Introduction to the

Clinical exposure at
Philippine Orthopedic
Center (POC)
Skeletal system
Consists of 206 bones
Function:

Serves as body’s
framework
Allows movement &
locomotion
Protect vital organs
Stores calcium
Manufactures new blood
cells (red bone marrow)
Bone
Firm structure of living
tissue with vascular
connections
Constantly being
remodeled (deposition &
resorption)
Osteoblasts – cells that
are active in bone
formation; deposition of
bone
Osteoclasts – bone
destroying cells;
associated with removal
Osteocytes – principal cell
of mature bone
Division of human skeleton:
3.Axial – body’s upright
structure; 80 bones
 Skull
 Vertebral column

 Ribs
1. Appendicular – body’s
appendages; 126 bones
Arms

Hips

legs
Classification of bones:
Long bones – femur
Short bones – carpals,
tarsals, phalanges
Flat – ribs, sternum,
scapula
Irregular– vertebrae
Sesamoid – patella

Connective Tissue –
supports and binds other
body tissues
Tendon – attaches muscle
to bone
Ligaments – bind joints
together; connects
articular bones &
cartilages
Cartilage – non-vascular
tissue, protects bone
edges from rubbing
Joint – a space in which 2
or more bones come
together
Provide movement &
flexibility in the body
Types of joint:
Synarthrodial –
completely immovable
joints (Ex. Joints in the
cranium)
Ampiarthrodial – slightly
movable joints (Ex. Pelvis)
Diarthrodial (Synovial) –
freely movable joint
(Ex.Elbow & knee)
Synovial joints are the only
joints lined by synovium;
a membrane that secretes
synovial fluid for
lubrication & shock
absorption
Epiphyses – 2 knob-like
ends; primarily cancellous
bone; assists with bone
development
Diaphysis – bone shaft;
provides strength; resists
bending forces
Plays a role in growth &
development
Acetabulum N
eck
Greater
HHead
trochanter
Lesser
trochanter

Proximal 3rd

Diaphysis Midshaft

Distal 3rd

Lateral condyle
Medial condyle
Epiphysis
Epiphyseal plate – area
between the metaphysis
& epiphysis
Periosteum – CT covering
the bone
Musculoskeletal Injury –
accounts for about 66% of
all injuries
One of the primary causes
of disability in the US
Fracture – break or
disruption in the
continuity of bone
Caused by direct blow,
crushing force, sudden
twisting motion or
extreme muscle
Classification of fractures:
According to the extent of
the break:
Complete fracture – break
is across the entire width;
bone is divided into 2
distinct sections
Incomplete fracture –
partial break in the bone;
break is confined through
only part of the bone
According to the extent of
associated soft tissue
damage:
Open (Compound) – skin
over broken bone is
disrupted; soft tissue
injury & infection are
These are graded to define
the extent of tissue
damage:
Grade 1 – least severe
injury; skin damage is
minimal
Grade 2 – accompanied
by skin & muscle
contusions
Grade 3 – damage to the
skin, muscle, nerve tissue
& blood vessels
Wound is more than 6-8
cms.
Closed (simple) fracture –
skin over the fractured
area remains intact
Pathologic ( spontaneous)
– occurs after minimal
trauma to a bone that has
been weakened by a
disease
Greenstick fracture – one
side of bone is broken, the
other is bent, most
commonly seen in
children
Classification According to
pattern:
Transverse fracture – bone
is broken straight across
Oblique fracture – the
break extends in an
oblique direction; slanting
direction
Spiral fracture – the break
partially encircles the
bone
Classification as to
appearance:
Comminuted – bone is
splintered or crushed with
3 or more fragments
Impacted – when
fractured end of bones are
pushed into each other
Compression fracture –
produced by a loading
force applied to the long
axis of cancellous bone
Depressed – usually
occurs in the skull; broken
bone driven inward
Longitudinal – break runs
parallel with bone
 Fracture dislocation –
fracture is accompanied
by a bone out of joint
 Fatigue or stress fracture
results from excessive
strain or stress on the
bone
Fractures
Classification in relation to
the joint:
Intracapsular within the
joint
Extracapsular – outside the
capsule
Intra-articular – within the
Classification as to
Location:
Proximal

