A skeletal traction kit is included. Set of surgical instruments for skeletal traction

Skeletal traction is a functional method of treatment.

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

Indications for implementation:

1. Pronounced displacement of fragments along the length.

2. Late admission of the patient.

3. Inefficiency of one-stage 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. Drill manual or electric.

6, Clamp CITO.

7. Kirchner spoke.

8. Rubber plugs.

Manipulation #37

Skeletal traction

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

Indications (for traction)

1) pronounced displacement of fragments along the length

2.) late admission of the patient

3) inefficiency of one-stage 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 needles

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

4. Scissors, tweezers - 2 pcs.

5.Drill manual or electric

6. Bracket, knitting needles, rubber cork Cyto Kirchner

Pin insertion sites:

1.heel bone

2. upper metaphysis (tuberosity) of the tibia

3.above the condyles of the thigh

Technique:

(carried out by a doctor in strict observance of asepsis)

1. Process the operating field

2. Limit the operating field

3. Perform local anesthesia in the area of ​​​​introduction of the spokes.

4.Introducing the needle with a drill in the transverse direction

5. Put on sterile panty napkins at the ends of the knitting needles and press them with stoppers

6. Attach the CITO arc to the needle.

7. Tie a cord to the arc

8. Put your foot on the Beler splint.

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

Bed preparation:

1. Shield longitudinally or transversely at the foot end for limb abduction

2. Raise the foot end

3. Reinforce the Balkan frame above the bed.

Limb care:

1. Stop at an angle of 90 with the help of a load thrown over the block forward of the foot.

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

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

Manipulation #38

Carry out tests on the quality of gypsum

1. When squeezing in a fist, the gypsum should not stick together into a lump.

2. Mix two parts of gypsum with one part of water to a homogeneous mushy mass in an enameled basin with a layer of 1-2 cm, after 5-10 minutes. the plaster should become hard enough that no dents form on its surface when pressed with a finger.

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

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

Manipulation #39

Preparation of a plaster bandage

Equipment:

1. Gauze bandage - 1 pc.

2.Gypsum powder.

3. Oilcloth.

Order of execution:

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

2. A layer of gypsum is poured onto the bandage and the gypsum is rubbed into the pores of gauze with vigorous movements of the brush.

3. Having loosely folded the rubbed part of the bandage into a roll 5-7 cm wide, gypsum is successively rubbed into the following parts of the bandage.

4. The roll of the plaster bandage should be loose, this will ensure rapid and simultaneous impregnation of the bandage when it is immersed in water.

Manipulation #40

Emergency specific prophylaxis for tetanus in the unvaccinated

Equipment:

1.Tetanus toxoid SA - 1 ml.

2. Anti-tetanus serum PSS - 3000 IU

3. Anti-tetanus serum razv.PSS 1 ml. 1:100

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

5. Needles for subcutaneous and intradermal injections

6.Kidney trays 2 pcs.

8. Sterile cotton balls

Medicines for first aid for anaphylactic shock:

Adrenaline solution 1 ml. No. 3, 0.25% solution of novocaine, prednisone - 1 bottle, strophanthin or corglicon, 40% glucose solution - 20 ml

