2-27-08 Mrs.

Banks

Fractures/ Traction
May 19th-22nd 7:30-4:30 first day then 8:30-4:30 for meds pub live review

Lunch Thursday march 6th

Hip Fracture Case study

• Neck fractures are dangerous because they can cut off blood supply and
cause necrosis

o Avascular necrosis

• Place in bucks tractions which is specific to hip fractures

o Classification-Straight traction- extremity is lying straight in the bed

o Method-skin

o Leg will be resting flat on the bed

o Countertraction- pull against the traction, typically the upper body of

the patient is enough for contertraction, they should be lying flat

o Don’t want to flex hip joint by raising the bed

o 5.5lbs is normal amount of weight applied to bucks traction

• Place them NPO for surgery (THA) total hip arthroplasty

• Neurovascular checks should be done every two hours

o Check pedal pulse (dorsalis pedis, posterior tibial)

o Check capillary refill

o Skin color

o Sensation (note any numbness or tingling) due to pressure on a nerve

 6 hours of pressure on a nerve can lead to paralysis

o Skin temperature- should be warm

o Muscle mobility-can they wiggle their toes, dorsiflexion-peroneal nerve-

means intact, platarflex-tibial nerve

• Pre-Op teaching
 o PCA pump

o TED hose

o Anticoagulant therapy

 Lovenox- check platelet shouldn’t be below 100

 Arixtra –another anticoagulant

o Risk for infection-UTI, dressing changes, etc.

o Pneumonia

 Encourage activity

 Incentive spirometer- every one to two hours while awake

 TCDB

• Turn just keep affected side up

o Dislocation-keep affected extremity abducted- don’t want pulling

inward

 Can use wedge pillow or blankets between the legs

 Greatest risk is in the first six months

• Post-Op

o Just be sure that hip is not flexed more than 90 degrees. Usually 30-45
degrees

o Maintain abduction

o Check foley output

o Monitor hemovac drainage

 Output shouldn’t be more than 500cc’s over 24 hours

 No more than 250 in the first 8 hours of the 24 hours

o During transfers no inward rotation of the hip, keep 3-6 inches

between knees and feet, bear most of their weight on unaffected
extremity

o If it’s dislocated it can be shorter, more pain, externally rotated- foot

2-27-08 Mrs. Banks

will be out to the side

o Avoid crossing legs (adduction) and acutely flexing the hip greater
than 90 degrees (putting their shoes on, etc.)

Nursing Skills

• Braces/ splints

o Make sure it is fitted corectly

• Soft immobilizers

o Allows a little bit of flexion at the knee

• Braces (orthoses)

• Cast/cast care

o Check circulation

o Check swelling, may need to take the cast off

o Bivalve-cut it the length of the cast to relieve pressure, may leave

bottom part on

o Want cast to dry as quickly as possible, expose to air, casts can be

different thicknesses

o Extremeties may be smaller after cast is taken off

o Spika cast- around the waist goes down one leg or both, can also be
used on the arm

• Pin care

o In relation to skeletal traction

 Clean each pin site separately with NS or peroxide (half

strength), can put betadine around each pin site (assuming
they’re not allergic)

 Look for purulent drainage or any drainage and notify MD

• External fixators

o Use to manage open fractures

o Provides stable support

 o Used for complicated fractures

o Usually a series of pins inserted into the bone

o Elevate it to reduce swelling

o Cover sharp points

o Assess each pin site for redness, swelling, drainage, odor

o Clean with cotton applicator soaked in NS or half strength peroxide

o Pg. 2025

o Also can be used with at least 3 fragments

• Continuous passive motion (CPM)

o Used for total knee replacements

o Used for flexing and extending

o Usually set out 30-45 post op, can be set up to 90 degrees of flexion
with full extension by discharge

• Re-infusion devices (Stryker drain)

o Looks like a suction container at the foot of the bed, drains bloody loss,
can drain fluid loss into bag and re-infuse it.

• Remember, total hip arthroplasty (THA) and total knee arthroplasty (TKA)

• Crutch walking gaits: four-point, two-point, three-point, swing-to, swing-

through

o Three point gait-can’t bear weight with both extremeties

 Seen with broken leg

 Make sure they can balance themselves

• Tripod-crutches diagonal about 8-10 inches

o Four point gait- can bear weight on all extremeties

 Left crutch-right leg then right crutch-left leg (alternating)

o Two point gait- right crutch-left leg, left crutch-right leg

o Swing-to-
2-27-08 Mrs. Banks

o Swing through- advance both crutches, then swing forward with both
feet, need good arm strength

• Going up steps- put stronger leg, then crutches, then weaker leg

• Going down steps-advances crutches to the lower step, weaker extremity

goes first and then the stronger one

Purpose of Traction

• Minimize muscle spasms

• Reduce, align, and immobilize fractures

• Increase space between opposing surfaces within a joint- ex: low back pain
put in pelvic sling

• Prevent soft tissue damage- ex: broken bone or slipped disc impinging upon
soft tissue and/ or nerves

o Traction is the application of a pulling force to part of the body, and

must be applied in more than one direction to achieve the desired line
of pull

Principles of traction

• Must have contertraction which is maintained by:

o Body weight of patient

o Bed position

• Traction must be continuous

o Weights never removed unless intermittent treatment

o Never interrupt skeletal treatment

• Line of pull is always maintained

• Center patient in bed with

• Good body alignment

• Weights must hang free and not rest on floor or bed

Methods of Traction

• Skin:
 o Applied to the skin transmitting traction to musculoskeletal structure

o Exerts force directly on the surface of the body and indirectly on

underlying muscles and bones

• Skeletal

o Applied directly to bony skeleton

o Direct pull to skeletal structured by use of pins or tongs inserted into

bone distal to fracture

Cervical Traction

• Skin

o Helps relieve muscle spasms and nerve compression in the neck,

upper arms, and shoulders

o The frontal strap of the cervical head halter fits underneath chin, while
the rear strap fits at base of skull away from earlobes

• Skeletal

o Stabilizes fracture and displaced vertebrae in the neck and upper

thorax preventing injury to spine

o Crutchfield, Gardner-wells, Blackburn, Vinke, and halo vest