Distal

Mid-shaft
Clinical Manifestations:
Pain or tenderness over
the involved area
Swelling

Loss of function
Obvious deformity
Crepitus – grating
sensation either heard or
felt
Erythema, Edema
Muscle spasm/impaired
sensation
Bleeding from an open
wound with protrusion of
fractured bone
Principles of fracture
treatment:
Reduction of bone
fragments to normal
position & immobilization
Maintenance of reduction
until healing is sufficient
to prevent displacement
Preservation & restoration
of musculoskeletal
function
Stages of bone healing:
1. Hematoma formation
– blood accumulates into
the area between &
around the fragments.
The clot begins 24 hrs
after the fracture occurs
2. Cellular proliferation –
(within 5 days) hematoma
undergoes organization.
Fibrin strand form with the
clot creating a network for
revascularization &
invasion of fibroblast &
osteoblast.
 Beginning of external
cartilaginous callus
formation.(osteoid tissue)
3. Callus formation – (2-3
weeks) minerals are being
deposited in the osteoids
forming a large
mass of differentiated
tissue bridging the
fractured bone.
4. Ossification – mineral
deposition continues &
produces a firmly reunited
bone. Final ossification
takes
5. Consolidation &
remodeling – final stage of
fracture repair consists of
removal of any remaining
devitalized tissue &
reorganization of new
bone
Complications of Healing:
Interruption in the
sequence of healing are
caused by:
Original injury

Debridement
Loss of bone substance
Infection

Loss of circulation

Improper immobilization
Inadequate fixation
Necrosis

Metabolic disturbance
Possible Complications
from Fractures:
Pulmonary Embolism
Caused by immobility;
precipitated by fracture
Clinical Manifestations:
Restlessness &
Apprehension
Substernal pain

Dyspnea
Diaphoresis
ABG changes
Implementation:
Administer O2, notify the
doctor, prepare to
administer anti coagulant
therapy
Fat Embolism
 An embolism originating
from bone marrow (fat
globules); occluding the
small blood vessels of lungs,
brain, kidneys etc.
 Occurs 24-72 hrs following
an injury
Respiratory failure is the
most common cause of
death
Occurs frequently in
young adults (20-30 years
old) Elderly with fracture
of long bones
Clinical manifestations:
Mental confusion

Restlessness due to
hypoxia
Tachycardia, tachypnea,
dyspnea
Cough, chest pain
Thick white sputum

Petechial rash over the

upper chest & neck
ABG – decrease PaO2
Implementations:

Early surgical fixation

Administer O2 as ordered

Administer
morphine/corticosteroids
Compartment Syndrome
Increased pressure within
one or more
compartments causing
massive compromise of
circulation to an area
Enclosing muscle/fascia is
too tight or cast/dressing
is constrictive
Increased compartment
content due to
hemorrhage/edema
Forearm/leg muscles
frequently affected
4-6 hrs. after the onset of
compartment syndrome,
neuromuscular damage is
irreversible
Clinical Manifestations:
Paresthesia

Throbbing pain

Cyanosis of nail beds,

pallor, cold finger or toes
Pulselessness
Implementation:
Notify physician
immediately
Elevate leg above level of
heart
Remove restrictive
Prepare client for
fasciotomy
Passive ROM q 4-6 hrs.

Wound closure in 3-5 days

Infection & Osteomyelitis
Can be caused by
interruption of integrity of
the skin, infection invades
bone tissue
Clinical Manifestation:
 Fever> 38° C
 Pain
 Erythema in the area
surrounding the fracture
 Tachycardia
 Increase WBC Count
Implementation:
Notify the physician

Prepare to initiate
aggressive IV antibiotic
therapy
Delayed Complications:
Non-union
Fibrous tissue exists
between bone fragments;
no bone salts have been
deposited
Reinforce information
regarding bone grafts,
immobilization & non-
weight bearing
Avascular Necrosis
Interruption in the blood
supply to the bony tissue;
resulting to death of bone
tissue
Clinical Manifestation:
Pain

 Decrease sensation
Implementation:
Notify physician

Prepare the client for

removal of necrotic tissue
(sequestration)
Mechanical Aids for
Walking:
Canes:

