Bi-valving
Involves cutting the cast as for removal, and slightly separating edges with a cast splitter. Used when causing discomfort but NOT compromising NV status.
Uni-valving
Involves making a single cut in the cast. Used when causing discomfort but NOT compromising NV status.
Valving should be used if.....
....surgery is in the near future.
....pt is uncomfortable, but NV status is intact.
Cast padding, AKA
Webril
Plaster casts are made from....
....rolls of dry muslin that have been coated with CALCIUM SULFATE.
Temperature of H20 used:
-Warmer increases the heat given off by plaster.
-Affects setting time
-Cold water takes longer to set
Setting
Feels hard in 10-15mins.
Truly takes 24-48hrs.
Munster cast
AKA supracondylar cast: Limits suppination and portion of arm w/out completely prevention flx/ext of elbow. Applied in manner of long arm cast, but cast is extended just above distal biceps. Once hardened, prox portion is trimmed around elbow jt. Pt compl
Delbert cast
Short leg cast. Prevents lateral movement, allows DF/PF. Applied then trimmed away from anterior and posterior ankle and heel.
Dehne cast
AKA three-finger spica cast: used to tx navicular fx's. Section that covers the thumb, separate section enclosing index and middle fingers.
Gauntlet cast
Fx's/dislocations of MC's and phalanges. Short cast that extends from above the worst to cover part of the palm of the hand. Often has an extension to control 1 or more of the digits.
Advantages of Fiberglass
-Ligher
-More comfortable
-More durable (less likely to need repair/replacement)
-More radioluscent
-More water resistant (padding still gets wet)
----> MORE EXPENSIVE :\
Cast removal
Mark on cast.
Avoid cutting over bony prominences.
Making cuts on opposite sides.
Retract, don't drag the saw.
Use spreader tool, then bandage scissors for padding.
Short leg cast
TX: foot, ankle fx's
Proximal end must stop below tibial tubercle to prevent damage/irritation to tibial tubercle and patellar tendon. Distal end covers plantar surface of foot, extends to MT heads. Toes exposed. Ankle @ 90* to prevent tightening of Achil
Long arm cast
TX: unstable wrist fx's, radial+ulnar fx's
Extends to at least mid-biceps. Elbow @ 90*. Forearm in neutral. Prevents wrist flx/ext, eliminates radial-ulnar suppination and pronation. May be used for non-adherent pt's, or younger pt's who can't muscularly
Windowing a cast
Allows monitoring of underlying wounds.
Diagram area before applying cast. After applying, carefully cut window utilizing wide margins. Margin of padding left to protect window'ed skin. Padding reapplied over window'ed area, cast shell placed back on, hel
Long leg cast
TX: non-displaced fx's of lower leg and knee
Extends from upper thigh to MT heads. Knee @ 15-20* flx. (prevents lower leg from rotating, permits ambulation w/crutches as leg can swing freely)
Long leg cylinder cast
TX: anterior knee injuries -- patellar fx, quad tendon rupture, patellar tendon rupture
Mid-thigh to Achilles tendon. Knee @ full ext. To prevent slipping, add extra padding at proximal end. Mold above knee to keep from sliding down.
PAD WELL: distal end
Thumb spica cast
TX: stable, reduced fx's, thumb ligament injuries, non-displaced scaphoid fx's
Aplpy stockinette as for short arm. 1" of stockinette unrolled to cover thumb. Cast padding rolled to cover thumb. Used 2" cast tape, lock thumb from both directions. May need
Cast shoes
TX: toe fx's, to cover WB'ing LE casts, some stable, non-displace foot fx's, ex. 5th MT proximal tip fx
Removable appliance w/rigid bottom that prevents foot from flexing during walking/WB'ing.
Short arm cast
TX: stable wrist fx's
Trop should start on forearm ~2" under antecubital crease to prevent cast from irritating upper arm. Bottom should end proximal to MC heads. Padding should end @ distal palmar crease. Allows flx of MCP jts. Allow free movement of thu
Hip spica cast
TX: femur fx's, hip injuries, some thigh injuries
Length generally extends from middle of chest to area below knees. Space allowed for toiling. Generally used in peds, done under general anesthetic.
PAD WELL: iliac spines, ribs, back.
Splint advantages
-Allows for swelling
-Allows for monitoring of wounds
-Easily removed
-Transitional tx after casting
-Removed for rehab
Wrist dorsal blocking splint
TX: surgical repair of flexor tendons, fx's of volar plate
Dorsal side of wrist/hand for purpose of limiting ext. Keep affected finger in flexion for volar plate fx. Must fit firmly, but not too tightly to create problems.
Splinting mallet finger
TX: damage to extensor mechanism of DIP (mallet finger)
Extension/hyperextension splint. Alumifoam splints are superior bc pliant. proximal IP may be left unsplinted. 6-8wks!!!
Ulnar gutter splint
TX: fx's of MC's and phalanges of ring and small fingers
Starts @ forearm, extends to tip of ring and small fingers. Long finger may be included. Fingers straight or flexed @ 90* at MCP's.
Clavicle fracture
Slings, figure-8 splints (needs to be kept tight, uncomfortable)
Spinal bracing
TX: spinal compression fx's
Extension bracing worn below the site of the fx w/rigid pad which applies pressure across pt's chest.
Pin-site Infections
Usually begin as a cellulitis. Most are due to Staphylococcus aureus & respond readily to oral antibiotics. Occasionally infection involves deeper tissues and bone and may persist despite the use of antibiotics. The stability of the fixation is thereby im
Volar wrist splint
TX: temporary support for acute wrist injuries
Pad wrist/hand w/Webril. Cover from proximal forearm to MC heads. Thickness of 10-12 layers of cast tape. 8-10 thickness of cast pad. Held in place w/ACE wrap.
Upper extremity posterior splint
TX: stabilize fx, immob elbow after surg, acute elbow injury
Distally from posterior surface of upper arm to wrist or hand. Elbow @ 90* typically. 10-12 thickness of splinting material placed onto posterior arm, molded around circumference.
PAD WELL: ulna
Sugar tong splint
TX: temp immobilize wrist, forearm fx's
Prevents suppinating and pronating. Measure from volar MC heads, around elbow, to dorsal MC heads to determine length. 8-10 layers padding and plaster.
Baseball splint
TX: fx of distal phalanx
Pre-fabricated. Applied to volar side of hand and forearm. Looks like baseball is being held in hand.
Airplane splint
Holds arm in position of abduction @ shoulder level. Forearm in flx, strut used for support.
Dynamic splint
Uses springs, elastic bands, to provide constant force to control position/ROM.
Co-aptation splint
2 pads of plaster placed on either side of an extremity, help in place by a dressing. May use 1 U-shaped pad instead.
Sutures
Surgical steel: strongest, lacks elasticity; T-T, B-B
Polyester (Ehibond): braided; T-B
Polypropylene (Proene): sub for stainless steel suture; T-B
Nylon (Nurolon): little tissue rxn; T-B
Chromic: chemically-treated for slow absorption; Periosteum-Periost
Hemostatic Agents
-Gelfoam: pad form; wet, squeeze excess, apply to bone
-Avitene: applied dry directly to bone surface
-Thrombin: bovine product; liquid, powder, or spray; only topical use!
-Bone wax: sterile beeswax; rolled into ball and applied at site of bleeding