James M. Alo, RN, MAN, MAPsycho, Ph.D Page 1

NURSING CARE FOR BST (BALANCED SKELETAL TRACTION)

1. Assess the patient’s level of consciousness and understanding.2. Provision of general comfort.3. Skin care4. Perineal Care

POTENTIAL COMPLICATIONS IN BST (BALANCED SKELETAL TRACTION)

1. Bed sores (advise the patient to turn sides, maintain the linens to be dry and clean aswell as free from wrinkles, etc)

2. Pneumonia (encourage deep breathing exercises to the patient in order to promote lungexpansion, back tapping to promote loosen the bronchial secretions)

3. Urinary Tract Infections (advise the patient to have a regular voiding, good perineal careand to increase fluid intake)

4. Constipation (advise to increase fluid intake, high fiber diet and have a regular bowelmovement)

5. Contractures and stiffness of the muscles (encourage to have a contraction andrelaxation of the quadricep muscles, foot pedal exercises/dorsiflexion of the feet)

6. Infection at the Steinmann pin sites

FORMAT FOR CASE ANALYSIS

Name: Age:Address: Status:Date admitted: Educational Attainment:Physician incharge: Case number:Diagnosis:Physical Assessment:Nursing History (present health history, past health history, family history):Pathophysiology (including the anatomy and physiology of the affected part)Diagnostic procedures:Medical Management:Surgical Management:Discharge Plan:

James M. Alo, RN, MAN, MAPsycho, Ph.D Page 2

FORMAT FOR REPORTING (ORAL AND WRITTEN)

Definition/alternative namesCausative agentCausative factorsClinical manifestationsPathognomonic signsPathophysiologyAnatomy and physiology (affected part)Diagnostic proceduresMedical managementSurgical managementNursing care

HARDWARE (Purpose: to put bones in good alignment without conformity and infection andalso to reduce fracture through external and internal fixators)

IMPLANTS INDICATION SURGERYINTERNAL FIXATORS:Hip prosthesis For fracture of the femoral

head and neckPartial hip replacementarthroplasty

Spacer with antibiotic For infected hip prosthesis Partial hip replacementarthroplasty

Hip prosthesis and acetabularcup

Fracture of femoral head,femoral neck including theacetabulum

Total hip replacementarthroplasty

Femoral-tibial component For osteoarthritis in the knee-joint

Total knee replacementarthroplasty

Cerclage wire Fracture of the patella Tension bond wiringAntibiotic beads Osteomyelitis Application of the antibiotic

beadsLuque rod/harrington rod Scoliosis Luque rod instrumentationSubluminar wires Spine surgeriesKirshneir’s wire Used in BSTKirshneir’s wire holder Used in BSTCompression plates and Inter-trochanteric of the Compression hip screw

James M. Alo, RN, MAN, MAPsycho, Ph.D Page 3

screws femur fixationAO Screw driverWire cutterGigli saw Amputation of long bonesStaple wire removerSkin stapler (after 7 days itwill be removed)Osteotomes and malletIntramedullary nail Fracture of the middle third of

the femurOpen reductionintramedullary nailing forfracture of middle third offemur

Intramedullary locking screws Fracture of distal offemur/tibia

Open reductionintramedullary nailing withstatic locking screws

Bone drillDrillbit For preparation for screw

fixationButtress plate/T plate Fracture of the proximal tibiaIntramedullary nail extractor Inserted laterally to the hipEXTERNAL FIXATORSRoger’s anderson Comminuted fracture Application of roger’s

anderson external fixatorsHybrid external fixator Periarticular injury of the

ankle and knee-jointApplication of hybrid externalfixators

Ilizarov Long bones with malunion(promotes bone growth andlengthening)

Application of ilizarov externalfixator

Modified skin external fixatorSpanning external fixator Long bones (distal

femur/proximal tibia)Application of spanningexternal fixator

Hoffman’s external fixator Fracture of pelvis (superiorand inferior)

Applicayion of hoffman’sexternal fixator

Fractures

· Simple (closed)

· Compound (open)

5 Cardinal Signs of Fracture:

· Swelling

· Tenderness

James M. Alo, RN, MAN, MAPsycho, Ph.D Page 4

· Pain

· Crepitus

· Loss of function

Treating Fractures:

· Reduction (Open or closed reduction)

· Realignment

· Rehabilitation

Stages of Bone Healing:

· Hematoma formation

· Cellular proliferation

· Callus formation

· Ossification

· Consolidation and remodeling

GADGETS

Traction

· Manual Traction

· Skeletal Traction

· Skin Traction (adhesive skin traction and non-adhesive skin traction)

