Skeletal traction kit included. Set of surgical instruments for skeletal traction

Skeletal traction is a functional treatment method.

The main principles are relaxation of the muscles of the injured limb and gradual loading.

Indications for implementation:

1. Pronounced displacement of fragments along the length.

2. Late admission of the patient.

3. Ineffectiveness of one-step reduction.

4. In the preoperative period to improve the condition of bone fragments before their fixation.

5. In the postoperative period.

Equipment:

1.Tray with sterile wipes.

2. Syringe and needles.

3. Glasses for iodonate, alcohol and 2% novocaine.

4. Scissors, tweezers – 2 pcs.

5.Hand or electric drill.

6, CITO bracket.

7.Kirchner wire.

8. Rubber plugs.

Manipulation No. 37

Skeletal traction

Skeletal traction– functional method of treatment. The basic principles are relaxation of the muscles, the injured limb and gradual loading.

Indications (for traction)

1) pronounced displacement of fragments along the length

2.) late admission of the patient

3) ineffectiveness of one-step reduction

4) in the preoperative period to improve the condition of bone fragments before their fixation

5) in the postoperative period

Equipment:

1.Tray with sterile wipes, balls

2.Syringe 10ml needle

3. Glasses for iodonate, alcohol and novocaine (2%)

4. Scissors, tweezers – 2 pcs.

5.Hand or electric drill

6. Brace, knitting needles, rubber stopper Cyto Kirchner

Knitting needle insertion sites:

1.calcaneus

2.upper metaphysis (tuberosity) of the tibia

3.above the femoral condyles

Technique:

(carried out by a doctor in strict adherence to asepsis)

1. Treat the surgical field

2. Limit the surgical field

3. Apply local anesthesia to the area where the needles are inserted.

4.Inserting the spokes with a drill in the transverse direction

5.Put sterile “pants” napkins on the ends of the knitting needles and press them with stoppers

6.Attach the CITO arch to the spoke.

7.Tie a cord to the arc

8.Place your leg on a Beler splint.

9. Throw the cord over the Beler tire block and install a load from 2 to 10 kg.

Bed preparation:

1. Shield longitudinally or transversely at the foot end to abduct the limb

2. Raise the foot end

3. Strengthen the Balkan frame above the bed.

Limb care:

1.Foot angle 90 with the help of a weight thrown over the block in front of the foot.

2.Pillows under the ankle-foot knee joint “donut”, under the heel

3. Observation of blood circulation: temperature of the foot, feel the movement of the fingers, pulsation of the arteries of the foot.

Manipulation No. 38

Test the quality of gypsum

1. When clenched in a fist, the plaster should not stick together into a lump.

2. Mix two parts of gypsum with one part of water to a homogeneous paste-like mass in an enamel basin with a layer of 1-2 cm, after 5-10 minutes. The plaster should become so hard that dents do not form on its surface when pressed with a finger.

3.Mix 1 part gypsum and 1 part water, roll into a ball, notice when it sets. Drop the ball from a height of 1.5 meters onto the floor; it should not break.

4.When mixed with water, gypsum should not smell like rotten eggs.

Manipulation No. 39

Preparing a plaster bandage

Equipment:

1.Gauze bandage – 1 pc.

2. Gypsum powder.

3. Oilcloth.

Execution order:

1.A thin layer of plaster is applied to the table and part of the gauze bandage (50-100cm) is spread on top.

2.Pour a layer of plaster onto the bandage and rub the plaster into the pores of the gauze with vigorous movements of the brush.

3. Loosely fold the rubbed part of the bandage into a roll 5-7 cm wide. The plaster is successively rubbed into the following parts of the bandage.

4.The rolling of the plaster bandage should be loose, this will ensure rapid and simultaneous soaking of the bandage when immersed in water.

