NURSING CARE FOR BST (BALANCED SKELETAL TRACTION)

1. Assess the patient’s level of consciousness and understanding.

2. Provision of general comfort.
3. Skin care
4. Perineal Care

POTENTIAL COMPLICATIONS IN BST (BALANCED SKELETAL TRACTION)

1. Bed sores (advise the patient to turn sides, maintain the linens to be dry and clean as well as
free from wrinkles, etc)
2. Pneumonia (encourage deep breathing exercises to the patient in order to promote lung
expansion, back tapping to promote loosen the bronchial secretions)
3. Urinary Tract Infections (advise the patient to have a regular voiding, good perineal care and to
increase fluid intake)
4. Constipation (advise to increase fluid intake, high fiber diet and have a regular bowel
movement)
5. Contractures and stiffness of the muscles (encourage to have a contraction and relaxation of the
quadricep muscles, foot pedal exercises/dorsiflexion of the feet)
6. Infection at the Steinmann pin sites

FORMAT FOR CASE ANALYSIS

Name: Age:
Address: Status:
Date admitted: Educational Attainment:
Physician incharge: Case number:
Diagnosis:
Physical Assessment:
Nursing History (present health history, past health history, family history):
Pathophysiology (including the anatomy and physiology of the affected part)
Diagnostic procedures:
Medical Management:
Surgical Management:
Discharge Plan:
 FORMAT FOR REPORTING (ORAL AND WRITTEN)

Definition/alternative names
Causative agent
Causative factors
Clinical manifestations
Pathognomonic signs
Pathophysiology
Anatomy and physiology (affected part)
Diagnostic procedures
Medical management
Surgical management
Nursing care

HARDWARE (Purpose: to put bones in good alignment without conformity and infection and also to
reduce fracture through external and internal fixators)

IMPLANTS INDICATION SURGERY

INTERNAL FIXATORS:
Hip prosthesis For fracture of the femoral head Partial hip replacement
and neck arthroplasty
Spacer with antibiotic For infected hip prosthesis Partial hip replacement
arthroplasty
Hip prosthesis and acetabular Fracture of femoral head, Total hip replacement
cup femoral neck including the arthroplasty
acetabulum
Femoral-tibial component For osteoarthritis in the knee- Total knee replacement
joint arthroplasty
Cerclage wire Fracture of the patella Tension bond wiring
Antibiotic beads Osteomyelitis Application of the antibiotic
beads
Luque rod/harrington rod Scoliosis Luque rod instrumentation
Subluminar wires Spine surgeries
Kirshneir’s wire Used in BST
Kirshneir’s wire holder Used in BST
Compression plates and screws Inter-trochanteric of the femur Compression hip screw fixation
AO Screw driver
Wire cutter
Gigli saw Amputation of long bones
Staple wire remover
Skin stapler (after 7 days it will
be removed)
Osteotomes and mallet
Intramedullary nail Fracture of the middle third of Open reduction intramedullary

Intramedullary locking screws
Bone drill
Drillbit
Buttress plate/T plate
Intramedullary nail extractor
EXTERNAL FIXATORS
Roger’s Anderson
Hybrid external fixator
Ilizarov
Modified skin external fixator
Spanning external fixator
Hoffman’s external fixator
the femur
Fracture of distal of femur/tibia
For preparation for screw
fixation
Fracture of the proximal tibia
Inserted laterally to the hip
Comminuted fracture
Peri-articular injury of the ankle
and knee-joint
Long bones with mal-union
(promotes bone growth and
lengthening)
Long bones (distal
femur/proximal tibia)
Fracture of pelvis (superior and
inferior)
nailing for fracture of middle
third of femur
Open reduction intramedullary
nailing with static locking screws
Application of roger’s Anderson
external fixators
Application of hybrid external
fixators
Application of ilizarov external
fixator
Application of spanning external
fixator
Application of Hoffman’s
external fixator

Fractures
 Simple (closed)
 Compound (open)

5 Cardinal Signs of Fracture:

 Swelling
 Tenderness
 Pain
 Crepitus
 Loss of function

Treating Fractures:
 Reduction (Open or closed reduction)
 Realignment
 Rehabilitation
Stages of Bone Healing:
 Hematoma formation
 Cellular proliferation
 Callus formation
 Ossification
 Consolidation and remodeling

GADGETS

Traction
 Manual Traction
 Skeletal Traction
 Skin Traction (adhesive skin traction and non-adhesive skin traction)

