FRACTURES

• Fracture: break in the continuity of bone, usually accompanied by

localized tissue response and muscle spasm.
 Etiology: usually cause by trauma, but can also be pathologic
(osteoporosis, multiple myeloma, bone tumor) which weaken the
bone structure.
 Causes:
1. In normal bones, fractures occurs when more stress is placed
upon a bone that is able to absorb such as:
a. Direct force or crushing force
b. Twisting force
c. Powerful contraction
d. Fatigue and stress

2. Pathologic Decay: bones weakened by disease or tumors and

subject to pathologic fractures. e.g.: Bone cancer, osteoporosis
 FRACTURES (cont…)
 Classification of Fractures According to:
 Displacement:
a. Displaced- two ends of the fractured bone are separated
b. Undisplaced-crack in the one may radiate in several direction but the
fragments do not separate
 Anatomical position:
proximal 3rd /Proximal
middle 3rd /Midshaft
distal 3rd /Distal
 Direction of the fracture line:
a. Transverse-break runs across the bone
b. Oblique- break runs in slanting direction
c. Spiral-break coils around the bone
 Number of Fragments:
a. Linear: 2 fragments
b. Comminuted: 3 or more fragments
 Condition of the skin overlying the fracture
a. Closed: skin is intact
b. Open: skin and tissue have been damaged
Specific Type of Fracture
• A fracture with a surface
or open wound.

• Does not produce a break

in the skin.
A fracture in which the
bone has been
compressed, seen in
vertebral fractures.

A fracture, caused by
repeated , prolonged
or abnormal stress
A pulling away of a
fragment of bone by a
ligament or tendon and
its attachment.

The bone bends without

fracturing across
completely, the cortex
on the concave side
usually remaining intact.
A fracture that is straight
across the bone, usually
caused by a force applied
to the site at which
fracture occurs.

A fracture with more

than one fragments.
A fracture where the
fragments are driven
into one another.
FEMORAL FRACTURE
 FRACTURES (cont…)
• Signs and Symptoms/Clinical Manifestations:
 Pain (especially at the time of injury)
 Tenderness at the site
 Loss of function
 Deformity
 Crepitus (grating sensation either heard or felt as bone ends
rub together.)
 Discoloration
 Bleeding from an open wound with protrusion of both ends.
 swelling
 FRACTURES (cont…)
• Diagnostic procedures:
 X-ray examination reveals break in the continuity of the
skin.
 Therapeutic Interventions:
1. Traction/Splinting is used to maintain alignment of bone fragments
and reduce the fracture until healing occurs.
2. Surgical intervention to align the bone (open reduction), often with
plates and screws to hold the fracture in alignment.
3. Manipulation to reduce fracture (closed reduction)
4. Application of cast to maintain alignment and immobilize limb.
( Plaster of Paris or fiberglass)
5. Application of external fixation device when fractures accompany
soft tissue injury.
 FRACTURES (cont…)
• Stages of Bone Healing
 Formation of Hematoma: blood extravagates into the area between and
around the fragments and the bone marrow. Clot begins 24 hours after
fracture occurs.
 Cellular Proliferation: takes place at the fracture site after several days. The
combination of periosteal elevation and granulation tissue containing blood
vessels , fibroblast and osteoblasts produce a substance called osteoids
forming a bridge across the fracture site.
 Callus Formation: after the following weeks minerals are being deposited in
the osteoids formig a large mass of differentiated tissue bridging the
fracture called callus.
 Ossification: final laying down of bone, the stage in which the fracture ends
knit together.
 Consolidation and Remodelling: when consolidation is completed, the
excess cells are absorbed. The primary cancellous bone is remodelled,
compact bone being formed according to stress pattern. Remodelling
continues as bone is formed in relation to its function (Wolff’s Law).
 FRACTURES (cont…)
• Average Period for Firm Union of Various Bones:
 Clavicle: 3-4 weeks
 Radius-Ulna 6-13 weeks
 Metacarpals: 4 weeks
 Femur: 12 weeks
 Fibula: 12-14 weeks
 OS calcis: 8-12 weeks
 Phalanges: 3 weeks
 Humerus: 6 weeks
 Lower 3rd Radius: 4 weeks
 Tibia: 8-12 weeks
 Tarsals: 6-8 weeks
 Metatarsals: 5-6 weeks
 FRACTURES (cont…)
• Nursing Care of clients with Fractures:
 Assessment:
3. Age of the patient
4. Ability of the client to move extremity
5. Altered appearance of the injured body part.
6. Neurovascular assessment: soft tissue injury or
edema may compromise circulatory or neurologic
functioning.
7. Factors precipitating injury.
8. Nutritional status.
 FRACTURES (cont…)
 Nursing Diagnoses:
2. Body image disturbance
3. Constipation
4. Fear
5. Risk for injury
6. Pain
7. Impaired physical mobility
8. Altered role performance
9. Self-care deficit
10. Risk for impaired skin integrity
 FRACTURES (cont…)
• Nursing Interventions:
 Enhance comfort
 Ensure adequate oxygenation of tissue
 Take measures towards restricting the function of the fractured bones.
 Maintain body mobility while keeping the injured part at rest.
 Protect against infection in the absence of an intact 1st line of defense.
 Provide adequate nutrition for healing.
 Prevent constipation.
 Promote urinary elimination.
 Prevent additional trauma to soft tissues.
 Assist in allaying anxiety.
 Assist patient to attain optimal level of independence.
 Help prevent boredom
 Anticipate underlying complications.
 FRACTURES (cont…)
• Complications:
 Early Complications:
3. Shock (hypotension)
4. DVT (leg pain)
5. Pulmonary embolism( chest pain)
6. Fat embolism ( diaphoresis, dyspnea,
pallor)
7. Compartment Syndrome.
 FRACTURES (cont…)
• Compartment Syndrome: an increase in
compartment pressure of the limb caused by
edema resulting to compromised circulation
leading to ischemia (death) to the muscles.
Five Cardinal Signs :
3. Pain: unrelieved pain
4. Pallor: pale skin or nailbeds, prolonged
blanching
5. Pulselessness: Decrease pulse
6. Paresthesia: Numbness or tingling sensation
7. Paralysis: inability to move fingers or toes
 FRACTURES (cont…)
 Late Complications:
2. Delayed Union
3. Non-Union
4. Mal-Union
5. Avascular Necrosis
6. Heterothropic Ossification/Myositis
ossificans
 FRACTURES (cont…)
• Evaluation/Outcomes
2. Reports reduction in pain
3. Maintains neurovascular functioning of the
extremities
4. Maintains skin integrity
5. Remains active participant in care without
compromising treatment.
6. Avoids complications of mobility.
7. Regains complete mobility and function after
healing.
FRACTURE EPONYMS
 Musculo-Skeletal Related Injuries
• Dislocation: displacement of the bone from its normal joint position to
the extent that articulating surfaces loss contact.
 Causes:
1. Trauma
2. Diseases
3. Congenital condition
 Signs and Symptoms:
1. Burning pain to joint
2. Deformity of the joint
3. Stiffness and loss of joint function
4. Moderate or severe edema around joint
