Nursing experience after external fixation stent surgery for open tibial and fibular fractures
The application of external fixation bracket for the treatment of tibial and fibular fractures is to restore the function of the injured limb as soon as possible. Different bracket accessories such as long screws and steel needles are inserted into both ends of the fracture, and fixed with fixation rods and steel needle clips to achieve anatomical reduction and relative fixation of the fracture. From December 2012 to December 2013, the trauma surgery department of the Third Military Medical University treated a total of 92 cases of tibiofibular fractures with external fixation brackets. The nursing experience is summarized as follows.
Tag: External fixed bracket; Tibiofibular fracture; nursing
In recent years, with the continuous development of transportation and the accelerating pace of life, the number of patients with open tibiofibular fractures caused by high-energy injuries has been increasing year by year. They are often accompanied by soft tissue damage, multiple complications, and difficult treatment. External fixation is considered the preferred method for early treatment of open tibiofibular fractures.
1 Clinical data
From December 2012 to December 2013, a total of 92 cases of tibiofibular fractures were treated with external fixation brackets in the Department of Trauma Surgery at the Third Military Medical University, including 59 males and 33 females; The age range is 22-64 years old, with an average age of 43 years old. Among them, there were 21 cases of multiple fractures. After treatment, all fractures achieved anatomical or approximate anatomical reduction and relative fixation. Three cases developed needle tract infections, and the removal of external fixation brackets took 6-32 weeks.
2 Nursing Experience
2.1 Psychological care: Patients with sudden fractures experience fear and anxiety, and have more concerns about the recovery of limb function after the fracture. They lack confidence, are emotionally depressed, and cannot cooperate well with rehabilitation training [2]. Therefore, the first step is to provide psychological care. We should actively communicate with patients, introduce ourselves and the environment to them, eliminate their unfamiliarity, take corresponding measures according to each patient's different psychological characteristics and requirements, explain the surgical methods to patients, and tell them the advantages of external fixation therapy, especially avoiding secondary surgery, reducing patients' pain and economic burden, so that they can actively cooperate with treatment.
2.2 Preoperative preparation of surgical field skin, skin preparation and cleaning, sterile gauze bandaging, raising the affected limb above the level of the heart to brake, early cold compress for swelling reduction, routine drug skin sensitivity test, whole body cleaning, dietary restriction, emergency surgery for open fractures, and intravenous use of broad-spectrum antibiotics before surgery.
2.3 General postoperative care
2.3.1 Maintain the correct position of the external fixation bracket. After surgical treatment, in order to avoid swelling of the affected limb, the affected limb should be lifted and fixed at an angle of 20 ° to 30 ° from the horizontal plane to accelerate blood circulation. After fixation, the firmness of the bracket should be checked. If the bracket becomes loose, it should be immediately tightened to maintain its stability and prevent fracture displacement caused by the loosening of the bracket.
2.3.2 Observation of peripheral blood circulation and functional status of the affected limb. Improper needle insertion can easily cause damage to blood vessels and nerves when using external fixation stents for fracture patients. Therefore, after treatment, it is necessary to constantly observe changes in the color of the peripheral skin of the affected limb. If there is an abnormal change in color, the doctor should be notified immediately to handle the external fixation stent. This group
The patient had good blood supply to the distal end of the affected limb after surgery, with normal motor function and no vascular or nerve damage.
2.4 Nursing for preventing complications
2.4.1 Prevention of Needle Infection: Needle infection is the most common complication of external fixation. Infected fixation needles may become loose, lose their fixation function, prolong fracture healing time, and even cause chronic osteomyelitis. In the first few days after the external fixation bracket is fixed, there is a lot of needle leakage, and the dressing should be changed daily and the wet dressing should be replaced in a timely manner. To maintain the cleanliness of the needle passage, under sterile conditions, inject 75% alcohol into the nail hole twice a day and cover it with sterile gauze. To prevent inflammation caused by skin contact between the stent and the pinhole, a piece of gauze can be placed between the two. At the same time, it is necessary to constantly observe the changes after treatment to prevent skin necrosis caused by improper handling. The patient's temperature should be monitored at all times. If the patient's temperature exceeds 38 ℃, the wound should be immediately checked for redness and swelling, and antibiotics should be taken under the guidance of a physician for treatment. There were 3 cases of needle tunnel infection in this group, which were cured after stopping functional exercise, raising the affected limb to brake, clearing secretions and fully draining, and applying sensitive antibiotics.
2.4.2 Fixed bracket prevention: Under the influence of external factors, the fixed bracket may become loose, leading to further displacement of the fracture and affecting fracture healing. Therefore, during the patient's hospitalization, the fixation of the bracket should be checked daily, and the nuts and knobs of the fixed bracket should be carefully inspected to observe whether there is any looseness. After the patient is discharged, guidance should be given to the patient, especially emphasizing the importance of avoiding trauma. One case of tibiofibular fracture in this group was fixed for 32 weeks, which was prolonged due to a subsequent fracture caused by a fall 10 weeks after surgery.
2.5 Functional Exercise: Strengthening physical exercise is beneficial for both the psychological and physiological well-being of patients. It not only helps patients recover quickly, but also enhances their psychological confidence. Therefore, patients should undergo postoperative recovery training after treatment, with moderate and regular training intensity. Reasonable and regular training can promote joint flexibility, reduce swelling in the affected limb, and accelerate bone healing. Regular exercise can also make bones stronger and prevent muscle atrophy and osteoporosis.
2.5.1 Muscle Exercise: Muscle relaxation and contraction can promote blood circulation, accelerate venous and lymphatic return, reduce swelling, and prevent muscle atrophy. Method: Patients can be guided to perform muscle contraction and relaxation exercises such as dorsiflexion and plantarflexion on the same day after surgery, 2-3 times a day, 15-30 minutes per session.
Exercise should begin 2-3 days after joint training surgery when swelling begins to subside. Early activity should not involve weight-bearing. For lower limb fractures, the main exercise is to flex the knee joint to 80 ° and the ankle joint to 90 °. The intensity of exercise should be tolerable for wound pain, with a range of motion from small to large and from light to heavy to prevent further displacement. After one month, compared with the first postoperative X-ray, if the callus grows, the fixation is reliable and stable, and the support can be used to walk with crutches. After 8-12 weeks, the X-ray shows that the fracture meets clinical healing standards and the fixed support can be removed.
3 Discharge guidance
The surgical operation of external fixation stent treatment is relatively simple, and the hospitalization time is generally short. Most of the treatment and rehabilitation are carried out outside the hospital. We usually provide a postoperative nursing manual for discharged patients, which mainly includes: ① keeping the skin around the needle passage clean and dry, using 75% ethanol drops 3 times a day, and changing dressings once a day; When local pain, swelling, or purulent discharge is found, it is necessary to seek medical treatment promptly at the hospital Avoid external injuries; ③ Pay attention to checking whether the external bracket is loose; ④ Persist in functional exercise; ⑤ Regular outpatient follow-up, taking photos every 4-6 weeks
1 film; Within 3 months after surgery, re examination should be conducted once a month, and within 1 year after surgery, re examination should be conducted every 3 months.
4 Discussion
External fixation bracket is a simple and firmly fixed medical device that plays a role in reducing fractures and fixing them. Although there may be complications such as needle infection loosening, fracture re displacement, and non healing during the treatment process, as long as sufficient preoperative preparation is made and postoperative scientific and meticulous care is provided, especially psychological care and functional exercise. Fully understanding the advantages of external fixation brackets, actively cooperating with treatment, and actively engaging in staged functional exercises can minimize the occurrence of complications. 92 patients with limb fractures in this group were treated with external fixation and achieved satisfactory results through the aforementioned nursing care.