Standard straight-legged
cane
Tripod or crab cane

Quad cane – provides the

Standard cane – 36 inches
in length
The length should permit
the elbow to be slightly
flexed
Health Teachings:
Hold the cane with the
hand on the stronger side
of the body
Position the standard cane
6 inches to the side & 6
inches in front of the near
When Maximum Support is
Required:
Move the cane forward 1
foot while the body weight
is borne by both legs
Movethe weak leg
forward to the cane while
weight is borne by the
cane & stronger leg
Movethe stronger leg
forward ahead of the cane
& weak leg while the
weight is borne by the
cane & weak leg.
Walkers – for ambulatory
clients needing more
support than a cane
provides.
Client needs to bear at
least partial weight on
both legs

Hand bar below the
client’s waist & client’s
elbow slightly flexed
Crutches
Axillary crutch with hand
bars
Loftstrand bar – extends
only to the forearm;
substitute to cane
Canadian or Elbow
Extensor Crutch – made of
single tube of aluminum
with lateral attachments,
a hand bar, cuff for the
forearm & has a cuff for
the upper arm
Nursing Alert:
The weight of the body
must be borne by the
arms rather than the
axillae (can injure the
radial nerve, eventually
can cause crutch palsy)
Crutch Palsy – weakness
of the muscles of the
forearm, wrist & hand
Measuring Clients for
Crutches:
To obtain the correct
length for the crutches &
the correct placement of
the handpieces
2 ways to measure the
crutch length:
Client in supine position,
the nurse measures from
the anterior axillary fold
to the heel of the foot &
add 1 inch.
Theclient stands erect.
The shoulder rest of the
crutch is at least 3 finger
widths, that is 1-2 inches
below the axilla.
The angle of the elbow
flexion must be 30
degrees.
Crutch stance (Tripod
Position) –proper standing
position with crutches.
Crutches are placed 6
inches in front of the feet
& 6 inches laterally.
Crutch gait – gait a person
assumes on crutches by
alternating body weight
on one or both legs & the
crutches.
5 Standard Crutch Gaits:
Four Point Gait

Three Point Gait

2 Point Gait

Swing to

Swing through
Four Point- Alternate Gait
– most elementary, safest
gait; client needs to bear
weight on both legs
The nurse ask the client to:
Move the right crutch
ahead 4-6 inches.
Move the left front foot
forward, to the level of the
left crutch
Move the left crutch
forward
Move the right foot
forward
3 Point Gait
Client bears entire body
weight on the unaffected
leg
Both crutches & affected
leg advances
Unaffected leg advances
Two-Point Alternate Gait
Partial weight bearing on
each foot
Faster than 4 point gait
Move the left crutch & the
right foot together
Move the right crutch &
the left foot ahead
together
Swing – To Gait – paralysis
of the legs & hips
Move both crutches ahead
together
Lift body weight by the
arms & swing to the
Swing –Through Gait
Move both crutches
forward together
Lift body weight by the
arms & swing through
beyond the crutches
Going up the Stairs
Nurse stands behind the
client
Placing weight on
crutches while moving the
unaffected leg onto the
Going down the Stairs
The nurse stands 1 step
below
Moving the crutches &
affected leg to the next
step
Interventions for Fracture:
Reduction

