CAST

CAST

 A RIGID EXTERNAL IMMOBILIZING DEVICE THAT IS MOLDED TO THE

CONTOUR OF THE BODY
 Mold – used for splinting the affected part of the body wherein there is infection, swelling
and wound

 PURPOSE
 Immobilize a reduced fracture
 Correct deformity
 Apply uniform pressure to underlying soft tissue
 Support and stabilized weakedned joints
TYPES OF CAST

 CAST IN TRUNK AREA

 Colar cast
 Affectation of the cervical spine
 Body cast
 Affectation of the lower thoracic and upper lumbar spine
 Minerva cast
 Affectation of the cervical and the upper dorsal spine
 Rizzer’s Jaket
 Affectation of the thoraco-lumbar spine; for scoliosis
 Shoulder spica cast
 Affectation of the upper portion of the humerus and the shoulder joint
 Sugar Tong
 Compound affectation of the humerus with open wound, inflammation and the shoulder joint
CAST

 CAST IN UPPER EXTREMITIES

 Short Arm circular cast
 Affectation of the carpals and metacarpals
 Short Arm posterior mold
 Affectation of the carpals and metacarpals with open wound, inflammation or swelling
 Munster/Fuenster Cast
 Affectation of the radius and ulna with callus formation, Allows flexion and extension
 Long Arm circular cast
 Affectation of the radius-ulna
CAST

 CAST IN UPPER EXTREMITIES

 Hanging cast
 Affectation of the shaft of the humerus with callus formation
 Functional cast
 Affectation of the shaft of the humerus with callus formation
 Airplane cast
 Affectation of the neck of the humerus, recurrent shoulder dislocation
 Thumb spica cast
 Affectation of the 1st metacarpal
CAST

 CAST IN LOWER EXTREMITIES

 Short leg circular cast
 Affectation of the tarsals and metatarsals
 Short leg posterior mold cast
 Affectation of the tarsals and metatarsals with open wound, inflammation or swelling
 Walking cast
 Affectation of tarsals and metatarsals with callus formation
 Long leg circular cast
 Affectation of the tibia-fibula
 Long leg posterior mold
 Affectation of the tibia-fibula with open wound, inflammation or swelling
CAST

 CAST IN LOWER EXTREMITIES

 Patellar Tendon Bearing Cast
 Affectation of tibia-fibula with callus formation
 Delvitt cast
 Affectation of the distal third tibia-fibula with callus formation
 Cylinder cast
 Affectation of the patella with open wound, inflammation or swelling
 Ischial weight bearing cast
 Affectation of the shaft of the femur with callus formation
 Basket Cast
 For massive bone injury of the patella to facilitate wound healing
CAST

 CAST IN LOWER EXTREMITIES

 Cast brace
 Fracture of the distal third femur and proximal third tibia with callus formation
 Single hip spica cast
 Affectation of the one hip and one femur
 One and one half cast
 Affectation of two hips and 1 femur
 Double hip spica cast
 Affectation of two hips and two femur
 Single hip spica mold
 Affection of the 1 hip, 1femur with open wound, inflammation or swelling
CAST

 CAST IN LOWER EXTREMITIES

 Pantalon Cast
 Affectation of the pelvis
 Frog cast
 For congenital hip dysplasia
 Internal rotator board
 For post hip surgery to maintain knee adduction
 Night splint
 For post poliomyelitis with contractures of hip and knee; applied at night only.
CASTING MATERIALS

Fiberglass Plaster Cast.

Made of an open weave, no fabric Rolls of crinoline with powder gypsum
impregnated with hardeners crystals mixed with water swells, and forms
into a hard cement
Water-activated polyurethane resin Traditional
Lighter in weight Plaster of paris
Costly Less costly
Stronger and more durable Achieve a better mold, not as durable
Water resistant
Dries completely within 10-15 minutes
Can bear weight within 30 minutes Requires 24-72 hours to dry completely
Nursing management for cast

 The nurse should prepare the patient for the sensation of increasing warmth so that the
patient will not be alarmed
 Promote cast drying
 Do not cover
 Leave exposed to circulating air
 Do not rest the cast on hard surfaces or sharp edges that can dent soft cast
 Control swelling and pain
 Elevate immobilize extremities to heart level
 Apply intermittent ice bag if prescribed
 Give analgesic as prescribed
Nursing management for cast

 Report pain uncontrolled by elevation, analgesic; may indicate compartment syndrome or

pressure ulcer
 Avoid excessive use of injured extremities; observe prescribed weight bearing limits
 Manage minor skin irritation
 Pad rough edges with tape
 Relieve itching
 Blow cool air from hair dryer
 Do not insert objects to cast
Nursing management for cast

