1. Care of casts and
tractions
By: Joanna Marie Victoria Abanes

2. Importance of Casts:
1. To immobilize and hold bone
fragments in reduction
2. To correct and prevent
deformities.
3. To support and stabilize
weakened joints.

3. 4. To apply compression
pressure to
underlying soft
tissue.
5. To permit early
mobilization while
restricting movement
of a body part.
6. To reduce further
fracture.

4. Complications
of
clients with
Cast

5. Signs and
Complications Definition Cause symptoms Management
1. Pressure It is also known The Very 1. Check to
ensure that the
as decubitus pressure of painful “hot
ulcers ulcers , are
cast is not too
tight and
localized injuries
cast on spot” under frequently
to the skin neurovascul the cast monitor client’s
ar and neurovascular
and/or
status, usually
underlying prominent Mustiness every hour for
tissue usually bony or the first 24
over hours after
a bony promine
structures. unpleasant application.
nce, as a result odor over 2. Mobilize
of pressure, or the affected &reposition the
pressure in area patient every
two hours.
combination
with shear
and/or friction.
Pain and 3. Use protective
devices (elbow
tightness in protector).
the area

6. Signs and
Complications Definition Cause symptoms Management
4. Keep the skin
always clean
and dry.
5. A well-
balanced,
high-protein
diet is
recommended
as well as a
daily high-
potency
vitamin and
mineral
supplement.

8. Signs and
Complications Definition Cause symptoms Management
2. Cast It is an uncommon Occurs initially Abdominal 1. Placing a window
but serious from distention in the abdominal
Syndrome
complication , is compression of portion of the cast
most often seen in the 3rd portion of  epigastric or bivalving the
( Superior pain
orthopedic clients the duodenum cast may be
Mesenteric Nausea
who have been between the sufficient to
artery placed in a hip superior relieve pressure
syndrome) spica or body cast. mesenteric Vomiting on the duodenum.
artery and aorta. 2. Nasogastric
Feelings of intubation may be
bloating or done to
tightness decompress the
intestine
Inability to 3. Antiemetics
take a deep should be used
breath sparingly.

9. Bivalving
• Means cutting the cast
along both sides and then
splitting it to decrease
pressure on underlying
tissue.

11. Signs and
Complications Definition Causes symptoms Management
3. Infection Is the invasion of Most often Musty, 1. Cleanse the
a host organism's b results from unpleasant odor wound and
odily tissues by dise the over cast or at remove as much
ase- breakdown of the ends of cast contamination as
causing organisms, skin under the Drainage possible from the
their multiplication, cast. through cast or skin, soft tissues,
and the reaction of cast opening and bone.
host tissues to  Cast is “hot spot” felt (Debridement
these organisms resting too on cast over and irrigation)
and the toxins they close to the lesion
produce. tissue -- Increased pain 2. Try to avoid getting
particularly the cast wet
over boney during bathing,
prominences you can put a
plastic bag over
Cast edges the cast and hold
are sharp and it in place with a
irritating the rubber band.
skin

12. Signs and
Complications Definition Causes symptoms Management
3. If your skin itches
underneath the cast,
don't slip anything
sharp or pointed
inside the cast to try
and itch the
spot. Instead, try
tapping the cast or
blowing air from a
hair dryer down into
the cast.

14. Signs and
Complications Definition Cause symptoms Management
4. Circulation An inadequacy It results Cold skin 1. Perform
of blood flow. commonly from temperature frequent
impairment pressure on neurovascular
Inadequate
and blood flow to a peripheral  decreased assessments.
peripheral nerves from peripheral pulses - The area
particular area
tight casts distal to the
nerve of the body can Slow capillary injury should
damage result in too refill time have no
little oxygen change in
being delivered  bluish skin pigmentation
to that area, a compared
condition with the other
known as parts of the
hypoxia body.
- The skin
distal to the
injury is
warm.
- No numbness
or tingling
present

15. Signs and
Complications Definition Cause symptoms Management
- Pulses are
strong and
easily
palpated
- Check
capillary refill
(least
reliable)
Blood returns to
usual color
within 3
seconds;
older adults:
5 seconds
2. Assess
sensation and
motion of the
peripheral
nerves.

16. Signs and
Complications Definition Cause symptoms Management
Compartment It is a serious It is caused by Diminished or 1. The affected
Syndrome condition that anything that absent pulses extremity
involves increased decreases the should be
pressure in a compartment Slow nail bed kept at heart
muscle size, including capillary refill level
compartment. It external time 2. Cold
can lead to compression applications
muscle and nerve factors such as Skin pallor, should be
damage and tight casts. cyanosis or avoided
problems with coolness 3. Adequate
blood flow. hydration is
Increasing pain important for
maintaining
Painful edema the client’s
peripheral to cast mean arterial
blood
Pain on passive pressure
motion 4. A constrictive
Paresthesia bandage will
(tingling/prickling be removed
sensation) as ordered.

