NURSING CARE OF PATIENTS WITH ALTERATIONS IN COORDINATION

APPLICATION BALANCED SKELETAL TRACTION

INDICATION:

1. To prevent or correct deformity

2. To maintain good body alignment
3. 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 of an Orthopedic Bed
1. Firm Mattress
2. Fracture Board
3. Bed Elevator or Shock Block
4. Balkan Frame
o 4 Vertical bars

o 2 Horizontal bars

o 1 diagonal bar

o 1 Straight bar or cross bar

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NURSING CARE OF PATIENTS WITH ALTERATIONS IN COORDINATION

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

• Provide privacy
5. 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), pass the 3rd pulley then hang and
tie the traction weight bag (any kind of knot will do, securely tied and will not fall)
7. Finish or tie the other end of the short rope to the lateral aspect of the Thomas splint
8. 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

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NURSING CARE OF PATIENTS WITH ALTERATIONS IN COORDINATION

• insert the rope to the 2nd pulley

9. Tie to the Tomas splint using the clove hitch knot then to Pearson attachment.

• 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. Apply foot support using Ribbon Knot
12. 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.) General hygiene and comfort

• Skin care

• Hair care

• Nail care

• Oral and perineal care

• Sponging of affected leg

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NURSING CARE OF PATIENTS WITH ALTERATIONS IN COORDINATION

2.) Conditioning exercises

• Deep breathing
• Coning exercise

• Address ROM exercise

• Static quadricep exercise

• Dorsiflexion and plantar flexion of leg

3.) Provide diversional activities –increase coping mechanics for boredom

4.) Meeting nutritional needs – protein, vitamin c, calcium

5.) 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, 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. Tie the rope the rest splint, Thomas splint and Pearson’s
attachment using the clove hitch knot. (READY TO TRANSFER)

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NURSING CARE OF PATIENTS WITH ALTERATIONS IN COORDINATION

TRACTIONS
TYPES
1. BALANCE SKELETAL TRACTION
2. BOOST CAST TRACTION
3. BRYANT TRACTION
4. BUCK’S EXTENSION TRACTION
5. COTREL TRACTION
6. CRUTCHFIELD ONG
7. DUNLOP TRACTION
8. HALO-FEMORAL TRACTION
9. HALO-PELVIC TRACTION
10. HAMMOCK SUSPENSION
TRACTION
11. HEAD HALTER TRACTION
12. 90 90 DEGREES TRACTION
13. OVERHEAD TRACTION
14. PELVIC GIRDLE
15. VINKE’S CALLIPER
16. ZERO DEGREE TRACTION
17. Stove in chest
INDICATION
Fracture of hip and femur
Post polio with residual paralysis
Fracture of hip and femur. For Congenital Hip
Dislocation
Fracture of hip and femur
For Scoliosis
Fracture of cervical spine
Fracture of the supracodylar of the humerus
For Scoliosis
For Scoliosis (severe)
Fracture of the pelvis
Fracture of the cervical spine
Fracture of the subtrochanteric
Fracture of the supracondyle of humerus
Fracture of the lumbar spine. For Herniated
nucleus Polposus
Fracture of the cervical spine
Fracture of the surgical humerus
Multiple rib fractures

BRACES
TYPES INDICATOR
1. BANJO SPLINT Peripehral nerve injury
2. BILATERAL LEG BRACE Post polio with residual paralysis,
3. CHAIR BACK BRACE Lumbo-sacral affection
4. COCKED-UP SPLINT Prevention of wrist drop
5. DENNIS BROWN SPLINT Club foot deformity
6. FORESTER BRACE Cervico-thoraco-lumbar spine affection
7. FOUR POSTER BRACE Cervical spine affection
8. JEWETTE BRACE Dorso-lumbar spine fracture
9. KNIGHT/TAYLOR BRACE Upper spine fracture
10. MILWAUKEE BRACE Scoliosis
11. OPPEN HEIMER SPLINT/LIVELY Peripheral nerve injury
FINGER
12. PHILADELPHIA COLLAR Cervical spine affection (thick)
13. SHANTZ COLLAR Cervical spine affection (soft)
14. UNILATERAL LEG BRACE Post polio with residual paralysis
15. YAMAMOTO BRACE scoliosis

GADGETS HARDWARE
TYPES INDICATOR
Crutch field Tong Cervical Spine
Circlage Wiring Patella
Gigli saw For amputations
Antibiotic bead Osteomyelitis
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X pinning/Y bone pinning Supracondylar fx of the humerus

Roger Anderson External Fixator (RAEF)
Total knee Arthroplasty (TKA)
Harrington Rod Instrumentation
Hybrid External Fixator
Ilizarov external Fixator
Total replacement Hip Arthroplasty
(TRHA)
Partial replacement Hip Prosthesis
(PRHP)
Compression Hip screw Fixation (CHSF)
Tower/Interdental Wiring
Intramedullary Nailing
Tibidal Femural component
T-plate or buttress planting
Planting with Screw
Hoffmann external fixator
Spacer antibiotic
Delta frame
Comminuted fracture of long bones
Tibial & Femoral components Degenerative joint
disease (osteoarthritis)
Scoliosis
Periarticular injuries such as your knee & ankle
joints
Mal-union, bone loss & bone lengthening
Femoral head, femoral neck including acetabulum
Femoral head and neck fracture
Intertrochanteric fracture
Fracture of mandible
Fracture middle 3rd femur
Degenerative uses
Proximal tibia
Radius ulna fracture
Fracture of pelvis
Infected hip prosthesis
Periarticular injuries such as your knee & ankle
joints

3 PRINCIPLES IN MANAGEMENT OF FRACTURE:

1. Close or Open Surgery – reduction

2. Immobilization – Traction, brace, cast
3. Rehabilitation – restoration of function, Physical Therapy exercise OT & Surgery

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