CARE OF PATIENTS WITH CRUTCHES, CANES, WALKERS,

CASTS, BRACES, TRACTION, FIXATORS

1. CRUTCH WALKING
CRUTCHES Are artificial support that assist patients who need aid in walking, usually post
orthopedic operations.
a. Goals before patient can use a crutch:
i. Develop power in the shoulder girdle and upper extremities that bears the
patients weight.
ii. trengthen and condition the patient.
b. !eaching a crutch stance:
i. "ave patient wear well fitting shoes.
ii. #ake patient stand on a chair or on the unaffected leg to obtain balance
iii. !he basic crutch stance is the !ripod $osition
a. !o position both crutches on a wide angle and unaffected leg
positioned closely behind the crutches
iv. !each the client to support weight on the hands and not on the axilla, as it
may cause crutch paralysis due to damage in the brachial plexus.
c. !eaching crutch gait
i. %rutch walking re&uires balance, coordination, and a high energy cost
ii. $ractice balance while leaning against the wall
iii. $ractice shifting body weight
iv. !each the client at least to gait speeds, fast and slow
v. hift gait from one to another to avoid fatigue
d. !ypes of crutch gaits
i. 'our(point gait ) slow but stable gait, weight is constantly shifted. !his can
only be used for patients who can move all of their extremities and can apply a
considerable amount on each foot
a. Advance the right crutch, followed by the left foot, then the left
crutch followed by the right foot
ii. !hree(point gait ) used when one leg is affected. *ittle or no weight bering is
allowed
a. Advance both crutches and the affected leg, then advance the
unaffected
iii. !wo(point gait ) weight bearing is allowed. !his is a progression from a four(
point gait that allows faster ambulation
a. Advance right foot and right crutch together, then do the
opposite foot and crutch
iv. wing(to(gait ) for a fast gait and considerable weight can be applied to both
feet.
a. Advance both crutches, and then swing the body so both feet
will be in the level of the crutch.
v. wing(though(gait ) faster gait and more weight can be applied.
a. Advance both crutches, and then swing the body so both feet
will be past the level of the crutches.
e. Going up the stairs using crutches ) +up with the good, down with the bad,. -hen
going up the stairs, advance the good leg first, then the bad leg and the crutches.
-hen going down, advance the bad leg and the crutches first then the good leg.
i. .ote: !he bad leg should always be with the crutches to provide support.
. A!BULATION WITH A CANE
CANE /s used for balance and support. .ormally has a curved handle and a rubber tip.
!ripod canes can provide more support
a. $urposes
i. Assist a patient to walk with greater balance
ii. !o compensate for deficiencies
iii. !o relieve pressure on weight bearing 0oints
iv. !o provide push or pull force forward, or to restrain the forward motion while
walking
b. !echni&ues for walking with a cane
i. "old the cane with the hand opposite the affected extremity
ii. Advance the cane at the same time the affected leg is moved forward
iii. 1eep cane close to the body to prevent leaning
iv. %an also be carried on the same hand as the affected side, and will be
advanced when the affected leg is advanced
v. !o go up and down the stairs
a. tep up on unaffected extremity
b. $lace cane and affected extremity next
c. 2everse procedure when going down stairs
d. !he strong leg goes up first then comes down last
". A!BULATION WITH A WALKER
WALKER $rovides more support than crutches or a cane for the patient who has poor
balance and cannot use crutches
a. Gives stability but does not permit a natural reciprocal walking pattern
b. 2olling walkers may assist the patient who has painful 0oints in the lower extremities,
decreased balance, or decreased cardiopulmonary function
c. e&uence used for a stationary 3non(rolling4 walker:
i. *ift the walker, placing it in front of you while leaning your body slightly forward
ii. !ake a step or two into the walker
iii. 2epeat the process
#. CASTS An immobili5ing device made up of layers of plaster of fiberglass
a. $urposes
i. !o immobili5e and hold bone fragments in reduction
ii. !o apply uniform compression of soft tissues
iii. !o permit early mobili5ation
iv. !o correct and prevent deformities
v. !o support and stabili5e weak 0oint
b. !ypes of cast
i. S$%&'(a&) Ca*' ) extends from below the elbow to the proximal palmar
crease
ii. Ga+,'-e' Ca*' ) extends from below the elbow to the proximal palmar crease,
including the thumb 3thumb spica4
iii. L%,.(a&) Ca*' extends from the upper level of the axillary fold to proximal
palmar crease6 elbow usually immobili5ed at right angle
iv. S$%&'(-e. Ca*' ) extends from below knee to base of toes
v. L%,.(-e. Ca*' extends from the upper thigh to the base of the toes, foot is
at right angle in a neutral position
vi. B%d/ Ca*' encircles the trunk immobili5ing the spine
vii. S0ica Ca*' incorporates the trunk and extremities
7. houlder spica cast ) a body 0acket that encloses trunk, shoulder and
elbow
8. "ip spica cast ) encloses the trunk and lower extremity
a. ingle hip spica ) extends from nipple line to include pelvis and
extends to one thigh
b. Double hip spica ) extends from nipple line or abdomen to
include pelvis and extends to include both thighs and lower legs
c. 9ne(and(a(half hip spica ) extends from upper abdomen,
includes 7 entire leg, and extends to the knee of the other leg
c. %are of clients with cast
i. %arry the newly casted body part with the palms of the hand to prevent
indentation and pressure.