Manipulation algorithm

Strict observance of the rules of asepsis and antisepsis

Stages	Execution tools
1. Wash your hands thoroughly under the tap, wipe and treat with 96% alcohol.	Soap, towel, cotton balls with alcohol - 1 pc.
2. Take an ampoule of SA, check the expiration date. Treat with alcohol, shake, open, draw 1 ml from the ampoule with a syringe with a needle. SA.	SA ampoule - 1 ml, ball with alcohol, syringe - 1 pc., needles - 2 pcs.
3. Enter subcutaneously into the shoulder.	2 balls with 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, syringe 1 g, needles (1 of them for intravenous injections), balls with alcohol.
5. Enter 0.1 ml intradermally (flexion surface of the forearm).	Treat the skin of the forearm with alcohol twice.
6. Evaluate the results after 20 minutes. Measure the papule with a ruler.	Ruler. The reaction is considered negative if the papule is no more than 0.9 cm. If the papule (edema, redness) is more than 0.9 cm, the reaction is positive and the introduction of PSS should be stopped.
7. In case of a negative intravenous test from the blue marking ampoule PSS-300 IU, inject 0.1 ml subcutaneously. to the outer surface of the shoulder.	A syringe with a division of 0.1, an ampoule of PSS-300 IU, a needle-2 pcs. (Dial one, inject the other). Evaluate the reaction after 30 minutes. Close the ampoule with a sterile ball.
8. After 30 min. Inject the remaining dose of serum subcutaneously into the shoulder with a sterile syringe, change the needle	Open PSS ampoule, 2 g syringe, 2 needles, 96% alcohol.

Manipulation #41

Assemble a set of instruments for tracheostomy

Equipment:

1. Korntsang - 2 pcs.

2. Linen claws - 4 pcs.

3.Scalpel - 2 pcs.

4. Surgical tweezers - 2 pcs

5. Kocher hemostatic clamps - 5 pcs.

6. Scissors - 1 pc.

7. Needle holder with a needle - 1 pc.

8. Farabeuf hook retractors - 1 pair

9. Single-pronged hook - 1 pc.

10. Tracheostomy cannula - 1 pc.

11. Trousseau tracheal dilator - 1 pc.

12. Sterile tray - 1 pc.

Manipulation #42

Tracheostomy care

Prevention of asphyxia, trecheitis, 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 bix

Furacilin solution for washing the catheter

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

Iodonate solution

3% hydrogen peroxide

0.5% chlorhexidine bigluconate

2. Near the bed - electric suction.

Order of execution:

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

2.II and I with the fingers of the left hand fix the plates of the outer cannula of both sides (so that it does not move and does not fall out)

3. Shutter - "flag" of the external tracheostomy cannula to move to the top with the finger of the right hand (separate the external and internal cannula)

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

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

6. With 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 with a curved button probe, rinsed with an antiseptic solution (clean the inner cannula from crusts and mucus)

8. Fixing the plates of the outer cannula I and II with the fingers of the left hand, inject a few drops of a 4% soda solution into the hole of the outer cannula. Let the patient cough up (sputum thinning).

9. Suck out mucus, 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 I and II with the fingers of the right hand by the “ears” and insert it into the outer cannula in an arcuate motion.

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

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

13. Change the napkins under the tube and wash 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 (humidification of the inhaled air).

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

Catheter sterility!!!

Manipulation #43

Performing a lumbar puncture

Punctures

Compilation of a set for lumbar puncture, skeletal traction and cast removal

Performing a lumbar puncture

Necessary toolkit:

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

Sequencing

1. Lay the patient on his side with the head brought to the chest and legs bent and brought to the stomach.
2. Put on rubber gloves.
3. Treat the skin in the region of IV-V lumbar vertebrae 2 times (treat the place indicated by the doctor during anesthesia) with a sterile gauze pad with alcohol on tweezers.
4. Perform layer-by-layer infiltration anesthesia of soft tissues with 0.5% novocaine solution.
5. Prepare a puncture needle with a mandrin on a sterile napkin.
6. The puncture is performed by a doctor!
7. Collect the flowing cerebrospinal fluid in a test tube.
8. Give the doctor Claude's manometer to determine the CSF pressure.
9. After removing the puncture needle, treat the puncture site and apply a sterile napkin with adhesive tape.
10. It is recommended that the patient has 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.

