Caring for a client with a cast or traction

Definitions & Key takeaways

Caring for a client with a cast or traction can be challenging, but there are some key things to keep in mind. It's essential to ensure that the cast or traction remains clean and dry. Also, the client will need to be encouraged to move their affected limb as much as possible to prevent stiffness and promote healing. Finally, it is vital to monitor the client closely for any signs of skin breakdown or other unusual findings such as pain and numbness, pale or immobile toes or fingers, and foul odor. With meticulous care, most clients will heal without any problems.

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Introduction0:00–0:33

As a nursing assistant, you may come across individuals that have musculoskeletal injuries or traumas. To recover, these clients require immobilization and stabilization, which are techniques used to limit the movement of body parts in order to keep them in the proper position to prevent injury and promote healing.
This can be achieved with the use of special devices, such as casts and traction. Now, the most common musculoskeletal injuries are fractures, which typically occur due to trauma or a fall.

Fracture0:33–2:07

Now, a fracture is defined as a complete or partial break in the bone, which occurs when the physical force applied to the bone is stronger than the bone itself.
Additionally, broken bones can damage surrounding structures, including nerves, blood vessels, muscles, and tendons. There are many different types of fractures and many different ways of getting them; for example, repetitive activities, such as running or jumping, can lead to small cracks in the bone, also known as stress fractures.
Pathologic fractures, on the other hand, occur in bones that are weakened by other conditions, such as bone cancers or osteoporosis.
Closed fractures, sometimes called simple fractures, occur when the bone breaks, but the overlying skin remains intact. On the other hand, open fractures, also known as compound fractures, occur when the fractured ends of the broken bone pierces through the overlying skin.
In greenstick fractures, one side of the bone breaks, while the other side bends; in impacted fractures, a piece of one bone gets wedged into another bone.
Finally, comminuted fractures occur when the bone breaks into multiple fragments, while spiral fractures occur when a strong, twisting force is applied to the bone.
Spiral fractures are commonly seen in non-accidental traumas, such as physical abuse, like when someone forcefully grabs and twists on an arm.
Now, for a bone to heal properly, fractured ends must be brought back and aligned into their proper position. This process is called reduction.

Reduction & Fixation2:07–3:16

Two types of reduction include closed and open reduction. Closed reduction, which is also known as manipulation, refers to the alignment of broken ends of the bone back into their proper position without surgical intervention.
On the other hand, open reduction refers to the alignment of broken ends using surgery. Once aligned, bones must be held in place with a process called fixation.
There are two types of fixation: internal and external fixation. In internal fixation, metal devices, such as nails, pins, screws, plates, and wires, are put in to connect fractured ends and hold them in place.
Once the bone is healed, internal fixators can be removed or left in place. On the other hand, in external fixation, pins, screws, and wires are inserted through or into the fractured ends and held in place by a bar or ring, which is positioned over the affected part of the body.
Once the bone is healed, external fixators are removed. Another form of external fixation is a cast.

Casts3:16–4:40

Casts are custom-made immobilization devices that keep a part of the body in place until it heals. Casts can be made of fiberglass, plastic, or plaster of Paris.
Common indications for casting include fractures, dislocations of joints, ligament injuries, and correction of deformities.
Now, when caring for a client with a cast, there are several things that you should keep in mind. First, do not cover or touch the cast until it’s dry.
Plastic and fiberglass casts take 10-15 minutes to dry, while plaster of Paris casts require 24-72 hours. Review the care plan and position a client as directed by the nurse.
Next, use pillows to support the body part in the cast, so there’s good alignment. For example, for a leg cast, the foot should be higher than the hip to prevent swelling.
The nurse will perform frequent neurovascular assessment and check for pain; pulselessness; pallor, or paleness; paresthesia, or numbness; and paralysis.
The skin under the cast itches, so remind your clients to avoid putting objects into the cast. Moreover, foreign objects in the cast can damage the skin and cause an infection.
Regularly inspect the surrounding skin and keep the cast clean and dry.On the other hand, traction refers to the application of a pulling force to the affected part of the body.

Traction4:40–6:49

This is done to help guide the body part back into place. In traction, systems of ropes, pulleys, and weights are used to mechanically stretch and align the fractured ends of the broken bone.
But, in order to apply the traction, there must be a force that acts in the opposite direction. In other words, there must be something to pull against.
This force is also known as counter traction, and it’s typically achieved by the client’s body weight. Traction also decreases pain and muscle spasms, stretches soft tissue, and expands joint spaces.
Two main types of traction include skin traction and skeletal traction. In skin traction, weights are attached to splints, adhesive tapes, or bandages that are applied to the client’s skin over the fracture.
Skin traction is typically used as a temporary measure until skeletal traction is applied or surgery is performed. On the other hand, in skeletal traction, weights are applied to pins and wires that are inserted through the fractured bone.
In contrast to skin traction, skeletal traction provides stronger pull and can be used for longer periods. Now, when caring for a client with traction, review the care plan to know the correct placement of straps and weights.
Also, ask the nurse for instructions on how to assist the client in the bed. First, make sure the client has proper body alignment.
Next, regularly check the traction equipment. Make sure that the weights are hanging freely and that the correct amount of weight is used.
Also, ensure that the ropes are in pulley grooves and that they are not frayed. To promote mobility in the bed, provide your client with a trapeze, an overhead triangular helping device.
Frequently observe the pin and wire sites for edema, redness, drainage, and foul odors. Finally, provide proper skin care to prevent pressure ulcers and assist your client with range-of-motion exercises as outlined in the care plan.Last but not least: reporting!

Reporting6:49–7:20

Report any unusual local findings, such as pain, numbness, swelling, pallor, cyanosis, foul odor, drainage, and cold or immobile toes or fingers.
Also, report systemic signs and symptoms that are associated with infection, such as nausea, vomiting, fever, and chills.
Finally, don’t forget to document the date and time, and any unusual observations regarding the client’s cast or traction.All right, as a quick recap...

Recap7:20–8:52

A fracture is defined as a complete or partial break in the bone, which occurs when the physical force applied to the bone is stronger than the bone itself.
For a bone to heal properly, fractured ends of the bone must be brought back together and aligned into their proper position.
This process is known as reduction. Closed reduction is the alignment of broken ends without surgical intervention, while open reduction refers to the alignment of broken ends using surgery.
Once aligned, bones must be held in place by fixation. Internal fixation includes the use of metal devices that connect the fractured ends and hold them in place.On the other hand, external fixation can be also achieved with metal devices, which are inserted through or into the fractured ends and held in place by a bar or ring that is positioned over the skin.
Another type of external fixation are casts, which are custom-made immobilization devices that hold the affected part of the body in place until it heals.
On the other hand, traction refers to the application of a pulling force that is used to mechanically stretch and align the fractured ends of the broken bone.
Finally, don’t forget to report and document any unusual observations, such as pain, numbness, swelling, pallor, cyanosis, foul odor, drainage, cold toes or fingers, or difficulty or inability to move toes and fingers.
Also report systemic signs and symptoms, such as nausea, vomiting, fever, and chills!