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To provide pain immobilization 4. To reduce pain and muscle spasm, reduce fracture. 5. To support the affected area PREPARATION PHASE: 1. Check for the doctor’s order 2. Inform and explain the purpose and procedure to the patient for easy installation and cooperation 3. Assemble all equipment • Thomas splint with Pearson attachment • Rest splint • 5 Slings (variable sizes) • 5 Paper Clips or Safety pins • Cord Sash (different length) • Short – for thigh • Long – for traction • Longest – for suspension • Weight’s and bags • Traction wt. 10% of patient’s weight • Suspension wt. (50% or ½ lighter than traction bag) • Foot support – (prevent foot drop) Parts 1. 2. 3. 4. of an Orthopedic Bed Firm Mattress Fracture Board Bed Elevator or Shock Block Balkan Frame o 4 Vertical bars o 2 Horizontal bars o 1 diagonal bar o 1 Straight bar or cross bar o 1 Curve bar (optional) 5. 3 Pulleys with the clamps (hold place) 6. Overhead Trapeze
PROCEDURE PHASE: 1. Mount Thomas splint to Pearson’s attachment • Upper part is Thomas splint, which support the thigh • Lower part is the Pearson’s attachment, which will support the leg • Check alignment of screw of Pearson’s with knee joint 2. Attach / apply Rest splint to Thomas splint and Pearson attachment 3. Apply slings to Thomas splint and Pearson attachment • Start from thigh area (Thomas splint) then to leg area (Pearson attachment) • From medial to lateral upright • Wider and long slings at thigh area • Smooth / right side should be touching or in contract the patient’s skin • Provide space or 1 inch apart between the slings for ventilation and prevent irritation • Popliteal and heel / sole of the foot should be free sling • Apply not to lose or not too tight to support and follow contour of leg 4. Tie the short rope (thigh rope) to medial portion of the Thomas splint with Slip Knot
) Conditioning exercises • Deep breathing • Coning exercise • Address ROM exercise • Static quadricep exercise 2 . Tie the longest rope to the middle of the short rope (slip knot) • Insert to the 1st pulley • Hang the suspension weight bag and anchor to the clamp • insert the rope to the 2nd pulley 9. Tie to the Tomas splint using the clove hitch knot then to Pearson attachment. Finish or tie the other end of the short rope to the lateral aspect of the Thomas splint 8. Apply the prepared set-up to the patient • 3 Manpower Apply manual traction • Apply manual traction • Lifting the affected leg removing the Braun Bohler • Insert the prepared set-up • At the count of 3 do simultaneously • Instruct the patient to flex the unaffected leg • Hold on to the overhead trapeze • Lift the buttocks 6. Tie the longer rope to the Steinmann’s pin (slip knot). securely tied and will not fall) 7. • Be sure the rope is outside the traction rope • Outside / under the rest splint (removed later) 10. Release suspension weight bag • Check alignment of the traction • 1st pulley – in line with inguinal area • 2nd pulley – in line with the knee • 3rd pulley – in line with the 1st and 2nd 11. Remove the Rest splint 13. Check the efficiency of the traction • Flex the unaffected side • Hold on the overhead trapeze • Swing the affect leg PRINCIPLES OF TRACTION APPLICATION • Have an opposite pull or counter traction • Line of pull should be in line of deformity • Traction should be continuous • Position of the point should be dorsal recumbent or supine • Avoidance of friction a) Weight should be hanging freely b) Observe for signs of wear and tear on the ropes and bag c) Rope should run freely along the grove of the pulley NURSING CARE 1.• Provide privacy 5. pass the 3rd pulley then hang and tie the traction weight bag (any kind of knot will do. Apply foot support using Ribbon Knot 12.) General hygiene and comfort • Skin care • Hair care • Nail care • Oral and perineal care • Sponging of affected leg 2.
