FINE A. Quito Fes PHILIPPINE ORTHOPEDIC CENTER ‘Nursing Training & Research Department ‘Ma, Clara St,, cor. Banawe, Quezon City ORTHOPEDIC HARDWARE Principles in the Management of Fracture: (4 R’s) 1, RECOGNITION - Involves history taking skills of nurses to assess the type of fracture and its ‘manifestations specifically the signs and symptoms. 2, REDUCTION/RETENTION ~ Putting back the bone to its proper alignment. It is categorized into two: a) Close Reduction ~ manual manipulation of the bone back to its proper alignment b) Open Reduction — surgical intervention in aligning the bone back to its normal form 3. RETENTION/IMMOBILIZATION ~ Maintaining the alignment of the fractured bone using immobilization gadgets such as Cast, Traction, External Fixators and Orthopedic Braces. REHABILITATION ~ Putting and helping the patient achieve the optimum level of functioning after having the Retention Phase, Common Orthopedic Hardware and Internal Fixators & Its Uses: caster poner tee therapeutic | effect for Osteomyel Provides prophylactic me effect in plating, IMN, s a and other types of 3 Internal and External Fixators) BONE DRILL & DRILL BIT ‘For boring hole through the one! 8. RE “To hold rod in place during instrumentation specially for Scoliosis OSTEOTOMES (CHISEL) *Used for obtaining bone chips for spinal fusion “Used for scraping dead/necrotic bone tissues INTRO 2019- HARDWARECERCLAGE WIRE * For fracture of the patella, used in Tension Band Wiring LUQUE ROD & HARRINGTON ROD * Instrumentation for Scoliosis INTRMEDULLARY NAIL EXTRACTOR * For removal of IM Nailing HEMOVAC/BAROVAC DRAIN ** For collection of drainage under negative pressure GIGLI SAW * To cut bones during amputation CRUTCHFIELD, TONG * Applied at Parietal area for cervical traction ‘SKIN STAPLER application *To hold skin edges together post operatively INTRAMEDULLARY NAIL (1M) with WIRE CUTTER LOCKING SCREW : 7 * For fracture of To cut wires the middle 3“ or Distal Femur INTRO 2019— HARDWAREINTRAMEDULLARY __RONGEUR IL nl - * For cutting * For fracture of bone chips the tibia INTRAMEDULLARY NAIL (1M) with LOCKING SCRI * For fracture of Distal Tibia PLATE * For fracture of Proximal BONE PLATES * For long bone Tibia fractures and not comminuted in appearance :INMANN PIN * Used for long bones COMPRESSION PLATE & ip ‘SCREWS * For Compression Hip iit Screw Fixations ; ¢ + . ROGER ANDERSON = larochrtrc 05, HOGER ANDERSON os trochanteric Fracture of (RAEF) | the Femur, * For comminuted = fracture of the long, bone NNTRD 2019- HARDWAREBIPOLAR HIP PROSTHESIS with BIPOLAR HIP. ACETABULAR CAP PROSTHESIS * For total hip * For partial hip replacement replacement arthroplasty (THRA) arthroplasty (PHRA) For total knee s replacement arthroplasty SPACER ANTIBIOTIC __ * For degenerative knee * Replacement of Joint diseases, fracture of infected hip prosthesis the distal femur and proximal part of the tibia, and rheumatoid arthritis of the knees HYBRID EXTERNAL FIXATOR * For peri-articular fracture of the ankle or knee joint, or near the joints * For comminuted fracture, non-union, mal-union and for bone growth & lengthening INTRO 2019 - HARDWARECommon Examples of External Fixators attached to actual patients: *ANNING EXTERNAL FIXATOR * For fracture of the knee joint, distal part of femur extending to the proximal part of the tibia/fibula DELTA FRAME * For fracture of the peri-articular area of wel the joint, proximal portion of the tibia DELTA FRAME * Applied with short leg posterior mold and rested/placed on a Bohler Braun Splint J INVERTED DELTA DELTA FRAME DEN FRAME HAM (ANKLE BRIDGE) * applied when there “The frame is is severe soft tissue extended to the ankle involvement that can interfere the insertion of pins to give way to soft. tissue granulation and healing INTRO 2018 HARDWAREQUADRILATERAL EXTERNAL FIXATOR * For fracture of the middle 3" of tibia fibula, comminuted ROGER ANDERSON EXTERNAL FIXATOR [RAEF) * For comminuted fracture of the