Вы находитесь на странице: 1из 45

Splint and Fixators

3/13/12

Splint

rigid

device

3/13/12

Uses

qis a

device

3/13/12

Types:

1. Hand and Finger Splints


For relief from arthritis, carpal

tunnel, after injury or surgery, or for the correction of physical deformity, hand and finger splints are available to hold the hand, wrist or fingers in a position that will allow maximum healing and ease of pain.
3/13/12

2. Leg Splints

3/13/12

3/13/12

3. Back Splints
Back

splints or supports are available for posture correction


3/13/12

4. Splints for Headaches and Dental Problems

Den

tal spli
3/13/12

Taking care of splint


Do not get the splint wet. Use

plastic bags to cover the splint while bathing.


Do not walk on the splint Do not stick anything down the

splint such as a coat hanger to scratch or itch.


3/13/12 This may lead to

Minimize swelling
Rest, Ice, and Elevate

Ice-apply to area where there is no plaster for no more than 15-20 minutes at a time Longer may numb the extremity shorter may not affect swelling May use an ice bag with a wet 3/13/12

Minimizing pain ice to injured Apply


extremity for 15-20 minutes of each hour for 1-2 days. May use ice in zip lock bags or bags of frozen peas.
Give acetaminophen

(Tylenol) or ibuprofen
3/13/12

If the injury

involves an arm, it should be placed in sling and kept at or above the level of the heart for 24 hours to limit swelling.

If the injury

3/13/12

The 6 Ps of extremity assessment


Pain: Palpate the entire extremity for increase pain Paresthesia: Assess for burning, tingling, numbness Pallor: Note color and temperature and capillary refill Paralysis: Assess motor function (both active and passive Pulses: Palpate proximal and distal pulses

Pressure: Palpate for firmness of compartment


3/13/12

Danger signs:

Numbness Tingling increased pain change in coloration of fingers or toes swelling in fingers or toes
3/13/12

Complications:
Abrasions Sores Neurovascular compromise

(tight fitting splints)


Contact dermatitis Pressure ulcers Thermal burns
3/13/12

PROBLEM
Skin irritation, red areas, blisters

POSSIBLE CAUSES
Pressure due to splint fitting incorrectly Splint applied incorrectly Poor sensation

WHAT TO DO
Remove splint Contact your Occupational Therapist Review how to apply the splint Review wearing regime

Increase in swelling

Straps fastened too Loosen straps tightly Review how to Improper apply positioning of the splint arm/hand Keep arms supported Splint/straps applied incorrectly Review wearing regime Consult your Occupational Therapist 3/13/12 Keep arms

Pain

FIXATORS
A device composed of rods

and pins designed to provide stabilization of a body part.

3/13/12

A. External Fixations
Definition:
A surgical treatment used to set bone

fractures in which a cast would not allow proper alignment of the fracture.
External Fixators - An apparatus

consisting of a rigid frame that connects pins passed through the skin into the bone above and below the fracture 3/13/12

Uses:
Provides stable support for severely

crushed or splintered fractures while permitting active treatment of damaged soft tissues
Used particularly to treat some

compound fractures
Also used for limb lengthening
3/13/12

Nursing Interventions:
Prepare the patient psychologically Elevate the extremity after the fixator is

applied
Sharp points of the fixators or pins should

be covered with cork or tape


Monitor neurovascular status of the

extremity every 2-4 hours


Assess each pin site for redness,

tenderness, pain and loosening of the pin


The nurse must be alert for potential

problem cause by pressure from the 3/13/12

q Nurse carries out pin care as specified q Nurse notifies the physician if theres a sign

for infections
q Encourage isometric and active exercises as

tolerated
q When the swelling subsides, the nurse helps

the patient become mobile with in the prescribed weight then bearing limits
q Fixator is removed after soft tissues heals
3/13/12

X-ray picture of

an external fixator

3/13/12

External fixators to correct club foot

3/13/12

3/13/12

3/13/12

External fixator at the lower extremity

3/13/12

3/13/12

B. Internal fixation
Definition:
Anoperationinorthopedicsthat

involves the surgical implementation of implantsfor the purpose of repairing a bone. An internal fixator may be made of stainless steelortitanium.
Fixation of screws and/or plates, intra-

medullary bone nails (femur,tibia, 3/13/12

An internal fixation device may be used to keep fractured bones stabilized and in alignment. The device is inserted surgically to ensure the bones 3/13/12 remain in an optimal position during and after the

Types

of internal fixations:

A. Open Reduction Internal Fixation(ORIF)


Involves the implementation of implants

to guide the healing process of a bone, as well as the open reduction, or setting, of the bone itself.
Refers toopen surgeryto setbones,

as is necessary for somefractures. 3/13/12

3/13/12

Rigid fixation prevents micro-

motion across lines of fracture to enable healing and prevent infection, which happens when implants such as plates (e.g. dynamic compression plate) are used.
Often used in cases involving 3/13/12

Risks and complications:


include bacterial colonization of the bone,

infection, stiffness and loss of range of motion, nonunion (improper healing), mal-union (healing in improper position), damage to the muscles, nerve damage and palsy, arthritis,tendonitis, chronicpain associated with plates, screws, and pins,
3/13/12 compartment syndrome,deformity,

B. Closed Reduction Internal Fixation(CRIF)


Reductionwithout any open surgery,

followed by internal fixation


Alternative in unstable displaced lateral

condylar fracturesof thehumerusin children, but if fracture displacement after closed reduction exceeds 2 mm, open reduction and internal fixation is
3/13/12

Common types of internal fixators:


1. Wires
Wires are often used as sutures or threads

to "sew" the bones back together.


Can be used in conjunction with other

forms of internal fixation to hold bones together.


3/13/12 Can be used alone to treat fractures of

2. Pins
Pins hold pieces of bone together. They

are usually used in pieces of bone that are too small to be fixed with screws.
These pins are usually removed after a

certain amount of time, but may be left in permanently for some fractures.

3/13/12

3.Plates
Plates are like internal splints that hold

the fractured ends of bone together.


Extend along the bone and are screwed

in place. If two bones that run parallel to each other both break, such as in the lower leg, plating one bone may provide enough support for the other bone as well.
3/13/12

3/13/12

3/13/12

4. Nails or Rods
In some fractures of the long bones, the

best way to align the bone ends is by inserting a rod or nail through the hollow center of the bone that normally contains some marrow.
Held in place by screws until the fracture

has healed.
May be left in the bone after healing is 3/13/12

5. Screws
Bone screws are used for internal fixation

more often than any other type of implant. Although the bone screw is a simple device, there are several designs based on how the screw will be used.
Can be used alone to hold a fracture, as

well as with plates, rods, or nails.


May be designed for a specific3/13/12 of type

3/13/12

3/13/12

3/13/12

Teyngk kyu 4 lisening (~_^)


3/13/12