Skills Laboratory

Musculoskeletal Care Modalities

Prepared by: Mark Joseph V. Liwanag, MSN, RN
 THE PATIENT IN CAST

▪ CAST - is a rigid external immobilizing device

that is molded to the contours of the body.

▪ MOLD – used for splinting the affected part

of the body wherein there is a infection,
swelling and wound
 THE PATIENT IN CAST
Purposes of CAST and MOLD:
▪to immobilize a reduced fracture
▪ to correct a deformity
▪to apply uniform pressure to underlying
soft tissue
▪to support and stabilize weakened
joints
TYPES OF CASTING MATERIALS
1. FIBERGLASS CASTS - are composed of water-
activated polyurethane materials that have
the versatility of plaster but are lighter in
weight, stronger, and more durable than
plaster

2. PLASTER CAST - are less costly and achieve

a better mold than fiberglass casts; however,
they are not as durable and take longer to
dry.
▪ Rolls of plaster of Paris-impregnated
bandages are wet in cool water and applied
smoothly to the body
PRINCIPLES
1. Provide maximal comfort
and alleviation of
complication
2. Maintain desired position
throughout cast application
3. Caution in handling cast
until it has set or hardened
 MATERIALS FOR
CAST APPLICATION
WADDING SHEET
1. Stockinet - Directly in
contact with the skin
PLASTER OF PARIS
2. Wadding sheet and
gauze bandage -
Serve as padding
STOCKINET
3. Plaster of Paris /
Fiber glass - Casting
material
FIBER GLASS
 MATERIALS FOR CAST
APPLICATION
▪ TRIMMING KNIFE – Smoothen
the edge of the cast

▪ CAST SPREADER – To widen a

bivalved cast

▪ STRYKER CAST CUTTER – Used

in windowing

▪ BANDAGE SCISSORS – To cut

wadding sheet and stockinet
 CAST TECHNIQUE
1. WINDOWING
▪ Cutting a hole in a structure, such as a plaster cast or the
pericardium, to relieve pressure,
permit drainage, or allow access to an underlying structure.
2. BIVALVING
▪ is the recommended method for emergency cutting to
relieve pressure.
▪ the cast must be cut along its entire length on two sides
(medial and lateral) and the base lining or padding cut
completely down to the skin.
 CAST IN THE TRUNK AREA

BODY CAST MINERVA CAST SUGAR TONG

Injury of the lower Injury of the cervical Compound injury of the
thoracic and upper and upper dorsal humerus with open wound
lumbar spine spine inflammation or swelling
CAST IN THE UPPER EXTREMITIES

ARM CYLINDER
SHORT ARM CAST LONG ARM CAST applied from the upper arm to the
Injury of the carpals and Fracture of the wrist to hold the elbow muscles
metacarpals radius and ulna and tendons in place after a
dislocation or surgery.
 CAST IN THE UPPER EXTREMITIES

MUNSTER CAST SHORT ARM POSTERIOR MOLD LONG ARM POSTERIOR MOLD
injury of the radius – injury to the carpals and Affectation of the radius and
ulna with callus metacarpals with open wound, ulna with open wound, swelling
formation inflammation or swelling or inflammation
 CAST IN THE UPPER EXTREMITIES

HANGING CAST FUNCTIONAL CAST THUMB SPICA CAST

Fracture of the shaft of the Fracture of HUMERUS (shaft) For the fracture of the first
humerus with callus formation metacarpal bone (scaphoid)
 CAST IN THE LOWER EXTREMITIES

SHORT LEG CIRCULAR CAST SHORT LEG POSTERIOR MOLD WALKING CAST
For the fracture of tarsals For fracture of the tarsals and For the fracture of tarsals and
and metatarsals metatarsals with open wound, metatarsals with callus
inflammation or swelling formation
 CAST IN THE LOWER EXTREMITIES

PATTELAR TENDON BEARING

LONG LEG CIRCULAR CAST LONG LEG POSTERIOR MOLD CAST
For fracture of the tibia- For fracture of the tibia-fibula For fraction of the tibia and fibula
fibula With open wound, swelling, or with callus formation
inflammation
 CAST IN THE LOWER EXTREMITIES

LEG CYLINDER CAST LONG LEG CYLINDER MOLD ISCHIAL WEIGHT – BEARING
For fracture of the patella For fracture of the patella CAST
With open wound, swelling or For the fracture of the shaft of
inflammation femur with callus formation
 CAST IN THE LOWER EXTREMITIES

CAST BRACE SINGLE HIP SPICA CAST ONE - ONE HALF HIP SPICA CAST
For fracture of the distal 3rd of Fracture of the one side of the Fracture of the both side of the
femur and proximal 3rd of the hip and one femur Hip and one femur
tibia with callus formation
 CAST IN THE LOWER EXTREMITIES

