chapter 40
body casts and spica casts typically stay on for how long ?
4-6 weeks
Stresses to the new hip joint should be avoided for the first ? weeks, when the risk of dislocation is greatest.
8 to 12 weeks
Open Reduction Internal Fixation (ORIF)
An open reduction involves a surgical dissection for the visualization of the bone ends and fragments.A metal plate and screws are used to correct and stabilize the fracture through internal fixation.
When is open reduction required?
An open reduction is required when soft tissue is caught between the ends of the broken pieces of bone, the bone has a wide separation, open fractures are evident, comminuted fractures are present, and the patella or other joints are fractured. It is also done when wound debridement or internal fixation is needed.
what is the most serious complication of casting and splinting?
Compartment syndrome—occurs when increased pressure within a confined space (e.g., cast, muscle compartment) compromises blood flow and tissue perfusion
signs and symptoms of dislocation of the prosthesis, which include:
Increased pain at the surgical site, swelling, and immobilization Acute groin pain in the affected hip or increased discomfort Shortening of the affected extremity Abnormal external or internal rotation of the affected extremity Restricted ability or inability to move the leg Reported "popping" sensation in the hip
what is the cause of footdrop (the inability to maintain the foot in a normally flexed position).
Injury to the peroneal nerve as a result of pressure, Consequently, the patient drags the foot when ambulating.
What is Ilizarov fixation ?
It is a specialized type of external fixator consisting of numerous wires that penetrate the limb and are attached to a circular metal frame. This device is used to correct angulation and rotational defects, to treat nonunion (failure of bone fragments to heal), and to lengthen limbs. The device gently pulls apart the cortex of the bone and stimulates new growth through daily adjustment of the telescoping rods.
What are the long term complications of total hip arthroplasty?
Long-term complications include heterotopic ossification (formation of bone in the periprosthetic space), avascular necrosis, and loosening of the prosthesis.
The physiological component of cast syndrome:
Superior mesenteric artery syndrome-is a digestive condition that occurs when the duodenum (the first part of the small intestine) is compressed between two arteries (the aorta and the superior mesenteric artery). This compression causes partial or complete blockage of the duodenum.
T OR F, The nurse never adjusts the clamps on the external fixator frame.
TRUE: It is the primary provider's responsibility to do so.
The psychological component of cast syndrome:
The patient exhibits an acute anxiety reaction characterized by behavioral changes and autonomic responses (e.g., increased respiratory rate, diaphoresis, dilated pupils, increased heart rate, elevated blood pressure).
what are major symptoms of fat emboli syndrome that may occur w/orthopedic surgery?
These major symptoms are referred to as the classic triad and include respiratory distress (dyspnea, tachypnea, and hypoxemia), onset of delirium or any acute change in level of consciousness and development of a petechial rash in the conjunctiva, oral membranes, axillae, neck, or anterior chest
Is traction a short term or long term intervention ?
Traction is used primarily as a short-term intervention until other modalities, such as external or internal fixation, are possible. These modalities reduce the risk of disuse syndrome and minimize hospital lengths of stay, often allowing the patient to be cared for in the home setting.
T OR F, The nurse must inspect the pin site at least every 8 hours for signs of inflammation and evidence of infection.
True
how are the effects of traction evaluated?
Xray studies
splint
a device used to immobilize body parts
For the first 48 hours after pin insertion, the site is covered with:
a sterile absorbent nonstick dressing and a rolled gauze or Ace-type bandage.
what are The "6 Ps" indicative of symptoms of neurovascular compromise ?
are pain, poikilothermia (i.e., takes on the surrounding enviorment temperature), pallor, pulselessness, paresthesia, and paralysis
external fixator
are used to manage Complicated fractures of the humerus, forearm, femur, tibia, and pelvis are managed with external skeletal fixators. They are also used to correct defects, treat nonunion, and lengthen limbs. The fixator provides skeletal stability for severe comminuted (crushed or splintered) fractures while permitting active treatment of extensive soft tissue damage
Braces:
are used to provide support, control movement, and prevent additional injury. They are custom-fitted to various parts of the body; thus, they tend to be indicated for longer-term use than splints.
