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Casting Techniques - Orthopaedic Trauma - Lecture Slides, Slides of Orthopedics

Acharya Nagarjuna UniversityOrthopedics

Casting Techniques, Skin Complications, Treatment of Acute Fractures, Soft Tissue Complications, Stockinette, Cast Padding, Plaster Vs Fiberglass, Cast Molding, Below Knee Cast are some points from this lecture. This lecture is for Orthopaedics Trauma course. This lecture is part of a complete lectures series on the course you can find in my uploaded files.

Typology: Slides

2011/2012

Uploaded on 12/21/2012

devaki
devaki 🇮🇳

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Casting
•Goal of semi-rigid immobilization while
avoiding pressure / skin complications
•Often a poor choice in the treatment of acute
fractures due to swelling and soft tissue
complications
•Good cast technique necessary to achieve
predictable results
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Download Casting Techniques - Orthopaedic Trauma - Lecture Slides and more Slides Orthopedics in PDF only on Docsity!

Casting

  • Goal of semi-rigid immobilization while avoiding pressure / skin complications
  • Often a poor choice in the treatment of acute fractures due to swelling and soft tissue complications
  • Good cast technique necessary to achieve predictable results

Casting Techniques

  • Stockinette - may require two different diameters to avoid overtight or loose material
  • Caution not to lift leg by stockinette – stretching the stockinette too tight around the heel may case high skin pressure

Casting Techniques

  • Cast padding
    • Roll distal to proximal
    • 50 % overlap
    • 2 layers minimum
    • Extra padding at fibular head, malleoli, patella, and olecranon

Plaster vs. Fiberglass

• Plaster

  • Use cold water to maximize molding time

• Fiberglass

  • More difficult to mold but more durable and resistant to breakdown
  • Generally 2 - 3 times stronger for any given thickness
  • Avoid molding with anything but the heels of the palm in order to avoid pressure points
  • Mold applied to produce three point fixation

Cast Molding

Below Knee Cast

  • Support metatarsal heads
  • Ankle in neutral – flex knee to relax gastroc
  • Ensure freedom of toes
  • Build up heel for walking casts - fiberglass much preferred for durability

Above Knee Cast

  • Apply below knee first (thin layer proximally)
  • Flex knee 5 - 20 degrees
  • Mold supracondylar femur for improved rotational stability
  • Apply extra padding anterior to patella

Forearm Casts & Splints

  • MCP joints should be free
    • Do not go past proximal palmar crease
  • Thumb should be free to base of MC
    • Opposition of thumb to little finger should be unobstructed

Complications of Casts & Splints

  • Loss of reduction
  • Pressure necrosis – may occur as early as 2 hours
  • Tight cast → compartment syndrome Univalving = 30% pressure drop Bivalving = 60% pressure drop Also need to cut cast padding

Complications of Casts & Splints

  • Thermal Injury - avoid plaster > 10 ply, water >24°C, unusual with fiberglass
  • Cuts and burns during removal
  • DVT/PE - increased in lower extremity fracture
    • Ask about prior history and family history
    • Indications for prophylaxis debated
  • Joint stiffness
    • Leave joints free when possible (ie. thumb MCP for below elbow cast)
    • Place joint in position of function