Manipulation No. 40

Emergency specific prevention of tetanus in unvaccinated people

Equipment:

1. Tetanus toxoid CA – 1 ml.

2.Antitetanus serum PSS – 3000IU

3. Antitetanus serum dil. PSS 1 ml. 1:100

4. Syringes 1g., 2g., 1 with division 0.1

5.Needles for hypodermic and intradermal injections

6. Kidney-shaped trays 2 pcs.

8.Sterile cotton balls

First aid medications for anaphylactic shock:

Adrenaline solution 1 ml. No. 3, 0.25% novocaine solution, prednisolone - 1 bottle, strophanthin or korglykon, 40% glucose solution - 20 ml

Manipulation algorithm

Strict adherence to the rules of asepsis and antisepsis

Stages	Execution Tools
1.Wash your hands thoroughly under the tap, dry and treat with 96% alcohol.	Soap, towel, cotton balls with alcohol – 1 pc.
2.Take an ampoule of SA and look at the expiration date. Treat with alcohol, shake, open, draw 1 ml from the ampoule with a syringe and needle. SA.	SA ampoule – 1 ml., alcohol ball, syringe – 1 pc., needles – 2 pcs.
3.Inject subcutaneously into the shoulder.	2 balls of alcohol.
4.Take an ampoule of PSS (red marking) 1:100, wipe with alcohol, open, draw 0.2 - 0.3 ml with another syringe with a needle and division 0.1 and replace the needle with an intradermal one.	PSS ampoule 1:100, 1 g syringe, needles (1 of them for intravenous injections), beads with alcohol.
5.Introduce 0.1 ml intradermally (flexor surface of the forearm).	Treat the skin of the forearm with alcohol twice.
6.Assess the results after 20 minutes. Use a ruler to measure the papule.	Ruler. The reaction is considered negative if the papule is no more than 0.9 cm. If the papule (swelling, redness) is more than 0.9 cm, the reaction is positive and the administration of PSS should be stopped.
7. If the intravenous test is negative, inject 0.1 ml subcutaneously from the ampoule marked in blue PSS-300 IU. into the outer surface of the shoulder.	Syringe with 0.1 division, PSS-300 IU ampoule, 2 needles (dial one, inject the other). Assess the reaction after 30 minutes. Close the ampoule with a sterile ball.
8.After 30 minutes. Inject the remaining dose of serum subcutaneously into the shoulder with a sterile syringe, change the needle	Open ampoule of PSS, syringe 2 g, needles 2 pcs., alcohol 96%.

Manipulation No. 41

Assemble a set of instruments for tracheostomy

Equipment:

1. Forceps – 2 pcs.

2. Linen tacks – 4 pcs.

3. Scalpel – 2 pcs.

4. Surgical tweezers – 2 pcs.

5. Kocher hemostatic forceps – 5 pcs.

6. Scissors – 1 pc.

7.Needle holder with needle – 1 pc.

8. Farabefa hook retractors – 1 pair

9. Single-tooth hook – 1 pc.

10. Tracheostomy cannula – 1 pc.

11. Trousseau tracheal dilator – 1 pc.

12. Sterile tray – 1 pc.

Manipulation No. 42

Tracheostomy care

Prevention of asphyxia, trieitis, pneumonia.

Equipment:

1.On the bedside table:

A glass with a disinfectant solution and tweezers in it, a rubber catheter in a glass with a disinfectant solution

Sterile wipes, turundas, button probe, gloves, balls in a small box

Furacilin solution for washing the catheter

4% soda solution, long pipettes, sterile oil, pipette

Iodonate solution

3% hydrogen peroxide

0.5% chlorhexidine, bigluconate

2.There is an electric suction unit by the bed.

Execution order:

1.Wash your hands with soap and dry with a towel.

2. With fingers II and I of the left hand, fix the plates of the outer cannula of both sides (so that they do not move or fall out)

3. Move the shutter - the “flag” of the external tracheostomy cannula upward with the finger of your right hand (separate the external and internal cannulas)

4. With fingers I and II of the right hand, the nurse takes the “ears” of the inner cannula.

5. Using traction with an arcuate movement of the right hand, the nurse removes the inner cannula from the outer one. Place in a kidney-shaped tray with a 6% peroxide solution.

6. Using the palmar surface of the hand, the nurse checks the patency of the outer tube - the movement of air flow.

7. The removed inner cannula is cleaned using a curved button probe, rinse with an antiseptic solution (clean the inner cannula from crusts and mucus)

8. Fixing the plates of the outer cannula with fingers I and II of the left hand, insert a few drops of a 4% soda solution into the hole of the outer cannula. Allow the patient to cough (to thin the sputum).

9.Suck out mucus and crusts from the tube with a catheter (cannula patency)

10. Continuing to fix the outer cannula by the plates with the fingers of the left hand, take the inner cannula with the fingers I and II of the right hand by the “ears” and insert it in an arcuate motion into the outer cannula.

11.Lock – lower the “flag” of the outer tube down (fix the inner cannula with the outer one).

12.Use a pipette to drop 2-3 drops of sterile oil (to eliminate drying and crusting)

13.Under the tube, replace the napkins and clean the skin.

14. The outer tube is attached behind the neck with ribbons inserted into the slot of the plate (fixation of the tracheostomy cannula to the neck)

15. The tracheostomy cannula is covered with a moistened napkin in 2 layers (humidifying the inhaled air).

16. The internal cannula is cleaned, as necessary, with an electric suction.

Catheter sterility!!!

Manipulation No. 43

Performing a lumbar puncture

Punctures

Setting up a kit for lumbar puncture, skeletal traction and cast removal

Performing a lumbar puncture

Required tools:

• sterile tray
• puncture needle with mandrin
• sterile test tube
• tweezers
• syringe with injection needle
• novocaine solution 0.5%
• 70% ethyl alcohol
• Claude pressure gauge
• rubber gloves, adhesive tape

Sequence of actions

1. Place the patient on his side with his head brought to his chest and his legs bent and brought to his stomach.
2. Wear rubber gloves.
3. Treat the skin in the area of ​​the IV-V lumbar vertebrae 2 times (during anesthesia, treat the area indicated by the doctor) with a sterile gauze pad with alcohol on tweezers.
4. Carry out layer-by-layer infiltration anesthesia of soft tissues with a 0.5% novocaine solution.
5. Prepare a puncture needle with a mandrel on a sterile napkin.
6. The puncture is performed by a doctor!
7. Collect the leaking cerebrospinal fluid into a test tube.
8. Give the doctor a Claude pressure gauge to determine the cerebrospinal fluid pressure.
9. After removing the puncture needle, treat the puncture site and apply a sterile napkin with adhesive tape.
10. The patient is recommended to have strict bed rest (2 hours) on his back without a pillow and bed rest for 2 days.
11. Place the treated instrument in a container with a disinfectant solution.
12. Remove rubber gloves and place them in a container with a disinfectant solution.

Compiling a set of instruments for thoracentesis and pleural puncture drainage
Performing pleural puncture - thoracentesis

Indications: exudative and purulent pleurisy.
Necessary tools

• sterile tray
• puncture needle 10 cm long, 1 mm in diameter
• drainage tube
• clamp
• tweezers
• syringe with injection needle - 2
• novocaine solution 0.5% - 10 ml
• 70% ethyl alcohol
• test tube and bacteriological laboratory
• X-ray of the chest in frontal and lateral projection
• rubber gloves
• adhesive plaster

Equipment:

• sterile tray
• Bobrov apparatus
• clamp
• tweezers
• scissors
• silk thread
• furatsilin solution
• rubber fingertip
• rubber gloves

Equipment:

• sterile tray
• rubber bulb
• Bobrov apparatus
• rubber gloves

Carrying out flow-aspiration drainage

Equipment:

• sterile tray
• 68% antiseptic solution (as prescribed by a doctor)
• 70% ethyl alcohol
• rubber gloves

Compiling a set of instruments for laparocentesis

Equipment:

• sterile tray
• trocar
• 2 syringes of 5-10 ml for anesthesia and emergency care
• 0.5% solution of novocaine
• alcohol
• vessel for collecting liquid (up to 10 ml)
• dressing
• sterile test tubes
• long sterile towel

Compiling a set of instruments for soft tissue puncture

Indications: aspiration of hematoma contents, removal of pus from an abscess for diagnostic or therapeutic purposes, administration of medications, biopsy for tumors.
Equipment:

• sterile tray
• syringe with injection needle
• a set of puncture needles of various lengths and thicknesses
• syringes with injection needle
• tweezers
• novocaine solution 0.5%
• ethyl alcohol
• glass slide or test tube
• adhesive plaster
• rubber gloves

Compiling a set of instruments for joint puncture

Equipment:

• sterile tray
• puncture needle with a diameter of no more than 2 M~f
• tweezers
• syringes 10.0 ml; 20.0 ml
• syringes with injection needle
• novocaine solution 0.5%
• ethyl alcohol 700
• sterile dressing material
• test tube in a bacteriological laboratory
• adhesive plaster
• rubber gloves

Technique for performing joint puncture

Compiling a set of instruments for bladder puncture

Equipment:

• sterile tray
• Vir puncture needle or needle 12-15 cm long
• drainage tube
• clamps
• tweezers
• syringes with injection needles
• novocaine solution 0.5%
• ethyl alcohol 70%
• sterile dressing material
• iodonate
• adhesive plaster
• rubber gloves

Skeletal traction is an integral part of the so-called functional treatment and one of the most common traumatological procedures. A thin wire is inserted into the patient's bone and pulled in an arc. With the help of traction along the axis, the displacement of the fragments is eliminated. The limb is usually placed on a special splint to rest the injured muscles and relieve their tension. For the upper limb, CITO abductor splints are used, for the lower limb, Beler-type splints are used.

a - arc for traction; b - screw for compressing the arc and tensioning the spokes; c - socket wrench; g - hand drill with a knitting needle.

Skeletal traction is most often performed in a plaster room, a clean dressing room, or a preoperative room. With a large volume of work in large hospitals, it is necessary to have several ready-made sterile kits for skeletal traction. The set includes: a kidney-shaped tray, a syringe with a capacity of 10 ml, a glass for novocaine, needles (2 pcs.), skeletal traction needles (2 pcs.), tweezers (2 pcs.), a hemostatic clamp, sterile balls (6 pcs.) , sterile wipes (2 pcs.), shaving sticks with alcohol and iodine. The tray is presented to the traumatologist with a sterile forceps. After processing the surgical field, it is covered with sterile towels. The needle is inserted into the head of an electric or hand drill and inserted into the bone in a transverse direction. Typical sites for insertion of pins: calcaneus, upper metaphysis of the tibia, subcondylar region of the femur, olecranon. After inserting the needle, sterile balls are placed on its ends, which are pressed tightly to the skin with special clamps or caps from penicillin bottles placed on the needle. The spoke is tensioned in the arc with a special spoke tensioner. In CITO arches, tension is carried out without a pin tensioner, but by screwing in the arch screw. A cord with a load of 2 to 8-10 kg (rarely more) is tied to the arc. With good tension, the spoke does not bend even with very heavy loads. The cord is thrown over the block of the splint on which the patient’s limb lies.

Equipment: syringe with a capacity of 10 m, needles – 2, Kirschner knitting needles – 2, drill - manual or electric, cyto arc, set of keys for opening the arc and securing the knitting needles in it, two knitting needle clamps, tweezers – 2, hemostatic clamp – 1, scissors, sterile balls, sterile wipes, towels, iodonate, alcohol, 1% - 2% novocaine solution in ampoules, cables, weights, Beller splint

Compiling a set of tools for applying and removing plaster casts

Equipment: basin for water, scissors for cutting the plaster cast, pliers for bending the plaster cast, saw for cutting the plaster cast, knife for cutting the plaster cast, dressing material, material scissors

Performing transport immobilization with standard splints for injuries to bones, joints and soft tissues of the extremities.

