Fracture refers to the interruption of the continuity of bones or trabecular bones due to various reasons. In recent years, with the deepening of the aging degree of the mainland, the number of patients with osteoporosis and fragile fractures has shown a significant upward trend; coupled with the prevalence of bad living habits, including uncontrolled smoking and drinking, abuse of glucocorticoids, poor eating habits and insufficient exercise, etc., the incidence of osteoporotic fractures has also increased. It can be said that fractures have become one of the major public health problems, which not only affect people's physical health, but also increase the burden on families and society.
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Reduction, fixation, and functional exercise are the three principles of fracture treatment at present. Among them, fixation is divided into many types, cast fixation is one of the commonly used external fixation methods in orthopedic trauma, which can keep the trunk and limb fixed in a special position, thereby reducing or eliminating the weight of the affected part, promoting the healing of tissues and fractures and correcting the shape of the limbs. Some patients think that after applying a cast, they can go home to recuperate and wait for the fracture to recover, but this is not the case! The quality of daily care after fixation is directly related to the success or failure of treatment.
For example, the following details must be paid attention to -
Promote dry gypsum before drying the quilt Do not cover the quilt, in the summer you can expose the gypsum to the air, or blow dry with an electric fan, in the winter you can use an electric lamp dryer, when using, pay attention to let the water vapor of the gypsum evaporate out of the quilt cover. Patients who are delirious, awake from anesthesia, or uncooperative should be cared for while using a baking lamp to avoid accidents. After drying, the plaster should be prevented from being deformed by moisture, keep it clean, and be careful not to be contaminated by defecation and so on.
Patient's movement Before the cast has dried, the patient should try not to move to avoid deformation of the cast; if you need to move, you should support the cast with the palm of your hand, but be careful not to grasp it with your fingers to avoid forming pressure points. To help flip the hip herringbone cast holder, the patient should be lifted up and flipped over.
Observation of the affected limb Because the cast tube is hard and fits closely with the limb, it is difficult to adapt to the reactive swelling of the limb after trauma, and it is easy to compress the limb and many complications, such as compressive ulcers, compressive nerve paralysis and blood circulation disorders, which can lead to limb necrosis. Therefore, after the cast is fixed, the excess plaster powder should be gently wiped off with warm water in order to observe the blood circulation at the end of the limb. If the skin of the affected area appears purple, blue, swollen, numb, painful, incision or wound bleeding, you must contact the doctor in time, if necessary, you can take measures such as incision in the middle of the cast, local window opening and decompression, so as not to cause plaster compression. After the window is opened and decompressed, the local gauze and cotton pads are placed on the skin of the window, and the external cover of the original plaster piece is bandaged with bandages to avoid tissue edema. To prevent nerve paralysis caused by gypsum edge compression, such as the high position of the calf plaster can compress the small head of the fibula and cause total peroneal nerve paralysis, it should be observed whether there is foot drooping, numbness in the back of the foot and other symptoms. At the same time, it is also necessary to observe whether there are signs of infection, such as fever, putrid odor in the cast, and tenderness in the lymph nodes adjacent to the limb.
Elevate the affected limb Elevate the affected limb above the level of the heart. Upper extremity fixation patients can lift their arms up with a triangle scarf suspension when they get out of bed. After the lower limbs are cast, a hard pillow pad is used to suspend the heel under the calf.
Prevention of pressure sores Family members or caregivers should regularly help the patient turn over and strengthen local skin massage, such as using your fingers to dip alcohol on the skin, tail sacrum, and osteophyllum part of the outer ankle of the foot that is not covered with plaster. Note that bed linen should be kept clean, flat, dry and free of debris.
Functional exercise Patients should actively move joints that are not fixed by the cast, even limbs wrapped in plaster, and practice muscle contraction exercises according to the doctor's instructions to prevent muscle atrophy or joint rigidity.
Dietary care Patients are encouraged to eat high-calorie, high-protein, high-vitamin, and easily digestible foods to prevent constipation. Patients can also add some foods high in calcium, such as milk, sea rice, shrimp skin, etc. Try to avoid spicy stimulation and the intake of high-oil and high-sugar foods, avoid adding burden to the stomach and intestines, and avoid irritation causing pain, which is not conducive to recovery. Patients with gypsum vest surgery should eat small and multiple meals due to tight upper abdominal wrapping.
Review on time Gypsum fixation generally takes 4 to 6 weeks, and patients must go to the hospital for follow-up according to the time specified by the doctor, and cannot remove the cast by themselves.
Source| Family Medicine
The author | Jian Jing, Yibin Traditional Chinese Medicine Hospital
Editor| Zhou You Pang Zuliang (Intern)
Zhang Yue, | second instance
Final Trial | Liu Huiying Zhang Ruxian