Handbook Ortho

7/23/2019 Handbook Ortho

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ORTHOPEDIC

NURSING


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TABLE OF CONTENTS

ANATOMY AND PHYSIOLOGY

Review of structure a! fuctio of "oes a! #oits

I$ Boe %%%%%%%%%%%%%%%%%%%%%%%%%%II$ Carti&a'e %%%%%%%%%%%%%%%%%%%%%%%%$III$ Li'a(ets a! Te!os %%%%%%%%%%%%%%%%%$$I)$ S*e&eta& Musc&es %%%%%%%%%%%%%%%%%%%%$$$)$ +oits %%%%%%%%%%%%%%%%%%%%%%%%%%)I$ S*u&& %%%%%%%%%%%%%%%%%%%%%%%%%%$)II$ S,ou&!er Gir!&e %%%%%%%%%%%%%%%%%%%%%$$)III$ -..er E/tre(it0 %%%%%%%%%%%%%%%%%%%%%$$I1$ 2rists3 Ha!s a! Fi'ers %%%%%%%%%%%%%%%%%

1$ T,oracic Ca'e %%%%%%%%%%%%%%%%%%%%%%$1I$ S.ie %%%%%%%%%%%%%%%%%%%%%%%%%%$1II$ Pe&vic Gir!&e %%%%%%%%%%%%%%%%%%%%%%%$1III$ Lower E/tre(it0 %%%%%%%%%%%%%%%%%%%%%$$1I)$ +oit Motio %%%%%%%%%%%%%%%%%%%%%%%$1)$ Basic Bo!0 Mec,aics %%%%%%%%%%%%%%%%%%$$$1)I$ So(e Muscu&o4S*e&eta& Ter(io&o'0 %%%%%%%%%%%%$$

Fractures3 Dis&ocatio3 Strais

I$ Fractures %%%%%%%%%%%%%%%%%%%%%%%%$$

II$ Dis&ocatios %%%%%%%%%%%%%%%%%%%%%%%$$III$ S.rai %%%%%%%%%%%%%%%%%%%%%%%%%%I)$ Strai %%%%%%%%%%%%%%%%%%%%%%%%%%$)$ )arious Fractures5

A$ Ma!i"&e %%%%%%%%%%%%%%%%%%%%%%%$B$ Ri" %%%%%%%%%%%%%%%%%%%%%%%%%%C$ Stera& %%%%%%%%%%%%%%%%%%%%%%%%$D$ -..er E/tre(it0 %%%%%%%%%%%%%%%%%%%%$E$ Pe&vic Fracture %%%%%%%%%%%%%%%%%%%%$$$F$ Lower E/tre(it0 %%%%%%%%%%%%%%%%%%%%$

)I$ Nursi' Itervetio %%%%%%%%%%%%%%%%%%%%

)II$ Co(.ressio Fracture of t,e )erte"ra& Bo!ies %%%%%%%%$$

Patiet i Cast

I$ Nursi' Care of Patiet i Cast %%%%%%%%%%%%%%%$A$ Defiitio %%%%%%%%%%%%%%%%%%%%%%%$B$ Fuctios %%%%%%%%%%%%%%%%%%%%%%%$


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C$ Areas w,e cast o a..&ie! %%%%%%%%%%%%%%%$D$ Co(.&icatio of a Cast %%%%%%%%%%%%%%%%%$$E$ Prici.&es i A..&0i' Cast %%%%%%%%%%%%%%%$$$F$ Cotrai!icatio of Cast A..&icatio %%%%%$$%%%%%%$G$ A..&0i' a P&aster Cast %%%%%%%%%%%%%%%%%$

H$ Nursi' Cosi!eratio %%%%%%%%%%%%%%%%%$$$I$ Neurovascu&ar C,ec*s %%%%%%%%%%%%%%%%%$$$+$ Ps0c,o&o'ica& I(.&icatios w,e 'oi' ,o(e i Cast %%%%$$6$ Turi' Patiet i Cast %%%%%%%%%%%%%%%%%%

II$ T0.es of Cast3 I!icatio a! O"servatio %%%%%%%%%%%

Patiet i Tractio

I$ Nursi' Care of Patiet i Tractio%%%%%%%%%%%%%%$A$ Defiitio %%%%%%%%%%%%%%%%%%%%%%%%B$ Basic T0.es of Tractio %%%%%%%%%%%%%%%%%$$C$ Pur.ose of Tractio %%%%%%%%%%%%%%%%%%%$D$ Prici.&es of Tractio %%%%%%%%%%%%%%%%%%$$E$ Nursi' I(.&icatios i )arious Tractio A..&icatio %%%%%F$ O"servatios to "e (a!e i Cari' for Patiet i Tractio %%$$

Re,a"i&itatio

I$Occu.atioa& T,era.0 %%%%%%%%%%%%%%%%%%%%%%%%%$

A$ Defiitio %%%%%%%%%%%%%%%%%%%%%%%%%%%$

B$ Services %%%%%%%%%%%%%%%%%%%%%%%%%%%$$

II$ P,0sica& T,era.0 %%%%%%%%%%%%%%%%%%%%%%%%%%%

A$ Defiitio %%%%%%%%%%%%%%%%%%%%%%%%%%%B$ Ai( %%%%%%%%%%%%%%%%%%%%%%%%%%%%%$C$ Differet Test a! Eva&uatio "ei' !oe i t,e PT De.art(et %%%D$ Too&s E(.&o0e! for T,era.eutic T,era.0 %%%%%%%%%%%%%

Aato(0 7 P,0sio&o'0

Review of structure a! fuctio of Boes a! +oits

T,e (uscu&os*e&eta& s0ste( ic&u!es 89: "oes w,ic, are coecte! to #oits$

T,e #oits are ,e&! to'et,er "0 &i'a(ets a! cus,ioe! "0 carti&a'e$ Te!os attac,

(usc&es to t,e "oes$


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I$ T,e Boes

T,e "oes serve as t,e "o!0 fra(ewor* or s*e&eto$

A$ T,e ,u(a s*e&eto cosists of two (ai !ivisio5

;$ A/ia& < "o!0 u.ri',t structure wit, =9 "oes

a$ S*u&&

"$ verte"ra& co&u(

c$ ri"s

8$ A..e!icu&ar < t,e "o!0 a..e!a'es wit, ;8: "oes$

a$ ar(s

"$ ,i.s

c$ &e's

B$ Your (a#or "oe t0.es$ T,eir a(es ref&ect t,eir s,a.es$

;$ Lo' "oes i w,ic, &e't, e/cee!s "rea!t, a! t,ic*ess$

8$ S,ort "oes < E>ua& i (ai !i(esios fou! (ai&0 o ,a!s a! feet$

?$ F&at "oes are .ri(ar0 (a!e u. of cace&&ous "oe tissue3 e/a(.&e3 sca.u&ae

@$ Irre'u&ar "oes < E/$ )erte"rae

C$ Lo' "oes 5

;$ Structure

a$ Dia.,0sis < s,aft .rovi!es stre't, resists "e!i'

"$ Meta.,0sis < f&aire! .ortio "etwee !ia.,0sis a! e.i.,0sisGrowi' .ortio$

c$ E.i.,0sis < E!

Pri(ar0 cace&&ous "oe$

Assist wit, "oe !eve&o.(et

!$ E.i.,0sea& .&ate&ie

Betwee (eta.,0sic a! e.i.,0sis

Carti&a'e 'rowt, i &e't, of !ia.,0sis a! (eta.,0sic

e$ Periosteu(

Coective tissue coveri' "oe

Cotiues at e! of "oe wit, #oit ca.su&e "ut !oes ot cover

articu&ar carti&a'e$

8$ B&oo! Su..&0

a$ Nutriet arter0

Tue& i !ia.,0sis of &o' "oe$


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Su..&0 "oes wit, utriets$

"$ Periostea& vesse&s

Su..&0 coect "oe of t,e !ia.,0sis

c$ Meta.,0sea& a! e.i.,0sea& vesse&s

Su..&0 t,e s.o'0 "oe a! (arrow of t,e e.i.,0sis

D$ Fuctios 5

;$ Provi!es fra(ewor* for t,e "o!0

8$ Serves as &ever for s*e&eta& (usc&es

?$ Protect vita& or'as suc, as t,e "rai3 ,eart a! &u's$

@$ Stores ca&ciu( a! re&ease it to t,e "&oo! strea( accor!i' to "o!0 re>uire(et$

$ Maufactures ew "&oo! ce&&s i t,e re! "oe (arrow$

E$ How a i!ivi!ua& "oe is structure!$

A "oe cotais "ot, o&ivi' a! &ivi' co(.oets3 or'aie! i 'rou.i's

ca&&e! ,aversia s0ste($

I eac, s0ste( ri'i! (ateria& for(s i &a0ers ca&&e! &a(e&&ae3 creati' t,e "oes

(atri/$

Betwee t,ese &a0ers are s(a&& s.aces ca&&e! &acuae3 t,at ,ouse &ivi' ce&&s

Tissue f&ui! circu&ates t,rou', t,is ri'i!ca&oifie! (ateria& to t,e "oe ce&&s "0 wa0

of (icrosco.e .assa'ewa0s ca&&e! caa&icu&i$ T,e tissue f&ui! su..&ies foo! a! o/0'e

a! re(oves ce&& waste$

T,e f&ui! is route! to t,e caa&icu&i fro( t,e ,aversia caa&3 a s(a&& vesse&&ocate! at t,e ceter of eac, c0&i!rica& &a(e&&a$ T,e ,aversia caa&3 i tur receives

f&ui! fro( )o&*(as caa&3 a c,ae& t,at co((uicates wit, t,e .eriosteu( at t,e

"oes surface$ T,e .eriosteu( is a vascu&arie! (e("rae &a0er t,at covers t,e "oe

e/ce.t at #oit surface$

Boe tissue for(atio3 ca&&e! osteo'eesis is a cotiuous .rocess$ Tissue

for(atio occurs outsi!e t,e "oe3 w,i&e tissue !estructio resor.tio "e'is isi!e

t,e "oe a! (oves outwar!$

I c,i&!,oo! a! a!o&escece3 'rowt, outs.aces !isite'ratio$ Duri' ear&0

a!u&t,oo!3 t,e two .rocesses "a&ace eac, ot,er$ However3 "etwee a'e ? a! @9

"oe resor.tio "e'is to overta*e t,e "o!0s tissue .ro!uctio3 ,a&&owi' out a!

wea*ei' "oe structure$ T,is !eterioratio (a*e a'i' "oes (ore vu&era"&e to

!a(a'e fro( a0 stress suc, as "e!i' or i(.act$

II$ Carti&a'e

Carti&a'e cotais a fir( 'e& su"stace i its (atri/ w,ic, 'ives it (ore f&e/i"i&it0

t,a "oe$


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Carti&a'e is avascu&ar3 so utriet tissue f&ui! reac, its ce&&s ca&&e! c,o!roc0tes

"0 !iffusi' t,rou', t,e (atri/ 'e& fro( ca.i&&aries i t,e carti&a'es fi"rous coveri'

.eric,o!riu( or fro( t,e s0ovia& f&ui! for coveri' a "oes #oit surface

A$ T,e (uscu&os*e&eta& s0ste( cotais t,ree t0.es of carti&a'es5

;$ Fi"rocarti&a'es

a$ 'reatest tesi&e stre't,

"$occurs i t,e iterverte"ra&!isos a! i t,e s0(.,0sis .u"is$

8$ E&astic carti&a'e

a$ .ossesses fir(ess a! e&asticit0

"$ fir( 0et s&i',t&0 f&e/i"&e

c$ cus,ios (ost of t,e #oits to ,e&. softe a0 i(.act$

!$ occurs a&so i .art of t,e asa& s0ste(3 t,e &ar0/3 t,e trac,ea3

a! t,e "roc,ia& ri'$

III$ Li'a(ets a! Te!os

A$ Li'a(ets are stro' cor!s of fi"rous tissue$

+oit ca.su&es .rovi!e t,e .ri(ar0 coectio "etwee t,e "oes3 "ut &i'a(ets "i!

t,e #oits (ore fir(&0$

B$ Te!os are fir( cor!s of fi"rous tissue t,at e/te! fro( t,e (usc&e to t,e "oes

.eriosteu($

Te!os a&so coect (usc&es to eac, ot,er a! to ot,er

I)$ S*e&eta& (usc&e

Musc&e are tissues co(.ose! of (usc&e fi"ers coective fi"ers a! erve fi"ers$

T,e0 var0 i sie3 s,a.e3 a! arra'e(et ra'i' fro( (iiature stra! as i t,e

sta.e!ius (usc&e of t,e (i!!&e ear to &ar'e (asses suc, as t,e '&uteus (a/i(us i t,e

"uttoc*s$

A$ Musc&es ca "e &o' a! ta.ere!3 s,ort a! "&ut3 tria'u&ar3 >ua!ri&atera& or

irre'u&ar$

B$ Musc&e fi"er arra'e(et varies5

;$ I so(e (usc&es3 t,e fi"er rus .ara&&e& to t,e (usc&es &o' a/is$

8$ I ot,ers3 t,e fi"ers are o"&i>ue a! "i.eate &i*e t,e feat,er of a >ui&& .i$

?$ Fi"ers curve out fro( a arrow attac,(et at t,e (usc&es a! to for( a

tria'&e$

C$ Fi"er arra'e(et is i(.ortat "ecause of its re&atios,i. to a (usc&es fuctio$

D$ Mai fuctios5

;$ Pri(over4 !irect&0 "ri's a"out a !esire! (otio$


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8$ Ata'oist4 o..oets (usc&es t,at !irect&0 o..oses t,e (ove(et u!er

cosi!eratio$

?$ Fi/atio (usc&e 'eera&&0 sta"i&ies a #oit or .art t,ere"0 (aitaii' .ositio

w,i&e .ri(e (over acts$

@$ S0er'ist4 a t0.e of fi/atio (usc&e t,at .revets a u!esire! actio at

iter(e!iate #oits w,e a .ri(e (over crosses two or (ore #oits$

E$ S*e&eta& (usc&e (ove(et

S*e&eta& (usc&es cotract to cotro& a .ersos .osture ,e&. (aitai ,is or(a&

"o!0 te(.erature a! iitiate (ove(et

To cotract3 a&& s*e&eta& (usc&es re>uire! so(e for( of sti(u&atio eit,er itera&

fro( (otor euro or e/tera& fro( sti(u&i suc, as e&ectricit0 ,eat or i#ur0$

S*e&eta& (usc&es usua&&0 retai so(e of t,eir tautess3 eve at rest$ T,is (usc&e

toe3 .ro(.te! "0 erve i(.u&ses fro( t,e s.ia& cor!3 ,e&.s (aitai "o!0 .osture$

S*e&eta& (usc&es a&so cotract i t,e fo&&owi' ei',t wa0s3 (ost of w,ic,.ro!uces (ove(et$

