Orthopaedic Cast and Braces

7/23/2019 Orthopaedic Cast and Braces

1/21

Orthopaedic Cast and

Braces

By Lisa Paxton MSN, RN, CPN


2/21

Cast Petalling

Why do we do it?Preserve sin integrity !y s"oothing ro#gh

edges o$ the cast

Red#ce soiling o$ any cast near the groin area%ow to petal&C#t "olesin padding approxi"ately 'x' inches,

ro#nded at one end

Place tape a!o#t ()* inches $ro" cast edge and$old over the edge o$ cast) +ae care to eeptape s"ooth and even)

ollow with a second piece o$ tape, overlappingthe -rst)


3/21

Cast Petalling

When to petal cast

Petal casts within . ho#rs o$ patient reaching the#nit to prevent ede"a $ro" ha"pering a!ility topetal the cast) /t will !e very hard to petal i$ the

extre"ity is ede"ato#s) Pre "edicate the child prior to petalling the cast

0ven i$ a cast is well padded, it "ay still need to!e petalled i$ there is a chance o$ the padding!eco"ing soiled1 s#ch as the diaper area edges o$a hip spica)

Parents should be taught how to petal castat home and be given extra petals to use ifneeded.


4/21

2iapering with a spicacast%ow +o&

3se a s"aller si4e diaper than #s#al and t#c!etween sin and cast) 3se a Poise pad inside thediaper $or extra a!sorption, partic#larly at night)

Chec the diaper every one to . ho#rs while awaeand at least twice at night) Change diaper as soonas it is wet or soiled)

+each parents5 caregivers how to diaper and

instr#ct on changing ti"es This is extremely important!! Cast will not be

changed due to soiling.


5/21

Spica 6 Petrie Cast

Bilateral Spica Cast

UnilateralSpica cast

Petrie Cast


6/21

Reso#rces

%ealth topics Cast care

http&55www)cincinnatichildrens)org5h

ealth5in$o5orthopaedics5ho"e5cast1care)ht"

%ip Spica cast carehttp&55www)cincinnatichildrens)org5h

ealth5in$o5orthopaedics5ho"e5hip1spica)ht"

Petri Cast carehttp&55www)cincinnatichildrens)org5h

ealth5in$o5orthopaedics5ho"e5petrie1
http://www.cincinnatichildrens.org/health/info/orthopaedics/home/cast-care.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/cast-care.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/cast-care.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/hip-spica.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/hip-spica.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/hip-spica.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/petrie-cast.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/petrie-cast.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/petrie-cast.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/petrie-cast.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/petrie-cast.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/hip-spica.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/hip-spica.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/hip-spica.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/cast-care.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/cast-care.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/cast-care.htm


7/21

Body Cast

+ypesMinerva Cast 7restricts cervical and #pper !ac "ove"ent8 9pplied aro#nd the nec and tr#n o$ the !ody

Cervical spine in:#ries

+orticollis release

Pantaloon Cast 7%ips will not "ove) No sitting or waling8 9pplied aro#nd the tr#n and to the nees o$ the !ody

Spondylolysis

Spondyliothesis

L#"!ar spine in:#ries

Risser Cast 7Can sit and wal8

9pplied $ro" the nec to the waist o$ the !ody Scoliosis

;yphosis

+horacic spine in:#ries


8/21

Minerva Cast

Photo. Courtesy of

http://www.flickr.com/photos/casts/3817!"!3/in/set#7$1!7%$$$8!$&!%$/


9/21

Risser 6 Pantaloon Cast


10/21

Body Cast

%ealth topicsRisser 6 Pantaloon Cast

http&55www)cincinnatichildrens)org5he

alth5in$o5orthopaedics5treat"ent5risser1pantaloon)ht"
http://www.cincinnatichildrens.org/health/info/orthopaedics/treatment/risser-pantaloon.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/treatment/risser-pantaloon.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/treatment/risser-pantaloon.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/treatment/risser-pantaloon.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/treatment/risser-pantaloon.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/treatment/risser-pantaloon.htm


11/21

Orthopaedic Braces

3nderar" Orthosis 7+LSO8 Prevents progression o$ spinal

de$or"ity

+horacic1L#"!o1Sacral1Orthosis Protection a$ter s#rgery

Prevent progressive scoliosis

Pavli %arness Ba!ies with hip disorders

Milwa#ee Brace

2e$or"ity o$ the spine


12/21

Orthopaedic Braces

'(S) BracePa*lik +arness

'(S) Brace


13/21

Orthopaedic Braces

ollow the lins to -nd o#t "orein$or"ation on the $ollowing !races

%ealth +opics

Milwa#ee Bracehttp&55www)cincinnatichildrens)org5health5in$o5orthopaedics5ho"e5"ilwa#ee)ht"

Pavli %arnesshttp&55www)cincinnatichildrens)org5health5in$o5orthopaedics5ho"e5pavli1harness)ht"

3nderar" Orthosis 7+LSO8
http://www.cincinnatichildrens.org/health/info/orthopaedics/home/milwaukee.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/milwaukee.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/milwaukee.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/pavlik-harness.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/pavlik-harness.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/pavlik-harness.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/underarm-orthosis.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/pavlik-harness.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/pavlik-harness.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/pavlik-harness.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/milwaukee.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/milwaukee.htmhttp://www.cincinnatichildrens.org/health/info/orthopaedics/home/milwaukee.htm


14/21

Orthopaedic patient and "#sclespas"s

M#scle Spas"s&

Spas"s can occ#r when a "#scle isover#sed and tired, partic#larly i$ it isoverstretched or i$ it has !een held in thesa"e position $or a prolonged period o$ ti"e)/n e


15/21

Signs 6 Sy"pto"s

9!nor"al "#scle rigidityPain in the a


16/21

>#estions to as thepatient5parent

9re yo# having pain?What does it $eel lie?2oes he5she always wae #p this

$re#ently or have di@c#lty withsleeping?

