INTRODUCTION:

A fracture is a break in the continuity of bone and is defined according to its type and extend. Fracture occurs when the bone is subjected to stress greater than it can absorb. Fractures are caused by direct blows, crushing forces, sudden twisting motions, and even extreme muscle contractions. When the bone is broken, adjacent structures are also affected , resulting in soft tissue edema , hemorrhage in to the muscle and joints, joint dislocations ,ruptured tendon, several nerves and damaged blood vessels (Black. M Joyce,2005).

Femur fracture is most common fracture among all other fractures. The use of Thomas splint will help to maintain proper alignment as well as to prevent complication such as pressure sore, bleeding, skin abrasion and neurovascular disintegrity

Ngowi A.V et al., (1998) conducted a survey worldwide and estimated number of leg fracture worldwide will rise from 1.7 million in 1990 to 6.3 million in 2050. The fracture rates seems to be raising in many parts of the world .On assumption that rates may rise by only 4% per year, so number of leg fracture could be as high as 8.2 million by 2050.

More critically, arteries and nerves run parallel to bones in the arms and legs. A mishandled severe fracture could result in a bone end severing an artery or major nerve creating a potentially fatal bleed or paralysis. Even small fractures, such as in a finger, can lead to a frustrating disability if not treated correctly. (Acta Orthop magazine, 2008)

A splint is a medical device for the immobilization of limbs or of the spine. Nurses should take care before and after the application of splint, if it is not so some complication can occur. Bedsore, skin abrasion and neurovascular disintergrity are the some of the complications of the splint with patient if care is not taken properly. (Trial Blazar magazine, 2004).

Leg’s three long bones — the femur (the thighbone) or the tibia and fibula in the lower leg. The femur is very strong, so it takes a large amount of force to fracture this bone in healthy people. Femur fractures generally occur in people who have suffered high-impact trauma, especially in automobile accidents, industrial accidents, falls from high places, or gunshot wounds to the thigh. (Rose, Magazine, 2003)

Femur fractures have the potential to cause dangerous, sometimes life-threatening complications, such as significant bleeding inside the thigh, with blood loss of one quart or more. Femur fractures occur in about three out of every 10,000 people in the United States each year. Among children, these fractures tend to happen because of a fall from a high place, such as a tree or the top of a slide. In adults, these injuries usually are related to motor vehicle accidents (either as a passenger or pedestrian) or to on-the-job trauma. There has been a significant rise in the number of femur fractures caused by gunshot wounds in recent years. (Acta Orthop magazine ,2008).

A survey conducted in USA and estimated that 75 percent to 85 percent of patients with tibia fractures, the fibula (the thin bone at the outer side of the lower leg) is fractured as well. Doctors treat more than 185,000 lower leg fractures in the United States every year, including both tibia fractures and fibula fractures (Rochestugia,2003).

All patients with thomas splint are bedridden , so that this experience might be affect as psychological and physical. Nursing action gives relief to patients in certain extend and their all needs should be satisfied by the nurse. Back care, skin care and elimination needs are some of these. In addition to this ,nurses will provide psychological support to overcome from mental shock (Jayasekhar,2001).

Nursing care is important to avoid complication such as pressure sore, skin abrasion-checking the pressure points and perineum everyday for abnormal pressure; bed pan and urine can has to given with care to avoid disturbance to the injured site; prevention of bed sore by giving back care; daily sponge bath; attention to the hair and nails of the patient; isometric exercises for the immobilized joints; arrangements for the supply of proper diet to the patiets; by providing instruction to the patient regarding to carry out active exercises of the unaffected joints and changing of splint if he canvas get soiled. (John Ebenezer,2002)

A thomas splint of traditional design was fitted with measuring devices and examined for its hip-relieving effect during varying activities. It was shown that there is no complete weight relief of the hip joint with this orthosis. In the most favourable case, 50% of the weight can be conducted via the ischial tuberosity and therefore transferred to the ground surface bypassing the hip joint. In regard to the hip joint, the Thomas splint is a device that reduces weight but does not entirely remove it. The results proved to be practically independent of the fitting of the orthosis and of the kind of activity. (Rochester,2003)

Tierney et. al (2003) conducted a study among hospitalized patients with splint and found 35 per of patient had complications such as pressure sore, skin abrasion, and nerovasular disinegrity due to the poor nursing care while their hospital stay. Quality of nursing care can be examined from the perspective of structure process, practice and outcome. Outcome are essential components of any quality assurance or quality improvement programme. Outcome management and effective research has become an imperative in nursing, in this era of managed care and integrated health care system. The investigator during the practice in orthopaedic ward and emergency department observed the management of patient with Thomas splint . So it is felt that the provision of planned nursing care can improve the patients health status and prevent complications.

MATERIAL AND METHODS:

Research design:

Case study design was selected for this study where the data was collected to assess the effectiveness of planned nursing care for the patient with thomas splint.

Setting of the Study:

The study was conducted in Vinayaka Missions hospital ,Salem which is located at Chinnaseeragapadi, about 12 km way from Salem town .Vinayaka Missions hospital is a 410 bedded multi specialty hospital in Tamilnadu.

Population:

Population for the study was patients with Thomas splint hospitalized in Vinayaka Mission’s Hospital, Salem.