long bone * Can be used both on upper and lower extremity) (COMMON SURGERY ABBREVIATIONS: 1. ACL—Anterior Cruciate Ligament 2. ADSF— Anterior Decompression Spinal Fusion 3. AEA—Above Elbow Amputation 4. AKA-Above Knee Amputation 5. BKA—Below Knee Amputation 6. BG—Bone Grafting 7. CHSF— Compression Hip Screw Fixation 8 CSTR—Complete Soft Tissue Release 9. CW-Cerclage Wiring 10. DCS — Dynamic Compression Screw 11. FTSG — Full Thickness Skin Grafting 12. HRI Harrington Rod Instrumentation 13. IMN~ Intra Medullary Nailing 14. ORSF— Open Reduction Screw Fixation 15. ORIF - Open Reduction Internal Fixation 16, PLBG ~ Postero-Lateral Bone Grafting 17. PMR~ Posterior Medial Release 18. PHRA/PHRP — Partial Hip Replacement Arthroplasty/Prosthesis 19. PSF = Posterior Spinal Fusion 20. PSTR- Postero Soft Tissue Release 21. PSR~ Progressive Surgical Release 22, RAEF ~ Roger Anderson External Fixation 23. ROI— Removal of Implant 24, RFS — Rush Frozen Section 25. CHSF — Compression Hip Screw Fixation 26. STSG — Split Thickness Skin Grafting rao 2019- HARDWARE27, $51—Segmental Spinal Instrumentation 28, TBW- Tension Band Wiring 29. TAR-Tendon Achilles Repair 30, THRP — Total Hip Replacement Prosthesis 31, VDO- Varus Derotation Osteotomy COMMON ANESTHESIA ABBREVIATIONS: PN OVEN ABPB — Axillary Brachial Plexus Block SAB — Subarachnoid Block GETA~General Endotracheal Anesthesia GOTA— General Orotracheal Anesthesia GA-General Anesthesia SA~Spinal Anesthesia CLEA — Continuous Lumbar Epidural Block ‘SCBPB — Supraclavicular Brachial Plexus Block: Republi of the Philippines A ME Department of Health PERLIPPINE ORTHOPEDIC NTL Elvira A.Quiton RH, MAN Maria Clara cor. Banawe St conte No 01747 Quezon City oar a ears Order-Uiseuss the importance of Doctor's order 2. Inform the patient about the need & purpose of the procedure. 3. Preparation: . a, Identify the different parts of the orthopedic bed. b. Assemble the needed equipments: Thomas splint & Pearson Attachment Medial side (lower portion) lateral side Medial upright upper portion ~ Know the affected extremity +* Where to stand on the demo side-leok for the last pulley and siand on the side. 4, Mount the Thomas and Pearson on the rest splint: 5 Principles in the application of the slings to be emphasized a. Not tostight Not to loose b. One (1) inch distance in between the slings to promote aeration or ventilatton Popliteal and Heel portion should be free from any sling. Smooth and right side should come in contact with the patient’s ski n>) ©. Two (2) longer and wider slings for the thigh portion and the dseee () for, he leg area How (0 apply sling? — start from the redial side to the lateral side , socure both ends together, fan fold nicely on the lateral aspect arid secure with the pin or clip. Observe the principle of not too tight not too loose and avoid hitting the patient’s extremity with the pin. The tic rope should be attach on the medial aspect to the lateral aspect, 5. Insertion of the apparatus under the affected extremity. Three (3) manpower needed: a. to insert the whale apparatus under the affected extremity. b. Manual Traction to be seleased after the completion of the traction weight on the 3" pully, c. To lift the affected extremity — - simultaneously at the count of three (3) * Instruction to the patient Hold on the trapeze, flex the unaffected Jeg athe count of three (3), the three. ' (3) manpower to do their work simultaneously. 6, «Application of Traction weight * Rope to be attached to the Steinmman’s pin holder to run along the 3 pulley and attach the prescribed weight, Check the principles of sling application, and make the necessary adjustments, also check the alignment. 