17. Signs and
Complications Definition Cause symptoms Management
5. A fasciotomy
may be
performed.
(an incision
through the skin
into the fascia of
the muscle
compartment
allows tissue
expansion and
restores blood
flow.)

18. Compartment
syndrome

19. Complications in
clients with
Tractions

20. Signs and
Complications Definition Cause symptoms Management
Urinary Stasis Urinary stasis - It Incomplete Cloudy urine, 1. Teach
and infection is the stoppage of emptying of the which may have patient to
the flow or bladder related a foul or strong consume
discharge of to positioning in odor
adequate
urine, at any level bed.
of the urinary Low fever
amounts of
tract. The patient fluids and to
may find use of Pain or burning void every 3
Urinary tract the bedpan with urination – 4 hours.
infection - uncomfortable
and may limit Pressure or 2. Antibiotic
fluids to cramping in the therapy as
minimize the lower abdomen prescribed
frequency of
by the
urination. Strong need to
urinate
physician.
3. Keep genital
area clean.

21. Signs and
Complications Definition Cause symptoms Management
Atelectasis and Atelectasis – -Patients in the Diaphoresis 1. Auscultate
pneumonia partial or hospital are patient’s lungs
complete collapse often very sick Chest pain every 4 – 8
hours to assess
of the lung. and cannot fight
respiratory
off germs. Productive status.
Pneumonia - Lung cough
inflammation -The types of
caused by germs present in Tachypnea 2. Teach patient
bacterial or viral a hospital are deep breathing
infection. often more Tachycardia and coughing
dangerous than exercises.
those Cyanosis
encountered in
the community. Crackles and
Rhonchi upon
auscultation

22. Signs and
Complications Definition Cause symptoms Management
Constipation and Constipation - It is a result of Lumpy of hard 1. Increase fiber
Anorexia refers to bowel the reduced stools intake of
movements that gastric motility patient.
are infrequent or due to Straining at 2. Instruct
hard to pass. decreased defecation patient to
activity level. increase fluid
-is a common Feeling of intake.
cause of painful incomplete 3. Therapeutic
defecation. evacuation measures:
- Stool
Anorexia – a lack Fewer than two softeners
or loss of bowel - Laxatives
appetite. movements in a - Enemas
week - Suppositories
4. Identify
patient’s food
preferences,
as appopriate

23. Signs and
Complications Definition Cause symptoms Management
Skin breakdown is caused by the Results from Redness 1. Closely
sweat or drainage irritation caused monitor the
that develops by the contact Discoloration status of the
during the of the skin with skin in
wearing of a cast. the tape or foam Blisters contact with
and shearing tape or foam
forces. Cracks to ensure
that shearing
Rashes forces are
avoided.
Scabs 2. Palpate the
area of the
dry, raised or traction tapes
shiny skin daily to
detect
Feeling for underlying
hard, soft, warm tenderness.
or wet skin. 3. Provide back
care at least
every 2
hours.

24. Signs and
Complications Definition Cause symptoms Management
Venous thrombo- It is the formation It is a result of include pain or 1. Teach patient
embolism of a blood clot in stasis of the tenderness and to perform
one of the deep blood flowing in swelling in the ankle and
veins within the the veins, upper and lower foot exercises
body, such as in increases extremities within the
the leg or pelvis. coagulability, limits of the
and injury to  increased traction
vessels. warmth therapy every
1 to 2 hours
Prolonged bed Edema when awake.
rest or 2. Encourage
immobility erythema patient to
promotes stasis. drink fluids
presence of (to prevent
dilated veins dehydration
and
on the chest associated
wall or leg. hemoconcent
ration which
contribute to
stasis.

25. Signs and
Complications Definition Cause symptoms Management
Circulatory An inadequacy of It results Pallor or 1. Assess
impairment blood flow. commonly from coolness of the circulation of
Inadequate blood pressure on patient’s the foot or
flow to a peripheral extremities hand within
particular area of nerves. 15 – 30
the body can Paresthesia minutes and
result in too little then every 1
oxygen being Slow capillary – 2 hours.
delivered to that refill time (Neurovascular
area, a condition assessment)
known as hypoxia. Complaints of
increasing pain 2. Encourage the
patient to
perform
active foot
exercises
every hour
when awake.