Sample and Sampling Technique:

A total of 4 patients with Thomas splint who were admitted in Vinayaka Mission’s Hospital, Salem were the sample for the study. Purposive sampling technique was used to select the subjects for the study.

Criteria for inclusion in the study:

· The clients of both sexes who were.

· Applied with Thomas splint.

· Admitted in Vinayaka Mission’s Hospital, Salem.

· Willing to participate in the study.

· Available during the data collection period.

Description of the tool:

The tool consists of two parts:

Part-A:

It consists of demographic variables of the patients such as age, sex, educational qualification, occupation, income, residential area, habits or addictions.

Part-B:

A well planned standardized nursing care module was prepared after reviewing the related literature from books, periodicals and reports based on the theoretical model.

Validity:

Validity of the tool was established by consultation with the guide and experts from various fields like cardiothoracic, Emergency medicine, Nursing and Biostatistics. Their suggestions were incorporated in the modification of the tool.

Data collection procedure:

· After obtaining the prior permission from the Medical Director of Vinayaka Mission’s Hospital, Salem.

· The purpose of the study was explained to the patients and consent was obtained.

· The well planned nursing care was provided to the study subjects.

· Assessment of effectiveness of planned nursing care was carried out after the implementation.

Data analysis:

Collected data were analyzed by using descriptive statistics and presented in the form of graph and tables.

RESULTS:

Comparison of the Demographic Data of Patients with Thomas Splint No of patients-4

Sl.no

Demographic data

No of patients

Age

- Young adult

- Middle adult

- Old adult

Sex

- Male

- Female

Dietary pattern

- Mixed diet

- Vegetarian

Habits / addictions

- Tobacco chewing

- Smocking

- Alcohol

- No addiction

No of days in hospital

- 10-15days

- 16 -18days

Comparison of investigations done on admission for patients with Thomas splint: No of Patients-4

Sl.no	Name of investigation	No. of patients
1.	Blood count (CBC)	4
2.	CT scan(Brain)	3
3.	Chest x-rays	4
4.	X-Ray of arm and legs	4
5.	USG abdomen	1

Comparison of treatment given on admission for patients with thomas splint No of Patients-4

Treatment given	No of patients
Oxygen administration	2
Oral suctioning	1
Thomas Splint application	4
Wound dressing	3
I.V access	4
Hypovolemia management	2
Urinary catheterization	3

Comparison of medications given for patients with thomas splint: No of Patients-4

Medications	No. of patients
Tetanus toxoid	4
Broad spectrum antibiotics	4
Barbiturate analgesic	4
Anti helminthics	4
Osmotic diuretics	2
Anti emetic	1
Anti epileptic	2
H₂receptor antagonist	4

Comparison of initial assessment of patients with thomas splint: No of Patients-4

S.no

Assessment parameter

No. of patients

Level of consciousness

- Conscious

- Semiconscious

- Unconscious

Vital signs

Pulse

- Regular

- Irregular

Respiration

- Regular

- Irregular

Temperature

- Normal

Blood pressure

- Decreased

- Normal

Musculoskeltal system

- Muscle weakness

- Bone fracture

Integumentry system

- Abrasion

- Cynosis

- wounds

Cardio vascular system

- Hypotension

- Hypertension

Pain

- Mild

- Moderate

- Severe

Age wise distribution of patients with thomas splint shown that highest percentage (50%) 0f them were in the age group of 20 to 50 years but it covers almost all the adult age group. This finding of the study is supported by Garretson (2004) conducted among 125 patients with leg fracture reveals that majority (67%) of patients age group were 30-50 years.

Sex wise distribution of patients with fracture revealed that majority of the patients with thomas splint were male. The finding of the study is supported by Samzi (2002) conducted 58 patients with femur fracture in hospital and the results shows that most (61%) of them were males.

The major problems faced by the patients with thomas splint in my study were skin abrasion, potential for pressure sore, fever, and difficulty in performing daily activities loss of appetite and open wounds. By the implementation of planned nursing case, patients got relief from these problems

DISCUSSION:

A case study was undertaken in Vinayaka Missions hospital, Salem from 01-11-2009 to 14/11/09 where the data were collected from the patients with thomas splint to assess the effectiveness of planned nursing care. The data was analyzed by using descriptive representations and the findings shown that the planned nursing care was effective. The technique used for collecting the sample was purposive sampling. The theoretical framework selected for this study was based on goal attainment model by Imogene King. The tool includes demographic data, detailed history, assessment and planned nursing care module for patients with thomas splint.

CONCLUSION:

From the findings it can be concluded that all the patients got relieved from their complaints because of effective nursing care. They did not develop any complaints during the period of care. The duration of hospital stay was minimized and the treatment was cost effective. Thus the planned nursing care was found to be effective for patients with thomas splint.

BIBLIOGRAPY:

1. AActa orthop (2008),magazine” uses of splints in orthopedicsAug;79(4):526-33

2. Alverson C, Browne D, et al.,(2006)“Incidence and prevalence of fracture”, International Journal of critical care, 12(5), Pp. 45-49

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Received on 10.12.2014 Modified on 07.01.2015

Int. J. Nur. Edu. and Research 3(1): Jan.-March, 2015; Page 70-73

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