UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Espana Boulevard, Sampaloc Manila, Philippines 1015
Tel. No. 406-1611 loc.8241 \ Telefax: 731-5738 \ Website: www.ust.edu.ph

ORTHOPEDIC HARDWARE

HARDWARE INDICATIONS
1. RAEF (Roger Anderson External For comminuted fracture of the long bone.
Fixator
2. Delta Frame External Fixator For fracture of proximal/distal tibia.
3. Spanning External Fixator For fracture of femur to tibia.
4. Hoffman’s External Fixator For pelvic affection; Ex: Hip dislocation.
5. Hybrid Extern Fixator For peri-articular fracture of the ankle or knee
joint.
6. CHSF (Compression Hip Screw For fracture of the intertrochanter of the femur.
Fixation)
7. Buttress plate/T-plate Proximal 3rd tibia.
8. X-pinning/Y-pinning For supracondyle fracture of the humerus.
9. HRI (Harrington Rod Instrumentation) For scoliosis.
10. Luque rod For scoliosis.
11. THRA (Total Hip Replacement Replacement of the femoral head, neck, and
Arthroplasty) acetabulum.
12. PHRA (Partial Hip Replacement Replacement of the femoral head and neck
Arthroplasty) only.
13. IMN (Intra Medullary Nailing) For middle 3rd femur/long bone.
14. IMN Extractor Used for removal of IMN.
15. Spacer Antibiotic Replacement of infected hip prosthesis.
16. Hemovac For collection of drainage under negative
pressure.
17. Gigli Saw For amputation.
18. Antibiotic Beads For osteomyelitis (therapeutic effect); for
plating, IMN, and all types of internal and
external fixators (prophylactic effect).
19. Tower External Fixator/ Interdental For fracture of the mandible.
Wiring
20. TBW (Tension Bond Wiring) with the For fracture of the patella.
use of cerclage wire.
21. Total Knee Arthroplasty/ Prosthesis For fracture of patella, femoral, and tibial
component-osteoarthritis bone.
22. Crutchfield Tong For cervical spine affection.
23. Steinmann’s Pins For fracture of femur and hips for BST.
24. Mini RAEF For fracture of carpals, metacarpals, radius, and
ulna.
1
 25. Osteotome (Chisel) Used for obtaining bone chips for spinal
fusion; used for scraping dead or necrotic bone.
26. Elizarov External Fixator For comminuted fracture: Non-union, Mal
union, bone lengthening.

CAST
- A fluid dressing that circumferentially encircles and extremity.
- Indications:
o Immobilization
o Prevent and correct deformity
o For support
o For elevation
o Serve as a model in making an artificial limb

TYPES OF CASTS

CAST OF THE UPPER EXTREMITIES

CAST INDICATIONS
1. Short Arm Circular Cast Affection of the wrist of the fingers.
2. Long Arm Circular Cast Affection of the radius and ulna.
3. Hanging Cast Affection of the neck of the humerus.
4. Fuenster’s Cast/ Munster Cast Affection of the radius and ulna with callus
formation.
5. Short Arm Posterior Mold Affection of the wrist and finger with infection,
swelling, and open wound.
6. Long Arm Posterior Mold Affection of the radius and ulna with infection,
swelling, and open wound.
7. Sugar Tong Affection of shoulder, upper portion of the
humerus with infection, swelling, and open
wound.
8. Airplane/ Abduction Splint Affection of the head of the humerus.
9. Shoulder Spica Cast Affection of should joint and upper portion of
the humerus.

CAST OF THE LOWER EXTREMITIES

CAST INDICATIONS
1. Short Leg Circular Cast Affection of ankle and toes.
2. Long Leg Circular Cast Affection of tibia-fibula.
3. Walking Cast Affection of ankle and toes with callus
formation.
4. PTB (Patellar Tendon Bearing Cast) Affection of shaft of tibia and fibula with
callus formation.
5. Quadrilateral Csat or Ischial Weight Affection of the shaft of femur with callus
Bearing Cast formation.

Dr. Jerry V. Manlapaz

 6. Cylinder Cast Affection of patella.
7. Short Leg Posterior Mold Affection of the ankle and toes with infection,
swelling, and open wound.
8. Long Leg Posterior Mold Affection of the tibia and fibula with infection,
swelling, and open wound.
9. Night Splint Post-polio.
10. Hip Spica Cast
a. Bilateral Hip Spica
b. Single or Unilateral Hip Spica Affection of the hip and femur.
c. 1 ½ Hip Spica
11. Frog Cast Congenital Hip Dislocation.
12. Pantalon Cast Affection of the pelvic bones.

CAST OF THE TRUNK

CAST INDICATIONS
1. Collar Cast Affection of the cervical spine.
2. Minerva Cast Affection of the upper dorsal cervical spine:
Trauma, Scoliosis, Pott’s disease.
3. Rizzer’s Jacket Scoliosis.
4. Body Cast Affections of the lower dorso-lumber spine.

BRACES
- Are temporary immobilizing devices used to support weakened muscles, joints, and
bones.

TYPES OF BRACES

BRACE INDICATIONS
1. Shantz Collar Brace For affection of the cervical spine.
2. Philadelphia Collar Brace For affection of the cervical spine; can be used
to a patient with tracheostomy tube).
3. 4 Poster Brace For affection of the cervical spine.
4. Forester Brace For affection of the cervical, thoracic, and
lumbosacral spine.
5. Knight Taylor Brace For affection of the dorsal thoracic and lumbar
spine.

Dr. Jerry V. Manlapaz

 6. Jewett Brace For affection of the lower thoracic and lumbar
spine.
7. Chairback Brace For affection of the lumbosacral spine.
8. Milwaukee Brace For scoliosis.
9. Yamamoto Brace For scoliosis.
10. Atlanta/ Scottish Wright Brace For Coxa Plana/ Leg Calve Perthes Disease.
11. Dennis Browne Splint For clubfoot.
12. Banjo Splint For peripheral nerve injury of the arm.
13. Long leg/ Short Leg Brace For post poliomyelitis with residual paralysis.

TYPES OF TRACTIONS

SKIN TRACTIONS
TRACTION INDICATIONS
SKIN ADHESIVE TRACTION
1. Bryant’s Traction Affection of hip and femur (children below 3
years old).
2. Buck’s Traction Affection of hip and femur.
3. Dunlop Supracondylar fracture of the humerus.
4. Zero Degree Traction Affection of the back of the humeral head.
SKIN NON-ADHESIVE TRACTION
1. Head Halter Traction Affection of the cervical spine.
2. Pelvic Traction Affection of the lumbar spine such as low back
pain syndromw, herniated nucleus pulposus
(HNP).
3. Hammock Suspension Traction Affection of the pelvic region.
4. Cotrel Traction For scoliosis.

SKELETAL TRACTIONS
TRACTION INDICATIONS
1. Balance Skeletal Traction Affection of the hip and femur.
2. Halo Pelvic Traction For moderate scoliosis.
3. Halo Femoral Traction For severe scoliosis.
4. Overhead traction For supracondylar affection of the humerus.
5. Vinke Skull Caliper For cervical spine affection.
6. 90-90 Degrees Traction For affection of the subtrochanter of the femur.
SPECIAL TRACTION
1. Boot Leg Traction For post poliomyelitis with residual paralysis
with knee contracture.

TRACTION
- An act of pulling and drawing associated with counter traction.
- The weight of the patient serves as counter traction.

Dr. Jerry V. Manlapaz

 - Indications:
o For immobilization of the affected part
o Prevent and correct deformity
o To support the affected joint
o To reduce muscle pain and spasm
o To reduce fracture
o To maintain proper body alignment of the affected part

TYPES OF TRACTION ACCORDING TO MANNER OF APPLICATION

1. MANUAL TRACTION
- Traction applied to the body by the hands of operator.

2. SKELETAL TRACTION
- Traction applied to the bones with the use of pins, wires, tongs.
- Ex:
o K-wires/Kirschners wires, Steinmann pins.
o Crutchfield tong – applied at the parietal region of the skull.
o Vinkerskull caliper – applied at the temporal region of the skull.
o Halo traction/ Halo vest – used when ambulating.

3. SKIN TRACTION
- Traction applied directly or indirectly to the skin.
- 2 types:
o Skin adhesive traction – traction applied with the use of adhesive tape,
tensoplast, foam, elastic bandage, spreader.
o Skin non-adhesive traction – traction applied with the use off materials such as
canvass, laces, buckles, leathers, and bells.

BALANCE SKIN TRACTION

- Indication
o For affection of the hip and femur.
- Purposes:
o For immobilization the affected extremity
o Prevent and correct deformity
o To reduce pain and muscle spasm on the affected extremity
o To reduce fracture of the affected part
o To maintain proper body alignment of the affected part

PRINCIPLES INVOLVED IN THE APPLICATION OF BST

1. Position – traction must be applied to client in supine or dorsal recumbent position.
2. Body weight of the client serves as the counter traction.
3. The line of pull must be in line with the deformity.
4. Traction must be continuous.
5. Avoid friction:

Dr. Jerry V. Manlapaz

 a. The rope must be running freely along the groove of the pulley.
b. Knots should be away from the pulley.
c. Weigh bags should be hanging freely.
d. Check for the wear and tear condition of the materials (Ex: Ropes, bags, etc.)