7. Apply suspension Traction * One (1) end of the thigh rope should be attached ‘o the latera Bids al aspect of the ischial ring with a slip knoteo * Attach suspension rope on the mid’ part of the thigh rope, to the first pulley insert suspension weight, hang it on the first pulley pass it on the second (2) fi pulley under the rest splint. Club hitch knot on the Thomas splint And another club hitch knot on the Pearson, closc it with a knot to socure it, * Be sure to maintain the traction rope inside, and the suspension wight should be outside 8 Remove the rest splint 9. Apply faot support 10. Check the principles of traction, Emphasizing the five (5) principles of traction and discuss the nursing care. Swing the patient to and fro , side (o side to heck the. efficiency of t:dction. a. patient should be on a dorsal recumbent position. ge +b. Line. of pull should be in line with the deformity. Positioning of a diagonal bar and Positioning ofa pulley. First pulley should be in fine with the thigh, 2" pulley should be in line with the knee or screw, 3" pulley should be in line with the 1 and 2™ pulley. c. Traction should always be continuous, emphasize the importance of manual traction. d. Avoid friction — rope should be running along he grove of he pulley, knots should be away from he pulley. Weight should be hanging fre¢ly. Observe for wear and tear of ropes and bags. ¢. Provide counter traction — Patient's body weight will serve as counter traction. REMOVAL OF TRACTION . Apply test splint, . .Hang suspension weight qn the first pulley. Complete removal of suspension weight — remove the knot on the Pearson and Thomas. 4. Manual traction on the steinmman’s pin holder, remove the traction weight on the third pulley, secure the traction rope on ‘he rest splint another on the Thomas and Pearson attachment NURSING CARE OF PATIENTS WITH TRACTION 1. Assessment — assess the patient as to level of understanding, consciousness. 2. Provision of general comfort: a. Skin care — head to toe, focus on the sponging of the allected cxtremity. HOW TO SPONGE? - 2 basins with face towels and soap. - Remove sling one by one and sponge. - Remove the foot support and*sponge. b. Changing of Linen c. Provide bedpan as needed. Serve bedpan on the unaffected side, provide pillow at the back and provide privacy : d, Perineal Care. 4 3. Potential Complications: a. Upper Respiratory — PNEUMONIA - bronchial taping and deep breathing. | b. Bedsore - good perineal care, proper skin care turning Jeft-buttocks once ina while. c. Urinary and Kidney problem — good perineal care, increase fluid inteke. d. Bowel complication — fear of apparatus, no privacy, lack of fluids, perineal care. ¢. Pin site infection — observe for s/sx of infection, losing pin tract, pus coming out, foul-smelling, fever.Elvira A. Quiton Ris, MAN Lic, No. 0137247 * - aseptic technique and proper referral to DIC. Deformity ~ contracted knee, atrophy, foot drop, joint contractures. 4. Provision of exercises a ROM exercises with the use of trapeze b. Deep breathing exercises Static quadriceps exercises, alternate contraction and relaxation of quadriceps muscles. d. Toes pedal exercises Nutritional status — depending on the status of patient Psychological aspect ~ fear of unknown, fear of death, fear of the Se fear of losing job, financial fear. « 7. Provision of supportive therapy — offer book to read, something to listen radio or tv, discover interest. 8. Spiritual aspect — know his religion, encourage relatives to give spiritual, communication, visiting, chaplain, 9. Diversional Activities — divert attention. &. eylic. No, 0937217... MENTS ie Be ‘ANCE "SKELETAL TR*OTION | a wiNDY MATERUL yextiiorepic WURSIN a". ast SruNnT CORD ‘eae ile OVERHRAD TIKAPEZE WEIGIT TEACTIO nx SUSFENTION Weil. AAG STEIN MANS PIN NOLDER BALAN anes : KIRSCHNERS WIRE — FRACTURE BOARD hover 4 VERTICAL, BARS Z HORIZONTAL BARS ‘ Foot BOARD 1 PIAGONAL BAR : 2 STRAIGHT o CROSS BAR 1 CURNE BAR HENRY L. MENDOZA, LMT, EMT, RN, MA CLINICAL INSTRUCTOR : oyha Be RGA SEDI UD. Ea A CGon Rs, WAY Ue No 017217 tf 1. Definition of Traction Traction is the act of pulling and drawing which is A associated with counter-traction. Patients’ body weight acts as a counter-traction. II. Indications. or purposes of traction; 1. For immobilization - 2. To prevent and correct deformity - 3. For support 2 4, To veduce muscle pain and spasm 5. To reduce fracture 6. To maintain good alignment IIL. Three general classifications of tract nianner of application, ; 1, Manual traction - traction applied to the body by the hands of the operator, fo Skeletal traction - {traction applied to the bones with tion according to the --—.. the use of piris, wires and tones. . 