;$ Isotoic cotractios4 s,orte (usc&e &e't, w,i&e (aitaii' (usc&e

tesio 'eerati' (ove(et$

8$ Iso(etric cotractios4 ti',te a (usc&e "0 icreasi' (usc&e tesio

wit,out s,ortei' t,e (usc&e$ A&t,ou', iso(etric cotractios .ro!uce o !irect

(ove(et3 (ost "o!0 (ove(ets ivo&ve a co("iatio of iso(etric a!

isotoic cotractios$

?$ Twitc, cotractios4 are >uic*3 #er*0 reactios to a si'&e sti(u&us$

Fo&&owi' t,e sti(u&atio$ T,e (usc&e s,ortes for a fractio of a seco!$ After itreac,es its s,ortest .oit3 t,e (usc&e re&a/es a! returs to or(a& sie$ T,e

etire cotractio usua&&0 &asts &ess t,a a tet, of a seco!$

@$ Tetaic cotractios are seria&3 cotiuous cotractios3 i w,ic,

i!ivi!ua& cotractio cat "e !isti'uis,e!$ T,e0 occur i res.ose to a

"o("ar!(et of t,e (usc&e "0 ra.i! successive sti(u&i$ If t,e e/cessive

sti(u&atio ceases a"ru.t&03 t,e ico(.&ete titaic to a or(a& cotractio$

$ Tre..e or staircase .,eo(eo is a series of icreasi'&0 stro'er

twitc, cotractios occurri' i res.ose to re.eate! sti(u&i of costat itesit0$

After a .erio! of re.eate! cotractios3 ,owever3 t,e re&a/atio .,ase of t,e

(usc&e cotractio !i(iis,es a! evetua&&0 !isa..ears3 &eavi' t,e (usc&e

.artia&&0 cotracte!$ T,is .,eo(eo ,as a .ractica& a..&icatio i a at,&etes

war(4u. e/.ressios$

:$ Fascicu&atio is a a"or(a& cotractio visi"&e t,rou', t,e s*i as a

s&i',t ri..&e$ It occurs after euro !estructio3 fro( s.otaeous eura&

i(.u&ses tras(itte! "0 t,e !0i' erve fi"ers$


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$ Fi"ri&&atio4 a a"or(a& cotractio i w,ic, i!ivi!ua& fi"ers cotract i

a us0c,roie! wa03 .ro!uces (usc&e f&atter "ut o effective (ove(et$ It

occurs i !iervate! (usc&e fi"ers after (otor euros ,ave "ee !estro0e!$

=$ Covu&sios are a"or(a&3 vio&et r,0t,(ic cotractios a! re&a/atios

of (usc&e 'rou.s$

To .erfor( a .articu&ar (ove(et3 s*e&eta& (usc&es s,eat,i' two

a!#acet "oes e/ert .u&& o t,ose "oes$ To !o so3 so(e (usc&e wi&& cotract

iso(etrica&&0 a! so(e wi&& cotract isotoica&&0$ T,e !e'ree of cotractio

ecessari&0 !e.e!s o t,e stre't, re>uire! to carr0 out t,e (ove(et$

S*e&eta& (usc&e a&(ost a&wa0s wor* i 'rou.$ Pri(e (over (usc&es

iitiate "oe (ove(et3 ata'oist (usc&es re&a/ !uri' (ove(et a!

s0er'ist (usc&e eit,er !irect&0 assist .ri(e (over orr stea!0 aot,er .art of t,e

.artici.ati' (usc&e "oe s0ste( to a&&ow (ore effective (ove(et$

)$ +oits+oits are .oits of articu&atio coectio "etwee "oes$ Most #oits a&&ow

(ove(et "etwee "oes$ Most #oits a&&ow (ove(et "etwee "oes3 .er(itti'

activities suc, as rui' or 'ras.i'$ Ot,ers #oi "oes fir(&0 to'et,er .er(itti' &itt&e

or o (ove(et$

A$ T,ree "asic #oit t0.es5

;$ Fi"rous4 co(.ose! of fi"rous tissue3 ti',t&0 coecti' t,e articu&ar

surfaces of two "oes$

Two t0.es of fi"rous #oit5

a$ sutures < .er(its o (ove(ets e/a(.&e t,e s*u&&"$ s0!es(osis < .er(its (ii(a& (ove(et "etwee "oes$ E/$

Dista& ti"io4fi"u&ar #oit

8$ Carti&a'eous #oits coect two "oes wit, carti&a'e3 a&&owi' o&0

s&i',t (ove(et$ T,e .u"ic "oes #ucture i a e/a(.&e$

?$ S0ovia& #oits3 t,e (ost co((o #oit t0.e3 ,ave t,e (ost co(.&e/

structure a! .er(it (a/i(u( (o"i&it0$ T,ese #oits ic&u!e t,e fo&&owi'5

a$ #oit ca.su&e

"$s0ovia& (e("rae

c$ articu&ar carti&a'e

!$ s0ovia& cavit0

B$ Differet t0.es of s0ovia& #oits5

;$ s0ovia& '&i!i' #oits a&&ow o&0 &i(ite! (otio "ac* a! fort, or

si!ewa0s

E/$ Betwee (ost car.a& a! (etacar.a&

8$ s0ovia& co!0&oi! #oits a&&ow (ove(et i two .er.e!icu&ar .&aes$

?$ s0ovia& sa!!&e #oits a&&ows "ia/ia& (ove(et$


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E/$ +uctio "etwee t,e t,u("s (etacar.a& "oe a! t,e wrists

tra.eiu( car.a& "oe

@$ s0ovia& .ivot #oits .er(it oe "oe to .ivot o its a/is i t,e arc, of a

seco! "oe$

E/$ Betwee t,e first 8 cervica& verte"rae t,e at&as a! t,e a/is

$ s0ovia& "a&& a! soc*et #oits .er(it t,e 'reatest ra'e of (otio$

E/$ Hi. #oit

T,e "a&&4s,a.e! ,ea! of oe "oe fits ito t,e cocave soc*et of aot,er

"oe$

C$ Motio

;$ F&e/io

a$ Dorsif&e/io

"$ P&atarf&e/io

8$ E/tesio

?$ A"!uctio@$ A!!uctio

$ Circu(!uctio

:$ Rotatio

a$ itera&

"$ e/tera&

$ Iversio

=$ Eversio

$ Proatio

;9$ Su.iatio

)I$ S*u&&

A$ Structures

;$ Craia& "oes

a$ frota&

"$ .arieta& .air

c$ te(.ora& .air

!$ occi.ita&

e$ s.,eoi!

f$ et,(oi!

8$ Facia& "oes

a$ 0'o(atic .air

"$ (a/i&&ae .air

c$asa& .air


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!$ &acri(a& .air

e$ vo(er

f .a&atie .air

'$ iferior coc,ae .air

,$ (a!i"&e

)II$ S,ou&!er Gir!&e

A$ Structure

;$ c&avic&e

8$ sca.u&a

a$ acro(io

"$ steroc&avicu&ar

c$ G&eo,u(era&

B$ +oits

;$ acro(ioc&avicu&ar8$ steroc&avicu&ar

?$ '&eo,u(era&

@$ coracoc&avicu&ar

$ coracoacro(ia&

:$ coracc,u(era&

C$ Nerves3 "rac,ia& .&e/us

;$ (e!ia

8$ u&ur

?$ ra!ia&

@$ (uscu&ocutaeous

D$ Ma#or arteries

;$ Su"c&avia

8$ A/ia&&ar

?$ Brac,ia&

)III$ -..er E/tre(it0

A$ Ar(5 ,u(erous

;$ Lar'est "oe i u..er e/tre(it0

8$ Structure

a$ Hea!

"$ Bice.s

c$ Tu"erosities

!$ Aato(ic ec*

e$ Sur'ica& ec*


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f$ Ca.ite&&u(

'$ Troc,&ea

,$ E.ico!0&es (e!ia&&atera&

B$ Forear(5 ra!ius

;$ s(a&&er "oe of t,e forear(

8$ structures

a$ ,ea!

"$ tu"erosit0

c$ st0&oi! .rocess

C$ Forear(5 u&a

;$ &ar'er "oe of t,e forear(

8$ structure

a$ o&eocrao .rocess

"$ corooi! .rocess

c$ 'reater a! &esser si'(oi!!$ cavities

I1$ 2rist3 ,a! fi'ers5

A$ Structure

;$ Car.a&s

a$ Pro/i(a&

; sca.,oi!

8 tri'uetriu(

? .isifor(

@ &uate

"$ Dista&

; tra.eiu(

8 tra.eoi!

? ca.itates

@ ,e(ate

8$ Metacar.a&s

a$ Five &o' "oes for(i' fra(ewor* of .a&(

"$ Nu("ere! oe t,rou', five starti' wit, t,u("$

c$ Structure

; Hea! Articu&ate wit, .,a&a'es

8 S,aft

? Base articu&ate wit, car.a&s

?$ P,a&a'es

a$ Eac, ,a! ,as ;@

"$ Eac, fi'er ,as ? e/ce.t t,e t,u(" w,ic, ,as two


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c$ Structure

; Dista& .,a&a/

8 Mi!!&e .,a&a/

? Pro/i(a& .,a&a/

1$ T,oracic Ca'e

A$ Ri"s5 ;8 .airs

;$ True

8$ Fa&se

?$ F&oati'

B$ Steru(

;$ Mau"riu(

8$ Bo!0?$ 1i.,oi! .rocess

1I$ S.ie5 )erte"ra& Co&u(

A$ )erte"rae

;$ Cervica&4 verte"rae "etwee t,e s*u&& a! t,ora/

a$ At&as

; first cervica& verte"rae

8 s*u&& rests o it

"$ A/is

; seco! cervica& verte"rae

8 site of t,e a!otoi! .rocess or !es8$ T,oracic5 ;8 verte"rae "etwee cervica& a! &u("ar verte"rae

?$ Lu("er5 verte"rae3 fuse!

@$ Sacru(5 five verte"rae3 usua&&0 fuse!

B$ Structure of )erte"rae

;$ Bo!0

a$ 'ives stre't,

"$ su..orts wei',t

c$ (ost&0 s.o'0 "oes

!$ se.arate! fro( ot,er "o!ies "0 iterverte"ra& !isc

; Au&us fi"rous outer ri'3 fi"rous tissue

8 Nuc&eus .u&.osus ier .ortio3 'e&atious structure

8$ S.ia& Fora(e5 .assa'e wa0 for t,e s.ie

?$ La(ia5 ri',t a! &eft &a(ia fro( verte"ra& arc,

@$ S.ious .rocess5 .osterior s.ia& .ro#ectios

$ Trasverse .rocess5 &atera& s.ia& .ro#ectios

:$ Articu&ar .rocess


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$ .e!ic&e

=$ Facet

C$ Sa'itta& curvatures of t,e a!u&t verte"ra& co&u(

;$ Cervica&

8$ T,oracic5 seco!ar0

?$ Lu("ar

@$ Sacra&

D$ A"or(a& curvature of t,e s.ie

;$ 60.,osis5 aterior cocavit0

8$ Lor!osis .osterior cocavit0

?$ Sco&iosis5 &atera& curvature

1II$ Pe&vis Gir!&e

A$ Structure

;$ Io(iate "oea$ i&iu(

"$ isc,iu(

c$ .u"ic

8$ Aceta"i&u(

?$ S0(.,0sis .u"is

@$ I&iac crest

$ Creater sciatic otc,

:$ Isc,ia& tu"erosit0

$ O"turator fora(e

=$ Ra(ia$ su.erior .u"ic

"$ iferior .u"is

$ Sacro4i&iac #oit

1III$ Lower E/tre(it0

A$ Hi.

;$ For(e! t,e articu&atio of t,e aceta"u&u( a! fe(ur

8$ Structure

a$ Aceta"u&u(

; su.erior !oe

8 fovea cetra&is

? .osterior &i.

@ &a"ru(

"$ Fe(ur

; fe(ora& ,ea!

8 fe(ora& ec*

? troc,aters


14/94

@ itertroc,ateric re'io

su"troc,ateric re'io

B$ Fe(ur

;$ Structure

a$ Fe(ora& ,ea!

"$ Fe(ora& ec* a! 'reater

c$ Troc,aters &esser

!$ S,aft

e$ Co!0&es

; (e!ia&

8 &atera&

C$ 6ee 'eus

;$ for(e! "0 t,e articu&atio of t,e !ista& fe(ur wit, t,e .ro/i(a& ti"ia

8$ "o!0 structurea$ .ate&&a

"$ ti"ia& s.ies

; aterior

8 .osterior

c$ ti"ia& tu"erc&e

!$ !ista& fe(ur

e$ ot,er structures

; su.ra.ate&&ar .ouc,8 .re.ate&&ar "ursa

? retro.ate&&ar fat .a!

