NURSING CARE FOR BST (BALANCED SKELETAL TRACTION) 1. 2. 3. 4. Assess the patients level of consciousness and understanding.

Provision of general comfort. Skin care Perineal Care POTENTIAL COMPLICATIONS IN BST (BALANCED SKELETAL TRACTION) 1. Bed sores (advise the patient to turn sides, maintain the linens to be dry and clean as well as free from wrinkles, etc) 2. Pneumonia (encourage deep breathing exercises to the patient in order to promote lung expansion, back tapping to promote loosen the bronchial secretions) 3. Urinary Tract Infections (advise the patient to have a regular voiding, good perineal care and to increase fluid intake) 4. Constipation (advise to increase fluid intake, high fiber diet and have a regular bowel movement) 5. Contractures and stiffness of the muscles (encourage to have a contraction and relaxation of the quadricep muscles, foot pedal exercises/dorsiflexion of the feet) 6. Infection at the Steinmann pin sites FORMAT FOR CASE ANALYSIS Name: Age: Address: Status: Date admitted: Educational Attainment: Physician incharge: Case number: Diagnosis: Physical Assessment: Nursing History (present health history, past health history, family history): Pathophysiology (including the anatomy and physiology of the affected part) Diagnostic procedures: Medical Management: Surgical Management: Discharge Plan:

FORMAT FOR REPORTING (ORAL AND WRITTEN) Definition/alternative names Causative agent Causative factors Clinical manifestations Pathognomonic signs Pathophysiology Anatomy and physiology (affected part) Diagnostic procedures Medical management Surgical management Nursing care HARDWARE (Purpose: to put bones in good alignment without conformity and infection and also to reduce fracture through external and internal fixators) IMPLANTS INTERNAL FIXATORS: Hip prosthesis Spacer with antibiotic Hip prosthesis and acetabular cup Femoral-tibial component Cerclage wire Antibiotic beads Luque rod/harrington rod Subluminar wires Kirshneirs wire Kirshneirs wire holder Compression plates and screws AO Screw driver Wire cutter Gigli saw Staple wire remover Skin stapler (after 7 days it will be removed) Osteotomes and mallet Intramedullary nail INDICATION For fracture of the femoral head and neck For infected hip prosthesis Fracture of femoral head, femoral neck including the acetabulum For osteoarthritis in the kneejoint Fracture of the patella Osteomyelitis Scoliosis Spine surgeries Used in BST Used in BST Inter-trochanteric of the femur SURGERY Partial hip replacement arthroplasty Partial hip replacement arthroplasty Total hip replacement arthroplasty Total knee replacement arthroplasty Tension bond wiring Application of the antibiotic beads Luque rod instrumentation

Compression hip screw fixation

Amputation of long bones

Fracture of the middle third of

Open reduction intramedullary

the femur Intramedullary locking screws Bone drill Drillbit Buttress plate/T plate Intramedullary nail extractor EXTERNAL FIXATORS Rogers Anderson Hybrid external fixator Ilizarov Fracture of distal of femur/tibia

nailing for fracture of middle third of femur Open reduction intramedullary nailing with static locking screws

For preparation for screw fixation Fracture of the proximal tibia Inserted laterally to the hip Comminuted fracture Peri-articular injury of the ankle and knee-joint Long bones with mal-union (promotes bone growth and lengthening) Long bones (distal femur/proximal tibia) Fracture of pelvis (superior and inferior) Application of rogers Anderson external fixators Application of hybrid external fixators Application of ilizarov external fixator

Modified skin external fixator Spanning external fixator Hoffmans external fixator

Application of spanning external fixator Application of Hoffmans external fixator

Fractures Simple (closed) Compound (open) 5 Cardinal Signs of Fracture: Swelling Tenderness Pain Crepitus Loss of function Treating Fractures: Reduction (Open or closed reduction) Realignment Rehabilitation

Stages of Bone Healing: Hematoma formation Cellular proliferation Callus formation Ossification Consolidation and remodeling GADGETS Traction Manual Traction Skeletal Traction Skin Traction (adhesive skin traction and non-adhesive skin traction) I. 1. 2. 3. 4. 5. II. SKELETAL TYPE OF TRACTION Halo femoral traction severe scoliosis Halo pelvic traction scoliosis 90-90 degrees sub-trochanteric of the femur Overhead traction supracondylar of the humerus Balanced skeletal traction (BST) hip and femur affection SKIN ADHESIVE TRACTION

