Not sure if this is the right place to ask but I had a question. I helped assist a male patient in his late 20's with a SCI of his T12 (if I remember correctly). He was using forearm crutches to assist ambulation, briefs to contain urinary incontinence, and a Jewett brace for support. I was under the assumption a Jewett was for injury's with no neurological symptoms? Am I wrong to think this? Thank you for any help!
Dec 14, '17
Not sure of the specifics of this pt's fracture -- anterior, posterior, spinous or transverse process, involvement of facets, compression fx, burst fx... Was he fused? I'm assuming his SCI is incomplete since he is ambulating. Jewetts are used typically with stable anterior fractures T12-L2
Dec 17, '17
Thank you for the reply! I actually didn't spend much time with the pt as I was assisting another nurse, it's just something I thought of later on. Like you stated, I thought Jewetts were only for stable fractures, but his incontinence obviously suggests a more serious neurological injury. Would that not require a different brace?
Dec 24, '17
Not necessarily. Depending on how far out from his injury, he could have had some swelling of the spinal cord -- vs pressure on/injury to the spinal cord from displaced vertebrae -- effecting his bladder function. Does the pt's spine particularly require the hyperextension that the Jewett brace affords? Has the pt undergone a spinal fusion -- which **stabilizes** the spine (the pt will typically wear a brace 3 months or so as their spine heals)?
Again, hard to say without knowing the pt. Can you talk to your clinical instructor who was overseeing your group that day?
Keep in mind too, that this pt would have worked with their neurosurgeon, PT, and certified orthotist -- not just nursing. Had this brace been inappropriate, I'm sure that pt never would have even been allowed out of bed. Even if the MD had ordered the wrong brace, an orthotist wouldn't fit that pt until s/he has an appropriate order. They would go directly to the physician and advise of any shortcomings of the inappropriate brace. PT would have evaluated the pt for safety before even working with him; the primary safety issue with spinal injuries is: is the pt moving in a way that could damage the spinal **cord**?
Must Read Topics