Nursing Interventions Rationale
Maintain bed rest or limb rest as indicated.
Provides stability, reducing the possibility of
Provide support of joints above and below
disturbing alignment and muscle spasms, which
fracture site, especially when moving and
enhances healing.
turning.
A soft or sagging mattress may deform a wet
Secure a bed board under the mattress or
(green) plaster cast, crack a dry cast, or interfere
place patient on the orthopedic bed.
with the pull of traction.
Support fracture site with pillows or folded
Prevents unnecessary movement and disruption of
blankets. Maintain a neutral position of
alignment. Proper placement of pillows also can
affected part with sandbags, splints, trochanter
prevent pressure deformities in the drying cast.
roll, footboard.
Use sufficient personnel for turning. Avoid Hip, body or multiple casts can be extremely heavy
using abduction bar for turning patient with a and cumbersome. Failure to properly support limbs
spica cast. in casts may cause the cast to break.
Coaptation splint (Jones-Sugar tong) may be used
to provide immobilization of fracture while excessive
Observe and evaluate splinted extremity for tissue swelling is present. As edema subsides,
resolution of edema. readjustment of splint or application of plaster or
fiberglass cast may be required for continued
alignment of fracture.
Traction permits pull on the long axis of the
fractured bone and overcome muscle tension or
shortening to facilitate alignment and union. Skeletal
Maintain position or integrity of traction.
traction (pins, wires, tongs) permits the use of
greater weight for traction pull than can be applied
to skin tissues.
Ascertain that all clamps are functional.
Ensures that traction setup is functioning properly to
Lubricate pulleys and check ropes for fraying.
avoid interruption of fracture approximation.
Secure and wrap knots with adhesive tape.
Keep ropes unobstructed with weights hanging An optimal amount of traction weight is maintained.
free; avoid lifting or releasing weights. Note: Ensuring free movement of weights during
Nursing Interventions Rationale
repositioning of patient avoids sudden excess pull
on fracture with associated pain and muscle spasm.
Assist with placement of lifts under bed wheels Helps maintain proper patient position and function
if indicated. of traction by providing a counterbalance.
Position patient so that appropriate pull is Promotes bone alignment and reduces the risk of
maintained on the long axis of the bone. complications (delayed healing and nonunion).
Review restrictions imposed by therapy such
as not bending at the waist and sitting up with
Maintains integrity of pull of traction.
Buck traction or not turning below the waist
with Russell traction.
Hoffman traction provides stabilization and rigid
support for fractured bone without the use of ropes,
Assess the integrity of the external fixation pulleys, or weights, thus allowing for greater patient
device. mobility, comfort and facilitating wound care. Loose
or excessively tightened clamps or nuts can alter the
compression of the frame, causing misalignment.
Provides visual evidence of proper alignment or
beginning callus formation and healing process to
Review follow-up and serial X-rays.
determine the level of activity and need for changes
in or additional therapy.
Acts as a specific inhibitor of osteoclast-mediated
bone resorption, allowing the bone formation to
Administer alendronate (Fosamax) as
progress at a higher ratio, promoting healing of
indicated.
fractures and decreasing rate of bone turnover in
the presence of osteoporosis.
Initiate or maintain electrical stimulation if May be indicated to promote bone growth in the
used. presence of delayed healing or nonunion.