D$ Ti"ia

;$ &ar'er "oe i &ower &e'

8$ structure

a$ .&ateaus

; (e!ia&

8 &atera&

"$ Co!0&es

; (e!ia&

8 &atera&

c$ Tu"ec&e

!$ S,aft

e$ Me!ia& (a&&eo&us

E$ Fi"u&a

;$ S(a&&er "oe i &ower &e'


15/94

a$ ,ea!

"$ ec*

c$ s,aft

!$ &atera& ,a&&eo&us

F$ A*&e a! Foot

;$ A*&e

a$ A*&e5 for(e! "0 t,e articu&atio of t,e !ista& fi"u&a a! ti"ia wit,

t,e ta&us$

"$ structure

; (e!ia& (a&&eo&us

8 .osterior (a&&eo&us

? &atera& (a&&eo&us

c$ te!os

;$ Ac,i&&es

8$ aterior ti"ia&?$ .osterior ti"ia&

8$ Foot

a$ Structures

; tarsus

a ca&caeus

" ta&us

c cu"oi!

! sca.,oi!

e cueifor(

8 (etatarsa&s

a Ha&uc 'reat toe

? .,a&a'es

@ sesa(oi!s

.&atar fescia

: fat .a!

1I)$ +oit Motio

T,e ter(io&o'0 use! to !escri"e t,e (ove(ets of t,e #oits is .reviewe!

"ecause *ow&e!'e of t,ese ter(s is essetia& i u(erous .,ases of t,e ursi' care

of t,e ort,o.e!ic a! ot,er .atiets$ +oit (otio ter(io&o'0 (a0"e uti&ie! i a

ursi' care .&a to !escri"e oe or (ore s.ecific e/tre(it0 .ositios to "e (aitaie!

or .revete!$ It (a0 a&so "e use! to !escri"e oe or (ore s.ecific #oit (otio to "e


16/94

a&&owe! or restricte!$ Nursi' 'oa&s a! ursi' care .&a (a0"e (a!e (ore .recise

a! (eai'fu& "0 usi' t,e a..ro.riate (otio ter(io&o'0$

;$ F&e/io

"oes$ E/$ Be!i' ,ea! forwar!

8$ E/tesio < icreases t,e a'&e "etwee t,e aterior surface of articu&ati'

"oes$ E/tesio returs a "o!0 .art fro( f&e/e! .ositio$ E/$ Strai',tei' 0our ,ea!

after f&e/io

?$ H0.ere/tesio < cotiues t,e act of e/tesio "e0o! t,e ori'ia&

aato(ica& .ositio$ E/$ Loo*i' u. towar! t,e cei&i'

@$ A"!uctio < w,e see fro( t,e frot3 (oves a "oe i t,e a..e!icu&ar

s*e&eto awa0 fro( t,e "o!0s (i!&ie$ E/$ S.rea!i' 0our ar(s outwar! at t,e

s,ou&!er

For .arts of e/tre(ities3 t,is ter( refers to (ove(et of t,e .art awa0 fro( t,e

e/tre(it0s a/ia& &ie

$ A!!uctio < w,e see fro( t,e frot3 (oves a "oe i t,e a..e!icu&ars*e&eto towar! t,e "o!0s (i!&ie$ E/$ C&as.i' 0our ,a!s to'et,er wit, 0our ar(s at

s,ou&!er ,ei',t$

For .arts of e/tre(ities3 t,is ter( refers to (ove(et of t,e .art awa0 fro( t,e

e/tre(it0s a/ia& &ie

:$ Rotatio < .ivots t,e "oe o its a/is

a$ e/tera& rotatio is (otio arou! a cetra& a/is awa0 fro( t,e (i!&ie$

E/$ Movi' ,ea! fro( &oo*i' strai',t a,ea! to &oo*i' to t,e si!e$

"$ itera& rotatio4 is (otio arou! a cetra& a/is towar! t,e (i!&ie$ E/$

Movi' ,ea! fro( &oo*i' to t,e si!e &oo*i' strai',t a,ea!$

$ Circu(!uctio4 co("ies a u("er (ove(ets to cause t,e !ista& e! of a"oe to !escri"e a circ&e$ E/$ Dro..i' 0our ,ea! to oe s,ou&!er3 t,e to 0our c,est3

t,e to t,e ot,er s,ou&!er a! fia&&0 "ac*war!s$

=$ Iversio4 turs a e/tre(it0 or .art of a e/tre(it0 iwar! t,e "o!0s (i!&ie$

E/$ Movi' t,e so&e of t,e foot iwar!

$ Eversio turs a e/tre(it0 or .art of a e/tre(it0 outwar! fro( t,e "o!0s

(i!&ie$ E/$ Movi' t,e so&e of t,e foot outwar!

;9$ Proatio < turs t,e .a&(3 or "o!0s frot towar! t,e f&oor

;;$ Su.iatio4 turs t,e .a&(3 or "o!0s frot towar! t,e cei&i'

;8$ Protractio4 (oves t,e (a!i"&e forwar!

;?$ Retractio (oves t,e .rotecte! (a!i"&e "ac* ito eutra& aato(ica&

.ositio

;@$ Two ui>ue (ove(ets of t,e forear($

4Proatio t,e "ac* of t,e ,a! forwar! a! crosses t,e rau&us over t,e

u&a

4Su.iatio < turs t,e frot of t,e ,a! forwar! a! (a*es t,e ra!ius

a! u&a .ara&&e&$


17/94

;$ T,e .atiets ursi' care .&a for a .assive ra'e of (otio e/ercises

ROM o

.atiets u..er e/tre(ities (eas t,at t,e urse s,ou&! (ove a&& #oits of t,e

.atiets ito a&& .ossi"&e .ositios3 t,e s,ou&!er3 e&"ow wrist a! fi'er #oits$

1)$ BASIC BODY MECHANICS

Bo!0 (ec,aics refers to t,e fuctio of (usc&es a! #oits a! t,e

a..&icatio of (ec,aica& .rici.&es to t,e activities of t,e .atiet a! t,e urse$

B0 a..&0i' t,e .rici.&es a urse ca efficiet&0 &ift a! tur t,e .atiet w,e

'ivi' care wit,out causi' i#ur0 to ,er ow "o!0$ It a&so cotri"ute! to t,e

attai(et of ursi' care 'oa&s$

;$ Nursi' care 'oa&s5a$ Per(it or(a& fuctioi'

E/$ Eati' is usua&&0 !oe i sitti' .ositio "ecause t,e 'ravitatioa&

f&ow assists t,e foo! i reac,i' t,e sto(ac,$"$ Ai!s i ,ea&i'

Patiet (ust a&so "e .ositioe! so t,at circu&atio is (aitaie!3

t,us ai!s ,ea&i'$c$ Prevet co(.&icatios a! !efor(ities!$ Re&ieves .ai

8$ T,e c,ec*.oit for correct sta!i' .osture Sta!i' .osture is t,e a"i&it0 of

t,e "o!0 to re(ai erect a! to (aitai t,is a&titu!e "0 resisti' outsi!e

force wit, t,e &east a(out of eer'0$

a$ Hea! < is ,e&! erect wit, t,e c,i !raw i

"$ C,est < e&evate!c$ Bac* < strai',tei' t,e "ac* w,ic, causes t,e steru( to "e i frot of

t,e rest of t,e "o!0 a! ,i.s!$ Feet < are .&ace! a.art "ut .ara&&e& wit, o itera& a! e/tera& rotatio

of t,e &e's$?$ T,e c,ec*.oits for t,e correct sitti' .ositio are5

a$ Hea! < is ,e&! erect wit, t,e c,i !raw i"$ C,est < e&evate!c$ Bac* < strai',tei' t,e "ac* w,ic, causes t,e steru( to "e i frot of

t,e rest of t,e "o!0 a! ,i.s!$ A"!o(e < *ee. f&at

e$ Hi.s < "e f&e/e! at t,e ri',t a'&esf$ 6ees < s,ou&! "e f&e/e! a! at t,e ri',t a'&es'$ Feet < are .&ace! a.art "ut .ara&&e& wit, o itera& a! e/tera& rotatio

of t,e &e's@$ I(.ro.er .osture a! "o!0 (ec,aics .&aces a"or(a& stress o wei',t4

"eari' #oits w,ic, is a factor i t,e !eve&o.(et of #oit !iseases suc, as

osteoart,ritis$


18/94

$ To .re.are to &ift a &oa! or a .atiet3 face t,e o"#ect a! sta! c&ose to it$:$ T,e sta!i' .osture s,ou&! "e c,ec*e! of .ai w,e &ifti'$ Get rea!0 to &ift

"0 cotracti' t,e (usc&es$ It is easier to .u&& o o"#ect t,a it is to .us, it$$ Hea! .i&&ow is .&ace! u!er t,e s,ou&!ers w,e .atiet is i .ositio to5

a$ A&&ow e/.asio of t,e c,est a! .er(it or(a& fuctioi' of t,e &u's$

"$ Su.ie .atiet caot (aitai correct &ower e/tre(it0 .ositio wit,outassistace$

After a s,ort ti(e3 t,e aterior &e' (usc&es are stretc,e! a! t,e

t,e foot assu(es a .&atar f&e/io .ositio3 so a "oar! or sa!"a's .&ace!

a'aist t,e so&e wi&& .revet foot !ro.$

=$ Maiteace of fuctio of t,e fi'ers a! ,a!s is ver0 essetia& "ecause of

its a"i&it0 to 'ras. or .ic*$$ T,e .roe .ositio is (ost co(forta"&e if oe .i&&ow is .&ace! u!er t,e

s,ou&!er a! c,est a! aot,er "eeat, t,e feet a! &ower &e's to *ee. t,e

toes off t,e "e!$

;9$2,e .atiet is (ove!3 ,is #oits (ust "e su..orte! to avoi! (usc&e s.as(sor strais$ 2,e .ositioi' a &i("3 .&ace t,e ,a! u!er t,e #oit to s.&it it$

;;$ To su..ort a .atiet i si!e&0i' &eft3 su..ort t,e "o!0 "0 .&aci' .i&&ows

"etwee t,e &e's3 ar(s a! "o!0 .ara&&e& to .revet t,e fo&&owi' !efor(ities

a"!ucte! a! itera&&0 rotate! ri',t &e' < a!!ucte! ri',t ar($

1)I$ So(e (uscu&o4s*e&eta& ter(io&o'05

A$ Atro.,0 < wasti' awa0B$ Causa&'ia < severe "uri' .ai .ro!uce! "0 severe! "erves t,at ,ave

(a&fuctioi' erve e!i's3 touc, ca ofte .ro!uce t,is .ai$

C$ Circu(!uctio 4 (otio ivo&ves a"!uctio3 a!!uctio3 f&e/io a! e/tesio?:9 !e'rees to co(.&ete a fu&& circ&e3 (otio of t,e s,ou&!er3 ,i. a! a*&e$

D$ Cotracture < t,e a"sece of fu&& ra'e of (otio of a0 #oit$ Most co((o

is f&e/io cotracture3 t,e &ac* of fu&& e/tesio$E$ Defor(it0 < (a&for(atio or !efect of a0 .art of t,e "o!0$F$ Le' &e't, !iscre.ac0 4 aiso(e&ia a ie>ua&it0 "etwee corres.o!i'

&i("s$G$ Dis&ocatio < (usc&e s*e&eta&3 trau(atic i#ur0 resu&ti' i !isru.tio of t,e

cotiuit0 of a #oits cofi'uratio a! articu&atio causi' t,e &oss of cotact

"etwee t,e #oit surfaces$H$ Dorsif&e/io < t,e (otio of (ovi' t,e "o!0 .art u. towar! t,e !orsu(5 t,e

(otio of t,e a*&e t,at (oves foot u. towar! t,e &e'$I$ D0s.&asia < a"or(a&it0 of !eve&o.(et$+$ Eversio < (otio of a*&e c,aracterie! "0 t,e so&e of t,e foot faci' awa0

fro( t,e o..osite foot$6$ Iversio < (otio of t,e foot c,aracterie! "0 so&e of foot faci' towar! t,e

o..osite foot$


19/94

L$ 60.,osis < .osterior cove/it0 of t,oracic .ortio of verte"ra& co&u( or(a&

curvative "ut "eco(es .at,o&o'ic if e/cessive$M$ Latera& < si!e towar! t,e outer as.ect of t,e "o!0$N$ Lor!osis < cocavit0 of t,e verte"ra& co&u( or(a& curvature e/isti' i t,e

cervica& a! &u("ar areas w,ic, (a0 "eco(e .at,o&o'ic if accetuate!$

O$ Me!ia& < si!e towar! t,e (i!&ie of t,e "o!0$P$ Pa&s0 < .ara&0sisJ$ P&ae

;$ Car!ia& frota& .&ae t,at !ivi!es "o!0 frot a! "ac*$8$ Car!ia& ,oriota& .&ae t,at !ivi!es "o!0 ito u..er a! &ower$?$ Car!ia& sa'itta& .&ae t,at !ivi!es "o!0 ito &eft a! ri',t$@$ Mi!sa'itta& .&ae car!ia& sa'itta& .&ae$

R$ Ra'e of Motio < t,e fu&& (otio t,e #oit ca assu(e$S$ Recurvatio < ,0.ertesio e/tesio "e0o! eutra& .ositio$T$ Rotatio < (otio ivo&vi' turi' of oe "oe o aot,er3 a'&e "etwee

t,e two "oes !o o c,a'e$

;$ E/tera& < outwar! rotatio8$ Itera& < iwar! rotatio

-$ Su"&u/atio 4 trau(atic i#ur0 to #oit structure resu&ti' i .artia& or

ico(.&ete !is.&ace(et of #oit surfaces$)$ )a&'us < a'u&ar !efor(it0 !eoti' a'u&atio awa0 towar! t,e (i!&ie of

t,e "o!0 *oc*4*ees$2$ )arus < a'u&ar !efor(it0 !eoti' a'u&atio awa0 fro( (i!&ie of t,e "o!0

!ista& to t,e aato(ic .art a(e! "ow&e's$

FRACT-RES

I$ FracturesA$ A fracture is a "rea* i t,e cotiuit0 of t,e "oe$ I a!u&ts3 t,is "rea* is

usua&&0 co(.&ete i t,at t,e .eriosteu( a! cortica& tissue o "ot, si!es

are co(.&ete&0 severe!$ A ico(.&ete "rea* or K'reestic* fracture is

(ore co((o i c,i&!re sice "oe tissue is re&ative&0 soft$ Boe "ro*e

is "et "ut secure&0 ,i'e! at oe si!e$

Ot,er .arts i#ure! w,e "oe is fracture! are soft tissues a! "&oo!

vesse&s$

Co(.&ete < Periosteu( a! cortica& tissues are co(.&ete&0 severe! o

"ot, si!es of "oe$

Ico(.&ete < Boe "ro*e3 "et "ut sti&& secure&0 ,i'e! at oe si!e$

B$ Fracture "oe fra'(ets are &a"e&e! accor!i' to re&atios,i. to t,e

ceter of t,e "o!0$;$ Dista& < awa0 fro(


20/94

8$ Pro/i(a& < ear to

C$ Causes of Fracture;$ I or(a& "oes3 fracture occurs w,e (ore stress is .&ace! u.o a

"oe t,at it is a"&e to a"sor" suc, as5

a$ Direct "&ow or a crus,i' for(E/a(.&e5 2,e a .erso is ,it "0 a "ase"a&& "at"$ Twisti' force torsio < severe twisti' of a "ro*e "oe at a site

!ifferet fro( w,ere t,e force was actua&&0 a..&ie!$E/a(.&e5 S*ii' acci!et

c$ Powerfu& (usc&e cotractios < ,i',&0 !eve&o.e! (usc&es cotract

so vio&et&0 t,at (usc&es tear fro( "oe so(eti(es .u&&i' a s(a&&

.iece of "oe wit, it$!$ Fati'ue a! stress < "oe "rea* after a re.eate! stress$

E/a(.&e5 So&!iers (a0 "rea* foot "oes !uri' .ro&o'e!

