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Cast and
immobilization
techniques in
orthopaedics by Dr
O.O. Afuye
A Alade Olubunmi
Jun 29, 2019 • 15 likes • 3,620 views
Health & Medicine
Cast, similar in function to splints are used to

immobilize broken bones. The principles of
its application and cast care most be follow…
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Science
Cast and immobilization techniques in

orthopaedics by Dr O.O. Afuye
1. Cast and Immobilization Techniques in Orthopaedics
Dr. O.O. Afuye
2. Outline • Introduction • History • Cast types • Materials
and equipment • Principles of cast application •
Advantages of casting • Disadvantages of casting •
Conditions that benefit from immobilization • Removal •
Complications • Conclusion • References
3. Introduction • Immobilization refers to the process of
holding a joint or bone in place with a splint, cast, or brace.
This is done to prevent an injured area from moving while
it heals. • Casts are generally used to immobilize a broken
bone. • An orthopedic cast, or simply cast, is a shell,
frequently made from plaster or fiberglass, encasing a limb
(or, in some cases, large portions of the body) to stabilize
and hold anatomical structures, most o"en a broken
bone(or bones), in place until healing is confirmed. • It is
similar in function to a splint.
4. History • The earliest methods of holding a reduced
fracture involved using splints. • Ancient Greeks used
waxes and resin to create sti!ened bandages • Roman
Celsus AD 30 described how to use splints and bandages
sti!ened with starch • Arabian Doctors used lime derived
from sea shells and albumen from egg whites to sti!en
bandages • Italian school of Salemo (20th century)
recommended bandages hardened with flour and egg
mixture • Medieval European bonesetters used casts made
of egg white, flour and animal fat • Ambroise Pare(1517-
1590) used artificial limbs, made casts of wax, cardboard,
cloth and parchment that hardened as they dried
5. • Dominique Jean Larrey (1768-1842) Concluded that
undisturbed wound had facilitated healing. Also sti!ened
bandages using camphorated alcohol, lead acetate and
egg whites beated in water • Louis Seutin (1793-1865) –
Seutin’s bandage amidonnee – consisted of cardboard
splints and bandages soaked in starch solution • 19th
century- Velpeau substituted Dextrin for starch • Consul
William Eton described immobilization of patient with
gypsum plaster (POP) • Antonius Mathijsen (1805-1878)-
developed a method of POP application
6. Cast Types • Upper extremity casts • Lower extremity
casts • Cylinder casts • Body casts • EDF (Elongation,
Derotation, Flexion)casts • Spica cast
7. Cast type Upper Extremity Casts Type location uses
Short Arm Cast Applied below the elbow to the hand.
Forearm or wrist fractures. Also used to hold the forearm
or wrist muscles and tendons in place a"er surgery. Long
arm cast Applied from the upper arm to the hand. Upper
arm, elbow, or forearm fractures. Also used to hold the arm
or elbow muscles and tendons in place a"er surgery. Arm
cylinder cast Applied from the upper arm to the wrist To
hold the elbow muscles and tendons in place a"er a
dislocation or surgery.
9. Cast type Loaction Uses Shoulder spica cast Applied
around the trunk of the body to the shoulder, arm, and
hand. Shoulder dislocations or a"er surgery on the
shoulder area. Minerva cast Applied around the neck and
trunk of the body. A"er surgery on the neck or upper back
area
10. Lower extremity Type of cast Location Uses Short leg
cast Applied to the area below the knee to the foot Lower
leg fractures, severe ankle sprains/strains, or fractures.
Also used to hold the leg or foot muscles and tendons in
place a"er surgery to allow healing. Long Leg cast Applied
from the upper thigh to the ankle Knee, or lower leg
fractures, knee dislocations, or a"er surgery on the leg or
knee area
12. Type of cast Location Uses Unilateral hip spica cast
Applied from the chest to the foot on one leg. Thigh
fractures. Also used to hold the hip or thigh muscles and
tendons in place a"er surgery to allow healing. One and
one-half hip spica cast Applied from the chest to the foot
on one leg to the knee of the other leg. A bar is placed
between both legs to keep the hips and legs immobilized
Thigh fracture. Also used to hold the hip or thigh muscles
and tendons in place a"er surgery to allow healing
Bilateral long leg hip spica cast Applied from the chest to
the feet. A bar is placed between both legs to keep the hips
and legs immobilized. Pelvis, hip, or thigh fractures. Also
used to hold the hip or thigh muscles and tendons in place
a"er surgery to allow healing
14. Type of cast Location Uses Short leg hip spica cast
Applied from the chest to the thighs or knees To hold the
hip muscles and tendons in place a"er surgery to allow
healing Abduction boot cast Applied from the upper thighs
to the feet. A bar is placed between both legs to keep the
hips and legs immobilized. To hold the hip muscles and
tendons in place a"er surgery to allow healing.
16. Materials and equipment • Adhesive tape (to prevent
slippage of elastic wrap used with splints) • Elastic
bandage (for splints) • Bandage scissors • Basin of water at
room temperature (dipping water) • Casting gloves
(necessary for fiberglass) • Padding • Plaster or fiberglass
casting material • Sheets, underpads (to minimize soiling
of the patient's clothing) • Stockinette • Cast saw and
spread
17. Plaster fibreglass Cost Lower higher Moldability
excellent average Strength average excellent Weight
heavier lighter Curing period 48–72 hours under 30
minutes Radiolucency poor good Water resistance poor
excellent Skin complications easily washes o! skin and
clothes gloves are mandatory, resin stains clothes and
bonds to skin for days Allergic reaction very low slightly
higher Monovalve spreads easily spreads but recoils; needs