3 main groups of casts:
arm casts, leg casts, and body or spica casts
What is the concern following the application of an immobilization device?
assessment and prevention of neurovascular dysfunction or compromise of the affected extremity
Neurovascular assessments include:
assessment of peripheral circulation, motion, and sensation of the affected extremity, assessing the fingers or toes of the affected extremity, and comparing them with those of the opposite extremity.
sling
bandage used to support an arm
avascular necrosis
death of tissue due to insufficient blood supply
the nurse should elevate the extremity so that it is above the level of the heart during the first 24 to 48 hours post-application of immobilization device to:
enhance arterial perfusion and control edema
The nurse should monitor the neurovascular status of a patient with and external fixator:
every 2-4 hours
How frequently should assessments be performed for the application of a immobilization device?
every hour for the first 24 hours and every 1 to 4 hours thereafter to prevent neurovascular compromise related to edema and/or the device.
Meniscectomy refers to the
excision of damaged joint fibrocartilage.
the surgical insertion of pins through the skin and soft tissues into and through the bone. A metal external frame is attached to these pins and is designed to hold the fracture in proper alignment to enable healing to occur
external fixation involves:
fiberglass casts:
fiberglass casts are light and stronger, water resistant and dry within 30 minutes
osteomyelitis
infection of the bone
skeletal traction :.
is often used when continuous traction is desired to immobilize, position, and align a fracture of the femur, tibia, and cervical spine. It is used when traction is to be maintained for a significant amount of time, when skin traction is not possible, and when greater weight (11 to 18 kg [25 to 40 lb]) is needed to achieve the therapeutic effect.
disuse syndrome
is the deterioration of body systems as a result of prescribed or unavoidable musculoskeletal inactivity
total hip arthroplasty
is the replacement of a severely damaged hip with an artificial joint.Indications for this surgery include osteoarthritis, rheumatoid arthritis, femoral neck fractures (i.e., hip fracture), failure of previous reconstructive surgeries, such as a failed prosthesis with osteotomy (surgical cutting of the bone), and conditions resulting from developmental dysplasia or Legg-Calvé-Perthes disease (avascular necrosis of the hip in childhood)
osteolysis
lysis of bone from inflammatory reaction against polyethylene particulate debris
Skin traction (Buck's traction)
may be prescribed for short-term use to stabilize a fractured leg, control muscle spasms, and immobilize an area before surgery. The pulling force is applied by weights that are attached to the client with Velcro, tape, straps, boots, or cuffs. The amount of weight applied must not exceed the tolerance of the skin. No more than 2 to 3.5 kg (4.5 to 8 lb) of traction can be used on an extremity. Pelvic traction is usually limited to 4.5 to 9 kg (10 to 20 lb), depending on the weight of the patient.
heterotopic ossification
misplaced formation of bone
trapeze
overhead assistive device to promote patient mobility in bed
Skeletal traction involves:
passing a metal pin or wire (e.g., Steinmann pin, Kirschner wire) through the bone (e.g., proximal tibia or distal femur) under local anesthesia, avoiding nerves, blood vessels, muscles, tendons, and joints. Traction is then applied using ropes and weights attached to the end of the pin.
Plaster casts:
plaster casts are heavy, can not get wet, and take up to 3 days to dry.
cast syndrome
psychological (claustrophobic reaction) or physiologic (superior mesenteric artery syndrome) responses to confinement in body cast and can occur weeks or months after the cast has been applied
Joint arthroplasty
refers to the surgical removal of an unhealthy joint and replacement of joint surfaces with metal or synthetic materials
Cast
rigid external immobilizing device molded to contours of body part
Splints are often used for :
simple and stable fractures, sprains, tendon injuries, and other soft tissue injuries
osteotomy
surgical cutting of bone
After skin traction is applied how frequently should the nurse assess circulation of the foot?
the nurse assesses circulation of the foot within 15 to 30 minutes and then every 1 to 2 hours. Circulatory assessment consists of: Peripheral pulses, color, capillary refill, and temperature of the fingers or toes. Manifestations of deep vein thrombosis (DVT), which include unilateral calf tenderness, warmth, redness, and swelling. The nurse also encourages the patient to perform active foot exercises every hour when awake.
The exothermic reaction during PLaster cast application has the potential:
to cause serious burns
T OR F, prophylactic broad-spectrum antibiotics given 60 minutes prior to skin incision and discontinued within 24 hours postoperatively are effective in preventing surgical site infections
true
traction
uses a pulling force to promote and maintain alignment to an injured part of the body. The goals of traction include decreasing muscle spasms and pain, realignment of bone fractures, and correcting or preventing deformities.