APPLYING A CAST.

When applying a cast the physician or nurse practitioner proceeds as follows:

 Support extremity or body part to be casted

 Position and maintain part to be casted in position indicated by physician
during casting procedures
 Drape patient
 Wash and dry part to be casted
 Place knitted materials over part to be casted
 Apply in smooth and unconstrictive manner
o Allow additional material
o Wrap soft non woven roll padding smoothly and evenly around part
with additional padding around bony prominences to protect
superficial nerves
 Apply plaster or nonplaster material on body part
o Chose appropriate width bandage
o Overlap proceeding turn by half the width of bandage
o Use continuous motion maintaining constant contact with body part
o Use additional casting material at joint and at points anticipated
for cast stress

 “Finish” cast
o Smooth edges
o Trim and reshape with cast knife or cutter
o Remove particles of casting material from skin

 Support cast during hardening

o Handle cast with palms of hands
o Support cast on smooth surface
o Do not rest cast on hard or sharp surface
o Avoid pressure on cast
 Promote drying of cast
o Leave cast uncovered and exposed to air
o Turn patient every two hours supporting major joist
o Fans may be used to increase air flow and speed drying

Nursing alert;
1. A patients unrelieved pain must be immediately reported to the physician
to avoid possible paralysis and necrosis
2. The nurse must never ignore complaints of pain from the patient in a cast
because of the possible of potential problems such as impaired tissue
perfusion or ulcer formation.

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 Bivalving of cast.
Bivalving of cast implies cutting a cast in half. This can be done to control
swelling or promote circulation.

Home care for a patient with a cast.

The role of a nurse as a care giver is to provide a home care teaching program.
The following information needs to be provided;

 The description of techniques used to promote cast drying

o Do not cover cat immediately
o Leave cast exposed to air drying
o Do not handle damp plaster cast with palms of hands
o Do not rest cast on hard surface or sharp edges

 Description of approaches to control swelling and pain

o Elevated casted limb to heart level
o Apply intermittent ice packs as prescribed
o Give analgesics as prescribed
 Report pain uncontrolled by elevating the casted limb and analgesia as
this may be an indication of impaired tissue perfusion, compartment
syndrome, or pressure ulcer.
 Patient should be able to demonstrate transfer ability from bed to a chair
 Patient should be able to use mobility aids safely
 Avoid excessive use of injured extremity
 Manage minor irritability from casts such as irritation from cast edge
 Demonstrate exercises t promote circulation and minimize disuse
syndrome

 State indicators for complications such as uncontrolled swelling, pain, cold

fingers parathesia paralysis purulent discharge staining cast, systemic
infections and breaking casts .

Guidelines for removing a cast

 Inform the patient about the procedure

 Reassure the patient that the electric saw or cutter will not cut the skin
 Wear eye protectors
 Bivalve the cast using a series of alternating pressures and linear
movements of bade along the line of cut
 Cut padding with scissors

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  Support body part as it is being removed from cast
 Gently wash and dry the limb that has been immobilized
 Apply lotion
 Teach patient to avoid rubbing and scathing
 Teach patient to control swelling by elevating extremity or using elastic
bandage if prescribed.

Specific cast management

Arm cast.

A patient whose arm has been immobilized in a cast must readjust to many
routine tasks. The unaffected arm must assume all the upper extremity activities.
The nurse in consultation with the occupational therapist advises the patient on
devices designed to aid one handed activities. The patient may experience
fatigue due to modified activities and the weight of the cast there fore frequent
rest periods will be advised
To control swelling the nurse advices elevation of immobilized arm. When the
patient is lying down the arm is elevated s that each joint is positioned higher
the preceding proximal joint. {E.g. elbow higher than the shoulder, hand higher
than the elbow} a sling may be used when the patient is ambulant

Leg cast

The application of leg cast imposes a great degree of immobility on the patients.
The cast may be long or short cast extending to the knee or groin. Fresh cast
must be handed in a manner that will not cause denting or disruption of cast
The nurse supports patient’s leg on pillows to hear to level to control swelling
and applies ice packs a prescribed over the site for 1 or 2 days. The patient is
taught to elevate the casted leg when seated the patient should also assume a
recumbent position several times a day with the casted leg elevated to promote
venous return and control selling
The nurse assesses circulation by observing colour temperature and capillary
refill to the exposed toes. Nerve function is assessed observing movement of the
toes and asking about sensation in the toes. in numbness tingling and burning
sensation which could be caused by perinea nerve damage from pressure at the
head of fibula

 Nursing alert.
Injury t the pineal nerve as a result of pressure is the cause of foot drop
{inability to maintain foot on the normal position} consequently the patient drags
the foot when walking.