5. Skin TRatrion 1 he i Ue He jhe use C : Hess ve DH ESSE : ATERIALS : re - [BRUANCE SKELETAL FRACTION] eRe Len ny rot > VINKE-Skull CAL eR 7 CRU THY I OVERHEAD 7 FOR CERVICAL Sine 70R Ceeulihe ONE Te SERA ATION | | 7 Skldat troche 1 Slut (pati ix OF Humerus — < |foam fraction > non-adhesive 1 mocigiea buck tension - hip and Femar Elvira A. Quilon Rit, MA‘ ee oe Lic, No. 0137217 {| wlide > qrendeltnbarg rauees > hip and nes RM pen ¢ |Hammock suspension] va jock suspension Headhalter. cervical ; - fracture of the pelvis. ne ae ASA i Malgaigne igne fracture. spine, oo ie lor amgeont WEN RE adlusrr contin us sn > (5 bo rane pebcee] SURGICAL NEC ~ affections of lumbar spine OF HUMERU S Fon Lambo sa i in nakave Ken “Gare ve I SSS 300T OT CAsT\ yas eee eees pee pete */ i wal ea ~I — al Sse =e contracture of hip and knee,WoT Ty Tr -b v v.-0f by Elvira A. Quion Rls, MAN er BRAC BS Ue Mo 0137217 weakened muscles; P : i ¢ BRACES - are mechanical support for Joints and bones in rehabilitation as supporting body ‘weight; to control involuntary movements, to prevent 5, and to correct deformities. osns: ‘a. immobilization b control involuntary movement support i! ; ‘ permit patients to walk with and without fatigue prevent and correct deformity iplittain body alignment AL iN ail gc ‘ShapLBanfo-sptinn\ OPPENHEIMER per’pheral nerve injury SPLINT |Shantz Colfar ~ affection of the cervical spine - affection of the cctvico-thoraco lumbar spine ong leg Brace: Ui ilateral long leg Brac: ~ indicated for post-polio 7 ole of the lumbar spine Dennis broune Splint “lume sacra) indi ibfo ~ Lowi Boek, pal - indicated for clubfoot. Fox Stou108i Sa Ny HENRY L. MENDOZ . A, LMT, cuiNcaL nisrRuctOR AN (‘Milwaukee Bracel- for scoliosis Cc Te ? iyfadial per helmer - Elvira A. Quivi ii, tals c | Lic. No, 0137217 FOUR POSTER BRALE FOR CERVICAL SPINE SOML-Steano epper dhercce ee ie (4 BRA UG] OCR EATO. (HAUDIGULAR PAUADELI BRA HENRY L. MENDOZA, LNT, EMT, RN, MAN CLINICAL. INSTRUCTOR ATLANTA BRA CE Uk Pla FOR LEGG CALVE PERTHESE DISEASE Tyamamord} FoR SCoLJosis TE~bebw ROGER ANDERSON EXTERNA TIYATOR Fon Comminurel Fy for the lone Bones TOWERS EXTERNAL FIXATOR TOR MANDIBIEsw dire 7 Wgft awa anit > P CH STS Elvira A Quion RI, MAN - Lic. Mo. 0137217 ee me a : CAST: form of support obtained as a gypsum rendered snhydrous by calcination, when mixed with water it anhyd: : swells, sets and forms rapidly a hard cement. Purposes: 1, for immobilization ; 2. prevent and correct deformity 3. for support « . 4, for clevation . 5. obtaining a mold of a limb to serve as a model for sd, making artificial limb. ThA 4 SOATT 9 TANGLKG ase oitD ranging cast fracture of the shaft of humerus [Body cast\, lower lunibar spine. ~ affection of the cervical spine re ee - wrist and fingers with infec- ae le : tion, gpea wounds and gwelline ; ee Gox 7 ISACC } affections of the wrist and fingers 6 — i : ee — et Arreetiod 2 panic sa for scoliosis A LACC } affections of radius ulna and wist it : ] FY agg anne ort Cenrrerk Sfmt ng arm posterior mold B28 ~ fox the affection of radius and meu 3 ulna with infection, oper wounds and swelling Ate Oe . ° mh i Proms -unaa € Caurus ~ Foe ni Arénd 1. os sens ‘ Fuenster or munster cast! ; = Fanerva cast] + fracture of radi ; radius ulna with - upper dprsal and cervical spine. callus formation, —Evra A. Quion Rt, AN Lic, No. 0137217 hip spica - affection of hips and femur a, We thay + Nfowe BVA + gubal nwo open c. double ~ prth hy o£ domme 