Fixation

Traction

Casts
Reduction – restoring the
bone to proper alignment
Closed Reduction –
performed by manual
manipulation
Maybe performed under
local/general anesthesia
Open Reduction – involves
surgical intervention
Treated with internal
fixation devices
Client may be placed in
traction or cast following
the procedure
Fixation
Internal fixation – follows
open reduction
Involves the application of
screws, plates, pins, nails
to hold the bone
fragments in alignment
May involved the removal
of damaged bone &
replacement with a
prosthesis
Provides immediate bone
strength
Riskof infection is
associated with this
procedure
 External fixation – an
external frame is utilized
with multiple pins applied
through the bone
Provides more freedom of
movement than with
traction
Roger Anderson External
Fixator (RAEF)
For fracture of the tibia,
radius, ulna done under
anesthesia
Ilizarov fixator – for
severe comminuted
fracture, bone
lengthening
Traction – is the act of
pulling and drawing which
is usually associated with
counter traction
Provides proper bone
alignment & reduces
muscle spasm
For support, reduce bone
fracture
Nursing responsibility:
Maintain proper body
alignment
Ensure that the weights
are hanging freely
Ensure that pulleys are
not obstructed; pulleys
move freely
Place knots in the ropes to
prevent slipping
Types of traction:
Manual traction – done
with the use of the hands
of the operator
Skeletal traction – pin is
driven across the bone to
provide an excellent hold
while a weight is attached
Use of pins, tongs & wires
 Crutchfield tongs
For fracture of cervical
spine
C1-C5 cervical spine
tension
Use for 4 weeks
 Vinke’s skull caliper
C1-C5 cervical spine
tension
Use for 4 weeks
Nursing responsibility:
Monitor color, motion &
sensation of affected
extremity
Monitor the insertion site
for redness, swelling or
infection
Provide insertion site care
as prescribed
Skin traction – applied by
the use of elastic
bandages or adhesive
straps to the skin while a
pull is applied by a weight
2 Types:
Non-adhesive type – uses
laces, buckles, leather &
canvas
Ex. Head halter strap
Adhesivetype – uses
adhesive tape or elastic
bandages
Ex. Dunlop skin traction
 Cervical skin traction –
relieved muscle spasm &
compression in the upper
extremities & neck
Uses a head halter & chin
pad
For cervical spine
affectation
For Pott’s disease
Head halter + Pelvic girdle for
Scoliosis
Pelvic guilder – for lumbosacral
affectation/slip disc
Buck’s skin traction- used
to alleviate muscle spasm
Immobilize a lower limb
by maintaining a straight
pull on the limb
Boot appliance is applied
to attached the traction
Not more than 8-10 lbs. of
weight must be applied
Elevate the foot of the
bed to provide traction
Bryant’s skin traction
Used to stabilize a
fractured femur or correct
a congenital hip
dislocation in children
Position child with a 90°
hip flexion
For congenital hip
dislocation
0-6 yrs/0-3 yrs old –
minimum of 4 weeks
Note: buttocks must not
be touching the mattress
Russell’s skin traction
Used to stabilized a
fractured femur before
surgery
Similar to Buck’s traction;
provides a double pull
with the use of a knee
sling
Traction pulls at the knee
& foot
Dunlop’s skin traction
For supracondylar fracture
of the humerus
Minimum 4 weeks of
application
Boot leg traction –
fracture of hip and or
femur
Post poliomyelitis with
residual paralysis
Halo-pelvic traction
For scoliosis

Temporal to occipital part

of pelvic area
Minimum 4 weeks of
application in preparation
for surgery
Halo-femoral traction
For severe scoliosis

Avoid progression of
scoliosis
From temporal to femural
area
 90-90 degrees traction
For subtrochanteric
fracture of femur or
intertrochanteric fracture
of femur
 Stove in chest
For multiple rib fracture
 Parts of an Orthopedic
bed:
Firm mattress

Fracture board

Bed elevator or shock

block
Balkan frame:
4 vertical bars
2 horizontal bars

1 diagonal bar

1 straight bar or cross bar

Pulleys
(3)
Clamps – to hold bars in
place
Overhead trapeze
Traction equipments:
Thomas splint

Pearson attachment

Rest splint

Cord sash (3)

Safety pins
Clips

Foot rest
Slings (2 sizes)

Weights
 Plaster cast – a temporary
immobilization device
which is made up of
gypsum sulfate
Undergoes unhydrous
calcinations when mixed
with water, swells & forms
Made of rolls of plaster
bandage, wet in cool
water & applied to the
body
Cools after 15 minutes

Requires 24-72 hrs to dry

completely
 Non-plaster cast –
(fiberglass cast)
Lighter in weight,
stronger, water resistant
& durable
Impregnated with cool
water-activated hardeners
& reach full rigidity in
minutes
Diminish skin problems
Functions:
To immobilize

To prevent or correct

deformity
To support, maintain &
protect realigned bone
Topromote healing &
early weight bearing
Materials for casting:
Stockinette

Wadding sheet

Plaster of Paris
Complications of cast:
2.Neurovascular
compromise
Watch out for 6 P’s:
Pain

Pulselessness

Pallor
Paresthesia

Paralysis

Poikilothermia
1. Incorrect alignment
2. Cast syndrome –
(Superior mesenteric
artery syndrome) occurs
with body casts; any
cast that involves the
abdomen
Decreases the blood
supply to the bowel
Signs/Symptoms:

Abdominal pain, nausea &

vomiting
1. Compartment syndrome
–increased pressure
within a limited space,
compromises the
function & circulation in
the area
Long arm circular cast – for
fractures of radius/ulna
Fuenster’s cast/Munster
cast
Fracture of radius/ulna
with callus formation
Long arm posterior mold
Fracture of radius/ulna
with open wound, swelling
or infection
Short arm cast
Fracture of the wrist,
carpals & metacarpals
Short arm posterior mold
Fracture of the wrist,
carpals & metacarpals
with open wound, swelling
& infection
Purpose:
To change dressing

To adjust the elastic

bandage
To assess presence of
infection & swelling
Long leg cast
Fracture of tibia fibula
Cylindrical leg cast
Fracture of patella
Quadrilateral/Ischial weight
bearing cast
Fracture of femur with
callus formation
Cast brace
Fracture of distal 3rd of
femur with callus
formation & proximal 3rd
of tibia fibula
Long leg posterior mold
Fracture of tibia fibula
with open wound, swelling
and infection (OSI)
Basket cast
Fracture of patella with
massive bone injury
Short leg cast
 fracture of ankle, tarsals
& metatarsals
Patellar tendon bearing
cast
For fracture of tibia fibula
with callus formation
Delvit cast
Fracture of distal 3rd of
tibia with callus formation
Boot leg
For post poliomyelitis with
residual paralysis
Internal rotator splint or
board
Fracture with post op hip
surgery
To maintain abduction &
prevent internal rotation
With pillow in between
Short leg posterior mold
Fracture of ankle, tarsals
& metatarsals with OSI
 Rizzer’s jacket
 scoliosis
Minerva cast
Upper dorsal lumbar
injury
Body cast
For lower dorsolumbar
injuries
Hanging cast
Fracture of the shaft of
humerus
Functional arm cast
Fracture of the shaft of
humerus with callus
formation
Allows abduction &
adduction
Shoulder spica cast
Fracture of upper portion
of humerus & shoulder
joint
Airplane cast
Fracture of neck of
humerus
Fracture with recurrent
shoulder dislocation
Body cast
Lower dorsolumbar spine

Double hip spica cast

Fracture of hips & both
femur
One & one half hip spica
cast
Fracture of ½ hip femur
Unilateral hip spica cast
Fracture of 1 hip & 1
femur
Pantalon cast
for pelvic fracture

At level of knees with

abduction
Frog cast
Congenital hip dislocation
Double hip spica posterior
mold
Fracture of both hips &
both femur with OSI
One & one half hip spica
posterior mold
Fracture of 2 hips & 1
femur
Single hip spica posterior
mold
Fracture of 1 hip or 1
femur with OSI
Pelvic bone with callus
formation
 Night splint
Post poliomyelitis with
residual paralysis
 Braces – are mechanical
support for weakened
muscles, joints & bones
Ex. Milwaukee brace,
Yamamoto brace
 Milwaukee brace
Personalized/customized

For scoliosis – thoracic T9

above the thoracic area
Yamamoto brace
Involvement of T9 and
below
Forrester brace
For cervico thoracic
lumbar spine affection
Pott’s disease
Taylor Knight brace
Upper thoracic spine
affectation
T1-T3

Pott’s disease
 Jewett brace
Lower thoracic spine
affection
 Chairback brace
For lumbosacral affection
 Philadelphia collar brace
For cervical spine
affection
Cervical collar/Shuntz collar
brace
Cervical spine affection
 Cocked-up splint
To prevent wrist drop

For Colle’s fracture – distal

radius affected
 Banjo splint
For peripheral nerve injury

For Carpal tunnel

syndrome
 Lively finger splint
Fracture of fingers
 Dennis Browne Splint
For clubfoot/congenital
Talipes Equinovarus
Tendon is short – complete
soft tissue release
Congenital Clubfoot
Treatment time – day 1 of
life to 7 yrs old
 Unilateral leg brace
For post poliomyelitis with
residual paralysis
Long leg brace Short leg brace
Bilateral leg brace (long)
Balance Skeletal Traction
Maintain the anatomical
position of fractured bone
Skeletal traction requires
an invasive procedure in
which
 wires, pins & screws are
inserted
Weight ranges from 25-40
lbs. (11-18 kg)
Traction Equipments:
2.Thomas Splint & Pearson
Attachment
3.Rest splint