3
Body spica casts

These are cast that encase the body truck {Body casts }and potions of one or
two extremities require special nursing strategies .Body spica are used to
immobilize the spine .Hip spica casts are used for hip joint surgeries and
shoulder spica casts are use for some humeral neck fractures .

Splints

A splint a rigid support to hold broken bone in position until healing has
occurred. Contoured splints of plaster or pliable thermostatic materials may be
used for conditions that do not require rigid immobilization i.e.
 for those in which swelling is anticipated
 for those that require special skin care.

The splint needs to immobilize and support a body part in a functional position.
It must be well padded to prevent pressure from abrasion and skin break down.
It is over wrapped with an elastic bandage applied in a spiral fashion and with
pressure uniformly distributed so that circulation is not restricted

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Traction

Introduction

Traction is the application of a pulling force to part of the body .Traction is used
to minimize muscle spasms to reduce, align and immobile space between
opposing surfaces. Traction must be applied in the direction and magnitude to
obtain its therapeutic effects. As muscle and soft tissue, relax the amount of
weight desired may be changed to obtain the desired effect.
At times traction needs to be applied I more than one direction t achieve the
desired line of pull when this done one of the lines of pull counteracts the other.
These lines of pull are known as the vectors of force. The actual resultant pulling
force is somewhere between the two lines of pull.
Traction primary used as a short term intervention until other modalities such a
external or internal fixation, are possible. This reduces the risk of disuse
syndrome and minimizes the length of hospitalization often allowing the patient
to be cared for at home.

Definition

Traction is force applied by weights or other devices to treat bone or muscle

disorders or injuries.

Purpose

Traction treats fractures, dislocations, or muscle spasms in an effort to correct

deformities and promote healing.

Types of Traction.

There are several types of traction. i.e.

 Straight Traction
 Balanced suspension Traction

Straight traction also called running traction applies force in a straight line with
the body part resting on the bed. Buck’s Traction is an example of a straight
Traction.

A Balanced suspension traction supports the affected the effected extremity off
the bed and allows and allows for some patient movement without disrupting the
line of pull.

5
Description/Methods

Traction is referred to as a pulling force to treat muscle or skeletal disorders.

There are two major types/methods of traction: skin and skeletal traction,
within which there are a number of treatments.

Traction may be applied to the skin. This is called skin traction.

Or it may be applied directly to the bone. This is called skeletal traction.
Traction can be applied with hands this is usually temporal and it is called
Manual traction.

Skin traction

 Skin traction includes weight traction, which uses lighter weights or

counterweights to apply force to fractures or dislocated joints. Weight
traction may be employed short-term, (e.g., at the scene of an accident)
or on a temporary basis (e.g., when weights are connected to a pulley
located above the patient's bed). The weights, typically weighing five to
seven pounds, attach to the skin using tape, straps, or boots. They bring
together the fractured bone or dislocated joint so that it may heal
correctly.
 Skin traction also refers to specialized practices, such as Dunlop's traction,
used on children when a fractured arm must maintain a flexed position to
avoid circulatory and neurological problems. Buck's skin traction stabilizes
the knee, and reduces muscle spasm for knee injuries not involving
fractures. In addition, splints, surgical collars, and corsets also may be
used.

 Skin traction is usually used to control muscle spasm and to immobilize an

area before surgery.
This is achieved by using a weight to pull on traction tape. The amount of weight
must not exceed the tolerance of the skin.
i.e. no more than 2kgs to 3.5 kgs can be used on the extremity.

Buck’s Extension traction

This is skin traction to the lower leg. It can unilateral or bilateral. The pull is
exerted in one plain. It is used to provide immobility in fractures of the femur
before surgical fixation is done.
To apply Buck’s traction, the nurse inspects the skin for abrasions and circulation
and assess if it can tolerate the traction.
She then elevates and supports the limb under the heel and knee while the other
nurse secures the Velcro straps around the leg. A foam boot is put on the leg or
heel where the spreader or footplate is fixed. Elastic tape is applied in a spiral

6
fashion avoiding excessive pressure over the bony prominences to avoid nerve
damage. A pulley is attached with a weight of usually 2kgs.

Skeletal Traction

 Skeletal traction is applied directly to the bone this method is used to

occasionally treat fractures of the femur, the tibia and cervicle spine.
The traction applied directly by use o f a metal pin or wire called Steinman’s
wire pin Kirsirchner wire that is inserted through the bone distal to the fracture
avoiding nerves ,blood vessels, muscles tendons and joints.