Compilation of a set of tools for thoracocentesis, drainage of pleural puncture
Performing a pleural puncture - thoracocentesis

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
• chest radiograph in direct and lateral projection
• latex gloves
• adhesive plaster

Equipment:

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

Equipment:

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

Conducting flow-aspiration drainage

Equipment:

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

Compilation of a set of instruments for laparocentesis

Equipment:

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

Compilation of a set of instruments for soft tissue puncture

Indications: aspiration of the contents of the hematoma, removal of pus from the abscess for diagnostic or therapeutic purposes, the introduction of drugs, 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%
• ethanol
• glass slide or test tube
• adhesive plaster
• latex gloves

Compilation of a set of instruments for puncture of the joints

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 willow bacteriological laboratory
• adhesive plaster
• latex gloves

Joint puncture technique

Compilation of a set of instruments for puncture of the bladder

Equipment:

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

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

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

Skeletal traction is most often performed in a plaster, clean dressing or preoperative room. With a large amount of work in large hospitals, it is necessary to have several ready-made sterile sets 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.), knitting needles for skeletal traction (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 served 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 the transverse direction. Typical pin insertion sites: calcaneus, upper metaphysis of the tibia, subcondylar region of the thigh, olecranon. After the needle is inserted, sterile balls are put on its ends, which are pressed tightly against the skin with special fixatives or stoppers from penicillin vials put on the needle. The spoke is tensioned in an arc with a special spoke tensioner. In the CITO arcs, the tension is carried out without a spoke tensioner, but by screwing the arc 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 large loads. The cord is thrown over the bus block on which the patient's limb lies.

Equipment: a syringe with a capacity of 10 m, needles - 2, Kirschner's knitting needles - 2, a drill - manual or electric, a cyto arc, a set of keys for expanding the arc and fixing the knitting needles in it, two clamps of the knitting needles, tweezers - 2, a hemostatic clamp - 1, scissors, sterile balls, sterile wipes, towels, iodonate, alcohol, 1% - 2% solution of novocaine in ampoules, cables, cargo, Beller's tire

Compilation of a set of tools for applying and removing plaster bandages

Equipment: basin for water, scissors for dissecting a plaster cast, tongs for bending a plaster cast, a saw for sawing a plaster cast, a knife for cutting a plaster cast, dressing material, material scissors

Implementation of transport immobilization with standard tires for injuries of bones, joints and soft tissues of the extremities.

Cramer splint

Equipment: Cramer splints, rollers, bandages, kerchief bandage, soft pads, cotton-gauze pads

Preparation for manipulation:

1. Before applying, the tire is wrapped and put in a cover made of oilcloth or plastic film

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

Performing manipulation:

Shoulder fracture:

1. Wash your hands hygienically

2. Check for a fracture

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

4. Have the casualty sit comfortably facing you.

5. Select the bar length. Remember the rule: obligatory 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. Attach the tire to a healthy limb from the fingertips to the elbow joint and bend it at a right angle in this place

7. Reattach the splint from the elbow to the shoulder joint and in this place 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 tire from the fingertips to the opposite shoulder joint or the inner edge of the opposite shoulder blade

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

10. In order to avoid additional trauma to the injured limb, the splint is applied over clothes and shoes

11. Lay cotton wool in the places where the bones protrude (epericondyles, processes, etc.)

12. Place your injured hand on the inside of the simulated tire

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

14. Put the roller in the palm of your hand, bandage the splint in the area of ​​​​the wrist joint with an eight-shaped bandage

15. Bandage the elbow splint with a tortoiseshell bandage

16. Bandage the splint around the shoulder joint with a spike bandage

17. Monitor the patient's condition

With a fracture of the leg

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

2. One splint is modeled for the posterior surface by bending it to match the profile of the leg. The foot is placed at right angles to the shin.

3. For better fixation of fragments of the bones of the lower leg, it is necessary to additionally apply 2 more tires on the sides of it so that they cover the foot in the form of a stirrup

4. Tires are fixed with gauze bandages

5. Monitor the patient's condition

With hip fracture

1. Cotton-gauze pads are applied to the bone protrusions of the limb (for the prevention of bedsores)

2. A tire 110 cm long, modeled according to the bulge of the heel and calf muscle, is placed on the back of the leg

3. Two other tires, fastened together along the length, go from the armpit along the outer surface of the limb to the foot, covering the latter, as well as the rear tire, with its end, curved in the shape of the letter G. Such laying of the tires prevents plantar sagging of the foot

4. If there is a sufficient number of ladder 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 G - for the sole

5. Tires are strengthened with gauze bandages

6. Monitor the patient's condition

In the treatment of severe fractures, injuries of the cervical spine, swelling of muscle tissue, the skeletal traction method is often used. It involves fixing the bones using a tire, knitting needles and weights. As a result, the area is immobilized, the muscles relax, and the bones fuse. Skeletal traction reduces the duration of treatment and rehabilitation.

