2nd page mod sir yuan splinting and casting

enumerate the basic rules of casting

a. stockinette

b. padding

c. POP

Provide comfortable lining for casts but is not used if swelling is expected, for example following manipulation, new injuries or if its application would cause undue pain.

a. Stockinette

Natural or synthetic should be applied evenly. One layer should be sufficient with a 50/50 overlap

b. Padding :

b. Padding :

↬ Natural or synthetic should be applied evenly. One layer should be sufficient with a ____ overlap

b. Padding :

↬ Natural or synthetic should be applied evenly. One layer should be sufficient with a 50/50 overlap

dipped in water. Very cold water will slow the setting process and very hot water can potentially burn the patient. All casting materials create their own heat (exothermic reaction) as they set/dry

c. Plaster of Paris Bandages / Slab : ↬

What do you call when all casting materials create their own head?

exothermic reaction

GENERAL PREPARATION OF THE PATIENT

1. Explain the procedure in order to gain the patient's cooperation

2. Maintain dignity and privacy and protect clothing

3. Remove any rings or jewellery and nail polish from the affected part

4. Position the affected limb in the prescribed position, promoting the best functional position for healing.

Bandages impregnated with gypsum powder (calcium salt) that, when exposed to water, crystallizes. The reaction then slows to a maturation process (hardening) that takes approximately 24 hours to dry. The heat felt by the patient is the crystallization process that takes place within the cast material.

� � PLASTER OF PARIS

What material does Plaster of Paris have that causes crystallization which slows to a maturation process (harden) that takes ~24hrs to dry?

Gypsum powder (calcium salt)

Advantes of Plaster or Paris

1. Less expensive

2. More moldable & pliable

Disadvantages of Plaster of Paris?

1. Poor resistance to water

2. Relative low strength-to-weight ratio (Heavier cast)

Can tolerate moisture harden within 5 minutes, allowing for immediate weight-bearing. This rolled type consists of resin, plastic polymer, and polyurethane that also crystallize on exposure to water. Long-wearing.

FIBERGLASS

Fiberglass consists of these materials which crystallize on exposure to water

resin, polyurethane, plastic polymer

POP harden within?

Fiberglass harden within?

24hrs | 5mins

Advantages of Fiberglass

1. Lightweight, yet strong

2. May be combined with waterproof liners to allow bathing

3. Lower risk for thermal injury

Disadvantages of Fiberglass?

1. More Expensive

2. More difficult to mold > stiff

3. Higher risk of pressure on and constriction of limb Not to be used in a Acute setting unless under close observation in the hospital

electrical circular oscillating saw for splitting or removing a cast. Long-handled cast-cutting instruments are also designed to remove small plaster casts from children.

Cast cutter: ↪

soft cotton wrap or synthetic wrap around material used with a plaster or fiberglass cast

Cast padding: ↪

Cotton roll is also known as?

Webril

material made from cotton that can be rolled as a bandage and acts as a buffer between the skin and plaster material; also called Webril. (newer padding material, and has greater tensile strength)

Cotton roll

strong, cotton material that clings to part being applied and molded to contour of that part. (same action as a Webril however may produce ridging of skin, as it does not follow contour of the extremity well)

Sheet wadding: ↪

cloth stocking roll used initially in cast applications; comes in many sizes; can be covered by padding followed by firm cast material

Stockinette: ↪

Felt padding is also known as?

Reston

Reston is also known as?

Felt padding

Webril is also known as?

Cotton roll

thick felt or felt like material added to the undersurface of a cast to relieve pressure on local areas of bony prominences or pressure areas; also called Reston.

Felt padding: ↪

adhesive, thin, velvet like material used to smooth edges of casts or to buffer areas of excessive skin wear.

Moleskin: ↪

When to use POP?

1. When a well-molded cast is crucial to MAINTAIN (closed-reduction)

2. In the busy NON-SURGICAL FRACTURE CLINIC (increased pliability of material and lower cost)

When to use fiberglass?

1. When Cast immobilization is used simply to offer and hold a limb in an anatomic position (stable minimally displaced fractures)

2. For Post-operative casting

➢ After initial post-op edema is gone

BOYAR, E. (2016) POSITION OF SAFE IMMOBILIZATION: (POSI)

Elbow

90 degrees flexion

BOYAR, E. (2016) POSITION OF SAFE IMMOBILIZATION: (POSI)

Wrist

30 degrees extension

BOYAR, E. (2016) POSITION OF SAFE IMMOBILIZATION: (POSI)

Thumb

Midway between maximal radial and palmar abduction

BOYAR, E. (2016) POSITION OF SAFE IMMOBILIZATION: (POSI)

Hand

Intrinsic plus (MCP jt in at least 70 degrees of flexion and IP jt in extension)

BOYAR, E. (2016) POSITION OF SAFE IMMOBILIZATION: (POSI)

Hip

1. 10-30 degrees of abduction

2. 20-45 degrees of flexion

3. 15 degrees of ER

BOYAR, E. (2016) POSITION OF SAFE IMMOBILIZATION: (POSI)

Knee

15-30 degrees of flexion

BOYAR, E. (2016) POSITION OF SAFE IMMOBILIZATION: (POSI)

Ankle

Neutral DF

PREPARING THE INJURED AREA

● Padding is measured and applied to cover the area and extend about _____ beyond each end of the intended cast site.