 Skeletal traction requires an invasive procedure in which pins, screws, or

wires are surgically installed for use in longer term traction requiring
heavier weights. This is the case when the force exerted is more than skin
traction can bear, or when skin traction is not appropriate for the body
part needing treatment. Weights used in skeletal traction generally range
from 25–40 lbs (11–18 kg). It is important to place the pins correctly
because they may stay in place for several months, and are the hardware
to which weights and pulleys are attached. The pins must be clean to
avoid infection. Damage may result if the alignment and weights are not
carefully calibrated.

Other forms of skeletal traction are tibia pin traction, for fractures of the pelvis,
hip, or femur; and overhead arm traction, used in certain upper arm fractures.
Cervical traction is used when the neck vertebrae are fractured.

Traction

Introduction

Traction is the application of a pulling force to part of the body .Traction is used
to minimize muscle spasms to reduce, align and immobile space between
opposing surfaces. Traction must be applied in the direction and magnitude to
obtain its therapeutic effects. As muscle and soft tissue, relax the amount of
weight desired may be changed to obtain the desired effect.
At times traction needs to be applied I more than one direction t achieve the
desired line of pull when this done one of the lines of pull counteracts the other.
These lines of pull are known as the vectors of force. The actual resultant pulling
force is somewhere between the two lines of pull.

7
Traction primary used as a short term intervention until other modalities such a
external or internal fixation, are possible. This reduces the risk of disuse
syndrome and minimizes the length of hospitalization often allowing the patient
to be cared for at home.

Definition

Traction is force applied by weights or other devices to treat bone or muscle

disorders or injuries.

Purpose

Traction treats fractures, dislocations, or muscle spasms in an effort to correct

deformities and promote healing.

Types of Traction.

There are several types of traction. i.e.

 Straight Traction
 Balanced suspension Traction

Straight traction also called running traction applies force in a straight line with
the body part resting on the bed. Buck’s Traction is an example of a straight
Traction.

A Balanced suspension traction supports the affected the effected extremity off
the bed and allows and allows for some patient movement without disrupting the
line of pull.

Description/Methods

Traction is referred to as a pulling force to treat muscle or skeletal disorders.

There are two major types/methods of traction: skin and skeletal traction,
within which there are a number of treatments.

Traction may be applied to the skin. This is called skin traction.

Or it may be applied directly to the bone. This is called skeletal traction.
Traction can be applied with hands this is usually temporal and it is called
Manual traction.

Skin traction

8
  Skin traction includes weight traction, which uses lighter weights or
counterweights to apply force to fractures or dislocated joints. Weight
traction may be employed short-term, (e.g., at the scene of an accident)
or on a temporary basis (e.g., when weights are connected to a pulley
located above the patient's bed). The weights, typically weighing five to
seven pounds, attach to the skin using tape, straps, or boots. They bring
together the fractured bone or dislocated joint so that it may heal
correctly.
 Skin traction also refers to specialized practices, such as Dunlop's traction,
used on children when a fractured arm must maintain a flexed position to
avoid circulatory and neurological problems. Buck's skin traction stabilizes
the knee, and reduces muscle spasm for knee injuries not involving
fractures. In addition, splints, surgical collars, and corsets also may be
used.

 Skin traction is usually used to control muscle spasm and to immobilize an

area before surgery.
This is achieved by using a weight to pull on traction tape. The amount of weight
must not exceed the tolerance of the skin.
i.e. no more than 2kgs to 3.5 kgs can be used on the extremity.

Buck’s Extension traction

This is skin traction to the lower leg. It can unilateral or bilateral. The pull is
exerted in one plain. It is used to provide immobility in fractures of the femur
before surgical fixation is done.
To apply Buck’s traction, the nurse inspects the skin for abrasions and circulation
and assess if it can tolerate the traction.
She then elevates and supports the limb under the heel and knee while the other
nurse secures the Velcro straps around the leg. A foam boot is put on the leg or
heel where the spreader or footplate is fixed. Elastic tape is applied in a spiral
fashion avoiding excessive pressure over the bony prominences to avoid nerve
damage. A pulley is attached with a weight of usually 2kgs.

Skeletal Traction

 Skeletal traction is applied directly to the bone this method is used to

occasionally treat fractures of the femur, the tibia and cervicle spine.
The traction applied directly by use o f a metal pin or wire called Steinman’s
wire pin Kirsirchner wire that is inserted through the bone distal to the fracture
avoiding nerves ,blood vessels, muscles tendons and joints.