APPLICATION OF BST

PROCEDURE RATIONALE
PREPARATORY PHASE
1. Check for the doctor’s order.  To identify the patient for traction.
 To know the part to be applied with traction.
 To know the weight of the traction bag.
2. Explain the procedure to the client.  To alleviate the anxiety and gain the
cooperation of the patient.
3. Prepare the orthopedic bed

PARTS OF THE ORTHOPEDIC BED

a. Balkan frames
 4 vertical bars
 Horizontal bars
 Straight corss bars
 Diagonal bars
b. Overhead trapeze
c. 3 pulleys  To save time and energy when performing the
d. Clamps procedure.
e. Firm mattress
f. Fracture board
Assemble the materials for BST
a. Splints
 Thomas splint
 Pearson attachment
 Rest splint
 Barun Bohler splint – supports the
affected leg.
b. Cord – sash/rope
 Thigh rope – long
 Traction rope – longer
 Suspension rope - longest
c. Weight bags
 Traction bag – at least 10% of
patient’s body weight.
 Suspension bag – 50% of traction
bag’s weight.
d. Slings – varies in size
e. Safety pins/clips – number of pins
depends on the number of slings.
f. Foot pedal/ foot board
g. Steinmann pin holder
4. Wash the hands  To prevent transmission of microorganism.

Dr. Jerry V. Manlapaz

 ACTUAL APPLICATION PHASE
1. Attach Pearson’s splint to Thomas splint  Medial upright of the Thomas splint is in line
(estimate the length from inguinal area to with the inguinal area and Pearson’s is in line
knee of patient.). Pearson’s splint with the knee.
attachment is under the Thomas splint.
2. Mount the Thomas and Person’s
attachment to the rest splint.
3. Tie the long rope (thigh rope) to the medial
upright of the Thomas splint, using a  To provide privacy.
slipknot.
4. Apply slings observing the following
principles:
a. Start applying from medial to lateral
portion of the Thomas splint with
smoother portion in contact with the
patient’s skin.
b. Apply not too loose or tight, just
enough to follow the contour of the
leg.
c. Provide at least 1 inch space between
each slings.  To provide ventilation.
d. Provide space at the popliteal and
heel.  To prevent skin irritation.
5. Transfer the affected leg to the prepared
Thomas splint by 3 manpower.
a. First one applying the manual traction  To provide continuous traction.
and will remove Braun Bohler.
b. Second one lifting the affected leg.
c. Third one inserting the prepared
Thomas splint.

Instruct the patient to flex the unaffected

leg, hold on to the overhead trapeze, at
the count of 3 lift the buttocks and
simultaneously insert the prepared  To facilitate faster transfer and prevent too
Thomas to the affected leg. much pain.
6. Attach traction rope to the pin holder then
pass it to the third pulley and attach the  Traction bag should not be too low nor too high
traction weight bag at the level of the bed. to provide continuous traction.
7. Tie the other end of the thigh rope to the
lateral upright of Thomas splint using
slipknot.
8. Tie the suspension rope at the middle of the
thigh rope using a slipknot, then pass it to
the first pulley, then pass it to the handle of
the suspension bag. Hang the suspension
bag temporarily at the clamp of the first
pulley, then pass it to the second pulley,
then pass it inside the rest splint and secure
it to the end of Thomas and Pearson’s  The rest splint is to be removed.

Dr. Jerry V. Manlapaz

 attachment using clove hitch knot.
(Suspension rope should be outside the
traction rope.)
9. Hang the suspension bag at the middle of
the suspension rope, and then remove the
rest splint. Check the alignment.
10. Place the foot support/ pedal using half  To prevent foot drop.
ribbon knot.
11. Check the traction unit by asking the client
to hold on the overhead trapeze and swing
it backward and forward 3 times then side
to side 3 times observing the principles of
traction.

REMOVAL OF BST

PROCEDURE RATIONALE
1. Explain the procedure to the patient.
2. Attach the rest splint to Thomas and
Pearson splint.
3. Hang the suspension bag to the clamp of
the first pulley. Remove the suspension  To prevent further injury to patient.
rope.
4. Apply manual traction by handling the pin
holder, then remove the traction bag.  To promote continuous traction.
5. Tie traction rope to the rest splint, Thomas
and Pearson’s using clove hitch knot.  Serves as the traction.
6. Transfer the patient to stretcher using the
overhead trapeze and moving slowly with
support on the affected leg. (Stretcher is
placed on the unaffected leg).

NURSING CARE OF PATIENTS IN TRACTION

1. Observation should be made on the following:

a. Patient is free from the following:
 Impaired circulation on the extremities
 Respiratory distress
 Condition of the skin with emphasis on the ischial, popliteal, Achilles tendon,
dorsum of foot heel.

Dr. Jerry V. Manlapaz

  Deformity like foot drop, atrophy, contracture of joints.
2. Bone alignment and position of extremity in which the purpose of traction is being
accomplished.
3. Patient comfort
a. Care of skin d. Care of nails
b. Care of mouth e. Care of toes and fingers
c. Care of hair f. Care of genitalia
4. Provision of exercises
a. Active motion of all unaffected joints must be encouraged.
b. Static quadriceps exercises.
c. Deep breathing and coughing exercises.
5. Check the nutritional status of the patient.
6. Every complaint of the patient in traction should be investigated.
7. Prevention of complications by performing the following measures:
a. Change the position of the patient at interval. Keep the skin dry.
b. Provide smooth, clean bed linen, avoid wrinkles.

Dr. Jerry V. Manlapaz