FRACTURE IMMOBILIZATION

Immobilization refers to the process of holding a joint or bone in place with rigid or flexible device. This is done to prevent an injured area from moving while it heals.

TYPES OF FRACTURE IMMOBILIZATION

TRACTION

Traction is a technique for realigning a broken bone or dislocated part of the body using weights, pulleys, and ropes to gently apply pressure and pull the bone or injured body part back into position. After a fracture, traction can restore the position of a bone during the early stage of healing or temporarily ease the pain before undergoing a corrective surgery.

PURPOSES OF TRACTION

• The purpose of traction is to stabilize a fracture or injury and restore tension to the surrounding tissues, muscles, and tendons.
• Stabilize and realign a broken bone or dislocated part of the body (such as the shoulder)
• Help regain the normal position of the bone that's been fractured
• Stretch the neck to reduce pressure on the spine by realigning the vertebrae
• Temporarily reduce pain prior to surgery
• Lessen or eliminate muscle spasms and constricted joint, muscles, and tendons
• Relieve pressure on nerves, especially spinal nerves
• Treat bone deformities
• The kind of traction used will depend on the location and severity of the broken bone or injury and the amount of force needed.

PRINCIPLES OF EFFECTIVE TRACTION

• Whenever traction is applied, counter-traction must be used to achieve effective traction. (Counter-traction is the force acting in the opposite direction. Usually, the patient’s body weight and bed position adjustments supply the needed counter-traction.
• Traction must be continuous to be effective in reducing and immobilizing fractures.
• Skeletal traction is never interrupted.
• Weights are not removed unless intermittent traction is pre-scribed.
• Any factor that might reduce the effective pull or alter its resultant line of pull must be eliminated
• The patient must be in good body alignment in the center of the bed when traction is applied.
• Ropes must be unobstructed.
• Weights must hang free and not rest on the bed or floor.
• Knots in the rope or the footplate must not touch the pulley or the foot of the bed.

TYPES OF TRACTION

• Skeletal Traction
  • Skeletal traction involves placing a pin, wire, or screw in the fractured bone. After one of these devices has been inserted, weights are attached to it so the bone can be pulled into the correct position.
  • Skeletal traction is most commonly used to treat fractures of the femur, or thighbone. It’s also the preferred method when greater force needs to be applied to the affected area.
• Skin Traction
  • Skin traction is far less invasive than skeletal traction. It involves applying splints, bandages, or adhesive tapes to the skin directly below the fracture. Once the material has been applied, weights are fastened to it. The affected body part is then pulled into the right position using a pulley system attached to the hospital bed.
  • Skin traction is used when the soft tissues, such as the muscles and tendons, need to be repaired. Less force is applied during skin traction to avoid irritating or damaging the skin and other soft tissues.
• Cervical Traction
  • During cervical traction, a metal brace is placed around your neck. The brace is then attached to a body harness or weights, which are used to align the fractured bone
  • It is done to gently stretch the neck muscles so muscle spasms can be relieved or prevented. It may also be performed to immobilize the spine after a neck injury.

CASTS & SPLINTS

Casts are generally used to immobilize a broken bone. Once the doctor makes sure the two broken ends of thebone are aligned, a cast is put on to keep them in place until they are re-joined through natural healing. Casts are custom-made to fit each person, and are usually made of plaster or fiberglass. Fiberglass weighs less than plaster, is more durable, and allows the skin more adequate airflow than plaster. A layer of cotton or synthetic padding is first wrapped around the skin to cover the injured area and protect the skin. The plaster or fiberglass is then applied over this and is then allowed to dry. It can take up to 24 hours for a cast to dry completely. Most casts should be kept dry. However, some types of fiberglass casts use Goretex padding that is waterproof, allowing the cast to be completely immersed in water when taking a shower or bath. There are some circumstances when this type of cast material cannot be used.

A splint is often used to immobilize a dislocated joint while. Splinting is used to immobilize an injured fingers, armor leg immediately after an injury. Before moving a child who has injured an arm or leg, some type of temporary splint should be applied to prevent further injury to the area.

SLINGS

Slings are often used to support the arm after a fracture or other injury. They are generally used along with a cast or splint, but are sometimes used alone as a means of immobilization. They can be used in an emergency to immobilize the arm especially in children. A triangular bandage is placed under the injured arm and then tied around the neck.

BRACES

Braces are used to support, align, or hold a body part in the correct position. Braces are sometimes used after a surgical procedure is performed on an arm or a leg. They may also be used when an injury has occurred.Since some braces can be easily taken off and put back on, they are often used when the child needs physical therapy or must exercise the limb during the healing process. Many braces can also be adjusted to allow for a certain amount of movement.

Either a custom-made or a ready-made brace can be used. The off-the-shelf braces are made in a variety of shapes and sizes. They generally have Velcro straps that make the brace easy to adjust and to put on and take off. Both braces and splints offer less support and protection than a cast and may not be a treatment option in all circumstances.

COLLARS

A collar is generally used for neck injuries. A soft collar can relieve pain by restricting movement of the head and neck. Collars also transfer some of the weight of the head from the neck to the chest. Stiff collars are generally used to support the neck when there has been a fracture in one of the neck bones. Cervical collars are widely used by emergency personnel at the scene of injuries when there is a potential neck or head injury. The collar helps to ensure that the neck and head do not move, which could make the injury worse.

PHARMACOLOGICAL MANAGEMENT

• MUSCLE RELAXANTS:
  • Carisoprodol, cyclobenzapine, methocarbamol
  • To treat pain caused my muscle spasms
• ANTIBIOTICS:
  • Cephalosporins like cefazolin
  • To prevent infection in open fractures
• SUPPLEMENTS:
  • Calcium & Vitamin C supplements
  • To promote bone & muscle healing.

NUTRITIONAL THERAPY

• Nutrition must include adequate proteins (1gm/kg body weight), vitamins especially B,C &D, minerals like calcium, phosphorous & magnesium to ensure bone & tissue healing
• Well balanced diet of 3 meals per day is advised for healing
• Adequate fluid Intake of 2000-3000 ml/ day to promote bladder & bowel function
• High fiber diet like fruits & vegetables to prevent constipation
• If client has signs of cramping & abdominal pressure due to immobilization then advice to eat small & frequent meals of 6 times a day rather than eating full meals.

SURGICAL MANAGEMENT

• OPEN REDUCTION & INTERNAL FIXATION (ORIF):
  • Open reduction and internal fixation (ORIF) is surgery to repair a broken bone. Open reduction means to make an incision to reach the bones & move them back into their normal position.
  • Internal fixation means metal screws, plates, sutures, or rods are placed on the bone to keep it in place while bone healing takes place
• SURGICAL DEBRIDEMENT & IRRIGATION OF OPEN FRACTURE:
  • The most important initial step in the surgical wound management of open fractures is regarded as copious fluid irrigation along with meticulous debridement of surrounding contaminated soft tissues.
  • Wound irrigation to remove debris and lessen bacterial contamination is an essential component of open fracture care when performed properly; wound irrigation can enhance wound healing by reducing infection and its related morbidities.
  • Isotonic saline is regarded as the most appropriate and preferred irrigant because it is a nontoxic solution that does not damage the healing tissue.