OVERHEAD TRACTION Fracture of the supracondyle of humerus 14. (READY TO TRANSFER) TRACTIONS TYPES INDICATION 1. Tie the rope the rest splint. BALANCE SKELETAL TRACTION Fracture of hip and femur 2. For Congenital Hip Dislocation 4. vitamin c. calcium 5. HEAD HALTER TRACTION Fracture of the cervical spine 12. lift buttock c) Joint contractor and muscleatrophy • Active exercise (unaffected) • Isometric (affected) d) Constipation • Fluid intake • High roughage diet • Exercise • Offer bedpan e) Infection • Meticulous wound care REMOVAL 1) Attach the rest splint 2) Anchor the suspension weight to the pulley 3) Remove the suspension rope 4) Apply manual traction 5) Remove traction weight. COTREL TRACTION For Scoliosis 6. CRUTCHFIELD ONG Fracture of cervical spine 7.) Working pertinent observation COMPLICATION AND NURSING MANAGEMENT a) Hypostatic pneumonia Deep breathing Keep back dry b) Bed sore /decubitus ulcer Linen free from wrinkles/ creases Keep back dry. HALO-PELVIC TRACTION For Scoliosis (severe) 10. VINKE’S CALLIPER Fracture of the cervical spine 16.• Dorsiflexion and plantar flexion of leg 3. Thomas splint and Pearson’s attachment using the clove hitch knot. ZERO DEGREE TRACTION Fracture of the surgical humerus 17. HALO-FEMORAL TRACTION For Scoliosis 9. Stove in chest Multiple rib fractures 3 .) Meeting nutritional needs – protein. HAMMOCK SUSPENSION Fracture of the pelvis TRACTION 11. For Herniated nucleus Polposus 15.) Provide diversional activities –increase coping mechanics for boredom 4. PELVIC GIRDLE Fracture of the lumbar spine. 90 90 DEGREES Fracture of the subtrochanteric TRACTION 13. BUCK’S EXTENSION TRACTION Fracture of hip and femur 5. BRYANT TRACTION Fracture of hip and femur. BOOST CAST TRACTION Post polio with residual paralysis 3. DUNLOP TRACTION Fracture of the supracodylar of the humerus 8.
YAMAMOTO BRACE GADGETS HARDWARE TYPES INDICATOR Crutch field Tong Cervical Spine Circlage Wiring Patella Gigli saw For amputations Antibiotic bead Osteomyelitis X pinning/Y bone pinning Supracondylar fx of the humerus Roger Anderson External Fixator Comminuted fracture of long bones (RAEF) Total knee Arthroplasty (TKA) Tibial & Femoral components Degenerative joint disease (osteoarthritis) Harrington Rod Instrumentation Scoliosis Hybrid External Fixator Periarticular injuries such as your knee & ankle joints Ilizarov external Fixator Mal-union. Lumbo-sacral affection Prevention of wrist drop Club foot deformity Cervico-thoraco-lumbar spine affection Cervical spine affection Dorso-lumbar spine fracture Upper spine fracture Scoliosis Peripheral nerve injury Cervical spine affection (thick) Cervical spine affection (soft) Post polio with residual paralysis scoliosis 7. Immobilization – Traction. bone loss & bone lengthening Total replacement Hip Arthroplasty Femoral head. Rehabilitation – restoration of function. cast 3. 4. SHANTZ COLLAR 14. brace. 5. 3. femoral neck including (TRHA) acetabulum Partial replacement Hip Prosthesis Femoral head and neck fracture (PRHP) Compression Hip screw Fixation Intertrochanteric fracture (CHSF) Tower/Interdental Wiring Fracture of mandible Intramedullary Nailing Fracture middle 3rd femur Tibidal Femural component Degenerative uses T-plate or buttress planting Proximal tibia Planting with Screw Radius ulna fracture Hoffmann external fixator Fracture of pelvis Spacer antibiotic Infected hip prosthesis Delta frame Periarticular injuries such as your knee & ankle joints 3 PRINCIPLES IN MANAGEMENT OF FRACTURE: 1. Physical Therapy exercise OT & Surgery 4 . FOUR POSTER BRACE 8. MILWAUKEE BRACE 11. PHILADELPHIA COLLAR 13.BRACES 1. TYPES BANJO SPLINT BILATERAL LEG BRACE CHAIR BACK BRACE COCKED-UP SPLINT DENNIS BROWN SPLINT FORESTER BRACE INDICATOR Peripehral nerve injury Post polio with residual paralysis. KNIGHT/TAYLOR BRACE 10. Close or Open Surgery – reduction 2. JEWETTE BRACE 9. UNILATERAL LEG BRACE 15. 6. OPPEN HEIMER SPLINT/LIVELY FINGER 12. 2.
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