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MUSCULOSKELETAL SYSTEM ALEXANDER L.

LEGION, RN, MANMS (C)

I. NURSING PROCESS ASSESSMENT:

Health History: Assessment of the patient with musculoskeletal dysfunction depends on the needs of the patient and also includes an evaluation of the effects of the musculoskeletal problem on the patient. Concerns of the nurse are focused on assisting the patients to maintain: (a.) general health, (b) accomplish their activities of daily living, (c) manage their treatment programs.

Initial interview: 1. Obtain a general impression of the patients health status. Gather subjective data from the patient concerning the onset of the problem and how it has been managed. PAIN Most patients with diseases and traumatic conditions or disorders of muscles, bones, and joints experiences pain. Pain is variable, and its assessment and management must be individualized.

Bone pain described as dull and deep ache in nature and throbbing. Muscle pain described as soreness, or aching and is referred to as muscle cramps. Fracture pain sharp and piercing and is relieved by immobilization. Sharp pain may also result from bone infection with muscle spasm or pressure on a sensory nerve. Pain that increases with activity may indicate joint sprain or muscle strain. Steadily increasing pain progression of an infectious process or neurovascular complications. Radiating pain occurs in condition in which pressure is exerted on a nerve root.

Questions that can be asked regarding pain: Joint Assessment: Any problem with your joints? Any pain? Location: which joint? On one side or both sides? Quality: what does the pain feel like? Severity: how strong is the pain? Onset: when did the pain started? Timing: what time of day does the pain occur? How long does it last? How often does it occur? y Is the pain aggravated by movements, rest position, weather? Is the pain relieved by rest, medications, application of heat or ice?

Is the pain associated with chills, fever, recent sore throat, trauma, repetitive activity? Any stiffness in your joints? Any swelling, heat, redness in the joints? Any limitation of movement in any joint? Which joint?
y

Muscle Assessment: Any problems in muscle, such as any pain or cramping? Which muscles? If in calf muscles: is the pain with walking? Does it go away with rest? Are your muscle aches associated fever, chills, or flu? Any weakness in muscles? Location: where is the weakness? How long have you noticed weakness?

Do the muscle look smaller?

Bones: Any bone pain? Is the pain affected by movement? Any deformity of any bone or joint? Is the deformity due to injury or trauma? Does the deformity affect ROM? Any accidents or trauma ever affected the bones or joints: fractures, joint stain, sprain, dislocation? Which ones? When did this occur? What treatment was given? Any problem or limitations now as a result? Any back pain? In which part of the back? Is pain felt anywhere else, like shooting down leg? y Any numbers and tingling? Any limping?

Functional Assessment of ADLs Bathing: turning faucets? Getting in and out of the tub? Toileting: urinating, moving bowels, able to get self on / off toilet, wipe self? Dressing: dong buttons, zipper, fasten opening behind neck, pulling dress or sweater over head, pulling up pants, tying shoes, getting shoes that fit? Grooming: shaving, brushing teeth, brushing or fixing hair, applying make up? Eating: preparing meals, pouring liquids, cutting up foods, bringing food to mouth, drinking? Mobility: walking, walking up or down stairs, getting in / out of be, getting out of house? Communicating: talking, using phone, writing?

2. Concurrent health conditions and related problems, such as familial or genetic abnormalities.

Did the patient had any past problems or injuries to the joints, muscles or bones. What treatment was given? If the patient had any after effect from the injury or problem?

3. History of medications used and response to pain medication. Developmental History: Was there any trauma to infant during labor and delivery? Did the baby come head first? Was there a need for forcep?

Were the babys motor milestones achieved at about the same time as siblings or age- mates? Does the child have broken any bones? Any dislocations? How were these treated? Is there any noticeable bone deformity? Spinal curvature? Unusual shape of toes or fee? Age of onset? Did they ever sought treatment for any of these?

History for adolescents: Is the child involved in any sports at school or after school? How frequently? Does the child use any special equipment? What is the nature of your daily warm up? What do you do if you get hurt?

Social History: Information concerning the patients learning ability, economic status, and current occupation, needed for rehabilitation and discharge planning. Assess the patients use of tobacco, alcohol, and other drugs to evaluate how these agents may affect patient care. Does the patient drink alcohol or caffeinated beverages? How much and how often? Describe the activities during a typical day. How much time is spent in the sunlight? y Describe any routine exercises that the patient do. y Describe the patients occupation. y Describe your posture at work and at leisure.

Does the patient have difficulty performing normal activities of daily living? Do they use assistive devices to promote mobility? How does musculoskeletal problems interfered with their ability to interact or socialize with others? Have they interfered with the usual sexual activity?

Psychological History: How did you view yourself before you had this musculoskeletal problem, and how do you view yourself now? Has your musculoskeletal problem added stress to your life? Describe.

PHYSICAL ASSESSMENT: The extent of assessment depend on the patients physical complaints, health history, and physical clues that warrant further exploration. Mostly the assessment focuses on the patients ability to perform activities of daily living; evaluating the patients posture, gait, bone integrity, joint function, and muscle strength and size. In addition, assessing the skin and neurovascular status is an important part of a complete musculoskeletal assessment. A.POSTURE Inspect the spinal curves and trunk symmetry from posterior and lateral views. Stand behind the patient and note for differences in the height of the shoulders and iliac crest. Gluteal folds are normally symmetric.

Shoulder and hip symmetry as well as the line of the vertebral column are inspected with the patient erect and the patient bending forward. Common deformities of the spine:

Kyphosis an increased forward curvature of the thoracic spine. Lordosis or swayback, an exaggerated curvature of the lumbar spine. Scoliosis lateral curving deviation of the spine.

B. GAIT Gait is assessed by having the patient walk away from the examiner for a short distance. Observe gait for smoothness and rhythm. Unsteadiness or irregular movements are considered abnormal.

Limping motion, most frequently caused by painful weight bearing. Have the patient pin point the area of discomfort, thus guiding further examination. One extremity is shorter than the other. Limited joint motion may affect gait. A variety of neurological conditions are associated with abnormal gait such as spastic hemiparesis gait ( stroke), steppage gait (Lower motor neuron disease ), and shuffling gait.

C. BONE INTEGRITY Bony skeleton is assessed for deformities and alignment. Symmetric parts of the body are observed. Abnormal bony growths due to bone tumors may be observed.

Shortened extremities, amputations, and body parts that are not in anatomic alignment are noted. Fracture findings may include abnormal angulation of long bones, motion at points other than joints, and crepitus at the point of abnormal motion. D. JOINT FUNCTION Inspect for size, shape, color and symmetry. Note any masses, deformities, or muscle atrophy. Compare bilateral joint findings. Normally the joint moves smoothly Evaluated by noting range of motion, deformity, stability, and nodular formation. Range of motion is evaluated both actively and passively.

Test each joints ROM. Demonstrate how to move each joint through its normal ROM, then ask the client actively to move the joint through the same motion. Compare bilateral joint findings. Goniometer tool used to give precise measurement of range of motion Palpation of the joint while it is passively moved provides information about the integrity of the joint. Limited range of motion may be a result of skeletal deformity, joint pathology or contracture of the surrounding muscles, tendons and joint capsules. Effusion excessive fluid within the capsule. Joint motion is compromised or joint is painful.

Effusion is suspected if joint is swollen and the normal body landmarks are obscured. The most common site for joint effusion is the knee. Joint deformity may be caused by: a. contracture ( shortening of surrounding joint structures) b. dislocation ( complete separation of joint surfaces) c. subluxation ( partial separation of articular surfaces) or disruption of structures surrounding the joint. Snap or crack may indicate that a ligament is slipping over a bony prominence. Crepitus grating, crackling sound or sensation, result if irregular joint surfaces move across one another. Surrounding joints are examined for nodule formation which are present on the different types of arthritis.

E. MUSCLE STRENGTH AND SIZE Is assessed by noting the patients ability to change position, muscular strength and coordination, and the size of individual muscles. Assessment of muscle strength is done by having patient perform certain maneuvers with and without added resistance. Test muscle strength by asking client to move each extremity through its full ROM against resistance. Do this by applying some resistance. If this is not possible, then attempt passively to move the part through its full ROM. If this is not possible, then inspect and feel for a palpable contraction of the muscle while the client attempts to move it.

Do not force the part beyond its normal range. Stop passive motion if the client expresses discomfort or pain. Be especially cautious with the older client when testing ROM. When comparing bilateral strength, keep in mind that the clients dominant side will tend to be the stronger side. Clonus rhythmic contractions of a muscle by sudden, forceful, sustained dorsiflexion of the foot or extension of the wrist. Fasciculations - involuntary twitching of muscle fiber groups. girth of an extremity are also being measured to monitor increase in size due to exercise, edema or bleeding into the muscle.

F. SKIN Inspect skin for edema, temperature, and color. Palpation of the skin can reveal whether any areas are warmer, suggesting increased perfusion of infection. Or cooler, suggesting decreased perfusion and whether edema is present. G. NEUROVASCULAR STATUS Neurologic system is responsible for coordinating the functions of the skeleton and muscles. It is also important to perform neurovascular assessments of patient with musculoskeletal disorders

DIAGNOSTIC ASSESSMENT OR EVALUATION


IMAGING PROCEDURES 1. X-ray studies Important in evaluating patients with musculoskeletal disorders. Multiple x-rays needed for full assessment of the structure being examined. X-ray study of the cortex of the bone reveals any widening, narrowing or signs of irregularity. Bone x-rays determines bone density, texture erosion and changes in bone relationships. Joint x-rays reveal fluid, irregularity, spur formation, narrowing and changes in joint structure.

2. Computed Tomography It is used to identify the location and extent of fractures in areas in areas that are difficult to evaluate. Shows in detail a specific plane of involved bone. Can reveal tumors of the soft tissue. Injuries to the ligaments or tendons. The patient must remain still during the procedure. 3. Magnetic resonance Imaging A non-invasive imaging technique that uses magnetic fields, radio waves and computers to demonstrate abnormalities. Contrast media may be injected intravenously to enhance visualization. Allows for detailed visualization of the internal structure. Provides much greater contrast between the different soft tissues than the CT Scan.

During the procedure the patient needs to lie still for 1 to 2 hours.

4. Arthrogram Allows visualization of the surface of the soft tissues, joint, tendons, ligaments, muscles and cartilage that cannot be seen through plain x-ray. A radiographic examination of the soft tissues of the joint structures and is used to diagnose trauma to joint capsule or ligaments. A local anesthetic is used for the procedure. A contrast medium or air is injected into the joint cavity, and the joint is moved through ROM as a series of x-ray films are taken. Interventions: Assess the client for allergies to iodine or seafood before the procedure

Obtain an informed consent. Inform the client of the need to remain as still as possible, except when asked to reposition. Minimize the use of the joint for 12hours after the procedure. Instruct the client that the joint may be edematous and tender for 1 to 2 days after the procedure and may be treated with ice packs and analgesics as prescribed. Instruct the client that if edema and tenderness last longer than 2 days to notify the physician. If air was used for injection, crepitus may be felt in the joint for up to 2 days.

5. Arthroscopy An invasive procedure, in which endoscope is being inserted into the joint through a small incision, and joint structure are being viewed on a video monitor. Provides an endoscopic examination of various joints.

Articular cartilage abnormalities may be assessed, loose bodies can be removed, and the cartilage can be trimmed. A biopsy may be performed during the procedure. Intervention: Instruct the client to fast for 8 to 12 hours before the procedure. Obtain an informed consent. Administer pain medication as prescribed post procedure. An elastic wrap should be worn for 2 to 4 days as prescribed post procedure. Instruct the client that walking without weight bearing usually is permitted after sensation returns but to limit activity for 1 to 4 days as prescribed following the procedure.

Instruct the client to elevate the extremity as often as possible for 2 days following the procedure and to place ice on the site to minimize swelling. Reinforce instructions regarding the use of crutches, which may be used for 5 to 7 days post procedure for walking. Advise the client to notify the physician if fever or increased knee pain occurs or if edema continues for more than 3 days post procedure.

6. Bone Mineral Density Measurement It also measures amount of calcium in certain bones and used to estimate fracture risk. It measures density of minerals using a special x-ray or CT scan. a. Dual energy x ray absorptiometry Measures bone mass of the spine, other bones, and the total body. Radiation exposure is minimal.

Is used diagnose metabolic bone disease and to monitor changes in bone density with treatment. Inform client that procedure is painless.

b. Quantitative ultrasound Evaluates strength, density and elasticity of various bones using ultrasound rather than radiation. Inform client that the procedure is painless. OTHER STUDIES 1.Bone Scan An imaging test used to detect increased activity in bone such as fractures, infection, inflammation or tumors. It detects changes in function before structural changes occur. Radioisotope is injected intravenously and will collect in areas that indicate abnormal bone metabolism and some fractures, if they exist.

The isotope is excreted in the urine and feces within 48 hours and is not harmful to others. Intervention: Obtain an informed consent. Remove all jewelry and metal objects. Following the injection of the radioisotope, the client must drink 32 oz of water (if not contraindicated) to promote renal filtering of the excess isotope. From 1 to 3 hours after the injection, have the client void, and then the scanning procedure are performed. Full bladder interferes with the scanning of the pelvic bones.

Inform the client of the need to lie supine during the procedure and that the procedure is not painful. No special precautions required after the procedure because a minimal amount of radioactivity exists in the radioisotope. Monitor the injection site for redness and swelling. Encourage oral fluid intake following the procedure. Scan is performed 2- 3 hours after the injection. Encourage patient to drink plenty of water before the procedure to help distribute and eliminate the isotope. Before the scan, ask the patient to empty to empty the bladder because full bladder interferes with scanning of the pelvic bones.

2. Arthrocentesis Involves aspirating synovial fluid, blood, or pus via a needle inserted into a joint cavity. Medication may be instilled into the joint if necessary to alleviate inflammation. Interventions: Obtain an informed consent. Apply a compress bandage post procedure as prescribed. Instruct the client to rest the joint for 8 to 24 hours post procedure. Instruct the client to notify the physician if a fever or swelling of the joint occurs. 3.Electromyography Provides information about the electrical potential of the muscles. Test is done to evaluate to evaluate muscle weakness, pain and disability

Purpose of the procedure is to determine any abnormality of function and to differentiate muscle and nerve problems. Needles are inserted into the muscle, and recording of muscular electrical activity are traced on the recording paper through an oscilloscope. Intervention: Obtain an informed consent. Instruct the client that the needle insertion is uncomfortable. Instruct the client not to take any stimulants or sedatives for 24 hours before the procedure. Inform the client that slight bruising may occur at the needle insertion sites. 4. Biopsy Performed to determine the structure and composition of bone marrow, bone muscle, or synovium to help diagnose specific disease.

Done during surgery or though aspiration or needle biopsy. Intervention: Obtain an informed consent. Monitor for bleeding, swelling, hematoma, or severe pain Elevate the site for 24 hours following the procedure to reduce edema. Apply ice packs as prescribed following the procedure to prevent the development of a hematoma. Monitor for signs of infection following the procedure. Inform the client that mild to moderate discomfort is normal following the procedure.

5. Myelogram An x-ray exam of the spinal cord. Requires injection of dye or air into the subarachnoid space followed by radiography to detect abnormalities of the spinal cord and vertebras.

Obtain an informed consent. Provide hydration for at least 12 hours before the test. Assess client for allergies to iodine or seafood. Premedicate for sedation as prescribed. Post procedure Intervention Obtain vital signs and perform neurological assess ment frequently as prescribed If a water based dye is used, elevate the head 15 to 30 degrees for 8 hours as prescribed. If an oil base dye is used, keep the client flat 6 to 8 hours as prescribed. If air is used, keep head lower than the trunk. Encourage fluids and monitor intake and output.

Nursing Diagnosis
Acute

Pain Impaired mobility Self- care deficit Altered Skin Integrity

PLANNING FOR HEALTH PROMOTION & MAINTENANCE / IMPLEMENTATION


A. CAST A cast is a rigid external immobilizing device that is molded to the contours of the body. Purposes: a. to immobilize a body part in a specific position and to apply uniform pressure on encased sot tissue. b. to immobilize a reduced fracture. c. to correct deformity. d. to apply uniform pressure to underlying soft tissue or to support and stabilize weakened joints.

CASTING MATERIALS: Nonplaster generally referred to as fibreglass casts. A water activated polyurethane materials that have the versatility of plaster. Lighter in weight, stronger, water resistant and durable. Consists of an open weave, non-absorbent fabric impregnated with cool water-activated hardeners that bond and reach full rigid strength in minutes. Porous, and therefore diminish skin problems. They do not soften when wet. When wet they are dried with a hair drier on a cool setting. Thorough drying is important to prevent skin breakdown. They are used for non displaced fractures with minimal swelling and for long term wear.

Plaster rolls of plaster bandage are wet in water and applied smoothly to the body. a crystallization reaction occurs, and heat is given off. Inform patient that the heat is given off can be uncomfortable and there is an increasing sensation of warmth so the patient would not become alarmed. The crystallization process produces a rigid dressing. Assessment: Before the cast is applied: 1.Asses the patients general health 2.Presenting signs and symptoms. 3.Emotional status

4. Understanding of the need for the cast

5. Condition of the body part to be immobilized. Major goals for the patient: 1. Knowledge of the treatment regimen. The patient need information concerning the pathologic problems and the purpose and expectations of the prescribed treatment regimen. This knowledge promotes the patients active participation in and adherence to the treatment program. It is important to prepare the patient for the application of the cast by describing the anticipated sights, sound and sensations. The patients need to know what to expect during application and that the body part will be immobilized after casting.

2. Relief of pain Carefully evaluate pain associated with musculoskeletal problems and help determine its cause. Most pain can be relieved by elevating the involved part. Applying cold as prescribed. Administer usual dosage of analgesics. Pain associated with disease process is frequently controlled by immobilization. Pain due to edema that is associated with trauma, surgery, or bleeding into the tissues can be controlled by elevation and intermittent application of cold. Pain may be indicative of complications. Severe pain over a bony prominence warns of an impending pressure ulcer. Pain decreases when ulceration occurs

Discomfort due to pressure on the skin may be relieved by elevation that controls edema or by positioning that alters pressure.

3. Improved physical mobility. Every joint that is not immobilized should be exercised and moved through its range of motion to maintain function. 4.Healing of lacerations and abrasions. 5.Maintenance of Adequate Neurovascular function and Absence of Complications. monitors circulation, motion, sensation of the affected extremity. Assessing the fingers or toes, of the casted extremity and comparing them with those of the opposite extremity.

Normal findings: minimal swelling, minimal discomfort, pink color, warm to touch, rapid capillary refill response normal sensations, and ability to exercise fingers or toes. Early recognition of diminished circulation and nerve function is essential to prevent loss of function. Assessment data: unrelieved pain, pain on passive stretch, paresthesia, motor loss, sensory loss, coolness, paleness, slow capillary refill.

6. Teaching Self Care Instruct the patient the following: Move about as normally as possible, but avoid excessive use of the injured extremity and avoid walking on wet, slippery floors or sidewalks.

Perform prescribed exercises regularly as scheduled. Elevate the casted extremities to heart level frequently to prevent swelling. Do not attempt to scratch the skin under the cast. This may cause a break in the skin and result in the formation of a skin ulcer. Cool air from a hair dryer may alleviate an itch. Cushion rough edges of the cast with tape. Keep the cast dry but do not cover it with plaster or rubber, because this causes condensation, which dampens the cast and skin. Moisture softens a plaster cast. Report any of the following to the physician: persistent pain, swelling that does not respond to elevation, changes in sensation, decreased ability to move exposed fingers or toes, and changes in skin color and temperature. Note odors around the cast, stained areas, warm spots, and pressure areas. Report them to the physician.

TRACTION Is the application of a pulling force to a part of the body. It must be applied in the correct direction and magnitude to obtain its therapeutic effects. Traction is used primarily as a short term intervention until other modalities (such as external or internal fixation.) are possible. Traction means that a pulling force is applied to a part of the body or an extremity where countertraction pulls in the opposite direction. Purposes: 1. To prevent / correct deformities 2. Relieve pain 3. Relieve muscle spasm 4.Reduce / immobilize / align fractures

Principles of Effective Traction Counter traction must be used to achieve effective traction. Usually the patients body weight and bed position adjustments supply the needed countertraction. Traction must be continuous to be effective in reducing and immobilizing fractures. Weights are not removed unless intermittent traction is prescribed. Any factor that might reduce the effective pull or alter its resultant line of pull must be eliminated.
 

the patient must be in good body alignment in the center of the bed when traction is applied. Weights must hang free and not rest on the bed or floor.

Types of Traction 1. Skin Traction A direct application of pulling force on a skin adherent that is attached to the skin to maintain a steady pull. It is often a temporary measure used to before surgery or to reduce muscle spasm. It should be removed and reapplied at least once a day. It also can be used for an extended period of time and is removed and reapplied intermittently as prescribed by the physician. The amount of weight applied must not exceed the tolerance of the skin. No more than 2 to 3.5 kg of traction can be used on an extremity. 2. Skeletal Traction Skeletal traction is applied directly to the bone. This method of traction is used occasionally to treat fractures of the femur, tibia and cervical spine.

The traction is applied directly to the bone by use of a metal pin or wire that is inserted through the bone distal to the fracture, avoiding nerves, blood vessels, muscles, tendons, and joints. Nursing Interventions: 1. Promoting Understanding of the Treatment Regimen. 2. Reducing Anxiety 3. Maintaining Position Patients body in traction must maintain proper alignment to promote an effective line of pull. Position the patients foot accordingly to prevent foot drop. 4. Preventing Skin Breakdown Protect the clients elbows and heel and inspect it for pressure areas.

Suspend a trapeze overhead within easy reach of the patient. This apparatus helps the patient to move about in bed and to move on and off the bedpan. Specific pressure points are assessed for redness and skin breakdown. If patient is not permitted to turn on one side or the other, the nurse must make a special effort to provide back care and to keep the bed dry and free of crumbs and wrinkles.

5. Monitoring Neurovascular Status Neurovascular status of the immobilized extremity is assessed at least every hour initially and then every 4 hours Instruct the patient to report any changes in sensation or movement immediately so they can be promptly evaluated. Encourage the patient to do active flexion extension ankle exercises and isometric contraction of the calf muscles 10 times an hour while awake to decrease venous stasis.

6. Providing Pin Site Care Assess pin site and drainage for signs of infection such as redness, tenderness and purulent drainage. Wound in pin insertion needs attention to avoid infection. Initially the site is covered with a sterile dressing. The nurse must keep the area clean. Slight serous oozing at pin site is expected, but crusting should be prevented. 7. Promoting Exercise Encourage the patient to exercise within the therapeutic limit of the traction, to assist maintain muscle strength, muscle tone and promoting circulation. Active exercises include pulling up on the trapeze, flexing and extending the feet, range of motion, and weight resistance exercises for non-involved joints

8. Achieving a Maximum level of Comfort Special mattress or mattress overlays designed to minimize the development of pressure ulcers may be placed on the bed before traction is applied. The nurse can relieve pressure on dependent body parts by turning and positioning the patient for comfort within the limit of the traction and by making sure the bed linens remain wrinkle free and dry. 9. Achieving Maximum Self Care The nurse helps the patient to eat, bathe, dress, and toilet. Convenient arrangement of items such as telephone, tissues, water and assistive devices may facilitate self care. Nurse and patient can creatively develop a routine that maximizes the patients independence.

10. Attaining Maximum Mobility with Traction Encourage the patient to exercise the muscles and joints that are not in traction to guard against their deterioration. 11. Monitoring and Managing Potential Complications a. Pressure Ulcers - examine frequently the patients skin for evidence of pressure paying more attention to bony prominences. - reposition patient frequently and use protective devices to relieve pressure such as elbow protector. - if a pressure ulcer develops the nurse consults with the physician. b. Pneumonia - auscultate the patients lung every 4 to 8 hours to determine respiratory status.

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- teach the client deep breathing and coughing exercises to aid in fully expanding the lungs and moving pulmonary secretions. - if a respiratory problem develops, prompt institution prescribed therapy is needed.

c. Constipation and Anorexia - a diet high in fiber and fluids may help to stimulate gastric motility. - therapeutic measures such as stool softeners, laxatives, suppositories and enemas. - identify and include patients food preference within the prescribed therapeutic diet.

d. Urinary Stasis and Infection - monitor the patients fluid intake. - teach the patient to consume adequate amounts of fluid and to void every 3 to 4 hours. - Notify the physician if the patient exhibits signs and symptoms of urinary tract infection.

Types of Cast
Short Leg Cast - From foot to below knee - Fracture of the foot, ankle, or distal tibia or fibula. - severe sprain or strain - postoperative immobilization following open reduction and internal fixation

Long Leg Cast


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Foot to upper thigh Fracture of the distal femur, knee or lower leg. Soft tissue injury to the knee or knee dislocation Postoperative immobilization

Abduction boots Feet to below knee or upper thigh - Postoperative immobilization following hip abductor release - Maintain abduction
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Unilateral Hip Spica cast


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Entire leg and trunk to waist or nipple line

Fracture of the femur Postoperative immobilization Correction of deformity such as congenital soft tissue injury following dislocation of the hip

Bilateral long leg Hip Spica Cast


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Entire leg bilaterally to waist or nipple line Fractures of femur, acetabulum, or pelvis Postoperative immobilization

Short Leg Hip Spica Cast


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Knees or thighs bilaterally to waist or nipple line Developmental dysplastic hip

Short Arm Cast


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Hand to below elbow Fracture of the hand or wrist. Postoperative immobilization

Long Arm Cast


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Hand to Upper Arm Fracture of the forearm, elbows or humerus. Postoperative immobilization

Shoulder Spica Cast


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Trunk and Shoulder, arm and hand Shoulder dislocation Soft tissue injury to the shoulder Postoperative immobilization

Types of Traction
1.Cervical Traction - Used for fractures or dislocation of cervical or high thoracic vertebrae

Halo Vest - Fractures or dislocation of cervical or high thoracic vertebrae

Bryants Traction - Used for femur fractures and congenital hip dislocation - Used in children younger than 3 years old, weighing less than 30 lbs. - Applied bilaterally with hips flexed 45 degrees and legs in extension.

Bucks Traction - Used for hip and knee contracture and immobilization of hip fractures. - This form of skin traction to the lower limb provides for straight pull through a single pulley attached to a crossbar at the foot of the bed. - The limb in traction lies parallel to the bed. The foot of the bed is routinely elevated to provide counter traction and to keep the patient from being pulled down to the foot of the bed. - In Buck's extension traction, the patient is usually not allowed to turn and must remain flat on his back

Dunlop skeletal traction - An orthopedic mechanism that helps immobilize the upper arm in the treatment of contracture or supracondylar fracture of the elbow. The mechanism uses a system of traction weights, pulleys, and ropes and may be accompanied by skin traction. Dunlop skeletal traction is usually applied unilaterally but may also be applied bilaterally.

Balanced Traction - Used for femur fractures. Hip and knee contracture and for postoperative positioning and immobilization.