Note 1? Nursing care after local external fixation with small splint. ① After the upper limb fracture is reduced and fixed, it should be held up by a triangle towel or a neck and wrist sling and hung on the chest to prevent the fracture from shifting again due to the loosening of splint when moving or the position of the patient's limb changes; ② Close observation of the blood circulation of the affected limb showed that the skin temperature decreased, the skin color turned blue or pale, the weather was cold, the blood returned slowly, the pulse of the radial artery weakened or disappeared, and the patient could not move his fingers autonomously, indicating that the limb circulation was affected by the tight splint, so he should immediately relax the splint and seek medical treatment in time; ③ When the splint is bound with the outer cloth belt, the tightness of the cloth belt should be adjusted at any time. The requirement is that the cloth belt can move up and down effortlessly when it is pinched1cm; ④ In addition to splint, paper pressure pad should be used to effectively control fracture re-displacement. If the paper pressure pad has severe pain, immediately check whether there is local skin compression and necrosis, loosen the cloth belt if necessary, and adjust the position of the splint.
2? Nursing care after plaster fixation. ① Closely observe skin color, temperature, numbness and persistent pain of limbs, and seek medical advice in time if found; (2) Don't cover the gypsum shell before drying and curing, so it can be dried and cured quickly. Bake with a special baking lamp when necessary to accelerate the drying and curing of gypsum; (3) Patients with plaster cast after limb surgery must raise the affected limb to prevent swelling and bleeding, and can be lifted by hanging or pillow. (4) When the patient complains of pain in a certain place or point of plaster, it must not be ignored. The pain is not necessarily in the wound or fracture, but may be the compression caused by the local plaster being too tight, and decompression should be done if necessary; ⑤ For the skin exposed to gypsum, especially the edge of gypsum and bony protrusions not wrapped by gypsum, check it at least once a day to see if there is redness, friction and other phenomena. , and give appropriate treatment. You can immerse your fingers in the edge of the plaster to massage the skin and promote local blood circulation. ⑤ For open fractures, after plastering, it is necessary to observe whether there is bleeding in the plaster, if the blood can penetrate to the surface of the plaster. In order to know whether the bleeding continues, you can trace the boundary of the blood with a pen. If the blood is beyond the scope of tracing, it means that the wound continues to bleed and you must go to the hospital immediately.
3? According to different fracture sites, pay attention to the position at rest. (1) clavicle fracture is forbidden to protrude from the shoulder. When taking a sitting position, supine position or slope position, be sure to hold your chest out; ② When the humeral surgical neck fracture is in supine position, the shoulders are slightly lifted, and the thin pillows under the upper limbs on both sides are placed parallel to the trunk to avoid backward extension; (3) No matter what form of external fixation is adopted for humeral shaft fracture, it is necessary to rest in a semi-seated position to maintain the drooping traction of upper limbs; ④ The external fixation position of humeral intercondylar fracture should be kept within 90 degrees of elbow flexion, and the swelling of elbow joint and blood supply of limbs should be closely observed after triangle towel suspension; ⑤ After the forearm fracture is fixed, elbow flexion should be kept at 90 degrees, and the forearm should be neutral (the tiger's mouth is upward) to prevent rotation; ⑥ Most fractures of the lower radius are fixed with small splints. Pay attention to keep wrist flexion and ulnar deviation after splint fixation. If there is severe swelling and finger numbness, it means that the splint is tied too tightly and should be adjusted in time.
4? During the period of external fixation of upper limb fracture, patients should be encouraged to actively practice the activities of stretching fingers and clenching fists, which can reduce swelling and relieve pain, promote blood circulation, and maintain the inherent activity of upper limb-grasping things, which is conducive to fracture repair and functional rehabilitation.