Caring for a client with a cast or traction

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.

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.

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. 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.