● Wrinkling over flexion points and bony prominences is minimized by smoothing or trimming the padding.

● Padding - _____ wide is used for the hands, _____ for upper extremities, _____ for feet, and _____ for lower extremities.

● Stockinette application. Stockinette should extend about _____ beyond each end of the intended splint site. Black lines beneath the stockinette indicate the ends of the intended splint.

● Padding is wrapped circumferentially for at least _____ layers around the extremity Each new layer overlapping the previous layer by _____. This technique will automatically provide two layers of padding For bony prominences add _____ layers of padding to prevent pressure ulcers

PREPARING THE INJURED AREA

● Padding is measured and applied to cover the area and extend about 10 cm beyond each end of the intended cast site.

● Wrinkling over flexion points and bony prominences is minimized by smoothing or trimming the padding.

● Padding - 2 inches wide is used for the hands, 2 to 4 inches for upper extremities, 3 inches for feet, and 4 to 6 inches for lower extremities.

● Stockinette application. Stockinette should extend about 10 cm beyond each end of the intended splint site. Black lines beneath the stockinette indicate the ends of the intended splint.

● Padding is wrapped circumferentially for at least 2-3 layers around the extremity Each new layer overlapping the previous layer by 50 percent. This technique will automatically provide two layers of padding For bony prominences add 2-3 layers of padding to prevent pressure ulcers

PREPARING THE INJURED AREA

● Padding is measured and applied to cover the area and extend about _____ beyond each end of the intended cast site.

PREPARING THE INJURED AREA

● Padding is measured and applied to cover the area and extend about 10 cm beyond each end of the intended cast site.

PREPARING THE INJURED AREA

● Wrinkling over flexion points and bony prominences is minimized by smoothing or trimming the padding.

PREPARING THE INJURED AREA

● Wrinkling over flexion points and bony prominences is minimized by smoothing or trimming the padding.

PREPARING THE INJURED AREA

● Padding - _____ wide is used for the hands, _____ for upper extremities, _____ for feet, and _____ for lower extremities.

PREPARING THE INJURED AREA

● Padding - 2 inches wide is used for the hands, 2 to 4 inches for upper extremities, 3 inches for feet, and 4 to 6 inches for lower extremities.

PREPARING THE INJURED AREA

● Stockinette application. Stockinette should extend about _____ beyond each end of the intended splint site. Black lines beneath the stockinette indicate the ends of the intended splint.

PREPARING THE INJURED AREA

● Stockinette application. Stockinette should extend about 10 cm beyond each end of the intended splint site. Black lines beneath the stockinette indicate the ends of the intended splint.

PREPARING THE INJURED AREA

● Padding is wrapped circumferentially for at least _____ layers around the extremity Each new layer overlapping the previous layer by _____. This technique will automatically provide two layers of padding For bony prominences add _____ layers of padding to prevent pressure ulcers

PREPARING THE INJURED AREA

● Padding is wrapped circumferentially for at least 2-3 layers around the extremity Each new layer overlapping the previous layer by 50 percent. This technique will automatically provide two layers of padding For bony prominences add 2-3 layers of padding to prevent pressure ulcers

How many sheets should be casted on the UE?

6-10 sheets of material

How many sheets should be casted on the LE?

12-15 sheets

Blue color under nails

VEINS –

The limb will be cold and pulses may be difficult to palpate

2. ARTE RIES –

gives pins and needles sensation

3. NERVE COMPRESSION –

uneven pressure and discomfort.

4. INSUFFICIENT or INAPPROPRIATE PADDING –

will cause the same s/sxs being applied to tight.

5. UNEXPECTED SWELLING –

damage the common peroneal nerve causing foot drop (Below knee casts ENDING at the fibular neck)

6. SUPERFICIAL NERVES –

Foreign bodies inside the cast

7. PLASTIC SORES –

AFTERCARE AND WARNING/S

VEINS

ARTERIES

NERVE COMPRESSION

INSUFFICIENT OR INAPPROPRIATE PADDING

UNEXPECTED SWELLING

SUPERFICIAL SWELLING

PLASTIC SORES

OTHER WARNINGS

DVT

PE

CRPS

PROBLEMS OR UNION

Pain in calf

1. DVT -

Chest pain on breathing in, Heamoptysis

2. PE –

Pain and stiffness Hand or foot is puffy, discoloured and moist

3. CRPS (complex regional pain syndrome??)

Mal union may cause deformity or shortening of the limb Delayed or slow union or nonunion

4. Problems of Union: