TRACTION/FRACTURE/ORTHOPEDIC DOCTOR ORDERS.(NURSES)

Patient with fracture depending on the position of fracture will have traction for example bucks traction, skeletal traction, immobilizer.

Pay attention to orthopedic doctor orders.

For example how many pounds of traction is needed?.

Place bed flat or in trendelenburg’s position.

Elevation of the foot of the bed will help to prevent patient from sliding down towards the foot of the bed.

It will depend on patient size and weight applied.

Properly position your patient well in the middle of the bed maintaining good body alignment.

This is for effective line of pulling.

Apply Traction based on the weight. Follow doctor orders.

You will need two nurses plus yourself. The skin must be in healthy condition to tolerate skin traction.

Inspect the skin for signs of :

atrophy,

bruises

circulation ,issues and abrasions.

Document neurovascular status of patient and any skin problems.

Apply continuous traction tape to lower part of leg below the knee and loosely around foot .This will allow for attachment of spreader.

The circular fixation may be used for limb rotation defects, treatment of nonunion, limb lengthening and corrections of angulation.

Application of external fixation is usually done under general anesthesia.The skin will be clean very well,and transfixing pin are inserted into the bone through small incisions below and above the fracture.

The application will be stabilized by adjusting and tightening the bars and connecting all the pins used.Then you protect the other extremity and caregivers by making sure that the sharp pin heads are covered with plastic, cork or rubber covers.

Perform Nursing assessment to find out if patient understand procedures and the external fixation.

Evaluate neurovascular status of body parts.

Assess open wounds for healing or infection. Assessment of other body systems affected by injury or immobilization.Instruct your patient to inspect around pin site daily for infection,drainage, increase in swelling.

Do not wound with hands,use sterile technique for dressing changes. Before external fixation placement encourage patients and provide reassurance. Inform patients that mobility can be achieved with external fixation. Get patients involve in their own health. Assessment of neurovascular frequently every 15 to 60minutes while swelling is significant and as the swelling decreases every 2 to 8hours .Elevate Extremity to reduce swelling and minimize pain.Suspend is to control edema and not application of traction force.Report any changes in neurovascular status.

PIN CARE.

Remove crusts with sterile cotton applicator. Clean pin sites.Use the solution as prescribed to clean pin sites.Follow your hospital policy and the doctor orders. Unremoved crusts formed by serious drainage can cause infection by preventing wound from draining.A small amount of drainage from the pain site is normal.

NURSES ALERT: Assessment of neurovascular status frequently and document findings. Don’t say CNS intact if it is not intact.

Report Inflammation, swelling loosened pins,skin tension at pin site,tenderness and virulent drainage at the pin site and infection. Use sterile technique for dressing changes.Monitor wound healing and any open wound at the fracture are treated with daily dressing.

Types of Orthopedic surgery. Arthroplasty which is repair of joint. Amputation which is removal of body part.

Bone graft placement of autologous or homologous bone tissue to replace, promote healing or stabilization of diseased bone.

Fasciotomy the cutting of muscle fascia to relieve contracture or constriction.

Internal Fixation is the stabilization of a reduced fracture with the use of metal screws, pin,plates or nails. Joint replacement is a type of arthroplasty that involves replacement of joint with metal or plastic materials. Meniscectomy is the excision of damaged fibro-cartilage of the knee.

Open reduction is reduction and alignment of the fracture through surgical incision. Tension transfer is movement of tendon insertion point to improve function. Total joint replacement is when both articular surfaces within a jont are replaced.

Jenny is a 62year old female that has been a bedside nurse in acute care hospital for 25years .Now ,Mrs Jenny faces a new challenge. The osteoarthritis in her right leg that was diagnosed 5years ago is so severe that his ability to walk, let alone stand for twelve hours. So her doctor has recommended total knee replacement. Total knee replacement is becoming very common procedure. In united States according to the American Academy of Orthopaedic surgeons perform over 300,000 surgeries each year. When you have severe knee pain and functional disabilities that is caused by arthr6or other musculoskeletal disorders or injury total knee replacement may be the needed surgery. The knee is a joint that connects two or mor bones together. It is a complex joint that allows movement to occur in three different planes flexion,extension,abduction and adduction,internal and external rotation. It is one of the largest complex joints in human body. The knee has the femur which is the thigh bone shin bone known as tibia.And the smaller bone that is alongside with tibia is the fibula and at the knee cap is the patella.