/s the pain "edicine not relieving

the pain?


17/21

Medication $or Spas"s

Aali#" Most o$ the ti"e ordered PRN $or

spas"s

/$ pain "edication is not relieving thepain& 9ssess the patient

2eter"ine i$ it co#ld !e "#scle spas"s

ive vali#" or as the M2 to ordervali#"

Re assess a$ter vali#" given


18/21

What is Aali#"

9 "#scle relaxant enerally )D* "g5g >E every E1F hrs) PRN

Be proactive w5 treat"entGo# have the a!ility to give PRN pain "edication

Round the Clock) 7%old $or sedation8

/tHs easier to prevent pain!e$ore it !eco"es worse


19/21

/A Aali#"

/A Rapid in:ection "ay ca#se respiratory

depression or hypotension

Infants and children& 2o not exceed (1.

"g5"in#te /)A) p#shAdults:Maxi"#" in$#sion rate& * "g5"in#teI

"axi"#" concentration $or ad"inistration& *"g5"L

9void extravasation 7tiss#e necrosis "ayocc#r8

/n:ection sol#tion availa!le as * "g5"L

/s not co"pati!le with any /AHs


20/21

%ow to ad"inister Aali#"/A

Stop the /AHs

l#sh with one "l NS

Slowly p#sh Aali#" as directed in theprevio#s slide

l#sh with one "l o$ NS

Restart =#ids

Aali#" will !#rn at the /A site) Preparepatient)


21/21

Re$erences

CC%MC %ealth topics) Retrieved on Nove"!er ., .J $ro"http&55www)cincinnatichildrens)org5health5in$o5de$a#lt)ht"

2e!ra Wol$ RN, MSN 7.J8) Post1op Pain in the OrthopedicPatient) Presented to 9'N in Octo!er .J

Minerva Cast5Brace) Retrieved Nove"!er .,.J $ro"&

http&55www)"ay-eldclinic)co"5P01!race)ht" Pediatric Lexi12r#gs Online&

http://www.crlonline.com/crlsql/servlet/crlonline

Pict#res co#rtesy o$ &http&55i"ages)google)co"5i"ages?hlKen6rl4K(R.92R9en3S'E*6Kpict#reo$petriespicacast6#"K(6ieK3+16eiK/SPvStLs;GvFM!es"G>M6saK6oiKi"ageres#ltgro#p6ctKtitle6resn#"K(6vedKCB>s9>w99
http://www.mayfieldclinic.com/PE-brace.htmhttp://www.crlonline.com/crlsql/servlet/crlonlinehttp://images.google.com/images?hl=en&rlz=1R2ADRA_enUS345&q=picture+of+petrie+spica+cast&um=1&ie=UTF-8&ei=ISPvStLsKYv6MbesmYQM&sa=X&oi=image_result_group&ct=title&resnum=1&ved=0CBkQsAQwAAhttp://images.google.com/images?hl=en&rlz=1R2ADRA_enUS345&q=picture+of+petrie+spica+cast&um=1&ie=UTF-8&ei=ISPvStLsKYv6MbesmYQM&sa=X&oi=image_result_group&ct=title&resnum=1&ved=0CBkQsAQwAAhttp://images.google.com/images?hl=en&rlz=1R2ADRA_enUS345&q=picture+of+petrie+spica+cast&um=1&ie=UTF-8&ei=ISPvStLsKYv6MbesmYQM&sa=X&oi=image_result_group&ct=title&resnum=1&ved=0CBkQsAQwAAhttp://images.google.com/images?hl=en&rlz=1R2ADRA_enUS345&q=picture+of+petrie+spica+cast&um=1&ie=UTF-8&ei=ISPvStLsKYv6MbesmYQM&sa=X&oi=image_result_group&ct=title&resnum=1&ved=0CBkQsAQwAAhttp://images.google.com/images?hl=en&rlz=1R2ADRA_enUS345&q=picture+of+petrie+spica+cast&um=1&ie=UTF-8&ei=ISPvStLsKYv6MbesmYQM&sa=X&oi=image_result_group&ct=title&resnum=1&ved=0CBkQsAQwAAhttp://images.google.com/images?hl=en&rlz=1R2ADRA_enUS345&q=picture+of+petrie+spica+cast&um=1&ie=UTF-8&ei=ISPvStLsKYv6MbesmYQM&sa=X&oi=image_result_group&ct=title&resnum=1&ved=0CBkQsAQwAAhttp://images.google.com/images?hl=en&rlz=1R2ADRA_enUS345&q=picture+of+petrie+spica+cast&um=1&ie=UTF-8&ei=ISPvStLsKYv6MbesmYQM&sa=X&oi=image_result_group&ct=title&resnum=1&ved=0CBkQsAQwAAhttp://images.google.com/images?hl=en&rlz=1R2ADRA_enUS345&q=picture+of+petrie+spica+cast&um=1&ie=UTF-8&ei=ISPvStLsKYv6MbesmYQM&sa=X&oi=image_result_group&ct=title&resnum=1&ved=0CBkQsAQwAAhttp://www.crlonline.com/crlsql/servlet/crlonlinehttp://www.mayfieldclinic.com/PE-brace.htm

Orthopaedic Cast and Braces

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