ii. :levate the part with a pillow to prevent edema
iii. :xpose the cast to dry. Dry cast appears white, shiny, hard and resonant.
ensation of heat while the cast is drying is normal. Dont cover with blankets
because the heat from the drying cast can cause burns.
iv. 1eep the cast clean and dry.
v. 9bserve hot spots and musty odor, or drainage from the cast.
vi. #aintain skin integrity by petalling 3 applying adhesive tapes at the edges of
the cast to smooth the areas4
vii. %heck if the site it too tight by:
7. $allor, cyanosis
8. %old skin
;. .umbness, tingling
<. /nability to move the body part
=. Absence of pulse
viii. -indowing ) done to facilitate observation under the cast, and to assess pulse
or to prevent +cast syndrome,. !he procedure involves removal of a part of the
cast.
7. %ast yndrome ) usually in body casts. #anifested by a boated
feeling, vomiting, nausea, abdominal distention, abdominal pain, 9>
i1. >ivalving ) done for wound care or x(rays. /t is also done when a cast is too
tight or when healing process occurred. $rocedure involves splitting of the
cast
2. TRACTIONS A force applied in a specific direction. !o apply the force needed to overcome
the natural force or pull of muscle groups, a system of ropes, pulleys and weights is used.
a. P+&0%*e %3 T&ac'i%,
i. !o reduce and immobili5e fractures
ii. !o regain normal length and alignment of an in0ured extremity
iii. !o lessen or eliminate muscle spasm
iv. !o prevent deformity
v. !o give the patient freedom for +in(bed activities
vi. !o reduce pain
b. T/0e* %3 T&ac'i%,
i. kin !raction
7. >ucks !raction ) exerts straight pull on affected extremity6 temporary
intervention to immobili5e the leg in a patient with a fractured hip.
a. hock blocks are placed on the foot of the bed to prevent the
patient from falling
b. %an immobili5e one bone only
c. !urn client towards the unaffected side
d. %heck for pressure sore at the heel of the feet
8. 2ussell !raction ) knee is suspended in a sling attached to a rope and
a pulley on a >alkan 'rame, creating upward pull from the knee
3vertical traction4
a. -eights are applied at the foot of the bed creating hori5ontal
traction
b. !reat fracture femur, and can immobili5e more than one bone
c. Allows patient to move in bed more freely and permits bending
of the knee 0oint
d. Assess back of the knee for pressure sores
;. >ryant !raction ) used for children under 8 years old or below ;?
pounds to treat fractures of the femur and hip dislocations
a. >uttocks must be slightly off the mattress
b. 1nees slightly flexed to prevent hyper extension deformity of
the knee 0oints.
<. %ervical !raction ) used for tissue damage or degenerative disc
disease of the cervical spine to reduce muscle spasm and maintain
alignment
a. %ervical bed halter attached to weights that hang over head of
bed
b. @sually intermittent traction, elevate head of bed to provide
countertraction
=. $elvic !raction ) used for low back to reduce muscle spasm and
maintain alignment
a. $elvic girdle is secured around iliac crest with extension straps
attached to ropes and weights.
b. @sually intermittently applied6 patient is in semi(fowlers position
c. :ncourage client to use overhead trape5e
ii. keleton !raction ) traction applied directly to the bones using pins, wires, or
tongs that are surgically inserted6 used for fractured femur, tibia, humerus
7. >alance uspension !raction ) produced by a counter force other than
the patients weight
a. :xtremity floats or balances in the traction apparatus
b. $atient may change position without disturbing the line of
traction
8. !homas plint with $earson Attachment ) used for fractures of the
femur6 hip should be flexed at 8? degrees
a. @se footplate to prevent footdrop
b. %heck pressure at the groin area
c. P&i,ci0-e* i, '$e C-ie,' ca&e 4i'$ T&ac'i%,
i. !he line of pull should be in line with the deformity
ii. !here should be an ade&uate countertraction
iii. Apply traction continuously
iv. Allow the weight to hang freely
v. !urn the client as indicated
vi. Avoid friction
vii. $in ite care for skeletal traction
7. %leanse and apply antibiotic creams as ordered
8. 9bserve site for signs and symptoms of infection6 redness, warmth,
pain
viii. Do a neurovascular check
i1. $revent complications of immobility