 Check the neurovascular status 8Ps

 Pain, pallor, pulselessness, paresthesia
 Paralysis, pink (cap refill), poikilothermia (cold extremities, Poor hair growth
 Report to the physician
 Uncontrollable swelling and pain
 Cool, pale fingers or toes
 Paresthesia
 Paralysis
 Purulent drainage staining cast
 Signs of systemic infection
 Cast breaks
SPLINTS AND BRACES

 May be used for condition that do not require rigid immobilization

 Immobilize and support the body part in a functional position and must be well padded to
prevent pressure skin abrasion and skin breakdown
 For short term use
SPLINTS AND BRACES

 Examples of splite
 Cock-up splint – wrist drop
 Banjo splint – peripheral nerve injury
 Oppenheimer – for radial nerve injury
 Lively finger splint – for fracture of the finger
 Arm sling – support affected upper extremity
 Shoulder strap - scoliosis
BRACES

 Mechanical support for weakened muscles, joints and bone in rehabilitation

 Purposes
 Provide support
 Control movement
 Prevent further injury
 For longer use
BRACES

 Examples
 Collar brace
 Cervical spine affectation
 Shantz and Philadelpia
 Four poster brace
 Cervical spine and upper thoracic spine
 Somi brace
 Sterno-Occipito-Mandibular immobilizer
 Forester brace
 Cervico-thoraco-lumbar spine
 Knight Taylor brace
 Affectation of the thoracic spine
BRACES

 Examples
 Chair back brace
 Lumbosacral spine
 Jewette brace
 Dorsolumbar and upper lumbar spine
 Miluakee brace
 Scoliosis
 T9 and below affectation
 Yamamoto brace
 Scoliosis
 T9 and above affectation
BRACES

 Examples
 Scottish Rite
 For coxa plana, or legg calve perthes disease
 Long leg brace
 Post poliomyelitis with residual paralysis
 Short leg brace
 clubfoot
 Dennis borwne shoe’
 Clubfoot (talipe equino-varus)
Nursing management

 Assess the neurovascular status before application

 Nurse gives information about the underlying pathologic condition and the purpose and
expectations of the prescribed treatment regimen
 Prepare the patient for the application of the cast, brace, or splint by describing the
anticipated sights, sounds and sensation.
 Evaluate pain associated with the musculoskeletal condition
Complications

 Compartment syndrome
 Occurs when there is increased tissue pressure within a limited space that compromises the
circulation and the function of the tissue within the confined area.

 Management
 The cast must be bivalved (cut in half longitudinally.)
 Extremity must be elevated no higher that heart level to ensure arterial perfusion
 A fasciotomy may be necessary to relieve pressure within the muscle compartment
Complications

 Pressure ulcers
 Main pressure sites
 Heel, malleoli, dorsum of the foot, head of the fibula, anterior surface of the patella, medial
epicondyle of the humerus, ulnar styloid.
 Clinical Manifestation
 Pain and tightness in the area
 A warm area on the cast or brace suggest underlying tissue erythema
 The main drainage may stain the cast & brace and emit odor
 Management
 Bivalve or cut an opening window in the cast
Complications

 Disuse Syndrome
 Muscle atrophy and loss of strength brought about by immobilization.

 Management
 Tense or contract muscles without moving the part
 Muscle setting exercise
 Quadriceps setting
 Gluteal setting exercise
Nursing management for patient with
immobilized extremities
 UPPER
 Frequent rest periods are necessary
 To control swelling, the immobilized arm is elevated
 A sling may be used when the patient ambulates
 VOLKSMANNS CONTRACTURE, a specific type of compartment syndrome. Contracture of
the fingers and wrist occurs as the result of obstructed arterial blood flow to the forearm and hand.
Permanent damage develops.
 Neurovascular checks must be done frequently
Nursing management for patient with
immobilized extremities
 LOWER
 The patient’s leg must be supported on pillows to heart level to control swelling
 Ice packs should be applied as prescribed over the fracture site of 1-2 days
 The patient is taught to elevate the immobilized leg when seated
 The patient should assume recumbent position several times a day with the immobilized leg
elevated to promote venous return and control swelling
 Nerve function is assessed by observing the patients ability to move the toes and by asking about
the sensations in the foot.

