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Asian Association for Dynamic Osteosynthesis Trauma Management with Cast Application
Common Fractures and Cast Application
Dr Eric Yeung Orthopaedics and Traumatology Yan Chai Hospital
3rd November 2013
Objectives:
1. Introduction to the different types of fractures
2.Basic principle of fracture management
3.The use of cast application in fracture treatment
What is a fracture?
Break Crack 斷骨 骨折
What is a fracture?
Discontinuity of a bone
What is a fracture?
Discontinuity of a bone
What is a fracture?
Complete or incomplete
What is a fracture?
Complete or incomplete
Closed or Open
What is a fracture?
Complete or incomplete
Closed or Open
Simple and Comminuted
What is a fracture?
Complete or incomplete
What is a fracture?
Complete or incomplete
What is a fracture?
Closed or open
What is a fracture?
Closed or open
What is a fracture?
Simple or Comminuted
What is a fracture?
Simple or Comminuted
What types of fracture?
Common fractures
Common fractures
Common fractures
Common fractures
Principle of Fracture management
Reduction
Stabilisation
Rehabilitation
Principle of Fracture management
Reduction
Stabilisation
Rehabilitation
Temporary
Definitive
Slab / splinting
Full cast
Back slab
Bivalved - Can be removed
secured with Velcro
Drop out cast - part of the extremity can be moved
cylindrical cast - typical fx cast
weight bearing casts - to hold extremity in position
to assist in weight bearing
Types of casting
Plaster of Paris
Synthetic cast (hard and
soft cast)
Comparison of plaster to synthetic cast
Longer drying time
more prone to
indentations that can
lead to breakdown
stronger
heavier
less costly
More versatile for
moulding
Shorter drying time
higher risk of splintering
harder
lighter
more resistant to dirt
more durable
more costly
Plaster of Paris is made from crystalline gypsum by
heating in controlled conditions (120 c – 160 c)
2(CaSO4.2H2O)+Heat→2(CaSO4,1/2H2O)+3H2O
Gypsum Plaster of paris Water
The POP powder then spread onto gauge bandage
which sets to hard cast when soaked in water
What is Plaster of Paris?
POP rapidly absorbs water which forms growing
solid crystals of CaSO4.2H2O
2(CaSO4,1/2H2O)+3H2O→2(CaSO4.2H2O)+Heat
Plaster of paris Water Gypsum crystals
During this time heat is generated(exotherm) as a
result of chemical activity(hydration)
What is Plaster of Paris?
Initial set
- <10 min
- crystals become longer and start to interlock
- end of the working time
- if the cast is manipulated after the initial set it will
be weak
- if immersed in cold water initial set will be
delayed , working time lengthened
- in warm water (< 50 c) initial set will be
accelerated
> 50 c the setting rate will slows,> 100 c no set
Cast Application
Final set
-forming a rigid structure around the gauze mesh
-heat is generated at this time
-end of the exotherm period
- 10 - 45 min
Cast Application
Hard set
-crystals are completely locked together,
excess water will be lost by evaporation
-strength of the cast increases considerably
during first 24 -72 hrs
-the plaster is then able to withstand considerable
forces
Cast Application
if the cast subsequently absorbs excess water, it
will weaken
- drying out will be delayed in cold or moist
conditions
- quicker in warm and dry environment
Cast Application
Expose the injured extremity completely
before splinting
• Clean, repair, and dress all open wounds
• Check for neurovascular compromise
• Choose the appropriate size and shape of
splint to be used
How to apply a cast??
Prevent stiffness and
loss of function by:
– Preparing extremities to be Splinted in their
functional position
How to apply a cast??
Be prepared!!
-Protect floor with newspaper or plastic
-Protect pt’s face, clothes & skin with towels
-Precut stockinet 4-6” longer than length of cast on
each end so it can be rolled back over cast
-Fill bucket with water
-Clean & dry skin thoroughly
How to apply a cast??
Padding
To protect skin soft tissue and bony prominences
from pressure and abrasion and for cast removal
To protect the skin from thermal injury during setting
Over padding will reduce closed fitting of cast and
permits excess movement at # site resulting in
impaired healing
How to apply a cast??
Padding
-stockinet over the area to be plastered and smooth
wrinkles
-then apply cotton padding overlap each turn by 1/3
in order to secure layers, and in figure 8 over elbow
or knee
-Decide on cast length
-padding is specially important in
a) swelling is present/expected
b) limb is thin, bones are superficial
c) when electric cutters used
How to apply a cast??
get ready with equipment and water (25c- 35c)
Pt in comfortable position and clothing protected
and understand what is going to happen
if Pt is tense, cast will loose and inefficient
desired position secured and held correctly
How to apply a cast??
Instruct the patient not to move hand/arm
Excessive movement can cause creases or ridges
which can cut skin
Dip plaster and slightly wring water out (hold ends
or crimp for ease of use)
dip 5-6 times until it bubbles
don’t remove too much water
How to apply a cast??
Apply 4-5 layers of plaster, 3-4 layers of fiberglass
just slightly overlapping
smooth in a circular motion between layers
Avoid pressing fingers or holding on one spot of the
cast for prolonged periods
Before last layer, pull stockinet out and turn down
onto the cast. Apply casting tape just below this
edge to create a smooth soft edge
Hold cast in correct position until it dries
How to apply a cast??
How to apply a cast??
How to apply a cast??
Fold last layer of stockinette and padding over cast and add several strips of plaster over this
How to apply a cast??
Moulding
How to apply a cast??
Moulding
How to apply a cast??
Moulding
How to apply a cast??
After care
Beware: Pain Oedema Sensory changes Circulatory Changes - check pulse points distally Increase or Decrease movement in cast Skin integrity Severe itching Cracks, dents, or softening of cast
Is it too tight???
After care
Generally: Do not get it wet. Use plastic bags to cover while bathing. Do not walk on it unless instructed. Do not stick anything down inside to scratch or itch. This may lead to injury and infection
After care
Complications: Most common : sores, abrasions, and secondary infections from loose or ill-fitting splints Less common: neurovascular compromise from tight fitting splints, contact dermatitis, thermal burns from heating of plaster, and deep venous thrombosis
Questions??
Key points for casting
1. Prepare the injured extremity - clean, repair, and dress all open wounds, check neurovascular status
2. Prepare for the procedure: environment, equipment, protecting staff and patient
3. Appropriate padding – size, length, thickness, special areas, even distribution
4. Plaster application – temperature, wetness, even distribution, thickness, tension
5. Position, creases/ridges, edges 6. Moulding – correct pressure as appropriate 7. Complications: tightness, pressure areas, thermal burns,
infection 8. Aftercare – keep dry
