Tag Archives: orthopedics

Nursing Tips for Managing Pediatric Orthopedic Trauma

Nurses have a complementary role with physicians in caring for children with orthopedic injuries. Typically, the child will have been evaluated and had some sort of fracture management implemented. In children, nursing management is easer than in adults since a child is less likely to need an invasive surgical procedure. Many fractures can be dealt with using casts and splints alone.

Here are a few tips for providing the best care for your pediatric patients:

  • Ensure adequate splinting / casting. You will have an opportunity to see the child at their usual level of activity. If it appears likely that their activity may defeat the purpose of the cast or splint, inform the surgeon or extender so they can apply a better one.
  • Focus on pain control. Nothing aggravates parents more than seeing their child in pain! Make sure acetominophen or ibuprofen is available prn if pain is very mild, or scheduled if more significant. Ensure that mild narcotics are available if pain levels are higher. Remember, stool softeners are mandatory if narcotics are given.
  • Monitor compartments frequently. If a cast is used, check the distal part of the extremity for pain, unwillingness to move, numbness or swelling. If any are present, call the physician or extender and expect prompt attention to the problem.
  • Always think about the possibility of abuse. Fractures are rarely seen in children under 3, and almost never if less than 1 year old. If you have concerns about the physical findings or parent interactions, let the physician and social workers know immediately.

New Technology: The Next Generation Antibiotic Bead?

A number of surgical disciplines use antibiotic beads to deliver antimicrobial drugs to sites that may not have ideal serum penetration. Unfortunately, beads require multiple operations for placement and replacement until the desired effect is achieved.

What if there was a way of delivering antimicrobial therapy directly to the tissues that works for up to two weeks, then dissolves with no trace? A system that does this is being developed by engineers at Tufts University and the University of Illinois at Urbana. They created a small magnesium coil that can be heated using magnetic induction. It is enclosed in a silk pocket and then implanted into the infected tissues. 

The tissues surrounding the device can be heated to different temperatures by placing an induction coil over it and delivering a specific amount of power.

It is also possible to deliver antibiotic doses directly to the tissue by embedding the drug into the silk pocket. As the coil heats up, the antibiotic is released from the fabric. 

The magnesium coil normally dissolves within a few hours when immersed in water, and it takes a bit longer when in direct contact with living tissue. The silk pocket prolongs the time to dissolution, depending on how thick it is. In the rat experiment described in the paper, there was little or no trace after 15 days.

Bottom line: This exciting technology has the potential to simplify the delivery of antimicrobial therapy directly to deeper tissues for extended periods, without the need for a second procedure to retrieve the device. We’ll see how this implant works in studies in larger animals. I’m sure other derivative applications are soon to follow.

Reference: Silk-based resorbable electronic devices for remotely controlled therapy and in vivo infection abatement. Proceedings in the National Academy of Sciences. Published online November 24, 2014.

Nursing Tips for Managing Pediatric Orthopedic Trauma

Nurses have a complementary role with physicians in caring for children with orthopedic injuries. Typically, the child will have been evaluated and had some sort of fracture management implemented. In children, nursing management is easer than in adults since a child is less likely to need an invasive surgical procedure. Many fractures can be dealt with using casts and splints alone.

Here are a few tips for providing the best care for your pediatric patients:

  • Ensure adequate splinting / casting. You will have an opportunity to see the child at their usual level of activity. If it appears likely that their activity may defeat the purpose of the cast or splint, inform the surgeon or extender so they can apply a better one.
  • Focus on pain control. Nothing aggravates parents more than seeing their child in pain! Make sure acetominophen or ibuprofen is available prn if pain is very mild, or scheduled if more significant. Ensure that mild narcotics are available if pain levels are higher. Remember, stool softeners are mandatory if narcotics are given.
  • Monitor compartments frequently. If a cast is used, check the distal part of the extremity for pain, unwillingness to move, numbness or swelling. If any are present, call the physician or extender and expect prompt attention to the problem.
  • Always think about the possibility of abuse. Fractures are rarely seen in children under 3, and almost never if less than 1 year old. If you have concerns about the physical findings or parent interactions, let the physician and social workers know immediately.

Hare Traction: The Orthopaedic Surgeon’s Perspective

Here’s a curbside consult from Peter Cole MD, Chief of Orthopaedics at Regions Hospital. This is very interesting information for prehospital and ED providers. Length is 5:23.

This video was presented at Trauma Education: The Next Generation last September. Be sure to check out the upcoming 2014 conference materials at www.TETNG.org. Be sure to register now if you want to get continuing education credit for it!

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The Medical Orthopaedic Trauma Service

Our population is aging, and falls continue to be a leading cause of injury and morbidity in the elderly. Unfortunately, many elders have significant medical conditions that make them more likely to suffer unfortunate complications from their injuries and the procedures that repair them.

A few hospitals around the world are applying a more multidisciplinary approach than the traditional model. One example is the Medical Orthopaedic Trauma Service (MOTS) at New York-Presbyterian Hospital/Weill Cornell Medical Center. Any elderly patient who has suffered a fracture is seen in the ED by both an emergency physician and a hospitalist from the MOTS team. Once in the hospital, the hospitalist and orthopaedic surgeon try to determine the reason for the fall, assess for risk factors such as osteoporosis, provide comprehensive medical management, provide pain control, and of course, fix the fracture. 

This medical center recently published a paper looking at their success with this model. They retrospectively reviewed 306 patients with femur fractures involving the greater trochanter. They looked at complications, length of stay, readmission rate and post-discharge mortality. No change in length of stay was noted, but there were significantly fewer complications, specifically catheter associated urinary tract infections and arrhythmias. The readmission rate was somewhat shorter in the MOTS group, but did not quite achieve significance with regression analysis.

Bottom line: This type of multidisciplinary approach to these fragile patients makes sense. Hospitalists, especially those with geriatric experience, can have a significant impact on the safety and outcomes of these patients. But even beyond this, all trauma professionals need to look for and correct the reasons for the fall, not just fix the bones and send our elders home. This responsibility starts in the field with prehospital providers, and continues with hospital through the entire inpatient stay.

Related post:

Reference: The medical orthopaedic service (MOTS): an innovative multidisciplinary team model that decreases in-hospital complications in patients with hip fractures. J Orthopaedic Trauma 26(6):379-383, 2012.