 Nursing Care:
1. To lessen swelling, elevate the affected extremity immediately. Keep it
elevated until after dislocation is reduced because manipulation increases
swelling.
2. Assess the extremity for signs of neurovascular problems and compartment
syndrome.
3. Administer pain medication as per doctor’s order.
4. Encourage patient to perform light exercise.
 Musculo-Skeletal Related Injuries
• Sprain: is an incomplete tearing of joint capsule or ligaments
surrounding a joint, which does not disrupt ligament continuity
or cause joint instability.
 Cause: Sudden twisting of joint beyond range or motion.
 Signs and Symptoms:
a. Pain at joint c. dislocation around joint
b. Edema around joint d. decrease joint function
 Nursing Care:
1. To reduce swelling, apply cold treatment (icebag/cold pack) for
the first 48 hours.
2. After swelling is controlled, apply warm treatment (warm
compress/heat pad).
3. Provide care to patient with extremity in cast or bandage.
Musculo-Skeletal Related Injuries
• Strain: injury to a tendon/muscle unit close to the joint it can be
acute or chronic.
 Cause: Over stretching tendons or over using muscles.
 Signs and Symptoms:
4. Acute strain produces sudden , severe pain at the time of injury
which then subside to local tenderness. Swelling occurs rapidly.
5. Chronic strain produces gradual onset stiffness, soreness and
tenderness.
 Nursing Care:
 For acute strain aplly ice packs for the 1st 48 hours to control
swelling.
 Then apply warm treatment
 Rest the affected part for 4-6 weeks.
 For both acute and chronic strains, permit only minimal
movemennt of the affected area.
Treatment
• Splinting: immobilization of injured limb
using rigid materials.
• Purposes;
3. To avoid further soft tissue injury.
4. Lower the incidence of clincal fat
embolism and shock.
5. Facilitates patients transportation and
radiographic studies.
CAST
• Cast: is a temporary immobilization.
• Types:
3. Plaster of Paris: consist of a roll of bandage stiffened
by dextrose or starch ad impregnated with
hemihydrates of calcium sulfate.
4. Fiber glass
 Purposes:
6. To promote healing and early weight bearing.
7. To support , maintain and protect realigned bone
8. To prevent or correct deformity
9. To immobilize the injured limb
 CAST
• Cast Application:
 A cast is applied with padding first.
 Padding materials include the following:
a. Stockinette
b. Wadding sheet
4. Apply first the stockinette
5. Apply the wadding sheet
6. Fiber glass or plaster cast
 Instruments for Cast Removal
8. Cast cutter
9. Cast spreader
10. Trimming knife
11. Bandage scissors
12. Plaster shears
 Contraindications
1. Pregnancy
2. Skin diseases
3. Swelling/edema
4. Open wound
5. Infection
 CAST
• Nursing Care;
2. Handle wet cast with palms of hands not fingers
3. Cast should be allowed to air dry.
4. Elevate the cast with one to two pillows during drying.
5. Observe hot spots and musty odor . These are signs and symptoms of
infection.
6. Maintain skin integrity
7. Do neurovascular checks:
h. Skin color d. mobility
i. Skin temperature e. pulse
j. Sensation
7. Assess for vascular occlusion
8. Adhesive tape petals reduce irritation at cast edges.
9. Prevent complication of immobility.
n. Bedsores d. Renal calculi
o. Hypostatic pneumonia e. osteoporosis
p. Constipation f. muscular atrophy
TYPES OF CAST, MOLDS AND
INDICATIONS
TYPES OF CAST, MOLDS
AND INDICATIONS
• Shoulder Spica:
humerus and
shoulder joint
TYPES OF CAST, MOLDS
AND INDICATIONS
• Airplane cast: for
humerus and
shoulder joint
with compound
fracture.
TYPES OF CAST, MOLDS
AND INDICATIONS
• Hanging Cast: for
fractured shaft of
the humerus
TYPES OF CAST, MOLDS
AND INDICATIONS
• Functional Cast;
for fractured
humerus with
abduction and
adduction
TYPES OF CAST, MOLDS
AND INDICATIONS
• Short Arm
Circular Cast: for
wrist and fingers
TYPES OF CAST, MOLDS
AND INDICATIONS
• Short Arm
Posterior Mold:
wrist and fingers
with compound
affectation.
•TYPES OF CAST, MOLDS
AND INDICATIONS
• Long arm Circular
Cast: fractured
radius or ulna
TYPES OF CAST, MOLDS
AND INDICATIONS
• Munster Cast/
Fuenster’s Cast:
for fractured
radius ulna with
callus formation
TYPES OF CAST, MOLDS
AND INDICATIONS
• Long Arm
Posterior Mold:
for fractured
radius or ulna
with compound
affectation
TYPES OF CAST, MOLDS
AND INDICATIONS
• Minerva Cast: for
upper dorsal/
cervical spine
affectation
TYPES OF CAST, MOLDS
AND INDICATIONS
• Rizzer’s Jacket:
for scoliosis
TYPES OF CAST, MOLDS
AND INDICATIONS
• Body Cast: for
lower dorso-
lumbar spine
affectation
TYPES OF CAST, MOLDS
AND INDICATIONS
• Double Hip Spica
Cast: for Fracture
of hip and femur
TYPES OF CAST, MOLDS
AND INDICATIONS
• . 1 And 1/2 Hip
Spica: Hip and
femur with
compound
affectation
TYPES OF CAST, MOLDS
AND INDICATIONS
• Basket Cast: for
severe leg trauma
with open wound or
inflammation.
TYPES OF CAST, MOLDS
AND INDICATIONS
. Long Leg
Posterior Mold:
for fractured tibia
fibula with
compound
affectation
TYPES OF CAST, MOLDS
AND INDICATIONS
• Long Leg Circular
Cast: for
fractured tibia
fibula
TYPES OF CAST, MOLDS
AND INDICATIONS