 Alert: injury to the peroneal nerve as result of pressure is cause of footdrop. Consequently the
patient drags the foot when ambulating.
Nursing management for patient with spica
body cast
 Assisting with skin care and hygiene.
 Nurse turns the patient as a unit toward the uninjured side every 2 hours to relieve pressure
and to allow cast to dry
 Nurse turns the patient to a prone position twice daily if tolerated, to provides postural
drainage of the bronchial tree and relieve pressure on the back.
 Nurse inspects the skin around the edges of the cast frequently for signs of irritation
Nursing management for patient with spica
body cast
 Perineal opening must be large enough for hygienic care.
 Monitoring for cast syndrome.
 Psychological component is similar to a claustrophic reaction
 Physiologic cast syndrome responses: SMA Syndrom are associated with immobility in a body cast.
Ileus may occur
 Management:
 Decompression (Suction thru NG)
 IV fluid therapy, until gastrointestinal motility is restored
 The abdominal window must be enlarged if the abdomen restricts.

 Alert: Nurse monitors the patient in large body cast for potential cast syndrome, noting bowel
sounds every 4-8 hours, and report distention, nausea, and vomiting.
Nursing management for patient with External
Fixators
 External fixator
 Use to manage open fractures with soft tissue injury
 Provides stable support for severe comminuted fractures while permitting active treatment of
damage soft tissue
 The fracture is reduced, aligned and immobilized by series of pins inserted in the bone
 Pin position is maintained through attachment to a portable frame
Nursing management for patient with External
Fixators
 Management:
 After the EF is applied, the extremities is elevated to reduced swelling
 If there are sharp points on the fixator or pins, they are covered with caps to prevent device
induced injury
 Monitory the neurovascular status of the extremity every 2-4 hours
 Assess each pin sites for redness, drainage, tenderness, pian and cleaning each pin sites separately
1 or 2 times daily with cotton tipped applicators soaked in chlorhexidine solution
 If signs of infection are present or the pins or clamps seems loose, notify the AP
 The nurse encourage isometric and ective exercise as tolerated.

 Alert: the nurse NEVER adjust the clamps on the ext. fixator frame.
TRACTION

 Traction is the application of pulling force to a part of the body.

 Purposes:
 Minimize muscle spasm
 To reduce, align, and immobilize fractures
 To reduce deformity
 To increase space between opposing surfaces
TRACTION

 Principles
 Traction must be continuous to be effective in reducing and immobilizing fractures
 Skeletal traction is never interrupted
 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
 Ropes must be unobstructed
 Weights must hang freely and should not rest on the bed or floor
 Knots in the rope or footplate must not touch the pulley or the foot of the bed
TRACTION

 TYPES OF TRACTION

 SKIN – applied in skin, non invasive

 SKELETAL – applied directly to the bone, invasive
 MANUAL – Applied with the hands, temporary traction may be used when applying cast,
giving skin care under Bucks extension foam boot, or adjusting the traction.
SKIN TRACTION

 Used to control muscle spams and to immobilize an area before surgery.

 Pulling force is applied to the skin, transmitted to the muscle, then to the bones.
SKIN TRACTION

 ADHESIVE SKIN TRACTION

 Dunlop Traction – supracondylar of the humerus
 Zero Degree Traction – surgical neck of the humerus and the shoulder joint
 Bucks extension traction – hip and femur
 Bryant traction- hip and femur below 3 years old
 Boot cast traction – post poliomyelitis with residual paralysis of the hip and knee
SKIN TRACTION (NON ADHESIVE)

 Use of canvas, sling, leathers , straps with buckles, laces and ribbons
 Head halter traction – cervical spine
 Pelvic girdle traction – LS spine, herniatiated nucleus pulposus
 Cotrel traction – scoliosis, combination of head halter and pelvic girdle
 Hammock suspension traction- pelvis, for misaligned fracture
 Bohler braun splint – support lower leg, fracture of the proximal 3 rd and middle 3rd tibia -
fibula
TRACTION (NSG INTERVENTION)

 Avoid wrinkling and slipping of the traction bandage and to maintain countertraction
 Proper positioning must be maintained to keep the leg in neutral position

 SKIN BREAKDOWN
 Removes the foam boots to inspect skin, ankle, and Achilles tendon 3 times daily.
 Provides back care atleast 2 hours to prevent pressure ulcers. The patient who must
remains in supine position is at increased risk.
 Uses special mattress overlays
TRACTION (NSG INTERVENTION)

 NERVE DAMANGE
 Nurse should immediately investigate any complaint of burning sensation under the traction
bandage or boot
 CIRCULATORY IMPAIRMENT
 Nurse assesses the foot within 15-30 minutes and then1-2 hours
 Circulatory assessment consists of the ff:
 Peripheral pulses
 Color
 Capillary refill
 Temperature of the fingers or toes
SKELETAL TRACTION

 Is applied directly to the bone by use of metal pin or wire that is inserted through the bone
distal to the fracture, avoiding nerved, blood vessels, muscles, tendons and joints.
 Frequently uses 7-12kg to achieve therapeutic effect.
 Supports the affected extremity off the bed and allows for some patient movement without
disruption of the line of pull
SKELETAL TRACTION

