and careful observation, reporting, and recording
of the patients condition will contribute markedly
to an optimal and timely postoperative recovery
course for the patient.
THE ORTHOPEDIC PATIENT
Patients on the orthopedic service are those
who require treatment for fractures, deformities,
and diseases or injuries of some part of the
musculoskeletal system. Some patients will require
surgery, immobilization, or both to correct their
condition. The basic principles and concepts of
care for the surgical patient will apply to ortho-
pedic patients. The majority of patients not re-
quiring surgical intervention will be managed by
bed rest, immobilization, and rehabilitation.
Many of the basic concepts of care of the medical
patient are applicable for orthopedic patient care.
In the military, the usual orthopedic patient is
fairly young and in good general physical condi-
tion. For these patients, bed rest is prescribed only
because his or her admitting condition limits other
kinds of activity.
Rehabilitation is the ultimate goal when plan-
ning the orthopedic patients total management.
Whether the patient requires surgical or conser-
vative treatment, immobilization is often a part
of the overall therapy. Immobilization may con-
sist of applying casts or traction, or using equip-
ment, such as orthopedic frames or Circ-O-Lectric
beds. During the immobilization phase, simple
basic patient care is extremely important. Such
things as skin care, active-passive exercises, posi-
tion changes in bed (as permitted), good nutrition,
adequate fluid intake, regularity in elimination,
and common basic hygiene not only contribute
to the patients physical but also psychological
Lengthy periods of immobilization are emo-
tionally stressful for patients, particularly those
who are essentially healthy except for the limita-
tions imposed by their condition. Prolonged in-
activity contributes to boredom that is frequently
manifested by various kinds of acting out
behavior. Often, the unoccupied orthopedic pa-
tient experiences exaggerated levels of pain.
Orthopedic pain is commonly described as sore
and aching. Because this condition requires long
periods of treatment and hospitalization, the wise
management of pain is an important aspect of
care. Constant pain, regardless of severity, is
energy consuming. You should make every effort
to assist the patient in conserving this energy.
There are times when the patients pain can and
should be relieved by medications. There are,
however, numerous occasions when effective pain
relief can be provided by basic patient care
measures such as proper body alignment, change
of position, use of heat or cold (if permitted by
a physicians orders), back rubs and massages,
and even simple conversation with the patient.
Meaningful activity also has been found to help
relieve pain. Whenever possible, a well-planned
physical/occupational therapy regimen should be
an integral part of the total rehabilitation plan.
As mentioned previously, immobilization is
often a part of the overall therapy of the ortho-
pedic patient; casting is the most common and
well-known form of long-term immobilization. In
some instances, a corpsman may be required to
assist in applying a cast or be directed to apply
or change a cast. In this section, we will discuss
the method of applying a short- and long-arm
cast, and a short-leg cast.
In applying any cast, the basic materials are
the same: webril or cotton bunting, plaster of
Paris, a bucket or basin of tepid water, a water
source (tap water), protective linen, gloves, a
working surface, a cast saw, and seating surfaces
for the patient and the corpsman. Some specific
types of casts may require additional material.
SHORT-ARM CAST. A short-arm cast ex-
tends from the metacarpal-phalangeal joints of
the hand to just below the elbow joint. Depend-
ing on the location and type of fracture, the physi-
cian may order a specific position for the arm to
be tasted. Generally, the wrist is in a neutral
(straight) position with the fingers slightly flexed
in the position of function.
Beginning at the wrist, apply three layers of
webril. Then apply webril to the forearm and the
hand, making sure that each layer overlaps the
other by a third as shown in figure 5-4. Check for
lumps or wrinkles and correct any by tearing the
webril and smoothing.
The plaster of Paris is then dipped into the
water for approximately 5 seconds. Gently
squeeze to remove excess water, but do not wring
out. Beginning at the wrist (fig. 5-4C) wrap the