(arc,i'$

8$ Boes wea*ee! "0 !isease or tu(ors are su"#ect to .at,o&o'ica&fractures$E/a(.&e5 Boe cacer causes "oes to "eco(e &i*e a K!r0 toast a!

to cru("&e u!er &itt&e or o stress$

D$ C&assificatio of Fractures


21/94

;$ Broa! C&assificatioa$ C&ose or Si(.&e < w,e t,e "rea* i t,e "oe ,as o

co((uicatio to t,e outsi!e$"$ O.e or Co(.ou! < w,e t,e "rea* i t,e "oe co(es out

t,rou', t,e s*i or t,ere is o co((uicatio of t,e "oe to t,e

outsi!e$

8$ C&assificatio as to Pattera$ Trasverse < w,e "rea* rus across t,e "oe$"$ O"&i>ue < "rea* rus i s&ati' !irectio o "oe$

c$ S.ira& < "rea* coi&s arou! t,e "oe$?$ C&assificatio as to A..earace

a$ Co((iute! < "oe s.&itere! ito fra'(ets t,ere are ? or (ore

fra'(ets$

"$ I(.acte! < w,e fracture! e!s of a "oe are .us,e! ito eac,

ot,er "oe "ro*e a! we!'e ito ot,er "rea*$


22/94

c$ Co(.ressio < a co!itio i w,ic, t,e "oe3 t0.ica&&0 a verte"ra

co&&a.ses i itse&f$!$ De.resse! fracture < usua&&0 occurs i t,e s*u&& wit, t,e "ro*e

"oe "ei' !rive iwar!$

e$ Lo'itu!ia& fracture < t,e "rea* rus .ara&&e& wit, "oe$f$ Fracture !is&ocatio < w,e a fracture is acco(.aie! "0 a "oe

out of #oit$

@$ C&assificatio i re&atio to t,e +oita$ Itraca.su&ar < wit,i t,e ca.su&e"$ E/traca.su&ar < outsi!e t,e ca.su&ec$ Itra4articu&ar < i t,e #oit

$ C&assificatio as to Locatioa$ Pro/i(a&


23/94

"$ Mi!s,aftc$ Dista&

E$ Si's a! S0(.to(s;$ Pai es.ecia&&0 at t,e ti(e of i#ur0

8$ Te!eress at t,e site?$ Swe&&i'@$ Loss of fuctio$ Defor(it0:$ Cre.itus 'rati' sesatio eit,er ,ear! or fe&t as "oe e!s ru"

to'et,er$ Dis&ocatio=$ B&ee!i' fro( a o.e wou! wit, .rotrusio of "oe e!s

F$ Treat(et;$ Prici.&es of Fracture Treat(et

a$ Re!uctio or rea&i'(et of "oe fra'(ets"$ Maiteace of rea&i'(et "0 i((o"i&iatioc$ Restoratio of fuctio

8$ Re!uctio is acco(.&is,e! "05a$ C&ose! (ai.u&atio i w,ic, a cast or s&i' is use!$"$ Itera& i sur'er0 o.e re!uctio i w,ic, various t0.es of

,o&!i' !evices are use!$c$ E/tera& fi/atio3 a&so i sur'er03 i w,ic, .is are iserte! ito t,e

"oe a"ove a! "e&ow t,e fracture a! ,e&! i .&ace "0 a c&a(.i'

!evice$!$ Tractio

?$ I((o"i&iatio < t,e (ost i(.ortat .,ase i o"taii' uio offracture fra'(ets$a$ I c&ose! re!uctio3 t,is is acco(.&is,e! "0 a..&icatio of .&aster

cast3 after t,e fracture a! ,ave "ee a&i'e! wit, or wit,out t,e

ai! of aest,esia3 to ic&u!e t,e #oit a"ove a! "e&ow t,e fracture

&ie$"$ I o.e re!uctio3 i((o"i&iatio is !oe "0 ai&s3 screws3 .is3

wires or ro!s w,ic, are iserte! wit, or wit,out .&ates$ Suc,

!evices usua&&0 sta0 i t,e .atiet i!efiite&0 u&ess t,e0 .ro!uce

s0(.to(s after ,ea&i' ta*es .&ace$

@$ Restoratio of fuctio < t,is ai( of treat(et is a o'oi' .rocessa! actua&&0 "e'is wit, t,e (aiteace of fuctio of t,e uaffecte!

#oits a! e/tre(ities$ Hea&i' of t,e fracture! .art wi&& "e faster if

or(a& circu&atio of t,e rest of t,e "o!0 is (aitaie!$

G$ Sta'es of Boe Hea&i';$ T,e re.air of fracture ta*es .&ace i a or!er&0 se>uece5


24/94

a$ For(atio of ,e(ato(a2,e a "oe is fracture!3 "&oo! e/travasates ito t,e area

"etwee a! arou! t,e fra'(ets a! t,e "oe (arrow$

T,e c&ot "e'is 8@ ,ours after t,e fracture occurs$ T,is &oca&

c&ots serves as a fe"ri etwor* for a su"se>uet ce&&u&ar

ivasio$"$ Ce&&u&ar .ro&iferatio < occurs a few !a0s after t,e fracture$ T,e

co("iatio of .eriostia& e&evatio a! 'rau&atio tissue cotaii'

"&oo! vesse&s3 fi"ro"&asts a! osteo"&asts .ro!uce a su"stace

ca&&e! osteoi!s3 for(i' a "ri!'e across t,e fracture site$c$ Ca&&us for(atio < after t,e fo&&owi' wee*s3 (iera&s are "ei'

!e.osite! i t,e osteoi! for(i' a &ar'e (ass of !ifferetiate!

tissue "ri!'i' t,e fracture ca&&e! ca&&us$!$ Ossificatio < fia& &a0i' !ow of "oe3 is t,e state i w,ic, t,e

fracture e!s ,ave *it to'et,er$

e$ Re(o!e&i' < w,e coso&i!atio is co(.&ete!3 t,e e/cess ce&&sare a"sor"e!3 t,e .ri(ar0 cace&&ous "oe is re(o!e&e!3 co(.act

"oe "ei' for(e! accor!i' to stress .atters$ Re(o!e&i'

cotiues as "oe is for(e! i re&atio to its fuctio$H$ T,e avera'e .erio!s for fir( uio of various "oes are as fo&&ows5

C&avic&e %%%%%%%%%%$ ?4@ wee*s

Ra!ius4-&a %%%%%%%$$$$ :4;? wee*s

Metacar.a&s %%%%%%%%$ @ wee*s

Fe(ur %%%%%%%%%%% ;8 wee*s

Fi"u&a %%%%%%%%%%%$ ;84;@ wee*s

OS ca&cus %%%%%%%%%$ =4;8 wee*s

P,a&a'es %%%%%%%%% ? wee*s

Nu(erus %%%%%%%%%$$$ : wee*s

Lower ?r!Ra!ius %%%%%%$ @ wee*s

Ti"ia %%%%%%%%%%%% =4;8 wee*s

Tarsa&s %%%%%%%%%%% :4= wee*s

Metatarsa&s %%%%%%%%% 4: wee*s

I$ Co(.&icatio i Hea&i';$ Iterru.tio i t,e se>uece of "oe ,ea&i' are cause! "05

a$ Ori'ia& i#ur0"$ De"ri!e(etc$ Loss of "oe su"stace!$ Soft tissue iter.ose! "etwee "ot, e!se$ Ifectiof$ Loss of circu&atio'$ Iterru.te! or i(.ro.er i((o"i&iatio


25/94

,$ Ia!e>uate fi/atioi$ Necrosis !ue to fi/atio !evices

#$ Meta"o&ic !istur"aces8$ Possi"&e co(.&icatios fro( fractures5

Co(.&icatio Ear&0 C&iica&Features

Reco((e!e!Nursi' Actio

Most Co((oFracture Locatio

a$Pu&(oar0

E("o&is( (a0 ot

occur wit,out

c&iica& s0(.to(

Su"stera& .ai

D0s.ea

Ra.i! wea* .u&se

A!(iister o/0'e

Notif0 .,0sicia

i((e!iate&0 as to

.ai a! vita& si's

Lower e/tre(ities

"$ Fat E("o&is( Meta& cofusio3

a..re,esio3

rest&essess !ue to

,0.o/ia

Fo&&owe! "0 fever3tac,0car!ia3

tac,0.ea3 !0s.ea

It is a!visa"&e to

,ave a sta!i'

or!er to !raw "&oo!

'ases at first si' of

(eta& cofusio$Notif0 .,0sicia

i((e!iate&0$

A!(iister o/0'e$

Lower e/tre(ities

a!or (u&ti.&e

fractures

c$ Gas Ga'ree Meta& a"erratio

fo&&owe! "0 si's of

ifectio

Notif0 .,0sicia

i((e!iate&0 of

(eta& status3 vita&

si's a!

a..earace of

wou!$

Co(.ou!

es.ecia&&0 wit,

s(a&& o.e area

!$ Tetaus Ma0"e oe uti&5.atiet ,as toic

twitc,i' a!

!ifficu&t0 o.ei'

(out,

Notif0 .,0siciai((e!iate&0$

C&ose watc, for

covu&sios$

Co(.ou!

?$ Co(.&icatios to "oe itse&fa$ Ifectio"$ No4uioc$ Ma&4uio!$ De&a0e! uio

+$ T,e ursi' care of t,e fracture! .atiet s,ou&! "e focuse! o t,e ear&0reco'itio to si's a! s0(.to(s of associate! co(.&icatios$ T,e urse

ee!s to *ow t,e si's a! s0(.to(s of i#ur0 to t,e "&oo! vesse&s3

viscera3 erves a! te!os$ I#uries (a0 over&a. "ut t,e urse !oes ot

!eter(ie w,ic, i#ur0 ,as occurre! "ut i((e!iate&0 re.orts ,er

o"servatio$ Si's a! s0(.to(s i!icative of i#ur0 to t,e "&oo! vesse&s3

viscera3 erves a! te!os are5


26/94

;$ C,a'e i sie8$ C,a'e i s*i te(.erature a! co&or or a..earace?$ C,a'es i fuctio@$ A"or(a& or !ecrease! sesatio of t,e affecte! e/tre(it0$ Si's of ,e(orr,a'e ic&u!i' !raia'e or "&ee!i'

II$ Dis&ocatio

Dis&ocatio < !is.&ace(et of a "oe e! fro( a #oit$ Associate! &i'a(ets

(a0 "e tor or stretc,e!$

Su"&u/atio < !is.&ace(et of a "oe fro( its or(a& #oit .ositio to t,e

e/tet t,at articu&ati' surfaces .artia&&0 &oss cotact$

A$ Cause;$ Trau(a

8$ Disease?$ Co'eita& co!itio

B$ Si's a! s0(.to(s

;$ Buri' .ai at #oit ?$ Stiffess a! &oss of #oit fuctio

8$ Defor(it0 @$ Mo!erate to severe e!e(a arou! #oit

C$ Nursi' cosi!eratio

;$ To &esse swe&&i'3 e&evate t,e affecte! e/tre(it0$ 6e.t it e&evate! uti&

after !is&ocatios re!uce! "ecause (ai.u&atio !ecreases swe&&i'$

8$ Assess affecte! e/tre(it0 for si's of eurovascu&ar .ro"&e(s suc, as

.ai3 a"set .u&se3 .arest,esia3 .a&or a! .ara&0sis$?$ Because co!itio causes severe .ai 'ive .ai (e!icatio .er