• Cylindrical Leg
cast; for
Fractured patella
TYPES OF CAST, MOLDS
AND INDICATIONS
• Quadrilateral
(Ischial Weight
Bearing) Cast: for
fractured shaft of
the femur with
callus formation
TYPES OF CAST, MOLDS
AND INDICATIONS
• Cast Brace: for
fracture of the
femur (distal
curve) with
flexion and
extension.
TYPES OF CAST, MOLDS
AND INDICATIONS

• Short Leg
Circular Cast:
ankle and foot
fracture
TYPES OF CAST, MOLDS
AND INDICATIONS
• PTB (Patellar
Tendon Bearing)
Cast: for
fractured tibia-
fibula with callus
formation
TYPES OF CAST, MOLDS
AND INDICATIONS

• Delvet/Delbit
Cast: fracture of
tibia or fibula
TYPES OF CAST, MOLDS
AND INDICATIONS

• Short Leg
Posterior Mold:
ankle and foot
with compound
affectation
TYPES OF CAST, MOLDS
AND INDICATIONS

• . Boot Leg Cast:

for hip and
femoral fracture
TYPES OF CAST, MOLDS
AND INDICATIONS

• Internal Rotator
Splint: for post
hip operation
TYPES OF CAST, MOLDS
AND INDICATIONS

• Collar cast; for

cervical
affectation
TYPES OF CAST, MOLDS
AND INDICATIONS

• Pantalon Cast: for

pelvic bone
fracture
TYPES OF CAST, MOLDS
AND INDICATIONS

• Single Hip Spica:

fracture of hip
and femur
TYPES OF CAST, MOLDS
AND INDICATIONS

• Frog Cast: for

congenital hip
dislocation
TYPES OF CAST, MOLDS
AND INDICATIONS

• For hip and femur

with compound
affection
TYPES OF CAST, MOLDS
AND INDICATIONS

• Double Hip Spica

Mold: cervical
affectation with
callus formation.
TYPES OF CAST, MOLDS
AND INDICATIONS

• Cocked-Up Splint
for wrist drop
TYPES OF CAST, MOLDS
AND INDICATIONS

• Night Splint:
for post
polio
TYPES OF CAST, MOLDS
AND INDICATIONS

• Single Hip Spica

Mold: pelvic
fracture with
callus formation
 TRACTION
Traction: is the act of pulling or drawing which is
associated with counter traction. Traction means
that pulling force is applied to a part of the body or
an extremity while a counter traction pulls in the
opposite direction. In straight or running traction
counter traction is supplied by the patient’s body
with the bed.
Purposes:
 Prevent/Correct deformities
 Relieve pain
 Relieve muscle spasm
 Reduce/immobilize fractures
 TRACTION
Principles:
2. Position should be supine
3. Avoid friction
4. Allow the weight to hang freely
5. Apply traction continuously
6. There should be an adequate counter traction
7. The line of pull should be in line with the deformity
Types:
1. Skin Traction: applies pull to an affected body structure by
straps attached to the skin surrounding the structure.
• Kinds:
a. Adhesive skin traction
b. Non-adhesive skin traction
 TRACTION
2. Skeletal Traction: is applied to the affected structure by a
metal pin or wire inserted into the structure and attached
to the traction ropes.
 Often used when continuous traction is desired to immobilize,
position and align a fractured bone properly during the healing
process.
Nursing Care:
Skin:
 Monitor for vascular occlusion
 Maintain counter traction
 Maintain weights hanging freely
 Maintain positioning
 Provide daily rewrapping
 Detection of pressure points
 TRACTION
Nursing Care:
Skeletal:
 Inspection
 Dressing
 Traction apparatus
 Skin care
 Prevent complication of bed rest
Muscles:
 Strengthening exercise for upper extremities
 Strengthening exercise for lower extremities
 Preparation for crutch walking
Vascular Occlusion
 Paralysis
 Paresthesia
 Pulselessness
 Pallor
 Pain
 TYPES OF TRACTIONS AND
INDICATIONS
1. BST (Balance Suspension Traction): for femoral
affectation.
2. Boot Leg Cast Traction: for hip and femur
affectation.
3. Braun Splint Traction: temporary traction before
the BST.
4. Bryant’s Traction: for femoral fractures and hip
injuries (for children below 4 yrs old)
5. Buck’s Extension: for fractured femur and hip
6. Dunlop’s traction: supracondylar fracture of the
humerus.
 TYPES OF TRACTIONS AND
INDICATIONS
7. Halo Femoral: for severe scoliosis
8. Halo Pelvic Girdle: for scoliosis and back pain
9. Head Halter Traction: cervical spine affectation.
10. Pelvic Girdle: for lumbo-sacral affectation, HNP.
11. Russell's Traction: for fracture of femur.
12. Stove –In-Chest: for sever chest injury with
multiple fracture.
13. 90-90: fracture of the femur.
TYPES OF TRACTION
KURCHNER’S WIRE HOLDER
STEINMANN PIN HOLDER
OVERHEAD