I. SKELETAL TYPE OF TRACTION

1. Halo femoral traction – severe scoliosis2. Halo pelvic traction – scoliosis3. 90-90 degrees – sub-trochanteric of the femur4. Overhead traction – supracondylar of the humerus5. Balanced skeletal traction (BST) – hip and femur affection

II. SKIN ADHESIVE TRACTION

1. Dunlop traction – supracondylar fracture of the humerus

James M. Alo, RN, MAN, MAPsycho, Ph.D Page 5

2. Bryant’s traction – hip and femur affection for children ages 6 years old or 3 years oldand below; congenital hip dislocation

3. Buck’s extension – hip and femur affection for adults4. Zero degree – for the neck of the humerus

III. SKIN NON-ADHESIVE TRACTION

1. Cotrel – combination of head halter and pelvic girdle traction; for scoliosis2. Pelvic girdle traction – for lumbo-sacral affection; for HNP (herniated nucleus pulposus)3. Hammock’s suspension – pelvic affections4. Head halter traction – for cervical spine affection5. Boot cast traction – special type of traction for hip and knee contractures and post-polio

with residual paralysis

Casts (it can be either plaster of paris or made up of fiber glass)(purposes):

· Immobilization

· Support

· Prevent and correct fractures

· Maintain good alignment

· Elevation

· Model in making and artificial limb

Principles for application:

· Immobilized the joint below and joint above

· Always apply a padding material

· Apply the cast in circular motion using the palm

Equipments in removal:

· Cast cutter

· Cast spreader

· Cast knife

· Bandage scissors

I. UPPER EXTREMITIES

James M. Alo, RN, MAN, MAPsycho, Ph.D Page 6

1. Body cast – lower thoracic and upper lumbar2. Minerva – upper dorsal; cervical spine3. Rizzer’s jacket – scoliosis4. Collar cast – cervical cast affection5. Hanging cast – fracture of the shaft of the humerus6. Functional cast – fracture of the shaft of the humerus with callus formation7. Long arm circular cast – fracture of the radius and ulna8. Long arm posterior mold – fracture of the radius and ulna with wound swellung and

infection9. Short arm posterior mold – fracture of the wrist and finger with open wound swelling

and infection10. Munster/fuenster cast – fracture of the radius and ulna with callus formation11. Shoulder spica cast – fracture of the upper portion of the humerus and the shoulder

joint12. Sugar tong – fracture of the upper portion of the humerus and shoulder joint with open

wound swelling and infection13. Airplane cast – fracture of the neck of the humerus/recurrent shoulder dislocation14. Thumb spica cast – fracture of the first metacarpal bone

II. LOWER EXTREMITIES

1. Pantalon cast – pelvic affections2. Brace cast – fracture of the distal third of femur with callus formation3. Quadrilateral cast – fracture of the shaft of the femur with callus formation4. Double hip spica cast – hip and femur affections5. 1 ½ hip spica cast – hip and femur affections6. Single hip spica cast – hip and femur affections7. Basket cast – severe/massive bone injury8. Frog cast – for congenital hip dislocations9. Delvit cast – fracture of the distal third of the tibia-fibula with callus formation10. Cylinder cast – for patellar affections11. Cylinder mould – fracture of the patella with open wound swelling and infection12. Single hip spica mould – fracture of the hip and femur with open wound swelling and

infection13. Long leg circulr cast – tibia and fibula affections14. Short leg circular cast – ankles, tarsals and metatarsals affections

James M. Alo, RN, MAN, MAPsycho, Ph.D Page 7

15. Patellar tendon bearing cast (PTB) – tibia-fibula with callus formation16. Long leg posterior mould – tibia-fibula affections with open wound swelling and

infection17. Short leg posterior mould – ankles, tarsals and metatarsals affections with open wound

swelling and infection18. Internal rotator board/splint – hip surgery (partial and total hip surgery)

Braces – mechanical support for weakened muscles, bones and joints(purposes):

· Immobilization

· Support

· Prevent and correct fracture

· Maintain good body alignment

· Control involuntary movements

· Permits patient to walk without fatigue

1. Shuntz collar-cervical spine affections2. Philadelphia collar – cervical spine affections3. Forester – cervico thoraco lumbar spine affections4. Taylor brace – upper thoracic affections; pott’s disease5. Jewett’s brace – lower thoracic and upper lumbar affections6. Chairback – lumbo sacral affections; HNP (herniated nucleus pulposus)7. Yamamoto – scoliosis8. Milwaukee – scoliosis9. Unilateral long leg brace – post-polio with residual paralysis10. Bilateral long leg brace – post-polio with residual paralysis11. Openheimer – residual nerve paralysis12. Banjo splint – peripheral nerve paralysis13. Dennis browne shoes – clubfoot14. SOMI (sterno-occipito-mandibular-immobilizer) – spinal injuries