!octors or!er$

@$ Provi!e a..ro.riate care if .atiet is i((o"i&ie! eit,er i tractio or i

cast$

$ Ecoura'e .atiet to !o e/ercise$

III$ S.rai

A$ S.rai is a ico(.&ete teari' of #oit ca.su&e or &i'a(ets surrou!i' a #oit

w,ic, !oes ot !isru.t &i'a(et cotiuit0 or cause #oit ista"i&it0$

B$ Cause

Su!!e twisti' of #oit "e0o! its or(a& ra'e of (otio

C$ Si's a! s0(.to(s

;$ .ai at #oit ?$ !isco&oratio arou! #oit

8$ e!e(a arou! #oit @$ !ecrease! #oit fuctio

D$ Nursi' cosi!eratio


27/94

;$ To re!uce swe&&i' a..&0 co&! treat(et3 suc, as ice "a' or a co&! .ac* for t,e

first @= ,ours$

8$ T,e3 after swe&&i' is cotro&&e! a..&0 war( treat(et suc, as war( co(.resses

or a ,eati' .a!$

?$ Provi!e care to .atiet wit, e/tre(it0 i cast or i "a!a'e$

I)$ Strai

A$ Strai is i#ur0 to a te!o(usc&e uit c&ose to t,e #oit$ It ca "e acute

or c,roic$

B$ Cause

Overstretc,i' te!o or over usi' (usc&e$

C$ Si's a! s0(.to(s5

;$ Acute strai .ro!uces su!!e3 severe .ai at t,e ti(e of i#ur0 w,ic, t,e

su"si!es to &oca& te!eress$ Swe&&i' occurs ra.i!&0$ 8$ C,roic strai .ro!uces 'ra!ua& oset a! te!eress$

D$ Nursi' cosi!eratio

;$ For acute3 a..&0 ice .ac*s for t,e first @= ,ours to cotro& swe&&i'$

8$ T,e3 after swe&&i' is cotro&&e! a..&0 war( treat(et suc, as war(

co(.resses$

?$ Rest t,e .art for @ to : wee*s$

@$ For "ot, acute a! c,roic strai .er(it o&0 (ii(a& (ove(et of t,e

affecte! area$

)$ )arious Fractures A$ Ma!i"u&ar fractures

;$ 2,at to o"serve w,i&e t,e .atiet is i Bartos "a!a'e5

a$ &ossei' of teet,3 !eta& occ&usio

"$ !ifficu&t0 of "reat,i'

8$ Mout, care

?$ Li>ui! !iet

B$ Ri" Fractures

;$ Assess(et5

a$ Te!eress

"$ Res.irator0 status3 ic&u!i' !e.t, of veti&atio3 si's of

,e(o.eu(ot,ora/

c$ Su"cutaeous e(.,0se(acre.itatio

8$ Treat(et5

a$ Aa&'esics

"$ Pu&(oar0 toi&et to .revet res.irator0 co(.&icatios$


28/94

c$ C,est stra..i' (a0 "e cotrai!icate!3 as it ca re!uce res.irator0

e/.asio

C$ Stera& Fractures

;$ Assess(et5 Swe&&i'3 te!eress over steru(

8$ Treat(et5 Fracture of t,e steru( if3 !is.&ace!3 (a0"e treate! wit, itera&

fi/atio wit, wire sutures$

D$ Fracture of t,e s,ou&!er or u..er area

;$ Assess(et5

a$ Re(ove c&ot,i' so t,at t,e etire u..er "o!0 (a0"e visua&ie3 Sice

(ove(et (a0"e .aifu& a! t,e (otio of "oe fra'(ets ,ar(fu& to

soft tissues3 t,e .atiet s,ou&! "e as*e! for .er(issio to cut awa0 t,e

c&ot,i' as ecessar0$

"$ If .ossi"&e3 t,e .atiet s,ou&! "e sta!i' or seate! u.ri',t wit,out "ac*

su..ort so t,at a0 a"or(a& "o!0 cotours3 suc, as (a0 "e cause! "0c&avic&e !is.&ace(et or a"or(a& .ositios3 suc, as t,e s,ou&!er !roo.3

(a0 "e visua&ie!$

c$ T,e area o t,e affecte! si!e (a0 "e su..orte! wit, t,e s,ou&!er i t,e

.ositio of 'reatest co(fort a! t,e e&"ow i f&e/io$

8$ Treat(et5

a$ Treat(et for u..er e/tre(it0 a! s,ou&!er 'ir!&e fractures are "ase! o

.atiets a'e3 t,e site a! t0.e of fractures t,e .resece of soft tissue

!a(a'e3 a! t,e .otetia& cos(etic affects$

"$ Fractures of t,e c&avic&e ,ea& ra.i!&0 "ut it is !ifficu&t to (aitai co(.&ete

i((o"i&it0 !uri' t,e ear&0 sta'es of ,ea&i'$

O.e re!uctio is 'eera&&0 avoi!e! u&ess ecessar0 "ecause sur'er0

icreases t,e ici!ece of ouio$ Sur'er0 is i!icate! w,e t,e "oe is

cosi!era"&0 fra'(ete! or w,e u!er&0i' fra'(ete! or w,e u!er&0i' soft

tissues (ust "e re.aire! or e/.&ore! for !a(a'e$

Coservative treat(et (a0 cosist of c&ose! re!uctio if ecessar03

fo&&owe! "0 at &east ? wee*s of i((o"i&iatio i a s.ica cast or i a fi'ure4of4ei',t

"a!a'e$ I cases w,ere o re!uctio is re>uire!3 so(e .atiets wi&& ee! at &east ?

wee*s of i((o"i&iatio i a soft i((o"i&ier w,i&e ot,ers wi&& ee! o&0 a s&i' for

su..ort !uri' t,e sa(e .erio! of ti(e$

c$ Fractures of sca.u&a

; uco((o

8 associate! wit, (ore serious i#uries w,ic, re>uire t,e .atiet to "e


29/94

cofie! to "e!$

? It ca "e treate! "0 a..&icatio of ice a! a!(iistratio of aa&'esics$

@ I t,e a"sece of serious i#ur03 (ost .atiets wit, sca.u&a fractures3

(a0"e a("u&ator0 wit, t,e ivo&ve! e/tre(it0 su..orte! i a s&i' for

a..ro/i(ate&0 8 wee*s$

So(e t0.es of sca.u&ar fractures caot "e treate! "0 coservative

(eas a! wi&& re>uire s*e&eta& tractio or o.e re!uctio a! itera&

fi/atio$

!$ Fractures of .ro/i(a& ,u(erus

A..ro/i(ate&0 = of t,ese fractures are u!is.&ace! or (ii(a&&0

!is.&ace! are treate! coservative&0$

; Cosists of a few wee*s of rest3 i a s&i'3 a co&&ar a! cuff3 fo&&owe! "0

a .ro'ra( of e/ercises$ 8 C&ose! re!uctio fo&&owe! "0 i((o"i&iatio i a s&i' or s.ica cast or

o.e re!uctio a! itera& fi/atio (a0 "e ecessar0$

? I certai cases3 fractures of t,e aato(ic or sur'ica& ec* ca iterru.t

"&oo! su..&0 to t,e ,ea! of t,e ,u(erus3 causi' avascu&ar ecrosis$

So(e cases re>uire sur'ica& re.&ace(et of t,e !evita&ie! ,u(era&

,ea! wit, a .rost,esis$

e$ Fractures of t,e ,u(era& s,aft

; Most ofte treate! wit, a ,a'i' cast w,ic, re!uces t,e fracture a!,e&.s (aitai "oe a&i'(et$

Ha'i' cast caot "e use! w,e t,e .atiet is u!er ;8 0ears of a'e

or is cofie! to "e!$ I suc, cases3 a"!uctio s.&its3 s,ou&!er s.ica cast

or s*e&eta& tractio (a0 "e use!$

8 O.e re!uctio a! itera& fi/atio is avoi!e! u&ess ecessar0 "ecause

t,is icrease t,e ici!ece of ouio$

f$ Fractures i t,e e&"ow area

De.e!i' o t,e i#ur03 t,ese are fractures (a0 "e treate! "0 o.e

re!uctio a! iter fi/atio3 c&ose! re!uctio "0 (ai.u&atio wit, or wit,out

'eera& aest,esia c&ose! re!uctio "0 s*e&eta& tractio$

I((o"i&iatio efforts (a0 uti&ie a cast3 a .osterior s.&it wit, or wit,out

a s&i'3 a s&i' a&oe3 a co&&ar a! cuff su..ort wit, e&"ow ,a'i' free3 or

si(.&0 rest for severa& wee*s$

I a&& i((o"i&iatio a..roac,es3 t,e ai( of treat(et is .revetio of


30/94

e/tesio cotractures "0 *ee.i' t,e e&"ow i at &east so(e !e'ree of f&e/io

!uri' ,ea&i'$

'$ Dis.&ace! fractures of t,e ra!ius3 u&a or "ot,$

; O.e re!uctio a! itera& fi/atio

8 For u!is.&ace! fractures < (a0 "e treate! "0 casti' a&oe$ Casts are

usua&&0 re>uire! for :4= wee*s for c,i&!re a! at &east ;8 wee*s for a!u&t$

,$ -!is.&ace!Co&&es fracture (a0"e i((o"i&ie! i a .&aster s.&it or cast for @

to wee*s$ Dis.&ace! Co&&es fractures (a0"e re!uce! "05

; si(.&e (aua& tractio

8 .&aster cast

? (aua& tractio fi/e! wit, s*e&eta& wires w,ic, are icor.orate! ito a cast$

@ Percutaeous .ii' of t,e forear($

i$ Fractures of !ista& forear( are treate! "05

; casti'

8 c&ose! re!uctio fo&&owe! "0 a cast or .&aster s.&it for ? to @ wee*s

? Less co((o3 is o.e re!uctio a! itera& fi/atio$

#$ Car.a& fractures5

; No re!uctio is ee!e! !or t,e (a#orit0 of car.a& fractures$ A s,ort

ar( cast w,ic, icor.orate t,e t,u("3 is use! to i((o"i&ie t,e sire for

a..ro/i(ate&0 ;9 wee*s$ O.e re!uctio a! itera& fi/atio is ecessar0 o&0

i certai cases$

*$ Most fractures i t,e ,a! are i((o"i&ie! "0 6irsc,er wire$ I((o"i&it0

s,ou&! ot e/cee! ? wee*s$

&$ w,e fractures of t,e u..er e/tre(it0 ,ave "ee ,ea&e! sufficiet&03 a

i(.ortat .art of treat(et is a .ro'ra( of actio e/ercises to restore (o"i&it0$

Pe&vic Fractures

;$ Assess(et5

a$ &oca& swe&&i' a! te!eress

"$ sta"&e fractures ui&atera& fracture of su.erior a! iferior .u"ic ra(i3 fracture

of t,e i&iac ri'

c$

; .e&vic sta"i&it0 ot affecte!

!$ -sta"&e fractures "i&atera& fracture of t,e su.erior a! iferior .u"ic ra(i3


31/94

ui&atera& fracture of t,e su.erior a! iferior .u"ic ra(i a! t,e sacro4i&iac #oit or a

fracture or !is&ocatio of t,e sacroi&iac #oit a! t,e s0(.,osis .u"is

; Ista"i&it0 of .e&vic ri'

8 ,i. !efor(it0

8$ Treat(et5

a$ Sta"&e fractures5

; Be!rest for ; to !a0s3 t,e .ro'ress fro( .artia& to fu&& wei',t "eari'$

8 -sta"&e fractures5 .e&vic e/tera& fi/atio wit, ,a&f4.is to recreate a sta"&e

.e&vis$ Ear&0 (o"i&iatio a! a("u&atio$

?$ Associate! co(.&icatios suc, as itera& ,e(orr,a'e a! e/travasatio of arie$

F$ Fracture of t,e &ower e/tre(ities

;$ Assess(et5 a$ Re(ove c&ot,i' so t,at t,e etire e/tre(it0 (a0 "e visua&ie!$ Cut c&ot,i'

a&o' sea(s w,e ecessar0$

"$ Su..ort e/tre(it0 at a&& ti(es3 ic&u!e #oit "e&ow a! #oit a"ove t,e sus.ecte!

i#ur0$

c$ Assess for c,a'e i &e't,3 s,a.e or a&i'(et$

!$ Assess for eurovascu&ar c,a'es !ista& to t,e fracture$

8$ Assess(et of .atiet wit, .ossi"&e ,i..ro/i(a& fe(ur fracture

a$ if fracture is i(.acte! t,e .atiet (a0 "e a"&e to "ear wei',t a! wa&* for a s,ort

.erio! of ti(e after t,e iitia& i#ur0$"$ ofte a ,istor0 of si(.&e fa&&

c$ .ai o (otio

!$ !ecrease! ra'e of (otio

e$ affecte! &i(" s,ortee! a!!ucte! a! e/tera&&0 rotate!3 'reater troc,ater (a0 "e

!is.&ace! ito t,e "uttoc*$

?$ Treat(et5

a$ Pro/i(a& fe(ure fractures

; ,i.s.ica

8 s*e&eta& tractio

? s*i tractio to !ise'a'e "oe fra'(ets a! .revet (usc&e s.as(s .rior to

sur'er0$

@ O.e re!uctio a! itera& fi/atio$ T0.es of fi/atio !e.e!et o a'&e a!

&ocatio of t,e &ie of fracture$

a .is t,rou', troc,ater a! fe(ur


32/94

" ai&s t,rou', fe(ora& ec* ito fe(ora& ,ea!

c .&ates wit, screws ito fe(ora& s,aft

! Boe 'rafts to sti(u&ate "oe 'rowt,

e ,i. .rost,esis "a&& a! itra(e!u&&ar0 ste( ,e(i art,ro.&ast0

"$ Su.raco!0&ar a! co!0&ar fe(ur fractures

; s*e&eta& tractio

8 itera& fi/atio wit, itra(e!u&&ar0 ro!s ai&s3 .&ates3 screws

c$ Fe(ora& s,aft fractures

; cotiuous s*e&eta& tractio

8 o.ec&ose! re!uctio wit, iertio of itra(e!u&&ar0 ro!s

!$ Ti"ia& fractures !e.e!i' o severit0

; Casti' if ico(.&ete a! c&ose!

