Postoperative nursing of fracture patients

- May 27, 2020-

Compression fracture of lumbar spine

Posture: Patients in lying position and injured vertebral pillow should lie on the rigid board after hospitalization and remove the pillow to keep the spine straight and prevent deformity or further injury.

a. At the same time, according to the degree of fracture compression, a suitable soft pillow is placed under the injured vertebral body. The pillow can be lowered first and then gradually increased. This method uses the principle of trunk gravity and lever to keep the spine stably extended and gradually reset. To expand the compressed vertebral body and correct the deformity of the fracture. b. The patient must adhere to the pillow for at least 6 weeks. A

The nurse should help guide the patient to perform axis turn over regularly, that is, shoulder and hip turn over at the same time to avoid twisting of the limbs and spinal twist. When turning over, instruct the patient to straighten the waist and back, tighten the back muscles, and form a natural internal fixation splint.

(1) Reduction period: pillows for 1 to 2 weeks, patients are encouraged to practice active abdominal lifting, 3 times a day, 5 to 10 minutes each time.

(2) 5-point support method: supine, using the head, elbows, and heels to support the whole body at 5 points, so that the back is vacated and stretched, about 1 week after the injury.

(3) Three-point support method: developed on the basis of the five-point support method, the patient lies on his back, his arms are placed in front of his chest, supported by the head and feet, and the waist, hips and back are vacated off the bed, which is beneficial to the lumbar and back muscles Exercise, perform this exercise 2 to 3 weeks after injury.

(4) 4-point support method: supine, with both hands, feet supported on the bed at 4 points, the whole body is vacant and arch-shaped, 3 to 4 weeks after injury.

(5) Feiyan point water method: the patient protrudes the upper limbs and stretches out, the lower leg and the ankle cushion a pillow, the neck stretches slightly, then lifts the chest away from the bed surface, the two upper limbs stretch toward the back, and the lower limbs stretch as far as possible , The whole body is tilted up, and only the abdomen is implanted as a supporting point, which is in an arc shape, and practiced after 5 to 6 weeks.

Pelvic fracture

1. For marginal pelvic fractures, only bed rest is required. Patients with anterior superior iliac spine fractures are placed in hip flexion position; ischial tuberosity fractures are placed in hip extension position. Rest in bed for 3 to 4 weeks.

2. When there is separation of pelvic single ring fractures, it can be fixed by traction with pelvic belt suspension. The pelvic sling is made of thick canvas, its width abuts the iliac wing, and the lower trochanter of the femur. The weight is suitable for lifting the hips away from the bed surface. After 5 to 6 weeks, use gypsum shorts to fix.

Pelvic traction must continue for more than 3 weeks. Due to the patient's long-term bed rest and limited mobility, it is necessary to prevent complications. The patient's bed should be kept flat, dry and free of debris, protect the bone protruding area, massage the compressed area regularly, and use air cushions reasonably to prevent the occurrence of bedsores. The width of the sling should be appropriate. When pulling, both sides must be pulled at the same time to prevent the pelvis from tilting and deforming the limbs. Instruct patients to perform functional exercises, gradually restore limb function, and recover soon.

Fracture of distal radius

1. No displacement fracture, can be fixed with functional cast or small splint for 4 weeks.

2. Displaced fractures require closed reduction. The surgeon pulled the patient's palm and thumb along the long axis of the forearm to deflect the wrist ulnar and pronation the forearm. Then flex the wrist joint, and simultaneously push the palm and ulnar on the distal radius fracture. Keep the wrist in pronation and mild palmar flexion deviation, use forearm cast or small splint to fix for 4 weeks, and change to neutral position for 4 weeks from 10 to 14 days.

Clavicle fracture

The 8-shaped bandage fixation method is the most economical method for treating clavicle fractures. It has the advantages of low cost and little pain, and will not cause a second injury. But the patient must not be moved. Because it is only a treatment to assist fracture healing, there are also treatments:

1. For infants with broken green branches, only triangle towels are used for suspension. If there is displacement, fix it with a figure 8 bandage or double circles for 1 to 2 weeks.

2. For adolescents or adults who have overlapping displacement or angular deformity, manual reduction can be used, and double-loop or 8-shaped bandages are used for fixation.

3. Open reduction and internal fixation: internal fixation with steel needle and bone plate.

Thoracic vertebral fracture

1. Maintain the stability of the thoracic spine: When the patient returns to the ward, three people should stand on the same side and lift the patient straight to the bed, go to the pillow for 6 hours. The nurse assists the patient to turn over once every 2 hours, and the head and torso are turned over be consistent.

2. Strictly observe the changes in the condition and the sensory movements of the lower limbs: closely observe the vital signs and make records, and check the patient's sensory function movement and autonomous urination function in time after the operation, especially the movement of the toes and ankle joints Feeling function.

3. Keep the drainage tube unobstructed: keep the drainage of the chest cavity smooth, properly fix the drainage tube, and instruct it not to stretch, press, or twist, and squeeze the drainage tube once every 2 hours. Observe the fluctuation of the water column in the breast bottle. The breast bottle is replaced once a day. Observe the volume and color of the drainage fluid in the chest bottle and record in time. When turning over, prevent the drainage tube from being pulled out or falling off.

4. Guide rehabilitation training: on the first day after surgery for patients without paraplegia, that is, to instruct the patients to do straight leg lifting exercises, 3 times a day, 30 minutes each time, to practice the isometric contraction of the quadriceps. Ankle dorsiflexion and plantar flexion, toe extension and flexion and other activities. Paraplegic patients wear corrective shoes to maintain joint function to prevent foot sag, and do passive exercise for the lower limbs of the patient 3 times a day, 1 hour each time, instruct and encourage the patient to do lower back muscle function exercises. To enhance spinal stability.

Start the five-point exercise 4 weeks after the operation, 3 to 4 times a day, 20 to 50 times each time, and gradually increase according to the situation, the amplitude gradually increases. After 1 to 2 weeks, you can change to the three-point support method and insist 6 to 12 months, no special circumstances should not be interrupted. 8 weeks after surgery, it can be moved under a wide belt or thoracolumbar brace.

Elderly femoral intertrochanteric fracture

Posture: After operation, the lower limbs should remain in abducted neutral position, and at the same time raise the lower limbs by 20-25 °. Place a soft foam pillow between the lower limbs and a soft pillow at the rouge to keep the knee flexion 10-15 °. When using the toilet, patients should avoid hip flexion, and the pelvis should be lifted up to prevent internal fixation.