4 (is LATERAL Ye, ost Fa arrecrinse hy en CA LUS Feeasarird sella cl Quadrilateral cast, og ischial weight bearing cast fracture ail 7 OA LURE FoRMarD Nn Pe een ? pantaon cast/- pelvis fracture q~ eS Boor LAST fas ing cast] > affection of ankles c COUNs FORMATION rotator splint DigtAL Bad Fumun. P-8ad TibIAG EibuLA ~ for patient who undergone hip operation to maintain the internal rotation jf 0Elvira A Quiton Rli, MAN Lic, No. 0137217 SLCG- ankle and toes ENRY L. iENDOZA, LMT, EMT, RN, MAN CLINICAL INSTRUCTOR \SLPM| affections of the ankle and toes with infections, worn 1B oplehcn 4 Fam Fimak ous be 20 JIRCULAR CAST LLP affections of tibie-fibula With infections, wounds and swelling care wounds and swelling. oe ~ upper portion of the mee and shoulder joint. patellar tendon Dearing cast ~ allections of tiblay bul, with callus formation ( h sugar tong} eee - affection of the upper portion of the hutnerus Saf eas> ie " re and shoulder joint with infection, open and swelling, Inder casi affection of patella s ylinder mold } affection of patella with sweeling ns sy z emp Reoure ‘ ig | pacar ee EBRTE aA or abduction splint ~ D/3rd of tibia fibule w/ callus ~ heck of the humerus formation aoe . IfJaen CONAN GoplamoaV ere = por spine done drill ~ more note © anttenal pixalor urges rill bit. punneet din bore un Samp > if alttady’ ampututel — tone peste ha Clap pk wre ~ For the ote a Mine Pam gem -and HDI M1 shin ctapler hole in Bane cement Dad fan naliast Ore T-plale + ' Povgcur - removal o Eira Aiton, i plate + proxima rerohic ee Orthopade Hardware tile Vébms > Plat * act! 7 | 1. RAEF (Roger Ande Fixator) anyeleeram 2. Delta Frame External Fixator w, My _| Forn fx of proximal/ distal tibi dye incerted - ternal Fixator.” longec Yeinen_| Por 6c of femur extended to ti pine cana Extemal Fixator For pelvic affection a : _._____| Ex: hip dislocati 2 7) 5. Hybrid Lxtermal Pixator w/ ing For periarticular-fx of the ankle or knee « joint : > | CUSF (Compression Hip Screw For intertrochanteric fx of femur - common! on sider people Fixation) : ——-_. ¢ | 7. Buttress Plate/T-plate ___| Proximal 3” of tibia 7 -| 8. XPinning/ ee _| Bor supracondylar fx ofthe humeri ~ | 9. HIRT (Harrington Rod Instrumentation) _ | For scoliosis 7 7 \10. Luque Rod —__| For scoliosis = tetera cvvatwe op spine [irale) _ | HL. THRA (Total Hip Replacement Replacement of femoral ead, necks neck and | OARTICUATI acetabulum Sew fin the join For replacement of femoral ret und neck Arthroplasty) = 12. PHRA (Partial Hip Replacement Arthroplasty) oe ~ (13 IMN (Intra Medullary Nailing) ~ (41MIN Extractor, i ~ | Used for removal of IMN — | 15. Spacer Amibiotic Replacement for infected hip prosthesis 16. Hemovac. For collection of drainage under negative | a __| pressure | Por amputation - (gical veneval oF a per For osteomyelitis (Therapeutic Sifect) For plating, IMN, and all types of internal | a = and extemat fixator (Prophylactic effect) 19. Tower External Pixator/ Interdenatal | For fx of the mandible “| Wiring fae =o 20. TBW (Tension Bond Wiring) with the | For fk of the patella _use of eerclage wire [ 21. Total Kuce Arthroplasty/ Prosthesis | For fi < component thritis bone spine affection — Fx of middle 3” of femur _— lacking “secew . a mur and hips for Woshners wire - [Por fx of carpals, metacarpils Hor chilaien 25. Osteotome (Chisel) ~ ber grorting | Used for obtaining bone chips for spinal ~ | egucer zation - - Gequesttomy - fasion quptat er dude, __cequetiiui\~ déad pone _ | Used for scraping (dead arneciptic bone) | uy gjpow aepe | 26, llizaroy External Fixator - pont gop Corcamiminied er one m4 fon union, Malunion, jen eu = 17.20 - £40 -ercig {____Terms_ ‘ L.ADSF (Anterior Decompression Spinal £25 -mi usion __ as - cist formation : | Frogessive desirucion of he anteior TAB surgery and kyphosis 2 Sequestrum 4, Sequestrectomy 5. Debridement = 6. Alas LA wiving - vertical (connect upp” inter dental wiring - ver fico! ard jouw ice)