Chapter 13- Immobilisation, Splintage Etc Flashcards
What can bracing or splintage be used for
- fractures: to maintain the fractured bone in an acceptable position during the healing process
- soft tissue injury: to protect the injured tissue against disruptive forces
- unstable joints: add support after previous ligamentous injury or neural or muscular injury
- to support limbs: where there is imbalance/ weakness
Types of bracing / splinting
- dynamic/ functional: permits motion of the injured joint or joint close to fracture/ injury
- static: immobilize joint in fixed position
What is traction
Implies a longitudinal pull on the injured part or limb and needs a counter pull
Types of skin traction and it’s use
- adhesive
- non adhesive
- usually for short term traction
- less than 4 kg
- for temporary use prior to ORIF
Types of skeletal Traction
- skull: Cohns calipers or Crutchfield tongs
- limb traction: Denham pin traction, K wire and bow
- for prolonged traction
- weight up to 4 kg
Indications for traction
- fractures
- dislocation : achieves reduction by heavy weight for short period e.g. Cervical spine and shoulder. Maintains the reduction by sustained traction with low weight
- deformity: corrects flexion deformity or contracture of hip, knee or spine
- analgesic: relieves pain and spasm (cervical spondylosis)
Complications with skin traction
- thin friable skin can be easily avulsed or torn
- allergy to adhesive
- if peripheral vascular disease or vascular insufficiency: use skeletal traction
- swelling of distal injury may impair circulation
- Impaired sensation
- pressure from traction apparatus and materials Over the malleoli, tendo-Achilles from bandages and heel on bed
- avoid under pulling (does not have potential for heavy traction)
Correct technique for pin placement in skeletal traction
- placement must avoid adjacent nerves or vessels
- pre drill bone hole in hard, cortical bone and use hand insertion techniques (power tools may cause bone necrosis, sepsis and loosening)
- avoid physeal plate
- adequately within bone
- re site denham pin if becomes loose or infected
When are POP slabs used (U slab, back slab, volar slab)
Non circumferential splintage used as temporary measure during early stage of fracture management when swelling of the limb may cause circulatory impairment
Follow up care for a cast
- monitor for pain and other possible compartment syndrome symptoms
- routine circulation check at 12- 24 hours
- give patient instructions for pop cast care and future management plan
- of pop tight, increasing pain or impaired circulation- split pop and padding so that skin is visible, do not give analgesics until you are sure what is causing the pain. If no relief from splitting, remove the plaster and assess circulation m
What should a pop cast be carefully and repeatedly observed for
- tightness
- pressure
- looseness
- moulding
- softening
- weakness
- modifications
- cast problems
What causes pressure source in POP cast? How do you prevent it
- caused by constant pressure over bony prominences, excessive moulding or foreign objects introduced introduced into the cast
- adequately pad bony prominences
- apply sufficient cast padding
- apply rolls evenly without tension to avoid constriction bands
- instruct patients to avoid pushing objects into the cast
When does swelling of fracture usually subside ; resulting in loosening of cast
In the first 7- 14 days
What causes softening of a cast
Water and external pressure
What problems usually arise after patients remain in a cast
- joint stiffness due to immobility and osteopaenia due to disuse