8 E/tera& fi/atio

? tractio @ o.ec&ose! re!uctio wit, isertio of itra(e!u&&ar0 ro!

e$ Fractures of t,e a*&e area5

; Casti'

8 O.e re!uctio c itera& fi/atio

? tractio

@ e/tera& fi/atio

s.&its

)I$ Nursi' Itervetio

Patiets wit, fractures

A$ E,ace co(fort

B$ Esure a!e>uate o/0'eatio of tissues

C$ Ta*e (easures towar! restri' t,e fuctio of t,e fracture! "oes

D$ Maitai tota& "o!0 (o"i&it0 w,i&e *ee.i' t,e i#ure! .art at rest

E$ Protect a'aist ifectio i t,e a"sece of a itact first &ie of !efese a'aist

ifectio

F$ Provi!e a!e>uate utritio for ,ea&i'

G$ Prevet costi.atio

H$ Pro(ote uriar0 e&i(iatio

I$ Prevet a!!itioa& trau(a to soft tissues

+$ Assist i a&&a0i' a/iet0

6$ Assist .atiet to attai o.ti(a& &eve& of i!e.e!ece

L$ He&. .revet "ore!o(


33/94

M$ Provi!e care for .atiet i cast tractio e/tera&3 fi/atio3 "race

N$ Provi!e care to .atiets for sur'er0

)II$ Co(.ressio fracture of )erte"ra& Bo!0

A$ Defiitio.at,o.,0sio&o'0 a! resu&ts fro( a a/ia& force t,at co(.resses t,e

ivo&ve! verte"ra& "o!0 "etwee t,ose a"ove a! "e&ow it$ T,is co(.ressio

force (a0 resu&t i t,e fracture of oe or (ore verte"ra& "o!ies$ Neuro&o'ic !eficit

(a0 occur !e.e!i' o t,e t0.e of severit0 of t,e i#ur0$

B$ Co(.ressio fractures "ase! o &ocatio5

;$ Cervica& s.ie

a T,ese are sta"&e fractures of t,ere is o !is&ocatio of t,e .osterior facets

or t,e iterverte"ra& !isc #oits a! if t,ere is o co((uutio of t,e "o!0$

T,e0 wi&& re(ai sta"&e uti& ,ea&e!$

" Neuro&o'ic !eficit is ot co((o "ecause t,e s.ia& &o'itu!ia& &i'a(etsa! au&us fi"rosis act to restrai !is.&ace(et of t,e fracture$

8$ T,oracic s.ie

a 2e!'e co(.ressio fracture is (ost co((o$ I t,is i#ur03 oe or (ore

verte"ra& "o!ies co&&a.se aterior&0 "eco(e we!'e s,a.e! a! create a

.ro(iece of t,e s.ious .rocess .osterior&0$

" )ertica& co(.ressio fracture5 e/te!s t,rou', t,e etire ,ei',t of t,e

verte"ra& "o!0 a! &a(ia or s.ious .rocess$ T,e verte"ra& "o!0 (a0

s,atter a! t,e fra'(ets (a0 "e !is.&ace!$

?$ Mi!&u("ar s.ie

a E/cessive &oa! seco!ar0 to (usc&e cotractio a&oe (a0 .ro!uce a

co(.ressio fracture es.ecia&&0 i osteo.otic "oe$

" Mi!&u("ar co(.ressio fracture wit,out si'ificat !a(a'e to t,e aterior

structura& co&u( of t,e s.ie (a0 "e cosi!ere! sta"&e a! rare&0

associate! wit, euro&o'ic !eficit$

@$ Ot,er co(.ressio fractures

a Co!fis, s.ie5 occurs w,e a verte"ra& "o!0 is iva!e! "0 "ot, its a!#acet

!isc a "icocave .rofits is .ro!uce!$ It is (ost ofte see i a!vace!

cases of osteo.orosis$ A resu&t of c,roic co(.ressive stress$

" Burst or e/.&osive fracture5 occurs fro( e/tre(e co(.ressive &oa!s$ It is

.ro!uce! "0 s.,erica& !e.ressio o "ot, su.erior a! iferior verte"ra&

a! .&ates #oie! "0 a vertica& fracture &ie s.&itti' t,e "o!0 ito two$ T,is is

a sta"&e fracture u&ess t,e .osterior .ortio !is.&aces .osterior&0 ito t,e

s.ia& caa&3 .ro!uci' euro&o'ic !eficit$ T,ere is &itt&e stress o t,e

&i'a(etous structures "ut if &ar'e co(.ressive &oa!s are a..&ie! to t,e


34/94

s.ie wit, !e'eerate! a! e/tesive&0 fi"rose! iterverte"ra& !iscs3 t,e

fracture wi&& "e a uifor( f&attei' of t,e verte"ra& "o!0 rat,er t,a a

s.,erica& !e.ressio$

C$ Ici!ece5

;$ a&& a'es

8$ (ost co((o i t,e (i!&u("ar area

?$ T,e (ost fre>uet co(.ressio fracture of t,e t,oracic s.ie is t,e we!'e

co(.ressio fracture

@$ Hi', ici!ece of .ara.&e'ia wit, vertica& fracture

$ Most co(.ressio fractures are sta"&e

:$ T,e (ost co((o cause of co(.ressio fracture a(o' e&!er&ies is

Osteo.orosis

D$ Etio&o'0 ;$ trau(atic

a !ivie acci!et

" auto(o"i&e acci!et

c fa&&s or "&ows to t,e ,ea!

! fa&&s i sitti' .ositio 3 i$e$race car !rivers a! .i&ots t,at ,ave use! e#ectio

seats i e(er'ec0 situatio

8$ Notrau(atic ori'i

a osteo.orosis

" (u&ti.&e(0o(a

c "oe cacer sacro(as a! .ri(ar0 a! (etastatic &esiosII$ Assess(et

A$ Histor0

;$ Mec,ais( of i#ur0

8$ Pro'ressio of s0(.to(

?$ Li(itatio of fuctio

@$ Descri.tio of .ai

$ Past ,istor0 of cervica& or &u("ar s.ie !iseases or i#ur0

B$ P,0sica& E/a(

;$ Positioi' a! a..earace of s.ie

8$ Sesatio of trau(a a! e/tre(ities

?$ a"!o(ia& e/a(

a Presece of "owe& sou!

" Presece of "owe& !istetio

c Te!eress a!or ri'i!it0

! Distetio


35/94

III$ Co((o Me!ica&Sur'ica& Itervetios5

A$ Cervica& co(.ressio fractures !e.e!et o severit0 of fracture

;$ S*e&eta& tractio suc, as t,e ,a&a or wit, a s*u&& to'

8$ ri'i! cervica& ort,osic

?$ Hea! ,a&ter

@$ cervica& ra'e of (otio e/ercises

B$ T,oraco&u("ar co(.ressio fractures5

;$ Iitia&&03 "e! rest o a fir( (attress$ Sitti' is ot .er(itte!$ Lo'ro&& o&0$

8$ As t,e s0(.to(s su"si!e3 .ro'ressive3 (usc&e stre't,ei' e/ercises

?$ If t,ere is severe .ai a "o!0 cast wit, a s.ie i tractio (a0"e a..&ie! for

a"out : wee*s fo&&owe! "0 a reiforce! corset for aot,er @4: wee*s$

@$ 2it, severe !efor(it0 a (o&!e! .&aster #ac*et (a0 "e a..&ie! to .revet

.ro'ressive !efor(it0 ;84;: wee*s re.&ace! wit, a corset for a a!!itioa& 8

(ot,s$

I)$ Nursi' Itervetios

A$ Moitor eurovascu&ar status

;$ Assess euro&o'ic status of t,e tru* a! e/tre(ities

8$ (aitai .ro.er .ositioi'

a$ Protect ,ea! a! s.ie fro( e/cessive f&e/io a! e/tesio

"$ (aitai i((o"i&iatio of t,e cervica& s.ie wit, sa!"a's is a..&ica"&e uti&

treat(et is iitiate!$

?$ -ti&ie s.ecia& "e!sfra(es or &o'ro&&i' for turi' or .ositioi'

B$ Pro(ote co(fort

C$ Discuss .atiets fee&i' a! fears D$ Provi!e (o"i&it0 wit,i .rescri"e! restrictios

E$ Provi!e se&f4care wit,i activit0 restrictios

F$ Discuss c,a'es i "o!0 i(a'e

G$ Discusse! ,ow &ifest0&e (a0"e a&tere! !ue to i#ur0

H$ Provi!e "owe& a! "&a!!er re,a"i&itatio .ro'ra(

I$ Provi!e !iversioar0 activities a..ro.riate for .atiets a'e a! activit0 &eve&

+$ Provi!e ca&(3 restfu& eviro(et

6$ Provi!e .atiet e!ucatio re'ar!i' .ro'ressive (usc&e stre't,ei' e/ercises

as i!icates

Care of Patiet i Cast

I$ Nursi' Care of Patiet I Cast

A$ Defiitio of .&aster cast < is a te(.orar0 i((o"i&ii' !evice w,ic, is (a!e u. of

'0.su( su&fate re!ere! u,0!rous "0 ca&ciatio w,e (i/e! wit, water swe&&s

a! for(s ito a ,ar! ce(et$


36/94

B$ Fuctios5

;$ To i((o"i&ie

8$ To .revet or correct !efor(it0

?$ To su..ort3 (aitai a! .rotect rea&i'e! "oe

@$ To .ro(ote ,ea&i' a! ear&0 wei',t ,eari'

C$ Cast ca "e a..&ie! to t,e e/tre(ities3 to t,e tru* a! to e/tre(it0 a! tru* as i

s.icas$

It ca "e a..&ie! to ecase t,e w,o&e area w,ere it s,ou&! "e a..&ie! or it ca

"e a..&ie! as a s.&it or (o&!

D$ Co(.&icatios of Cast

;$ Neurovascu&ar co(.ro(ise

8$ Icorrect fracture a&i'(et

?$ Cast s0!ro(e su.erior (eseteric arter0 s0!ro(e

a occurs wit, "o!0 cast " tractio o su.erior (eseteric arter0 causes !ecrease i "&oo! su..&0 to

"owe&

c Si's a! s0(.to(s3 a"!o(ia& .ai3 ausea a! vo(iti'$

@$ Co(.art(et s0!ro(e a co(.art(et s0!ro(e is a co!itio i w,ic,

icrease! .ressure wit,i a &i(ite! s.ace3 co(.ro(ises t,e circu&atio a!

fuctio of t,e tissues wit,i t,at s.ace$

E$ Prici.&es i a..&0i' .&aster cast

;$ A cast is a..&ie! wit, .a!!i' a..&ie! first

Pa!!i' (ateria&s ic&u!e t,e fo&&owi'5a$ s,eet wa!!i'

"$ ro&& of cotto

c$ stoc*iette

!$ fe&t

It ca "e a..&ie! as a co("iatio &i*e stoc*iette a! s,eet wa!!i'

8$ A..&0 it to ic&u!e t,e #oit a"ove a! t,e #oit "e&ow t,e i#ure! .art$

?$ A..&0 it i circu&ar (otio a! (o&! it as 0ou !o t,e .roce!ure "0 t,e .a&($

@$ Su..ort it wit, t,e .a&($

F$ Cotrai!icatios of P&aster Cast a..&icatio

;$ Pre'ac0

8$ S*i !iseases

G$ A..&0i' a P&aster Cast

Circu&ar cast a..&icatio

;$ C,ec* for t,e !octors or!er$8$ Ifor( a! .re.are t,e .atiet for t,e .roce!ure$


37/94

E/.&ai to t,e .atiet a!or ,is re&ative t,e ee! for .&aci' t,e affecte! .art of

t,e "o!0 i a cast$ S,ow a i&&ustratio of t,e t0.e of cast to "e a..&ie! to ,e&. t,e(

visua&ie K,ow it is a! Kw,at it is for t,e .atiet to ,ave it$ T,e0 are a&so (a!e

aware of t,e a..ro/i(ate !uratio for t,e "o!0 to re(ai i cast3 t,e &i(itatio a!

t,e !isco(fort arisi' fro( i((o"i&iatio &ess "ore so(e a! frustrati'$

It .ossi"&e3 a 'oo! c&easi' "at, a! s,a(.oo "e 'ive to t,e .atiet$ T,e

affecte! .art is c&ease! t,orou',&0 wit, soa. a! water or wit, a !eter'et a!

