the circulation and nerves around the elbow. Pelvic traction is applied to the lower spine, with a belt around the waist. Buck's skin traction is used to treat knee injuries other than fractures. The purpose of this traction is to stabilize the knee and reduce muscle spasm. Skeletal tractionSkeletal traction is performed when more pulling force is needed than can be withstood by skin traction; or when the part of the body needing traction is positioned so that skin traction is impossible. Skeletal traction uses weights of 25-40 pounds. Skeletal traction requires the placement of tongs, pins, or screws into the bone so that the weight is applied directly to the bone. This is an invasive procedure that is done in an operating room under general, regional, or local anesthesia. Correct placement of the pins is essential to the success of the traction. The pin can be kept in place several months, and must be kept clean to prevent infection. Once the hardware is in place, pulleys and weights are attached to wires to provide the proper pull and alignment on the affected part. Specialized forms of skeletal traction include cervical traction used for fractures of the neck vertebrae; overhead arm traction used for certain types of upper arm fractures; and tibia pin traction used for some fractures of the femur, hip, or pelvis. PreparationX rays are done prior to the application of both forms of traction, and may be repeated during treatment to assure that the affected parts are staying in alignment and healing properly. Since the insertion of the anchoring devices in skeletal traction is a surgical procedure, standard preoperative blood and urine testing are done, and the patient may meet with an anesthesiologist to discuss any health conditions that might affect the administration of anesthesia. AftercareAftercare for skin traction involves making sure the limb stays aligned, and caring for the skin so that it does not become sore and irritated. The patient should also be alert to any swelling or tingling in the limb that would suggest that the limb has been wrapped too tightly. Aftercare for skeletal traction is more complex. The patient is likely to be immobile for an extended period. Deep breathing exercises are taught so that respiratory function is maintained during this time of little activity. Patients are also encouraged to do range-of-motion exercises with the unaffected parts of the body. The patient is taught how to use a trapeze
Traction refers to the usage of a pulling force and special devices, such as a cast or splint, to treat muscle and skeletal disorders. It is used to treat fractures, dislocations, and long-duration muscle spasms, and to prevent or correct deformities. The illustration above features several commonly used forms of traction. (Illustration by Electronic Illustrators Group.) (an overhead support bar) to shift on and off a bedpan, since it is not possible to get up to use the toilet. In serious injuries, traction may be continued for several months until healing is complete. RisksThe main risks associated with skin traction are that the traction will be applied incorrectly and cause harm, or that the skin will become irritated. There are more risks associated with skeletal traction. Bone inflammation may occur in response to the introduction of foreign material into the body. Infection can occur at the pin sites. If caught early, infection can be treated with antibiotics, but if severe, it may require removal of the pin. Both types of traction have complications associated with long periods of immobility. These include the development of bed sores, reduced respiratory function, urinary problems, and circulatory problems. Occasionally, fractures fail to heal. Being confined to traction for a long period can take a an emotional toll on the patient, also. Normal resultsWhen correctly applied, traction generally produces very good, if slow, results. ResourcesBooks"Traction." In Everything You Need to Know About Medical Treatments. Springhouse, PA: Springhouse Corp., 1996. Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved. <!-- Types of traction : <!-- <!--
<!-- Cervical tong: <!-- Is a skeletal traction to cervical spine by tongs inserted into skull above the ears Its purpose : post operative cervical fusion ,cervical injury Comments : pin care must be done daily to tong insertion sites , child will need assistance of daily living Halo traction: Is a skeletal traction applied to the cervical spine by circular halo ring attached to skull with pins , pullis inline with the body Its purpose : : post operative cervical fusion ,cervical injury Comments ; cranial nerve function must be carefully assessed Halo vest : same as halo traction but is attached to a sheepskin – lined vest Its purpose : post operative cervical fusion ,cervical injury Comments : child can ambulate in halo vest , a walker may be necessary Cervical halter : is a skin traction to cervical spine by head halter that rests under the chin and across the ear its purpose ; torticollis cervical injury comments ; may be removed for meals , bath-room , cushion chin from pressure halter Dunlop sidearm ; skin or skeletal traction to humerus with shoulder abducted and elbow flexed Its purpose ; supracondylar fractures of humerus , post operative positioning Comments : if skeletal , pin care must performed daily Overhead sidearm ; skeletal traction , wire or pin inserted through distal humerus , child lies supine position with shoulder extended and elbow flexed 90 degree over body Its purpose : supracondylar fractures of humerus Comment : : if skeletal , pin care must performed daily Buck extension : skin traction, web stapping or removable foam boots