a wedge to maintain opening
18. Principles of cast application • Pre- cast applications •
Indications • Clinical evaluation • Investigation •
Preparation • Material needed • Templating • So" bands •
Cast layers • Informed consent • Reduction and manual
deformity corrections
19. • Cast application • Maintain reduction during
application • Avoiding dimple on the cast • Ensure
adequate layering of so" band and cast • Moulding to
correct deformity or redisplacement • Joint above and
joint below the fracture • Ensure cast not too tight. • (Px
protection and comfort, Px Position, Stokinette, cast
padding, water, Exotherm, Cast, Cast Tape, Rolling,
molding,so" spots) Px = Patient
20. • Post cast applications principles • Ensure no
compartment syndrome • Bivalve if sign of CS is noted •
Check x-ray • (Evaluate Px neurovascular status and range
of motion)
21. Window • Wound care • Investigating a complaint like
a pressure sore • Checking a pulse • Breathing window in a
body cast • Ultrasound bone stimulator
22. •Casts are wedged to correct for unwanted angulation
of long bones, joints, or the spine that have already been
casted. •Open wedge •Closed wedge •Trimming •Cast
Conversion
23. Factors a!ecting the timing for cast setting •Factors
that speed setting times •Higher temperature of dipping
water •Use of fiberglass •Reuse of dipping water •Factors
that slow setting times •Cooler temperature of dipping
water •Use of plaster
24. Rule of thumb •heat is inversely proportional to the
setting time and directly proportional to the number of
layers used.
25. Cast care • Keep the cast clean and dry. • Check for
cracks or breaks in the cast. • Rough edges can be padded
to protect the skin from scratches. • Do not scratch the skin
under the cast by inserting objects inside the cast. • Can
use a hairdryer placed on a cool setting to blow air under
the cast and cool down the hot, itchy skin. Never blow
warm or hot air into the cast.
26. • Do not put powders or lotion inside the cast. • Cover
the cast while your child is eating to prevent food spills
and crumbs from entering the cast. • Prevent small toys or
objects from being put inside the cast. • Elevate the cast
above the level of the heart to decrease swelling. •
Encourage to move his or her fingers or toes to promote
circulation. • Do not use the abduction bar on the cast to
li" or carry the child.
27. •Use a diaper or sanitary napkin around the genital
area to prevent leakage or splashing of urine. •Place toilet
paper inside the bedpan to prevent urine from splashing
onto the cast or bed. •Keep the genital area as clean and
dry as possible to prevent skin irritation.
28. Advantages of casting •Main stay in treatment of most
fractures •Provides more e!ective immobilization •Protect
the injury •Prevent further injury •Decrease pain
29. Disadvantages • Requires more skill • More time to
apply • High risk of complication from improper
application
30. Conditions that benefit from immobilization •
Fractures • Sprains • Severe so"-tissue injuries • Reduced
joint dislocations • Inflammatory conditions: arthritis,
tendinopathy, tenosynovitis • Deep laceration repairs
across joints • Tendon lacerations • Postoperative
immobilization • Px: obtunded or comatose multitrauma
patient, the patient under anesthesia, the very young
patient, the developmentally delayed patient, and the
patient with spasticity.
31. Complications • Immediate: • Compartment
syndrome • Pain • Heat injury • Hypersensitivity reactions •
Late: • Delayed union • Malunion • Non-union • Pressure
sores & skin breakdown • Infections • Joint sti!ness •
Neurologic injury
32. Follow-up and length of immobilization • Patient
education: elevation of injured extremity (decrease pain
and swelling) • Cast care and precautions • Check for and
report signs of compartment syndrome • Report: Fever,
pain, swelling, pressure, numbness/tingling, drainage/foul
odour, cool/cold fingers or toes
33. • Follow-up time and length of immobilization varies •
Depends on: site of injury • Type • Stability of injury •
Patient characteristics: age, accessibility, compliance •
Initial follow-up: within 1-2weeks a"er application • Injury
must be assessed, treated and management
individualized.
34. • Cast saw • Manually operated shears: paediatric/px
a!ected by noise of saw • Zip stick can be used • Cast-
cutting procedures: Monovalve/univalve or bivalve •
Position Px • Prepare Px and earn his/her trust • Inspect the
cast • Plan the cuts strategically • Stabilize the cast and
begin cutting • Release the cast
35. Conclusion • Cast and splints serve to immobilize
orthopaedic injuries. • They promote healing, maintain
bone alignment, diminish pain, protect the injury and help
compensate for surrounding muscular weakness • Proper
application technique, vigilance for complications and
timely follow-up are essential • Improper or prolonged
application can increase the risk of complication from
immobilization
36. References • Boyd A.S., Benjamin. H.J., Asplund. C.
(2009) Principles of Casting and Spllinting. American
Family Physician. • Brown. S.A., Radja.F. (2015).
Orthopaedic immobilization techniques. Sagamore
Publishing. 1-23
https://www.sagamorepub.com/sites/default/files/2018-
07/orthogalley1.pdf • Cast types and maintenance
Instructions. Standford Children’s Health.
https://www.stanfordchildrens.org/en/topic/default?
id=cast-types-and- maintenance-instructions-90-P02750 •
Matthew.H., Kenneth.N. J. (2008) Cast and Splint
Immobilization: Complications. Journal of the American
Academy of Orthopaedic Surgeons.16(1). 30-40 • Smith
and Nephew. The History and Function of Plaster of Paris
in Surgery
37. THANK YOU
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Trigger Finger Tape help you to move your finger

trigger!ngercure.com Learn More

Jun 29, 2019 • 15 likes • 3,620 views

Health & Medicine

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