Cramer splint application

Equipment: Kramer splints, rollers, bandages, scarf bandage, soft pads, cotton-gauze pads

Preparation for manipulation:

1. Before applying the splint, wrap it and put it in a cover made of oilcloth or plastic film

2. An inscription is made on the case (exchange fund)

Performing the manipulation:

For a shoulder fracture:

1. Wash your hands hygienically

2. Make sure there is a fracture

3. Explain to the victim the meaning of the manipulation, the need for it, reassure the patient

4. Make the victim sit comfortably facing you

5. Select the bar length. Remember the rule: mandatory fixation of the above and underlying joints from the fracture site, and in case of a shoulder fracture, immobilization of 3 joints is required

6. Apply the splint to the healthy limb from the fingertips to the elbow joint and bend it at a right angle at this point

7. Reapply the splint from the elbow to the shoulder joint and at this point bend it at an obtuse angle of 115 degrees, the end of the splint should reach the opposite shoulder joint or the inner edge of the opposite shoulder blade

8. Apply the prepared splint from the fingertips to the opposite shoulder joint or the inner edge of the opposite shoulder blade

9. Place the injured limb in an average physiological position: insert a small cotton swab into the armpit to slightly abduct the shoulder (up to 20 degrees); the forearm at the elbow joint is bent at an angle of 90 degrees and given a position midway between supination and pronation; the hand is extended at the wrist joint to an angle of 45 degrees

10. To avoid additional trauma to the injured limb, the splint is placed over clothing and shoes.

11. Place cotton wool in areas where bones protrude (epicondyles, processes, etc.)

12. Place the injured hand on the inner surface of the simulated splint

13. Tie the ends of the splint through the healthy shoulder girdle and axillary fossa

14. Place the roller in your palm, bandage the splint in the area of ​​the wrist joint with a figure-of-eight bandage

15. Bandage the splint in the area of ​​the elbow joint with a tortoiseshell bandage

16. Bandage the splint in the area of ​​the shoulder joint with a spica bandage

17. Monitor the patient’s condition

For a broken leg

1. Cotton-gauze pads, pads, etc. are applied to the bony protrusions of the limb.

2. One tire is modeled for the rear surface, bending it according to the profile of the leg. The foot is placed at a right angle to the shin

3. For better fixation of shin bone fragments, it is necessary to additionally apply 2 more splints on its sides so that they cover the foot in the form of a stirrup

4. The splints are fixed with gauze bandages

5. Monitor the patient's condition

For a hip fracture

1. Cotton-gauze pads are applied to the bony protrusions of the limb (to prevent bedsores)

2. A 110 cm long splint, modeled according to the convexity of the heel and calf muscle, is placed along the back of the leg.

3. Two other splints, fastened together along the length, run from the armpit along the outer surface of the limb to the foot, covering the latter, as well as the back splint, with their end curved in the shape of the letter G. This arrangement of splints prevents plantar drop of the foot

4. If there are a sufficient number of stair tires, it is advisable to lay the 4th tire along the inner surface of the thigh and lower leg, and also bend its lower end in the shape of the letter L - for the sole

5. The splints are strengthened with gauze bandages.

6. Monitor the patient's condition

In the treatment of severe fractures, injuries of the cervical spine, and swelling of muscle tissue, the method of skeletal traction is often used. It involves fixing the bones using a splint, knitting needles and weights. As a result, the area is immobilized, the muscles are relaxed, and the bones are fused. Skeletal traction can reduce the duration of treatment and rehabilitation.

During treatment, the doctor can monitor the process of fusion of bone tissue and, if necessary, adjust the structure. The application period is more than 1.5 months. Skeletal traction is not prescribed for children or elderly people. A contraindication is the inflammatory process in the area of ​​damage. There is a method of skeletal traction by A.V. Kaplan. It is characterized by the fact that bone fragments are connected and fixed using parallel and crossed knitting needles.

Before skeletal traction, local anesthesia of the skin, muscle tissue and bone tissue itself is performed. The procedure is performed by a surgeon, taking into account the requirements of a sterile room and the instruments used.

Metal Kirschner wires (wires for skeletal traction) are used. Using a drill, the doctor guides the needle through holes made in the bone tissue and secures it into the bone with special clamps. From the outside, in order to prevent infection, the knitting needles are covered with sterile dressings or napkins. The tension of the spoke occurs through a bracket mounted on the spoke. The skin at the places where the needles exit and the places where the needles are attached are regularly examined by a doctor.

An important point in the effectiveness of bone repositioning in this technology is the correct calculation of the loads used. Thus, when calculating the load on the lower limb for injuries of the femur, the weight of the leg is used, which is 15% of the weight of the human body (6-12 kg). For lower leg injuries, this weight is divided by half (4-7 kg). For old injuries, as well as in case of damage to large bones, the weight of the weights used increases to 15-20 kg. The exact weight of the load is determined by the attending physician two days after application of the device.

The weight of the weights used depends on the nature of the injury (length of displacement of the broken bones, how long ago the injury was), the age of the patient, the condition of his muscle tissue and muscle development. The load on the affected limb is given gradually, with 50% of the planned required weight, which prevents strong contraction of the muscle tissue around the bone fracture and allows for sufficient accuracy in the reposition of bone fragments.

The patient is placed in a bed with a shield, the lower end of the bed is raised by 40-50 cm to obtain a counter-traction effect, and the more the load is used, the more the end of the bed is raised.

There are 3 stages in therapy:

1. repositioning (up to 72 hours), during which bone fragments are compared under the control of x-rays;
2. retention (2-3 weeks), a period of rest to begin further bone tissue regeneration;
3. reparation, ending with the beginning of callus formation (4 weeks after application of the mechanism) and lack of mobility of fragments.

The duration of therapy using such a special design, on average, ranges from 4 to 8 weeks, but depends on the nature of the injury, the age of the patient, the condition of his body and his individual characteristics of tissue regeneration. Subsequently, bone fusion is carried out by applying a plaster cast.

Indications and contraindications

Skeletal traction is used for:

• helical, comminuted, complex open and closed fractures of the limbs;
• injuries with displacement of bone tissue in the vertical and (or) diagonal direction;
• injuries of the hip bone, as well as bones of the lower leg, thigh, shoulder;
• cervical spine injuries;
• broken calcaneal bone of the skeleton;
• if it is impossible or inappropriate to use other methods of repositioning and fixing bone fragments;
• postoperative rehabilitation period;
• severe swelling of injured muscle tissue.

The skeletal traction procedure is not used if there is inflammation of the damaged bone and at the site where the wire exits. The use of this technique is not recommended for young patients and elderly people. In addition, the method is not used for persons in a state of intoxication of various types, given the danger to life and health.

Advantages and Disadvantages

The advantages of using this technique are:

Among the shortcomings are the following:

• the likelihood of infection of bone tissue during the installation of instruments for skeletal traction during the treatment period;
• the need for constant antiseptic treatment of the places where the needles exit through the skin with special wipes (by applying antiseptic dressings);
• long course of treatment (more than 6 weeks).

The location of the injured limb, the size and weight of the load applied and the duration of therapy will depend on the nature of the fracture and the presence of complications.

Skeletal Traction Instruments

The set of devices for this technique consists of the following:

1. hand or electric drill;
2. Kirschner bracket, in the shape of a horseshoe with special clamps for the knitting needles, to which the load for traction is attached;
3. a skeletal traction wire (several wires), which are used to attach Kirschner staples for the procedure;
4. special key for fixing the clasp;
5. clamp and pin for tensioning the spokes.

Kaplan method

Method A.V. Kaplan is a mechanism of osteosynthesis using a thin metal pin with artificial narrowing of the medullary cavity at the site of bone injury. It is a method of securing damaged bone fragments using crossed or parallel wires. Used when there are mobile bone fragments in the ankle bones and tibia.

Skeletal traction according to Kaplan for an ankle fracture is applied through three-point traction. The first wire is fixed through the calcaneus, the second through the anterior edge of the distal tibia just above the ankle joint. The injured limb is placed on a Beler splint. For traction, a load of 6-7 kg is used, with simultaneous upward traction using a load of 3-4 kg, put on special hooks. To load downwards, weights of 3-4 kg are hung on the tibia wire.

In order to monitor the position of the damaged limb and the correct installation of the mechanism, an x-ray is taken in two projections after a couple of days. Gradually, as the bone tissue grows together, the load is reduced. After a month, the load is removed, and a plaster cast is applied to the injured limb. The plaster is completely removed after 2.5-3 months.

For complete rehabilitation, therapeutic massage, baths, bandaging with an elastic bandage, physiotherapy and exercise therapy are prescribed.