!rie!$ If t,ere is wou! ,ave it !resse! accor!i'&0$

?$ Rea!0 a&& t,i's ee!e! for t,e a..&icatio$@$ Positio t,e e/tre(it0 "0 t,e !octor$$ A..&0 .a!!i' ic&u!i' t,e #oits a"ove a! "e&ow fracture &ie wit, t,ic*er .a!s

o "o0 .ro(ieces$:$ Soa* t,e .&aster cast ito a "uc*et wit, water &eave it u!istur"e! uti& "u""&es

cease3 oe after t,e ot,er$

$ Gras. "ot, e!s of t,e cast3 w,e "u""&es c&ose3 towar!s t,e cetre wit,outs>ueei' it$

=$ Free t,e e! of t,e cast a! ,a! it to t,e o.erator$$ A..&0 cast i circu&ar (otio uti& t,e w,o&e area is covere! a! (ou&!i' it

!uri' t,e .rocess of a..&icatio "0 t,e .a&($;9$Su..ort t,e cast w,i&e a..&0i' wit, t,e t,eas a! ,0.ot,eas e(ieces$;;$ Ha!&e t,e cast wit, care$

Movi' .atiets or trasferri' wit, wet cast (ust "e avoi!e! as (uc, as

.ossi"&e$ If t,is is ecessar03 care (ust "e ta*e to (aitai t,e ite'rit0 of t,e cast$

T,e e/cess .&aster cast is tri((e! "0 (eas if a tri((i' *ife$ Cast s.i&&e! ot,e s*i is easi&0 re(ove! "0 wi.i' wit, a !a(. c&ot,$

To ,aste !r0i' of t,e cast severa& wa0s ca "e use! e/.osure to o.e air or

e&ectric fa3 e/.osure to ,eat &a(. a! .&aci' t,e .atiet i a war( roo($

Care s,ou&! "e ta*e i .rotecti' t,e .atiet fro( ra.i! !r0i' of t,e cast as

t,is wi&& resu&t to a !r0 outer &a0er w,i&e t,e ier &a0er re(ais wet .reveti'

.eu(oia to !eve&o. a! .reveti' "o!0 f&ui! &oss fro( e/cessive sweati'$

Co(.&aits of !isco(fort s,ou&! "e ivesti'ate! a! a..ro.riate (easures "e 'ive

to "ri' a"out co(fort$

Fiis,i' touc,es o t,e !rie! cast$

E!'es t,at are e/tre(e&0 rou', to "e'i wit,3 s,ou&! "e tri((e! or s(oot,e!

ver0 s&i',t&0$

Rou', e!'es ca "e covere! wit, a!,esive .eta&s3 es.ecia&&0 if t,ere is o

stoc*iette u!ereat, t,e .&aster a! s,eet wa!!i'$

Care for .atiets wit, o cast


38/94

T,e !uratio of *ee.i' t,e "o!0 .art of it i cast is at &east oe (ot,$ It varies

a(o' .atiets$ Factors t,at if&uece t,e !uratio are5

1. A'e of t,e .atiet2. Part of t,e "o!0 affecte!3. T,e !e'ree of i#ur0 or affectio of t,e .art$

H$ Duri' t,e etire .erio! t,at t,e .atiet is i cast t,e "urse res.osi"i&it0 is focuse!

o t,e fo&&owi'5

;$ Neuro4vascu&ar c,ec*s8$ Preservatio of t,e efficiec0 of t,e cast$?$ Maiteace.ro(otio of t,e ite'rit0 of t,e s0ste( of t,e "o!0$@$ Maiteace of t,e c&ea&iess of t,e cast$

I$Neuro4vascu&ar c,ec*s$

I a&& caste! .atiet3 co&our3 (otio3 te(.erature a! sesatio of toes or

fi'ers s,ou&! "e o"serve! ever0 ?9 (iutes for severa& ,ours$ After casta..&icatio3 &o'er if t,ere is (uc, e!e(a3 a! t,e re'u&ar&0 ever0 ? ,ours$

Circu&ator0 i(.air(et resu&ts i s0(.to(s of co&!ess3 e!e(a3 c0aosis3

.ai a! fia&&0 u("ess i t,e toes or fi'ers$ T,e "&ac,i' si' wi&&

i!icate w,et,er or ot t,ere is a a!e>uate circu&atio$ 2,e t,e ai& of t,e

t,u(" or 'reat toes is co(.resse! a! i((e!iate&0 re&ease!3 t,e co&our

s,ou&! 'o fro( w,ite to .i* wit, t,e sa(e s.ee!$ If ot3 t,e circu&atio is &ow

a! t,e toes or fi'ers ee! c&oser o"servatio$

Patiets i ar( a! &e' casts s,ou&! "e a"&e to (ove a! fee& eac, toes

or fi'er3 "ecause t,e sa(e erve !oes ot iervate eac, ot,er$ A&& toes a!

fi'ers s,ou&! "e c,ec*e!$

NERVE FUNCTION TEST

Nerve Actio "0 t,e Nurse4Test

for Sesor0 Fuctio

Actio "0 t,e Patiet Test

for Motor Fuctio

Ra!ia& Pric* we" .art "etwee

t,u(" a! i!e/ fi'er

H0.er e/te! t,e t,u("$

Me!ia Pric* !ista& surface of

i!e/ fi'er

O..ose t,u(" a! &itt&e

fi'er3 f&e/ wrist-&ar Pric* !ista& a! of s(a&&

fi'er

A"!uct a&& fi'er

Peroea& Pric* &atera& surface of

'reat seco!s toes

Dorsif&e/ a*&e e/te!

toesTi"ia& Priv* (e!ia& a! &atera&

surface of so&e of foot$

P&atar f&e/ a*&e a! f&e/

of toes$

PLASTER CAST FOR UPPER EXTREMETIES


39/94

SHORT AND CIRC-LAR CAST

M-ENSTER CAST


40/94

LONG ARM CIRC-LAR CAST

SHO-LDER SPICA

CAST FOR THE LOWER EXTREMETIES


41/94

SHORT LEG CIRC-LAR CAST LONG LEG CIRC-LAR CAST

2AL6ING CAST NIGHT SPLINT


42/94

PATELLAR TENDON BEARING CAST

J-ADRILATERAL CAST

SPICA TYPE

Si'&e S.ica ; HIP SPICA


43/94

DO-BLE HIP SPICA

PANTALON CAST


44/94

FROG CAST

J. Psych!"#c$! #%&!#c$'#( $() "#(" h%* #( c$s'.

To re&ieve .atiets a..re,esios a! a/ieties t,at crow! t,eir (i!s wit, t,eir cast

o3 t,e urse ca ,e&. t,e .atiet (a*e a start towar! reso&vi' so(e t,e .ro"&e( "0

,e&.i' t,e( "eco(es or re(ai as i!e.e!et as .ossi"&e$

Istructio re'ar!i'3 cast care ee! to "e receive! a! .atiet "e re(i!e! t,at

fre>uet rest .erio! for t,e etire "o!0 are ecessar0$ Discussi' .&as wit, t,e .atiet

"efore !isc,ar'e wi&& (a*e t,e trasitio fro( t,e ,os.ita& to aot,er faci&it0 (uc,

s(oot,er a!! to ,er .eace of (i!$

+. T,-(#(" P$'#*(' #( C$s'

Turi' a caste! tru* a! &ower e/tre(ities (ust "e !oe carefu&&0$ T,e .atiet (ust

"e &iste! a! ot ro&&e! or !u(.e!$ Su..ort s,ou&! "e .rovi!e! to t,e ecase! .art a!

t,e w,o&e "o!0$T,e first c,a'i' of t,e .atiets .ositio is !e.e!et o t,e co!itio of t,e case a!

t,e "o!0 area ivo&ve!$ T,e first turi' usua&&0 is to !r0 t,e .osterior surface of t,e

cast as we&& as to .rovi!e co(fort a! .rotect .atiets a'aist res.irator0 co(.&icatio$

T,ere s,ou&! "e o atte(.t to tur t,e .atiet a&oe if oe esti(ates t,at oe .,0sica&&0

ua"&e wit,out t,e .atiets assistace$

;$ Turi' Patiets i Hi. S.ica ;

a$ Su.ie to &atera&$

2it, 84? (e("ers wor*i' to'et,er t,e .atiet is 'et&0 .u&&e! towar! t,e

uaffecte! si!e$ Me("er re(ais o t,is si!e to 'ive t,e .atiet t,e sese of

securit0 w,i&e t,e ot,er (e("ers (oves to t,e o..osite si!e of t,e "a!

w,ere t,e affecte! &e' is to arra'e t,e .i&&ow a&o' t,e etire &e't, of t,e

caste! &e'$"$ Su.ie to .roe

Oe (e("er .&aces ,is ,a!s o t,e .atiets s,ou&!er a! ,i.s3 w,i&e t,e

ot,er su..orts t,e t,i',s a! e/tre(ities$ T,e (e("er of t,e o..osite si!e

.u&&s t,e s,ou&!er a! t,i',s as t,e .atiet is 'et&0 ease! o ,is for($ After

t,e .atiet ,as "ee ture! .oits to "e o"serve! are5

;$ Toes4 s,ou&! ot !i. a'aist t,e (attress8$ Bo!0 sectio of t,e cast4.&aster s,ou&! ot .ress t,e "ac*3 c,est a!

a"!o(e$?$ Hee&s s,ou&! (aitaie! i correct a'u&atios a! s,ou&! "e a&&owe! to

e/te! "e0o! (attress3c$ P&aci' Patiet o t,e Be!.a


45/94

I t,e "owe& or "&a!!er e&i(iatio t,e "uttoc*s s,ou&! "e &ower t,a t,e

,ea! a! towar! t,e "reast$ T,is ca "e ac,ieve! "05

;$ E&evati' t,e ,ea! .art s&i',t&0 a! .&aci' a s(a&& .i&&ow u!er t,e "ac*

of t,e .atiet$

8$ P&aci' a fo&!e! c&ot, o t,e .osterior as.ect of t,e "e!.a wi&& a"sor"(oisture a! t,is .revets s.oi&i' t,e cast$

A!u&t .atiets are usua&&0 .&ace! i t,eir 'oo! si!e first$ T,e "e!.a is .&ace! so

t,at t,e "uttoc*s are o t,e .osterior sectio of t,e "e!.a$ Pi&&ows3 "&a*ets are t,e

arra'e! to su..ort t,e &e's a! "ac* so t,at t,ere wi&& "e o f&ow$

If t,e .atiet ca su..ort ,i(se&f "0 &ifti' ,i(se&f wit, t,e ai! of t,e over,ea!

tra.a3 t,e "e!.a i s&i..e! u!er t,e "uttoc*s$

B&a!!er3 "owe& e&i(iatio i c,i&!re wit, ,i. s.ica if .&ace! i ,ea!"oar! fra(e

is ot !ifficu&t if t,e "e!.a is *e.t costat&03 i t,e s.ica u!er t,e "uttoc*s$

Istru(et for cast re(ova&

;$ Cast cutter (aua&3 e&ectric8$ S.rea!er?$ Tri((i' *ife@$ Ba!a'e scissors$ P&aste sears

Poits to re(e("er5

;$ After t,e cast is re(ove!3 su..ort t,e .art wit, .i&&ows (aitaii' t,e sa(e

.ositio t,at e/iste! i t,e cast38$ Move t,e e/tre(it0 'et&0$?$ O"serve t,e s*i for a0 a"rasios a! .&aste sore$

@$ Mas* s*i wit, (i&! soa. fo&&owe! "0 a..&icatio of oi& or &ao&i$

I$ 6i!s of Cast3 its i!icatio a! w,at to o"serve


46/94

A. CAST FOR THE UPPER EXTREMITIES

6i!s of Cast I!icatio 2,at to o"serve Re(ar*s

S,ort ar( circu&ar

cast

Affectio of t,e

wrist of t,e fi'er

;$Si's if i(.aire!5

Circu&atio o fi'ers

suc, as5

a$ C0aosis of t,e

s*i$"$ Co&!ess of t,e

s*i$c$ Loss of fuctio$!$ Nu("ess$

e$ P&u&se&essessf$ Severe .ai'$ Mar*e! swe&&i'

;$Avoi! isertios

of forei' "o!ies i

t,e east$

8$Avoi! soi&i' t,e

cast

?$Re.orts for si's

of crac*s a!

wea*ess of t,e

cast$

@$Maitai .ro.er

a&i'(et of caste!

e/tre(ities$Lo' ar( circu&ar

cast

Affectios of t,e

ra!ius4u&a

8$Nerve !a(a'e !ue to

.ressure o t,e erve as

it .asses over t,e "o!0

.ro(ieces5

a$ Pai icreasi' i

.ersistece a!

&oca&ie!$"$ Aaest,esia a!

u("ess$c$ Fee&i' of !ee.

.ressure$!$ Parest,esiae$ Motor wea*ess

.ara&0sis$

$Pro.er su..ort of

cast$

Ha'i' cast Fracture of t,e

ec* of t,e

,u(erus

?$Ifectios3 tissue3

ecrosis !ue to s*i

"rea*!ow$

a$ Must03 u.&easat

o!or over t,e cast

or e!'es of t,e

cast is w,at to

o"serve$"$ Draia'e t,rou',

t,e cast or


47/94

wi!ous$c$ Su!!e

ue/.&aie! rise

i "o!0

te(.erature$

!$ Hot s.ot fe&t ocast over &esio$

Fuesters cast Fractures if t,e

ra!ius4u&a wit,

ca&&us for(atio$

@$Pressure o t,e

a/i&&ae3 e&"ows3 wrists3

(etacar.a& a! i&iac

orestS,ort ar( .osterior

(o&!$

Affectios of t,e

wrist a! fi'er

wit, ifectio or

o.e wou!$

Lo' ar( .osterior(o&!

Affectios of t,era!ius a! u&a

wit, ifectio a!

o.e wou!s$Su'ar To' Affectios of t,e

s,ou&!er u..er

.ortio of t,e

,u(erus wit,

ifectio a! o.e

wou!$A"!uctio S.&it Fracture t,e ec*

of t,e ,u(erus$

. CAST OF THE LOWER EXTREMITIES

6i!s of Cast I!icatio 2,at to o"serve Re(ar*s

Boot cast4 s,ort &e'

circu&ar cast

Affectio of a*&e

a! toes$

;$O"serve for

i(.aire! circu&atio

as (aifeste! "05

a$ C0aosis or

"&uis,

!isco&oratio of

t,e s*i"$ Co&!ess of

;$Avoi! isertio of

forei' "o!ies i t,e

cast

8$ Avoi! soi&i' of

t,e cast

?$ Re.ort for si's

a! wea*ess of t,e

cast$


48/94

sesatioc$ Less fuctio

of t,e affecte!

e/tre(it0!$ Nu("ess

e$ A"sece of.u&se

f$ Mar*e!

swe&&i'

@$ Maitai .ro.er

a&i'(et of cast

e/tre(ities

$ Pro.er su..ort of

cast$

2ac*i' cast Affectio of t,e

a*&e wit, ca&&us

for(atio

8$Nerve !a(a'e !ue

to .ressure o t,e

erve as it .asses

over t,e "o0

.ro(iece

a$ icreasi'3

.ersistat&oca&ie! .ai$

"$ Nu("ess i

t,e e/tre(it0c$ Fee&i' of

!ee. .ressure!$ Parest,esiae$ Motor

wea*ess or

.ara&0sis$

P$T$B$4 Pate&&arTe!o Beari'

cast$

s,aft ti"ia a!fi"u&a wit, ca&&us

for(atio$

?$Ifectios3 tissueacross !ue to s*i

"rea*!ow$

a$Must03 u.&easat

o!or over t,e cast or

e!'es of t,e cast$Lo' &e' circu&ar

cast

Fracture ti"ia fi"u&a "$ Draia'e t,rou',

cast or wi!ows$Jua!ri&atera& cast or

Isc,ia& wi',t "eari'

cast

of t,e s,aft of

t,e fe(ur wit,

ca&&us for(atio

c$ Su!!e

ue/.&aie! rise i

t,e "o!0C0&i!rica& cast of t,e .ate&&a !$ ,ot s.ot fe&t oS,ort &e' .osterioir

(o&!

