Closed Reduction, Casting, and Traction Flashcards
goals of reducing all displaced fractures (2)
minimize soft tissue trauma, provide patient comfort
ways to make splints respect soft tissues (2)
pad all bony prominences, allow for post injury swelling
basic principle to correct and reduce a fracture (2)
axial traction, reversal of mechanism of injury
parameters to restore with reduction (3)
length, rotation, angulation
which joints should be immobilizated in a closed reduction
joint above and below injury
minimum point-contact for stable closed reduction
3-point contact
which extremity is a “bulky” jones splint typically used for
lower extremity
what two slabs make up the “bulky” jones
posterior slab, u-shaped slab medial and lateral
how is the u-shaped slab applied in a “bulky” jones
applied from medial to lateral around the malleoli
which extremity and fracture location are sugar-tong splints used on
upper extremity distal forearm fractures
how is the u-shaped slab applied in a sugar-tong splint
applied to the volar and dorsal aspects of the forearm encircling the elbow
which fracture location are coaptations splints used on
humerus fractures
how is the u-shaped slab applied in a coaptation splint
applied to medial and lateral aspects of the arm encircling the elbow and overlapping the shoulder
casting goals (2)
semirigid immobilization, avoidance of pressure or skin complications
padding a cast things to know (4)
distal to proximal, 50% overlap, minimum 2 layers, extra padding for bony prominences
cold water effect on plaster
maximizes molding time
hot water effect on plaster
decreased molding time
danger with hot water-soaked plaster
burning the skin
preferred water temperature for plaster
room temperature
plaster width for thigh
6-inch
plaster width for leg
4- to 6-inch
plaster width for arm
4- to 6-inch
plaster width for forearm
2- to 4-inch
fiberglass pro’s (2) and con (1)
more resistant to moisture (breakdown), 2-3x stronger for any given thickness, more difficult to mold
general ankle position in below knee cast (short leg cast)
neutral
knee position when applying short leg cast
flexion
action required when constructing a walking cast
build up plantar surface
preferred casting material for walking cast
fiberglass
general approach to above knee cast (long leg cast)
apply below the knee first
how to add rotational stability to long leg cast
mold supracondylar femur
distal volar extent of short and long arm casts
palmar crease
earliest pressure necrosis can occur after cast/splint application
2 hours
ways to treat/prevent tight cast or compartment syndrome (2)
uni/bivalving, cut cast padding
upper limit of plaster thickness to prevent thermal injury
10 ply
ankle position of function
neutral dorsiflexion
hand position of function (intrinsic plus)
mcp flexed (70-90 degrees) and ip joints in extension
maximum force applied with skin traction
10 lbs
bucks traction definition
soft dressing around calf and foot attached to weight off foot of bed
bucks traction maximum weight
7-10 lbs
patients at risk for skin complications from skin traction (2)
elderly and rheumatoid
weight limit for lower extremity skeletal traction
20% of body weight
local anesthesia trick with skeletal traction pin insertion
anesthetize the sensitive periosteum
pin options for skeletal traction
thin wire or steinmann pin (smooth or threaded)
general size of steinmann pin for skeletal traction
largest pin (5-6mm)
where is the pin placed with tibial skeletal traction
2cm posterior and 1cm distal to tibial tubercle
with tibial skeletal traction, in which direction is the pin drilled and why
lateral to medial to avoid common peroneal nerve
with femoral skeletal traction, in which direction is the pin drilled and why
medial to lateral to avoid neurovascular bundle
where is the pin placed with calcaneal skeletal traction
medial to lateral, 2 to 2.5cm posterior and inferior to medial malleolus
anterior halo pin sites
above eyebrow
posterior halo pin sites
superior and posterior to ear
structures to avoid with anterior halo pin sites (3)
supraorbital artery, nerve, sinus