• For fracture of
humerus
BOOT LEG TRACTION

• For Hip and

Femoral
Affection
COTREL
• Head Halter
– For cervical spine
affection

• Pelvic Girdle
– For lumbo-sacral
affection and
Herniated Nucleus
Pulposus
BRYANT’S SKIN TRACTION

• for femoral
fracture, hip
injuries among
kids below 3 years
old
HALO FEMORAL

• For severe
scoliosis
HALO PELVIC

• For Scoliosis
90 DEGREE

• For fracture of
femur
STOVE IN CHEST

• For severe chest

injury with
multiple rib
fracture.
DUNLOP SKIN TRACTION

• For
supracondylar
fracture of the
humerus
HAMMOCK SUSPENSION
KRUTCHEDFIELD TONGS
VINKE’S CALIPER
TOWERS
 TYPES OF BRACES,
SPLINTS AND INDICATIONS
1. Banjo Splint: for peripheral nerve injury.
2. Bilateral Leg Brace: for polio
3. Chair Back Brace: lumbo-sacral affectation
4. Cock up splint: for wrist drop
5. Dennis Brown Splint: Clubfoot or Talipes
6. Finger Splint: for fractured digits
7. Forester Brace; lower thoracic and upper lumbar affectation
8. Jewett Brace: for scoliosis T9 and above
9. Milwaukee Brace: lower thoracic and upper lumbar
affectation
10. Shantz Collar: cervical affectation
12. Unilateral leg Brace: polio unilateral affectation
13. Yamamoto Brace: severe scoliosis T9 and below.
MILWAUKEE BRACE

• For Scoliosis
FORESTER BRACE
• Cervico-Thoraco
Lumbar Affection
Spine
YAMAMOTO

• For Scoliosis
TAYLOR BRACE

• For upper thoracic

JEWETT BRACE

• For Lower Thoracic

CHAIRBACK BRACE

• For Lumbo-sacral
fracture
CERVICAL COLLAR/ SHUNTZ
COLLAR

• For cervical
affection
PHILADELPHIA

• For Cervical
affection
BANJO SPLINT

• For Peripheral
Nerve Injury
LIVELY FINGER SPLINT

• For fracture of
finger
DENIS BROWNE SPLINT

• For Clubfoot or
talipes
equinovarus
UNILATERAL LEG BRACE

• For Polio (one

leg affection)
BILATERAL LEG BRACE

• For Polio
(bilateral leg)
Roger Anderson External
Fixator
 MOBILITY
Use of Braces and Splints:
B. Purposes:
 Support and protect weakened muscles
 Prevent and correct anatomic deformities
 Aid ain controlling voluntary muscle movements
 Immobilized & protect a diseased or injured joint
 Provide for improvement of function
B. Nursing Care:
9. Keep equipment in good repair (oil joints, replace straps when worn,
wash with saddle soap)
10. Provide adequate shoes( keep in good repair, heels low and wide, high
top to hold the heel in the shoe).
11. Examine the skin daily for evidence of breakdown at pressure points.
12. Check alignment of braces( leg braces: joint should coincide with body
joint; back brace: upright bars in center of the back, brace should grip
the pelvis and trochanter firmly, lacing should begin from the bottom).
13. Evaluate client’s response to procedure.
 MOBILITY
Use of Cane:
A. Purposes:
 improve stability of the client with lower limb disability.
 Maintain balance
 Prevent further injury
 Provide security while developing confidence in
ambulating.
 Relieve pressure on weight bearing joint
 Assist in increasing speed of ambulation with less fatigue
 Provide for greater mobility and independence
 MOBILITY
B. Nursing Care:
1. Ascertain that the client is able to bear weight bearing on the affected extremity
2. Ensure that the client is able to use the upper extremity opposite the affected lower
extremity
3. Measure to determine the length of cane required
a. Highest point should be approximately level with the greater trochanter
b. Handpiece should allow 30 degrees of flexion at the elbow with the wrist held in extension.
4. Explain the proper technique in using cane.
a. Hold in the hand opposite the affected extremity
b. Advance the cane and the unsaffected extremity simultaneously and then the affected leg.
c. Keep cane close to the body
d. When climbing, step up with the unaffected extremity and then place the cane and the affected
lower extremity on the step; when descending, reverse the procedure.
5. Observe for incorrect use of cane
a. Leaning the body over the cane
b. Shortening the stride on the affected side
c. Inability to develop a normal walking pattern
d. Persistence of the abnormal gait pattern after the cane is no longer needed.
6. Observe client’s response to procedure
 MOBILITY
Crutch Walking:
A. Purposes:
 Support body weight, assist weak muscles, and provide joint stability.
 Relieve pain.
 Prevent further injury and provide for improvement of function.
 Allow for greater independence.
Nursing Care:
1. Ensure proper fit of crutches by measuring the distance from the anterior
fold of the axilla to a point 15 cm (6 inches) out from the heel.
i. Axillary bars must be 5 cm (2 inches) belaw the axillae and should be
padded.
j. Hand bars should allow almost complete extension of the arm with the
elbow flexed about 30 degrees when the client places weight on the
hands.
k. Rubber crutch tips should be in good condition, about 5.1 to 7.6 cm ( 3-
 MOBILITY
2. Assist in use of proper technique, depending on ability to bear weight and to take steps
with either one or both of the lower extremities.
a. Four point alternate crutch gait
 Right crutch, left foot, left crutch right foot
 Equal but partial weight bearing on each limb
 Slow but stable gait; there are always three points of support on the floor
 The client must be able to manipulate both extremities and get one foot ahead of the
other (e.g. persons with polio, arthritis, cerebral palsy)
b. Two point alternate crutch gait
 Right crutch and left foot simultaneously
 There are always two points of support on the floor
 This is a more rapid version of the four point gait and requires more balance and strength
(e.g., a bilateral amputee)
c. Three-point gait
 Advance both crutches and the weaker lower extremity simultaneously, then the stronger
lower extremity
 Fairly rapid gait, but requires more balance and strength in the arms and good lower
extremity
 Used when one leg can support the whole body weight and the other cannot take full
weight bearing (e.g a client with a fractured hip)
MOBILITY
d. Swing crutch gait
d.1 Swing-to-gait
 Place both crutches forward, lift and swing the body up to
the crutches, then place crutches in front of the body and
continue
 There are always two points of support on the floor
 This technique is indicated for anyone with adequate
power in the upper arms.
d.2 Swing-through-gait
 Place both crutches forward, lift and swing the body