4.5 Slings (variable sizes)

1. 5 paper clips/safety pins
2. Cord sash – short – thigh
longer -
traction
longest – for
the
1. Weights & bags –
suspension weight is ½
lighter compared to the
weight of the traction
2. Foot support – to
prevent foot drop
Materialsneeded:
Thomas Splint –
placement of the thigh
Pearson Attachment –
placement of the leg
Steinman’s holder
Steinman’s pin

Traction weight
10 % of the body weight
Inside of the suspension
rope
Suspension weight
50 % of the traction weight
Rest Splint
3 Cord Sash
Thigh rope – the shortest
 Suspension rope – the
longest
Traction rope

Slings& pins
Foot board
Application of traction:
1. Verify Doctor’s order
2. Inform the patient about
the need & purpose of the
procedure
3. Preparation
 Identifythe different parts of
the orthopedic bed
 Assemble the needed
equipments
Thomas splint

Pearson Attachment
 Know the affected extremity
 Where to stand? Look for the
last pulley & stand on the
side
4. Mount the Thomas &
Pearson on the rest splint
5 principles in the application
of slings to be emphasized:
 Not too tight nor too loose

 Maintain 1 inch distance

between the slings to
promote ventilation or
aeration
 Popliteal & heel portion must
be free from sling
 Smooth & right side must
come in contact with the
patient’s skin
 (2) longer & wider slings in
the thigh area
and (3) for the leg area
Sling application:
 Start from the medial to the
lateral side
 Secure both ends together
 Fan fold nicely on the lateral
aspect & secure with a pin
or clip.
 Observe the principle of not
too tight or not too loose &
avoid hitting the patient’s
extremity with the pin
 The thigh rope should be
attached on the medial
aspect to the lateral aspect
5. Insertion of the apparatus
under the affected
extremity:
 Insertthe whole apparatus
under the affected extremity
 Manual traction to be
released after the
completion of the traction
weight on the 3 pulley
rd
 Liftthe affected extremity
on the count of three
Instruct the patient:
 Hold on the trapeze, flex the
unaffected leg at the count
of 3
6. Application of traction
weight
 Rope to be attached to the
Steinman pin holder to run
along the 3 pulley &
rd

attached the prescribed

weight
 Check the principles of sling
application, make necessary
adjustments & check the
alignment.
 Pulleys must be aligned to
the area of injury
 1stpulley – aligned to the
groin area
 2nd pulley – aligned to the
knee area
7. Apply suspension traction
 1 end of the thigh rope to be
attached to the lateral
aspect of the ischial ring
with a slip knot
 Attach the suspension rope
on the midpart of the thigh
1st pulley. Insert suspension
weight, hang it on the 1st
pulley pass it on the 2nd
pulley under the rest splint.
Clovehitch knot on the
Thomas splint & another
clovehitch knot on the
Pearson. Secure the knot by
 Be sure to maintain the
traction rope inside, & the
suspension weight should be
outside.
 9. Remove the rest splint

 10. Mount foot board to

prevent foot drop with a
11. Check for the principles of
traction. Swing the affected
leg forward, lateral &
backward to check the
efficiency of traction.
Principles of traction:
1.Patient must be in dorsal
recumbent position
2.Line of pull should be in line
with the deformity. Consider
the position of diagonal bar
& positioning of pulley.
 1st pulley in line with the
thigh, 2nd pulley in line with
the knee or screw, 3rd pulley
in line with the 2 & 3
nd rd