Affectios of t,e

a*&e a! toes wit,

ifectios a! o.e

wou!s

cast over t,e &esio$

e$ .ressure o t,e

'rois3 *ee a*&e

a! (etatarsa&s$Lo' &e's .osterioir Affectios of ti"ia4


49/94

(o&! fi"u&a wit, ifectio

a! o.e wou!sNi',t s.&it Post4.o&ioS.ica t0.e cast5

Ic&u!e t,e tru* 7

oe or "ot, u..era! &ower

e/tre(ities s,ou&!er

s.ica$

Affectio of

s,ou&!er #oit a!

u..er .ortio of,u(erus$

;$Si's of res.irator0

!istress$

8$Si's of casts0!ro(e$

?$Si's of i(.aire!

circu&atio$

C. CAST OF TRUN+

Co&&ar Cast Affectios of t,e cervica&

s.ie

;$Si's of res.irator0

!istress$Mierva cast Affectio of t,e u..er

cervica& s.ie

4trau(a

4sco&iosis Potts !isease

8$Si's of cast

s0!ro(e

a$ Pro&o'e!

ausea"$ Re.eate!

vo(iti'c$ A"!o(ia&

!istesio!$ )a'ue

a"!o(ia&

.ai$

e$ A"sece of

"owe& sou!s$Rier #ac*et Sco&iosis ?$Pressures o t,e

s*i3 #aw3 ears3 face3

a/i&&ae3 c&aviscu&ar

area3 aterior su.erior

i&iac crest3 'roi3

"uttoc*s a! a"ove

t,e *ee$Bo!0 cast Affectios of t,e &ower

!orso &u("ar s.ie$

@$-riar0 a! "owe&

!istur"ace$Si'&e Hi.

S.ica

Affectios of t,e ,i. a!

fe(ur$

$Si's of P&aster

Cast$

a$ Itc,iess a!

"uri'

sesatio"$ Severe .ai


50/94

c$ Rise i "o!0

te(.erature$!$ Distur" s&ee.e$ Ni',t cries

a(o' "a"ies

f$ rest&essessFro' Cast Co'eita& ,i. !is&ocatio :$Si's of ifectios

a! tissue ecrosisPata&o Cast Fracture of t,e .e&vic

"oes

INSTRUMENT USED FOR CAST REMOVAL

E!*c'-#c C$s'

C,''*-

H$()

C$s' C,''*-

C$s'

S&-*$)*- C$s' S&-*$)*-


51/94

C$s' +(#/*

C$s' Sc#ss-

CARE OF PATIENT IN TRACTION

I$ Care of Patiet i TractioA$ Tractio (eas t,at a .u&&i' force is a..&ie! to a .art of t,e "o!0 or a

e/tre(it0 w,i&e a coutertractio .u&&s i t,e o..osite !irectio$ I strai',t

or rui' tractio coutertractio is su..&ie! "0 t,e .atiets "o!0 wit,

t,e "e! i oe of t,e fo&&owi' .ositios$

;$ F&at8$ Ti&te! awa0 fro( t,e tractio .u&&?$ A&tere! "0 e&evati' t,e ,ea! a! or *ee 'atc,

B$ Basic t0.es of tractios;$ S*i tractio4 is t,e a..&icatio of a .u&&i' force to t,e s*i fro( w,ere

it is tras(itte! to t,e (usc&es a! t,e to t,e "oes "0 t,e use of5A!,esive t0.e (ateria&E/a(.&e5 Br0at Du&o. Buc*s E/tesio

No4a!,esive t0.e (ateria&s &i*e5 cavas3 s&i's &eat,ers a! stra.s wit,"uc*&es a! &aces

E/a(.&es5 ,ea! ,a&ter tractioHe((oc* sus.esio tractioPe&vic tractio

A*&et tractio


52/94

8$ S*e&eta& tractio < t,e .u&&i' force is a..&ie! !irect&0 to t,e "oe usi'.is a! wires suc, as 6irso,ers wire$ Stei(as .i3 viicis s*u&&retractor a! crutc, fie&! to's$

?$ Maua& tractio < t,e .u&&i' force is a..&ie! "0 t,e ,a!s of t,eo.erator$ It is a te(.orar0 (easure so(eti(es e(.&o0e! i ,a!&i'

ec* i#ur0 w,e a cervica& s.ie is fracture!$ It is a&so use! to a..&0t,e ecessar0 .u&& to a e/tre(it0 w,e cast is "ei' a..&ie!$

C$ Pur.oses of tractio;$ Tractio is ofte use! i t,e treat(et of fracture! e/tre(ities$

a$ To &esse (usc&e s.as("$ To re!uce fracturec$ To .rovi!e i((o"i&iatio!$ To (aitai a&i'(et t,us .rove

8$ Tractio is a&so use! to correct3 &esse or .revet !efor(ities as i t,e

case of art,ritis .atiet wit, f&e/io cotractio or a c,i&! w,o ,assco&iosis a! is .&ace! i tractio to ,e&. &esse t,e curvature of t,es.ice "efore correctio sur'er0 is carrie! out to isert a Har&i'toHo!$

?$ Prior to tota& ,i. re.&ace(et3 sur'eos (a0 a..&0 s*e&eta& tractio3 ia atte(.t to stretc, (usc&es a! o"tai (ore Kwor*i' s.ace wit,it,e #oits$

@$ It &esses (usc&es s.as( i "ac* .ai a! i resti' a !isease! #oitas i tu"ercu&osis$

D$ Prici.&es of tractio < certai .rici.&es (ust "e a!,ere! to if tractio is to"e affective$

Tractio (ust5

;$ Have a o..osite .u&& or coutertractio8$ Be free fro( a0 frictio?$ Fo&&ow a esta"&is,e! &ie of .u&& t,at is t,e &ie of .u&& (ust "e i &ie

wit, t,e !efor(it0@$ Be coti(ious$ Be a..&ie! to a .atiet i a su.ie .ositio

E$ Nursi' i(.&icatio i various tractios a..&icatio

P,0cisias var0 i t,eir (et,o!s of a..&0i' tractio accor!i' ot,e wa0 t,e0 ,ave "ee tau',t3 w,at t,e0 ,ave .ractice! a! w,at t,e0,ave fou! to "e effective a! efficiet$ T,is cotri"utes to (a*i'!ifferece i tractio a..&icatio re'ioa& as we&& as .ersoa&$ I a!!itio,os.ita&s var0 i t,e t0.es of e>ui.(et t,e0 use$

A&& of t,ese (eas t,at t,e urse (ust "e *ow&e!'ea"&e a"out.rici.&es first of a&&3 "efore s,e ca u!ersta! t,e tractio routies of t,e


53/94

,os.ita&s a! staff .,0sicias$ T,e urse (ust u!ersta!s t,e "asic careof a .atiet i tractio$

F$ O"servatios to "e (a!e i cari' for Patiet i Tractio$;$ Patiet is free fro( t,e fo&&owi'5

a$ I(.aire! circu&atio of t,e e/tre(ities"$ Res.irator0 !istressc$ Co!itio of t,e s*i wit, e(.,asis o t,e isc,ia&3 sacra&3 .o.&itea&3

ac,i&&as te!o3 !orsu( of foot3 ,ee&&$!$ Defor(it0 &i*e foot!ro. cotracture of #oit$e$ Si's of ifectio

8$ Boe a&i'(et a! .ositio of e/tre(it0i w,ic, t,e .ur.ose oftractio is "ei' acco(.&is,e!$

?$ Patiets co(fort < tractio s,ou&! ever "e a source of u!ue!isco(fort of t,e .atiet$ Care of s*i3 (out,3 ,air3 ai&s a! toes3

'eita&ia (ust "e ic&u!e! i t,e .&a of !ai&0 care$@$ Provisios of e/ercises

a$ ROM e/ercise of a&& uaffecte! #oits"$ Static >ua!rice.s e/ercisesc$ Dee. "reat,i' a! cou',i' e/ercises!$ F&e/io a! e/tesio of t,e toes3 fi'ers i tractio

$ Provisio of su..ortive t,era.0:$ C,ec*s t,e utritioa& status of t,e .atiet$ Ever0 co(.&ait of t,e .atiets i tractio s,ou&! "e ivesti'ate!=$ C,ec* t,e tractio set4u. for t,e fo&&owi'

a$ C,ec* t,e a..aratus if it is acco(.&is,i' eac, .ur.ose of tractioa! t,at t,e e>ui.(ets are safe as .ossi"&e$

"$ Sas,3 cor!s a! .u&&e0s s,ou&! "e uo"structe!$c$ E/a(ie *ots3 c&a(.s a! wei',ts to "e certai t,e0 are

ti',tee!$!$ Do ot "u(.s t,e "e! a! tractio causi' t,e wei',t to swi'$e$ A&wa0s c,ec* t,e tractio a..aratus after a .atiet ,as (ove! to

(a*e certai t,at t,e .atiet is correct&0 re.ositioe!$

$ Provi!e care to s.ecific t0.e of tractio

a$ Br0at tractio

;$ A..&ie! for tractures of t,e fe(ur3 i#uries to t,e ,i. a(o'c,i&!re "e&ow ? 0ears o&!$

8$ S.ecific o"servatio4 carea$ Positios &eve& "e! two &e's sus.e!e! vertica&&03 ,i.s

f&e/esat ri',t a'&e "uttoc*s ot resti' a'aist (attress$


54/94

"$ C,ec* for .resece of .i(.&es3"&isters a! .uru&et!isc,ar'es o tracte! &e's$

c$ C,ec* for si's of i(.aire! circu&atio of toes!$ S*i tractio su' a! i .&acee$ Pro.er a..&icatio if !ia.er

f$ Provi!e to0s for c,i&!re to .&a0 o$"$ Buc*s e/tesio tractio

;$ I!icatio5 affectios of fe(ur a! ,i.8$ S.ecific o"servatios

a$ Positio4 "e! "r! i tre!e&e"ur', wit, t,e &e's i tractiosu..orte! "0 a Brau s.&it or .i&&ow$

"$ C,ec* toes for si's of i(.aire! circu&atioc$ C,ec* for si's of irritatio a! !isc,ar'e o tracte! &e's!$ Pressure arou! (a&&ea&i a! .e.&itea& re'io a! ,ee&$

e$ S*i tractio su' a! i .&ace$

c$ Russe&4;$ I!icatio5 affectios of fe(ur a! ,i.8$ S.ecific o"servatios

a$ Positio &eve& "e! .i&&ows to su..ort t,e &e's wit, t,e ,i. i89 a'&e fro( t,e "e!$

"$ C,ec*s for si's of i(.aire! circu&atio of toes

c$ Si's of irritatio of !isc,ar'es o t,e isc,ia& tu"erosit03.o.&itea& re'io3 (e&&eo&i a! ,ee&!$ Patiet a&&owe! to sit3 tur a! (ove wa&& w,i&e i tractio

!$ Du&o. tractio5;$ i!icatio5 su.raco!0&ar fracture3 ,u(erus8$ s.ecific o"servatios

a$ .ositio < &eve& "e!3 ti&te! &atera&&0"$ c,ec*s si' of i(.aire! circu&atioc$ c,ec* ra!ia& .u&se of fi'ers!$ c,ec* si's of irritatio "&isters a! .uru&et !isc,ar'es o

tracte! ar(s e$Hea! Ha&ter Tractio

;$ i!icatio5 Cervica& s.ie affectios8$ S.ecifiv o"servatios

a$ Positio4se(i fow&ers"$ C,ec* for si's of res.irator0 !istressc$ C,ec* for si's of irritatio o t,e c,i3 #aw3 face3 a! ear

a! o t,e .osterior .ortio of t,e ,ea!


55/94

!$ C,ec* sesatio of t,e e/tre(itiese$ C,ec* for uriar0 a! "owe& !istur"aces

f$ Pe&vic tractio;$ I!icatio5 affectios of t,e &u("ar s.ie suc, as H$N$P3 &ow "ac*

s0!ro(e

8$ S.ecific O"servatiosa$ Positio < &eve& "e! i s&i',t tre!e&e"ur',"$ C,ec* for si's of irritatio a&o' t,e &u("o4sacra& re'ioc$ Pe&vic stra. (ust ot "e a..&ie! !irect&0 to t,e s*i3

.rovi!e .a!!i' (ateria& "efore a..&0i' stra.!$ C,ec* for free (ove(et of t,e &ower e/tre(it0

'$ Ha((oc* Sus.esio Tractio;$ I!icatio5 affectio of t,e .e&vis re'io affectio8$ S.ecific o"servatios

a$ Positio4 &eve& "e!3 "uttoc*s ot resti' o t,e (attress"$ P&ace .a!!i' (ateria& first "efore a..&0i' t,e ,a((oc*

sus.esio c$ It is a..&ie! ic&u!i' t,e &u("ar s.ie a! (i!4t,i',!$ C,ec* for si's of itraa"!o(ia& i#ur03 uriar0 a! "owe&

!istur"acee$ C,ec* for irritatios o e!'es of t,e ,a((oc* sus.esio

,$S*e&eta& tractio

S*e&eta& tractio is ac,ieve! "0 isertio of a Stei(a .i3

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