through the crutches. Then place crutches in front of the
body and continue.
 Very difficult gait, because as the client swings through the
crutches it necessitates rolling the pelvis forward and
arching the back to get the center of gravity in front of the
hips.
 Indicated for the client who has power in the trunk and
upper extremities, excellent balance, self confidence, and
a dash of daring (e.g., bilateral amputee, paraplegic with
 MOBILITY
e. Tripod crutch gait
e.1 Tripod alternate gait
 Right crutch, left crutch, drag the body and legs forward
 The client constantly maintains a tripod position: both crutches are held
fairly widespread out front while both feet are held together in the back
 Necessary for the individual who cannot place one extremity ahead of
the other ( e.g. persons with flaccid paralysis from poliomyelitis, one
with spinal cord injury.
e.2 Tripod simultaneous gait
 Place both crutches forward, drag the body and legs forward
 Because the tripod must have a large base, the client’s body must be
inclined forward sufficiently to keep the center of gravity in front of the
hips.
 MOBILITY
3. Observe for incorrect use of crutches
b. Using the body in poor mechanical fashion
c. Hiking hips with abduction gait( common in amputees)
d. Lifting crutches while still bearing down on them
e. Walking on ball of foot with foot turned outward and
flexion at hip or knee level
f. Hunching shoulders (crutches usually too long) or
stooping with shoulders ( crutches usually too short).
g. Looking downward while ambulating
h. Bearing weight underarms; should be avoided to prevent
injury to the nerves in the brachial plexus; damage to
these nerves can cause paralysis (crutch palsy).
4. Evaluate client’s response to the procedure.
 MOBILITY
Use of walker
B. Purposes:
 Maintain balance
 Provide additional support because of wide area of contact with the floor
 Allow for some ambulatory independence
Nursing Care:
7. Assist in selecting a walker
 Device should not be used unless the client will never be able to ambulate with
a cane or crutches
 Measure for a walker are the same as for cane
 The client must have a strong elbow extensor and shoulder depressor and
partial strength in the hands and wrist muscles.
 The client needs maximum support to ensure security and enhance confidence.
 Device is ordinarily limited to the home because it cannot be used on steps
2. Assist in ambulating with the walker
 Lift the device off the floor and place forward a short distance, then advance
between the walker
 Two wheeled walkers: raise back legs of the device off the floor, roll walker
forward, then advance to it.
 Four wheeled walkers: push device forward on the floor and then walk to it.
 MOBILITY
3. Observe for incorrect use of walker
Keeping arms rigid and swinging through to
counterbalance the position of the lower
extremities
Tending to lean forward with abnormal
flexion at the hips.
Tending to step forward with the unaffected
leg and shuffle the affected leg up to the
bar.
4. Evaluate client’s response.
 RELATED TERMS IN ORTHOPAEDIC,
DIAGNOSTIC, PROCEDURES AND
SURGERY
• Ventriculography: x-ray examination of the ventricular system brain
after replacing some of the cerebrospinal fluid with air.
• Angiography: x-ray of the cerebrovascular tree following the injection
of a radio-opaque medium into the spinal arachnoid space.
• Craniotomy: an incision to the soft and underlying tissues and removal
of the part of the skull in order to gain access to brain to reduce a
depressed fracture of the skull.
• Myelography: x-ray examination of the spinal cord after the injection of
a radio-opaque medium into the spinal arachnoid.
• Cranioplasty: repair of the skull either with metal plates or a bone
graft.
• Lumbar Sypathectomy: surgical removal of a portion of a symphatetic
nerve ganglion.
• Open Reduction: the correction through surgical method of fracture in
a dislocation by the use of nails, screws, wires, or rods with or without
plates.
 RELATED TERMS IN ORTHOPAEDIC,
DIAGNOSTIC, PROCEDURES AND
SURGERY
• Screwing: is used for fixation of bone fragment that are
partially threaded.
• Wiring: internal fixation of fracture by means of wire cup.
• Bone Graft:
a. Autogenous bone graft: graft taken from the patient
himself, usually taken from either the tibia, fibula or
ilium.
b. Femogenous bone graft: graft taken from another
human donor, are obtained from non-infected
amputated limbs and are strored in deep freeze.
• Aspiration: removal of fluid on a joint by suction using a
syringe and hallow needle under local anesthesia
• Arthrectomy: removal of loose bodies (knees), removal
of a test semi lunar cartilage or removal of loose bodies
which are usually osteocartilageous in nature.
RELATED TERMS IN ORTHOPAEDIC,
DIAGNOSTIC, PROCEDURES AND
SURGERY
ORTHOPAEDIC,
DIAGNOSTIC,
PROCEDURES AND
SURGERY
ORTHOPAEDIC,
DIAGNOSTIC,
PROCEDURES AND
SURGERY
ORTHOPAEDIC,
DIAGNOSTIC,
PROCEDURES AND
SURGERY
ORTHOPAEDIC,
DIAGNOSTIC,
PROCEDURES AND
SURGERY
ORTHOPAEDIC,
DIAGNOSTIC,
PROCEDURES AND
SURGERY
ORTHOPAEDIC,
DIAGNOSTIC,
PROCEDURES AND
SURGERY