pulleys
 Weight bag must be at the
level of the bed frame
3.Traction must be
continuous. Emphasized the
importance of manual
traction.
 4. Avoid friction – rope
should be running along the
groove of the pulley, knots
away from the pulley.
Weights should be hanging
freely. Observe for wear &
tear of ropes.
 5. Provide counter traction.
For every traction there
must be a counter traction
(Patient’s body weight)
Removal of traction:
1. Apply rest splint
2. Hang suspension weight on
the 1st pulley
3. Complete removal of
suspension weight – remove
the knot on the Pearson &
Thomas
4. Manual traction on the
Steinman pin holder
5. Remove the traction weight
on the (3rd) pulley, secure
the traction rope on the rest
splint, another on the
Thomas & Pearson
attachment.
Summary- Application of
Balance Skeletal Traction
in Chronological Order:
2.Inform the patient about
the purpose of traction
1. Assemble the
equipment needed
2. Apply the rest splint to
Thomas & Pearson
attachments
1. Apply slings on Thomas
splint & Pearson
attachments
2. Apply traction weight
3. Apply suspension weight
4. Check alignment of
screw of Pearson’s with
1. Remove rest splint
2. Apply foot board
3. Apply initially the
principles of traction
Nursing Care of Patients with
Traction:
1. Assessment
 Assess patient as to level of
understanding/consciousnes
s
2. Provision of general
comfort
 Skin care – head to toe;
focus on the sponging of
affected extremity
3. Potential Complications:
 Upper respiratory –
Pneumonia – back tapping &
deep breathing
 Bed sore – good perineal
care; proper skin care,
turning, lift buttocks once in
 Urinary & kidney problem –
good perineal care, increase
fluid intake
 Bowel complication – fear of
apparatus, no privacy, lack
of fluids/perineal care
 Pinsite infection – observe
for signs & symptoms of
infection; loosening pin
tract, pus coming out from
insertion site, foul smelling
odor, fever
 Deformity – contracted
knees, atrophy of muscles,
foot drop, joint contractures
4. Provision of Exercises:
 ROM exercises with the use
of trapeze
 Deep breathing exercises
 Static quadriceps exercise –
alternate contraction &
relaxation of quadriceps
muscles
 Toe pedal exercises
5. Nutritional status
6. Psychological aspect
 Fear of the unknown, fear of
death, fear of apparatus,
fear of losing a job, financial
fear
 7. Provision of supportive
therapy
 Offer books to read, listen to
radio or TV, discover interest
 8. Spiritual aspect
 Know patient’s religion,
encourage relatives to give
spiritual communication,
visiting chaplain
 Divertional activities – divert
attention for any pain
 Surgery Abbreviations &
Meaning:
ACL – Anterior Cruciate
Ligament
AEA – Above Elbow
Amputation
BKA – Below Knee Amputation
CW – Cerclage Wiring
IMN – Intra Medullary Nailing
ORIF – Open Reduction
Internal Fixation
PSF – Posterior Spinal Fusion
ROI – Removal of Implant
RCHSF – Richard Compression
Hip Screw Fixation
THRP – Total Replacement &
Hip Prosthesis
AKA – Above Knee
Amputation
BG – Bone Grafting
Fx - Fracture
HRI – Harrington Rod
Instrument
RAEF – Roger Anderson
Anterior Decompression
Spinal Fusion (ADSF) -
surgical intervention for
Pott’s disease
Sequestrum – dead or
necrotic bone
Sequestrectomy – removal of
dead or necrotic bone
Gibbus formation – classical
sign of Pott’s disease;
progressive destruction of
anterior spine leading to
collapse & kyphosis
Axis – 1st cervical vertebra
Atlas 2nd cervical vertebra
Intertrochanteric fracture –
fracture within the greater &
lesser trochanter
Supracondylar fracture –
fracture above the condyle
Subcondylar fracture -
fracture below the condyle
Involucrum – new bone
Screws– used to attach
implants such as plates &
prosthetic devices to
bone; to fix bone to bone,
ligaments & tendons to
bone
Guideline
in Choosing Absoanchor MIA
for Maxilla : Buccal Area
-06,-07,-08

-06, -07,-08

Diameter: 1.2 - 1.3 mm

Holding power of screw in
bone is most dependent
on the density & quality of
bone
Screw Points:
Non-self taping

Trocar

Standard

Pilot point
Plates – stabilize the
fracture; provide support
to bone as it heals, held in
place by screws
Recommended time for
removal of plates:
Tibial plates – 1 year

Femoral plates – 2 years

Forearm & humeral plates

– 11/2 -2 years
Rodsor nails – stabilize
diaphysis fractures of
middle 2/3 of long bones
Nail-and- plates
combination – for rigid
immobilization of femoral
neck when complete
prosthetic replacement is
not indicated
Identify the following:
Head halter + Pelvic girdle for
Scoliosis