1. Dunlop traction supracondylar fracture of the humerus 2. Bryants traction hip and femur affection for children ages 0- 3 years old; congenital hip dislocation 3. Bucks extension hip and femur affection for adults 4. Zero degree surgical neck of the humerus III. 1. 2. 3. 4. 5. SKIN NON-ADHESIVE TRACTION

Cotrel combination of head halter and pelvic girdle traction; for scoliosis Pelvic girdle traction for lumbo-sacral affection; for HNP (herniated nucleus pulposus) Hammocks suspension pelvic affections Head halter traction for cervical spine affection Boot cast traction special type of traction for hip and knee contractures and post-polio with residual paralysis 6. Stove in chest multiple rib fracture

Casts (it can be either plaster of paris or made up of fiber glass) (purposes): Immobilization Support Prevent and correct fractures Maintain good alignment Elevation Model in making and artificial limb Principles for application: Immobilized the joint below and joint above Always apply a padding material Apply the cast in circular motion using the palm Equipments in removal: Cast cutter Cast spreader Cast knife Bandage scissors I. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. UPPER EXTREMITIES Body cast lower thoracic and upper lumbar Minerva upper dorsal; cervical spine Rizzers jacket scoliosis Collar cast cervical cast affection Hanging cast fracture of the shaft of the humerus Functional cast fracture of the shaft of the humerus with callus formation Long arm circular cast fracture of the radius and ulna Long arm posterior mold fracture of the radius and ulna with wound swelling and infection Short arm posterior mold fracture of the wrist and finger with open wound swelling and infection Munster/fuenster cast fracture of the radius and ulna with callus formation Shoulder spica cast fracture of the upper portion of the humerus and the shoulder joint Sugar tong fracture of the upper portion of the humerus and shoulder joint with open wound swelling and infection Airplane cast fracture of the neck of the humerus/recurrent shoulder dislocation Thumb spica cast fracture of the first metacarpal bone

II. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17.

LOWER EXTREMITIES

Pantalon cast pelvic affections Brace cast fracture of the distal third of femur with callus formation Quadrilateral cast fracture of the shaft of the femur with callus formation Double hip spica cast hip and femur affections 1 hip spica cast hip and femur affections Single hip spica cast hip and femur affections Basket cast severe/massive bone injury Frog cast for congenital hip dislocations Delvit cast fracture of the distal third of the tibia-fibula with callus formation Cylinder cast for patellar affections Cylinder mould fracture of the patella with open wound swelling and infection Single hip spica mould fracture of the hip and femur with open wound swelling and infection Long leg circular cast tibia and fibula affections Short leg circular cast ankles, tarsals/ and metatarsals affections Patellar tendon bearing cast (PTB) tibia-fibula with callus formation Long leg posterior mould tibia-fibula affections with open wound swelling and infection Short leg posterior mould ankles, tarsals and metatarsals affections with open wound swelling and infection 18. Internal rotator board/splint hip surgery (partial and total hip surgery) Braces mechanical support for weakened muscles, bones and joints (purposes): Immobilization Support Prevent and correct fracture Maintain good body alignment Control involuntary movements Permits patient to walk without fatigue 1. 2. 3. 4. 5. 6. 7. 8. Shuntz collar-cervical spine fracture Philadelphia collar cervical spine fracture Forester cervico thoraco lumbar spine fracture Taylor brace upper thoracic affections; potts disease Four-poster upper thoracic and cervical spine Jewetts brace lower thoracic and upper lumbar affections Chairback lumbo sacral affections; HNP (herniated nucleus pulposus) Yamamoto scoliosis (up to axilla) Milwaukee scoliosis (up to chin)

9. 10. 11. 12. 13. 14.

Unilateral long leg brace post-polio with residual paralysis Bilateral long leg brace post-polio with residual paralysis Openheimer peripheral nerve injury Banjo splint peripheral nerve injury Dennis browne shoes congenital clubfoot SOMI (sterno-occipito-mandibular-immobilizer) spinal injuries