During treatment, the doctor can observe the process of bone tissue fusion and, if necessary, adjust the structure. Overlay period - more than 1.5 months. Do not prescribe skeletal traction to children, as well as to people in old age. A contraindication is the inflammatory process in the area of ​​damage. There is a method of skeletal traction A.V. Kaplan. It is characterized by the fact that bone fragments are connected and fixed using parallel and crossed spokes.

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

Kirschner metal wires are used (knitting needles for skeletal traction). The doctor, using a drill, passes the needle through the holes made in the bone tissue, and fixes it in the bone with special fixators. Outside, in order to prevent infection, the spokes are closed with sterile dressings or napkins. The tension of the spoke occurs through the bracket mounted on the spoke. The skin in the places where the pins exit, the places where the pins are attached are regularly examined by a doctor.

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

The weight of the loads used depends on the nature of the injury (the length of the displacement of breaks, the duration of the injury), the age of the patient, the state of his muscle tissue and the development of the muscles. The load on the injured limb is given gradually, with 50% of the weight of the planned required weight, which prevents a strong contraction of the muscle tissue near the bone fracture and allows obtaining 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 an anti-traction effect, while the more 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 there is a comparison of bone fragments under the control of x-rays;
2. retention (2-3 weeks), rest period to start further regeneration of bone tissue;
3. reparative, ending with the beginning of the formation of callus (4 weeks after the imposition of the mechanism) and the lack of mobility of fragments.

The duration of therapy using such a special design, on average, is from 4 to 8 weeks, but depends on the nature of the injury, the age of the patient, the state of his body and his individual characteristics for tissue regeneration. In the future, the fusion of the bone 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 extremities;
• injuries with displacement of bone tissue in a vertical and (or) diagonal direction;
• injuries of the hip bone, as well as the bones of the lower leg, thigh, shoulder;
• injuries of the cervical spine;
• broken calcaneus 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 applied in case of inflammation of the damaged bone and in the place where the pin exits. This technique is not recommended for young patients and the elderly. In addition, the method is not applicable to 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, the following should be mentioned:

• the likelihood of infection of the bone tissue during the installation of instruments for skeletal traction during the treatment period;
• the need for constant antiseptic treatment of the exit points of the needles 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 magnitude 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 Tools

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

1. manual or electric drill;
2. a Kirchner bracket, in the form of a horseshoe with special clamps for the spokes, to which a load is attached for traction;
3. a spoke (several spokes) of skeletal traction, with which Kirchner staples are attached for the procedure;
4. a special key for fixing the fastener;
5. clamp and pin for tensioning the spokes.

Kaplan's way

Method A.V. Kaplan is an osteosynthesis mechanism using a thin metal pin with an artificial narrowing of the bone marrow depression at the site of bone injury. It is a method of fixing damaged bone fragments using cross or parallel wires. It is used in the presence of mobile bone fragments in the ankle and tibia bones.

Kaplan skeletal traction for ankle fracture is applied through three-point traction. The first pin 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 stretching, a load of 6-7 kg is used, with simultaneous pulling upwards using a load of 3-4 kg, put on special hooks. To load downwards to the spoke of the tibia, weights of 3-4 kg are hung.

In order to control the position of the injured limb and the correct installation of the mechanism, an x-ray is taken in two projections in a couple of days. Gradually, as the bone tissue grows together, the load is reduced. A month later, the load is removed, a plaster cast is applied to the injured limb. The gypsum 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.