 KIRSCHNERS WIRE HOLDER - Radius and ulna, thinner than Steinmanns pin
 STEINMANN PIN HOLDER – Humerus, femurs, tibia fibula
 CRUTCHFIELD TONG- Upper dorsal cervical spine, inserted at parietal area
 BALANCE SUSPENSION TRACTION- hips or femur
 OVERHEAD TRACTION – Supracondylar fracture of the humerus
SKELETAL TRACTION

 NINETY-NIE DEGREES TRACTION

 Subtrochanteric and prx 3rd fracture of the femur
 HALO-PELVIC TRACTION
 C type scoliosis
 HALO-FEMORAL TRACTION
 S Type scoliosis
 STOVE-IN TRACTION
 Massive rib fracture
NURSING INTERVENTION

 Maintain alignment of the patients body in traction

 Avoid foot drop, inversion and eversion
 Protect elbows and heels inspect for ulcers
 Assess NV status atleast every hours for 1st 4 hours
 Encourage to do active flexion-extension ankle excericses and isometric contraction of the
calf muscle 10x an hour while awake to decrease venous stasis
 Anti-embolic stockings, compression devices and anticoagulant therapy may be prescribed
to prevent thrombus formation
NURSING INTERVENTION

 Chlorhexidine solution, most effective cleaning solution. However, water and saline is
alternative.
 Must inspect pins sites every 8 hours for reaction and infection
 Patients are permitted to take showers within 5-10 days if pin insertion are encourage to
leave the pins exposed to water flow.

 Alert: Nurse must NEVER to remove weights from Skeletal traction unless life-threatening
situation occurs. Removal of weights completely defeats its purpose and may result in
injury to patient.
COMPLICATION

 ATELECTASIS AND PNEUMONIA

 Nurse auscultates the patient lungs every 4-8 hours
 Assess respiratory status
 Teach patient deep breathing and coughing exercises to aid in fully expanding lungs and clearing
secretions
 CONSTIPATION AND ANOREXIA
 Diet
 High fiber and fluid may help motility
 May include use of stool softeners, laxatives, suppositories and enemas
BALANCE SKELETAL TRACTION
BALANCE SKELETAL TRACTION

 EQUIPMENTS
 Ropes:
 Thigh – short
 Traction – long
 Suspension- longest
 Foot Board/pedal
 Paper clips/safety pins
 Slings
 Wide and long for thigh part
 Shorter for leg part
BALANCE SKELETAL TRACTION

 EQUIPMENTS
 Splint/Attachment
 Pearson attachment
 Rest splint
 Thomas Splint
 Weight Bags (2)
 Traction- 10% of body mas
 Suspension- 50% of the traction
BALANCE SKELETAL TRACTION

 PRINCIPLES
 Avoidance of friction
 Ropes run freely along the groove of the pulley
 Knots away from the pulley
 Continuous traction
 Observe wear and tear of the bags and ropes
 Weight bags hanging freely
BALANCE SKELETAL TRACTION

 PRINCIPLES
 Line of pull in line of deformity
 1st pulley in line with inguinal area
 2nd pulley in line with knee
 3rd pulley in line with 1st and 2nd pulley
 Opposite pull or counter traction
 Supine/Dorsal recumbent position
BALANCE SKELETAL TRACTION

 NURSING INTERVENTION
 General hygiene and comfort
 Sponging of the affected leg
 Conditioning exercises
 Deep and coughing exercises
 Dorsiflexion and plantar flexion of toes to prevent foot drop
 Active ROM to unaffected extremity
 Static quadriceps to affected extremity
 Alternate contraction and relaxation
BALANCE SKELETAL TRACTION

 NURSING INTERVENTION
 Prevent complications
 Hypostatic Pneumonia
 Deep breathing
 Keep back dry
 Frequently turning / repositioning
 Bes sores/decubitus ulcer
 Linen free from wrinkles and crumps
 Lift buttocks use trapeze
 Frequently turning / repositioning
 Massage
 Joint contractures and muscle atrophy
BALANCE SKELETAL TRACTION

 NURSING INTERVENTION
 Prevent complications
 Constipation /UTI
 Increase fluid
 Exercise
 Bedpan at regular interval;
 repositioning

 Infection /NV status of affected extremity

 Aseptic technique, sterile dressing
BALANCE SKELETAL TRACTION

 NURSING INTERVENTION
 Prevent complications
 Provide diversional activities
 Meet nutritional needs
 Pertinent inspection and observation of the patient
 https://youtu.be/juEijU1SLCA