attached to weight keep hip and knee in extension Its purpose : hip and knee contractures , treatment of disease processes of knee and hip , postoperative positioning Comment : countertraction applied mainly by body may be intermittent , prone to skin breakdown , especially if adhesive is used Russell : same as buck extension with sling added under the knee Its purpose ; femoral fracture , preoperative or postoperative positioning Comment; countertraction applied mainly by body may be intermittent , prone to skin breakdown , specially if adhesive is used . and maintain position of sling Balanced suspension ; skeletal traction, hip and knee supported by thomas splint , flexion of lower leg provided by person attachment Its purpose : femoral fracture Comment : a child moves , suspension apparatus adjusts without disturbing traction pull Bryant : skin traction , both legs extended above the body with hips flexed at 90 degree , web strapping is applied to the lower legs with elastic bandage Its purpose : femoral fracture , congenital dislocated hip , only used in children who weight <30 los Comment : child,s buttocks are raised slightly off the bed so that the body weight provides countertraction , both legs are suspended even if only one leg is involved 90-90 : skeletal traction , wire or pin inserted through distal femur , child lies supine position with hip and knee flexed 90 degrees Its purpose : femoral fracture Comment : skeletal pin site care Types of cast Short arm cast is applied below the elbow to the hand Uses : forearm and wrist fractures , also used to hold the forearm and wrist muscles Long arm cast : is applied from the upper arm to the hand Uses ; upper arm , elbow and forearm fractures . also used to hold the arm or elbow muscles and tendons in place after surgery Arm cylinder cast : is applied from the upper arm to the wrist Uses : hold the elbow muscles and tendons in place after a dislocation or surgery
<!-- Shoulder spica cast : is applied around the trunk of the body to the shoulder , arm and hand Uses ; shoulder dislocation or after surgery on the shoulder area Minerva cast : is applied around the neck and trunk of the body Uses : after surgery on the neck or the upper back area Short leg cast : is applied to the area below the knee to the foot Uses : lower leg fractures , sever ankle sprains / strains , or fractures . also used to hold the leg or foot muscles and tendons in place after surgery to allow healing Leg cylinder cast ; is applied from the upper thigh to the ankle Uses ; knee or lower leg fractures , knee dislocations , or after surgery on the leg or knee area <!-- Unilateral hip spica cast : is applied from the chest to the foot of one leg Uses : thigh fractures . also used to hold the hip or thigh muscles and tendons in place after surgery to allow healing One and one –half hip spica cast : is applied from the chest to the foot on one leg to the knee of the other leg .a bar is placed between both legs to keep the hips and legs immobilized Uses: thigh fractures . also used to hold the hip or thigh muscles and tendons in place after surgery to allow healing Bilateral long hip spica cast : is applied from the chest to the feet . a bar is placed between both legs to keep the hips and the legs immobilized Uses : pelvis , hip , or thigh fractures . also used to hold the hip or thigh muscles and tendons in place after surgery to allow healing <!-- Short leg hip spica cast ; is applied from the chest to the thighs or knees Uses ; hold the hip muscles and tendons in place after surgery to allow healing <!-- Abduction boot cast : is applied from the upper thighs to the feet . a bar is placed between both legs to keep the hips and legs immobilized Uses :hold the hip muscles and tendons in place after surgery to allow healing
<!-- Plaster of paris ;(pop) A temporary immobilization device which is made of gypsum sulphate anhydrous by calcinations that swells and forms into hard comment when mixed with H2O Gypsum sulphate : 1) More common minerals in sedimentary environment 2) A major rock forming mineral 3) Chemistry : CASO4 - 2(H2O) hydrate calcium sulphate 4) USES: plaster , wall board , comments , paint , filler , ornamental stone Indications : severely displaced function Advantages of pop : 1) Low allergic response 2) Offers rigid protection 3) Easy to apply 4) Inexpensive 5 ) shape better than fiber glass Disadvantages of pop : 1) Long drying 2) Heavy 3) May crumble and disintegrate at edges 4) Not water proof Pop materials ; Stockinet – protect the skin Wadding sheet – for cushing Plaster of paris / strip roll – for casting Moleskin : 1) For additional padding 2) Put on bony prominence (because it is the site which are prone to break ) Walking heal – for weight bearing Apron to protect clothes Plastic gloves – protect hand Bucket with plastic liner – remove plaster with /without going to drain Water – to dip pop Drapes Cast knife – trim around the edges smoothly Cast bender – lift cast away from the skin Bandage scissors – remove excess web roll /padding Fiber glass Synthetic in form – polyurethane Indication : Non – displaced fracture Fitted when swelling has subsided Long term casting Advantages : Light weight – less bulky Easy to apply Moisture proof Fast drying (15min) With different colors Early weight bearing Radiolucent ( x-ray vision can past) Strength weight ration Feels cooler in hot weather No crumble Disadvantages : Application requires speed and accuracy May bind if tissues swell(rigid) High risk for irritation – tissue breakdown under the cast – extra rigidity Expensive Inner layer dries slowly Risk for over physical mobility – light Differences between synthetic and pop:
| ||||||
ساحة النقاش