 Skeletal traction requires an invasive procedure in which pins, screws, or

wires are surgically installed for use in longer term traction requiring
heavier weights. This is the case when the force exerted is more than skin

9
 traction can bear, or when skin traction is not appropriate for the body
part needing treatment. Weights used in skeletal traction generally range
from 25–40 lbs (11–18 kg). It is important to place the pins correctly
because they may stay in place for several months, and are the hardware
to which weights and pulleys are attached. The pins must be clean to
avoid infection. Damage may result if the alignment and weights are not
carefully calibrated.

Other forms of skeletal traction are tibia pin traction, for fractures of the pelvis,
hip, or femur; and overhead arm traction, used in certain upper arm fractures.
Cervical traction is used when the neck vertebrae are fractured.

For tibial traction, a pin is surgically placed in the lower leg (A). The pin is
attached to a stirrup (B), and weighted (C). In cervical traction, an incision is
made into the head (D). Holes are drilled into the skull, and a halo or tongs are
applied (E). Weights are added to pull the spine into place (F). (

Proper care is important for patients in traction. Prolonged immobility should be

avoided because it may cause bedsores and possible respiratory, urinary, or
circulatory problems. Mobile patients may use a trapeze bar, giving them the

10
option of controlling their movements. An exercise program instituted by
caregivers will maintain the patient's muscle and joint mobility. Traction
equipment should be checked regularly to ensure proper position and exertion of
force. With skeletal traction, it is important to check for inflammation of the
bone, a sign of foreign matter introduction (potential source of infection at the
screw or pin site).

Preparation

Principles of effective Traction.

When ever traction is applied counter- traction must be used to achieve effective
traction. Counter- traction must be used to achieve effective traction. Counter
traction is force acting in the opposite direction. Usually the patient body weight
and bed position adjustment supply the needed counter traction.

 Traction must be continuous to be effective in reducing and immobilizing

fractures.
 Skeletal traction should never be interrupted
 The weights should not be removed unless intermittent traction is
prescribed
Any factor that might alter the resultant pull must be eliminated, e.g.
1. Patient must be in a good body alignment in the center of the bed
when traction is in effect.
2. The ropes must not be interrupted.
3. The weights must hang freely and not rest on the bed or floor
4. The knots in the rope must not touch the pulley or the foot of the
bed.

Both skin and skeletal traction require x rays prior to application. If skeletal
traction is required, standard pre-op surgical tests are conducted, such as blood
and urine studies. X rays may be repeated over the course of treatment to insure
that alignment remains correct, and that healing is proceeding

11
For tibial traction, a pin is surgically placed in the lower leg (A). The pin is
attached to a stirrup (B), and weighted (C). In cervical traction, an incision is
made into the head (D). Holes are drilled into the skull, and a halo or tongs are
applied (E). Weights are added to pull the spine into place (F). (

Proper care is important for patients in traction. Prolonged immobility should be

avoided because it may cause bedsores and possible respiratory, urinary, or
circulatory problems. Mobile patients may use a trapeze bar, giving them the
option of controlling their movements. An exercise program instituted by
caregivers will maintain the patient's muscle and joint mobility. Traction
equipment should be checked regularly to ensure proper position and exertion of
force. With skeletal traction, it is important to check for inflammation of the
bone, a sign of foreign matter introduction (potential source of infection at the
screw or pin site).

Preparation

Principles of effective Traction.

12
When ever traction is applied counter- traction must be used to achieve effective
traction. Counter- traction must be used to achieve effective traction. Counter
traction is force acting in the opposite direction. Usually the patient body weight
and bed position adjustment supply the needed counter traction.

 Traction must be continuous to be effective in reducing and immobilizing

fractures.
 Skeletal traction should never be interrupted
 The weights should not be removed unless intermittent traction is
prescribed
Any factor that might alter the resultant pull must be eliminated, e.g.
1. Patient must be in a good body alignment in the center of the bed
when traction is in effect.
2. The ropes must not be interrupted.
3. The weights must hang freely and not rest on the bed or floor
4. The knots in the rope must not touch the pulley or the foot of the
bed.

Both skin and skeletal traction require x rays prior to application. If skeletal
traction is required, standard pre-op surgical tests are conducted, such as blood
and urine studies. X rays may be repeated over the course of treatment to insure
that alignment remains correct, and that healing is proceeding

13