DOUBLE HIP SPICA CAST PANTALON CAST FROG CAST

For fracture of two hips and Fracture of the pelvis Congenital hip dislocation
two femur
 ▪ A mechanical support for weakened muscle,
joints, and bone rehabilitation
FUNCTIONS:
1. Maintains body ALIGNMENT
BRACE 2. Prevent and correct DEFORMITY
3. Permit patient to walk without FATIGUE
4. For IMMOBILIZATION
5. To control INVOLUNTARY MOVEMENTS
6. For SUPPORT
 EXAMPLE OF BRACES

PHILADELPHIA COLLAR BRACE

SHANTZ COLLAR BRACE For cervical spine affection FOUR POSTER BRACE
For cervical spine affection a neck brace used to prevent For cervical spine and upper
head and neck movement after thoracic spine affection
a spinal cord injury.
 EXAMPLE OF BRACES

SOMI BRACE
KNIGHT TAYLOR BRACE
Sternal Occipital Mandibular Immobiliser
Affection of the upper
effectively controls the rotation, flexion, extension thoracic spine
and lateral movement of the cervical spine.
 EXAMPLE OF BRACES

JEWETTE BRACE
designed to give support to your MILWAUKEE BRACE
CHAIR BACK BRACE thoracic and lumbar spine by is a back brace most often
lumbo-sacral spine affection preventing twisting and flexion used in the treatment of spinal
designed to maintain the (bending forward). curvatures (such as scoliosis
spine in a neutral position or kyphosis)
 EXAMPLE OF BRACES

SCOTTISH RITE
For patients who is having Legg- COCK – UP SPLINT
YAMAMOTO BRACE Perthes disease to immobilize the hand in the
For scoliosis position of function (dorsal
LEGG-PERTHES DISEASE - extension) during healing (as of a
is a childhood condition - fracture).
femoral head begins to die.
 EXAMPLE OF BRACES

OPPEN HEIMER SPLINT

BANJO SPLINT For Radial nerve injury
To treat fracture and LIVELY FINGER SPLINT
contracture of the finger For fracture of the finger
 EXAMPLE OF BRACES

DENNIS BROWNE SHOE

foot abduction orthosis, is a
SHORT LEG BRACE
medical device used in the
LONG LEG BRACE It is designed to stabilize or assist treatment of club foot.
(unilateral/Bilateral) weak muscles, immobilize painful
For post poliomyelitis with joints, or correct the position of Metatarsus adductus refers to a
residual paralysis the foot and ankle; FOR clubfoot condition where
the metatarsal bones are turned
toward the middle of the body.
ORTHOPEDIC HARDWARE AND THEIR INDICATIONS

MINI ROGER ANDERSON

ROGER ANDERSON EXTERNAL FIXATOR
TOWERS EXTERNAL FIXATORS EXTERNAL FIXATOR For comminuted fracture of the
For fracture of the mandible For comminuted fracture of long bone of upper extremity
the long bone (radius, ulna, and humerus)
ORTHOPEDIC HARDWARE AND THEIR INDICATIONS

ILIZAROV EXTERNAL FIXATOR

HYBRID EXTERNAL FIXATOR
DELATA FRAME EXTERNAL For comminuted fracture, non-
For periarticular fracture of union, mal-union, & for bone
FIXATOR
the ankle or knee joint lengthening
For fracture of the proximal 3rd
and distal 3rd of tibia-fibula
ORTHOPEDIC HARDWARE AND THEIR INDICATIONS

Spanning external fixator

For the fracture of the femur Hoffmann’s external fixator
extended to tibia For pelvic fracture or hip
dislocation
ORTHOPEDIC HARDWARE AND THEIR INDICATIONS

COMPRESSION HIP SCREW Y BONE PLATE

INTRAMEDULLARY NAIL For supracondylar fracture of the
FIXATOR
For fracture of the middle 3rd humerus
Intertrochanteric fracture of
of the femur/long bone X BONE PLATE – for fracture of the
the femur
medial 3rd of radius-ulna
ORTHOPEDIC HARDWARE AND THEIR INDICATIONS

CERCLAGE WIRE
BUTTRESS BONE PLATE Used in tension bond wiring LUQUE ROD & HARRINGTON ROD
Fracture of the proximal 3rd of For fracture of the patella For Scoliosis
Tibia
ORTHOPEDIC HARDWARE AND THEIR INDICATIONS

SUB LAMINAR WIRE AUSTIN MOORE HIP PROSTHESIS BIPOLAR HIP PROTHESIS
To hold rod in place during Replacement of femoral head Replacement of femoral head,
instrumentation specially for and neck neck, and acetabulum
scoliosis For Partial hip replacement For total hip replacement
Arthroplasty Arthroplasty
ORTHOPEDIC HARDWARE AND THEIR INDICATIONS

KNEE PROSTHESIS ANTIBIOTIC BEADS SPACER ANTIBIOTICS

For osteoarthritis of knee For osteomyelitis For replacement of
For fracture of the patella Used for prophylactic effect in
platting, internal, and external
infected hip prosthesis
fixators
ORTHOPEDIC HARDWARE AND THEIR INDICATIONS

OSTEOTOME (CHISEL) GIGLI SAW BONE DRILL HEMOVAC

Used in obtaining bone For amputation For boring hole For collection of
chips drainage under
Used for scraping
through the bone negative pressure
necrotic bone tissue
 TRACTION
▪ is the application of a pulling
force to a part of the body.

▪ is used primarily as a short-term

intervention until other
modalities, such as external or
internal fixation, are possible.

▪ effects of traction are evaluated

with x-ray studies, and
adjustments are made if
necessary.
 TRACTION
PURPOSES:
▪ to minimize muscle
spasms
▪ to reduce, align, and
immobilize fractures
▪ to reduce deformity
▪ to increase space
between opposing
surfaces.
 PRINCIPLES OF EFFECTIVE TRACTION

▪ Whenever traction is applied,

countertraction must be used to
achieve effective traction.

▪ Countertraction is the force acting in

the opposite direction.
▪ the patient’s body weight
▪ bed position adjustments supply
the needed countertraction.
 PRINCIPLES OF EFFECTIVE TRACTION

The following are additional principles to

follow when caring for the patient in
traction:
1. Traction must be continuous to be
effective in reducing and immobilizing
fractures.
2. Skeletal traction is never interrupted.
3. Weights are not removed unless
intermittent traction is prescribed.
 PRINCIPLES OF EFFECTIVE TRACTION

4. Any factor that might reduce the effective

pull or alter its resultant line of pull must be
eliminated:
a. The patient must be in good body
alignment in the center of the bed when
traction is applied.
b. Ropes must be unobstructed.
c. Weights must hang freely and not rest on
the bed or floor.
d. Knots in the rope or the footplate must not
touch the pulley or the foot of the bed.
 TYPES OF TRACTION
1. STRAIGHT OR RUNNING TRACTION
▪ applies the pulling force in a straight
line with the body part resting on the
bed.
▪ Example: Buck’s extension traction

2. BALANCED SUSPENSION TRACTION

▪ supports the affected extremity off
the bed and allows for some patient
movement without disruption of the
line of pull.
▪ Example: Balance Skeletal Traction
TYPES OF TRACTION
1. Traction applied to the skin
(skin traction)
2. Directly to the bony skeleton
(skeletal traction).
3. Traction applied with the
hands (manual traction).

***mode of application is
determined by the purpose of
the traction.
 SKIN TRACTION TRACTION TAPE

▪ is used to control muscle spasms and

to immobilize an area before surgery.
▪ Is accomplished by using a weight to
pull on traction tape or on a foam
boot attached to the skin.
▪ The amount of weight applied must
not exceed the tolerance of the skin.
A. EXTREMITY - No more than
2 to 3.5 kg (4.5 to 8 lb)
B. PELVIC TRACTION - 4.5 to 9 kg (10
to 20 lb), depending on the weight of
the patient. FOAM BOOT
 SKIN TRACTION: TYPES
1. ADHESIVE – use of adhesive tape, elastic bandage, wooden
spreader, and wadding sheet.

1.1 DUNLOP TRACTION 1.2 BUCK’S EXTENSION TRACTION

Supracondylar fractures in children, allows Affection of the hip and the femur
swollen elbow to settle and contraindicated in
open fractures and skin defects
 SKIN TRACTION: TYPES

1.3 BRYANT TRACTION 1.4 MODIFIED BUCK’S EXTENSION

It is mainly used in young children who have TRACTION
fractures of the femur or congenital Use of foam instead of plaster
abnormalities of the hip. (BELOW 3 y/o) Affection of hip and femur
 SKIN TRACTION: TYPES
2. NON ADHESIVE – use canvass, slings, straps with buckles,
laces, and ribbons.

2.1 HEAD HALTER TRACTION 2.2 PELVIC GIRDLE TRACTION

2.3 COTREL TRACTION
used for short term cervical ▪ For lumbo-sacral spine
For scoliosis
traction. Uses include minor affection
A combi of head halter
neck injuries without ▪ For Herniated Nucleus
and pelvic girdle
obvious fractures Pulposus
 SKIN TRACTION: TYPES

2.5 BOHLER BRAUN SPLINT

2.4 HAMMOCK SUSPENSION TRACTION Support the lower leg
For affection of the pelvis For fracture of the proximal
3rd and middle 3rd of the tibia
and fibula
 SKELETAL TRACTION: TYPES

90 – 90 DEGREE
BALANCED SKELETAL
OVERHEAD TRACTION TRACTION
TRACTION
Supracondylar Fracture Subtrochanteric and
Affection of the hips and or
of the Humerus Proximal 3rd Fracture of
Femur
Femur
 SKELETAL TRACTION: TYPES

HALO FEMURAL STOVE IN TRACTION

HALO PELVIC TRACTION
TRACTION For massive rib fracture
For C type Scoliosis
For S Type Scoliosis