I. SKELETAL TYPE OF TRACTION

1. Halo femoral traction – severe scoliosis

2. Halo pelvic traction – scoliosis
3. 90-90 degrees – sub-trochanteric of the femur
4. Overhead traction – supracondylar of the humerus
5. Balanced skeletal traction (BST) – hip and femur affection

II. SKIN ADHESIVE TRACTION

1. Dunlop traction – supracondylar fracture of the humerus

2. Bryant’s traction – hip and femur affection for children ages 6 years old or 3 years old and
below; congenital hip dislocation
3. Buck’s extension – hip and femur affection for adults
4. Zero degree – for the neck of the humerus

III. SKIN NON-ADHESIVE TRACTION

1. Cotrel – combination of head halter and pelvic girdle traction; for scoliosis
2. Pelvic girdle traction – for lumbo-sacral affection; for HNP (herniated nucleus pulposus)
3. Hammock’s suspension – pelvic affections
4. Head halter traction – for cervical spine affection
5. Boot cast traction – special type of traction for hip and knee contractures and post-polio with
residual paralysis
Casts (it can be either plaster of paris or made up of fiber glass)
(purposes):
 Immobilization
 Support
 Prevent and correct fractures
 Maintain good alignment
 Elevation
 Model in making and artificial limb

Principles for application:

 Immobilized the joint below and joint above
 Always apply a padding material
 Apply the cast in circular motion using the palm

Equipments in removal:
 Cast cutter
 Cast spreader
 Cast knife
 Bandage scissors

I. UPPER EXTREMITIES

1. Body cast – lower thoracic and upper lumbar

2. Minerva – upper dorsal; cervical spine
3. Rizzer’s jacket – scoliosis
4. Collar cast – cervical cast affection
5. Hanging cast – fracture of the shaft of the humerus
6. Functional cast – fracture of the shaft of the humerus with callus formation
7. Long arm circular cast – fracture of the radius and ulna
8. Long arm posterior mold – fracture of the radius and ulna with wound swelling
and infection
9. Short arm posterior mold – fracture of the wrist and finger with open wound swelling and
infection
10. Munster/fuenster cast – fracture of the radius and ulna with callus formation
11. Shoulder spica cast – fracture of the upper portion of the humerus and the shoulder joint
12. Sugar tong – fracture of the upper portion of the humerus and shoulder joint with open wound
swelling and infection
13. Airplane cast – fracture of the neck of the humerus/recurrent shoulder dislocation
14. Thumb spica cast – fracture of the first metacarpal bone
 II. LOWER EXTREMITIES

1. Pantalon cast – pelvic affections

2. Brace cast – fracture of the distal third of femur with callus formation
3. Quadrilateral cast – fracture of the shaft of the femur with callus formation
4. Double hip spica cast – hip and femur affections
5. 1 ½ hip spica cast – hip and femur affections
6. Single hip spica cast – hip and femur affections
7. Basket cast – severe/massive bone injury
8. Frog cast – for congenital hip dislocations
9. Delvit cast – fracture of the distal third of the tibia-fibula with callus formation
10. Cylinder cast – for patellar affections
11. Cylinder mould – fracture of the patella with open wound swelling and infection
12. Single hip spica mould – fracture of the hip and femur with open wound swelling and infection
13. Long leg circular cast – tibia and fibula affections
14. Short leg circular cast – ankles, tarsals/ and metatarsals affections
15. Patellar tendon bearing cast (PTB) – tibia-fibula with callus formation
16. Long leg posterior mould – tibia-fibula affections with open wound swelling and infection
17. Short leg posterior mould – ankles, tarsals and metatarsals affections with open wound swelling
and infection
18. Internal rotator board/splint – hip surgery (partial and total hip surgery)

Braces – mechanical support for weakened muscles, bones and joints

(purposes):
 Immobilization
 Support
 Prevent and correct fracture
 Maintain good body alignment
 Control involuntary movements
 Permits patient to walk without fatigue

1. Shuntz collar-cervical spine affections

2. Philadelphia collar – cervical spine affections
3. Forester – cervico thoraco lumbar spine affections
4. Taylor brace – upper thoracic affections; pott’s disease
5. Jewett’s brace – lower thoracic and upper lumbar affections
6. Chairback – lumbo sacral affections; HNP (herniated nucleus pulposus)
7. Yamamoto – scoliosis
8. Milwaukee – scoliosis
9. Unilateral long leg brace – post-polio with residual paralysis
10. Bilateral long leg brace – post-polio with residual paralysis
11. Openheimer – residual nerve paralysis
12. Banjo splint – peripheral nerve paralysis
13. Dennis browne shoes – clubfoot
14. SOMI (sterno-occipito-mandibular-immobilizer) – spinal injuries