PLASTER OF

PARIS AND ITS

USES
By
Hemanta Kumar Bamidi
Department of Orthopaedics
• Many thousands year ago the Egyptians
immobilised fractures by linen stiffen with gum
or plaster,also starch,clay and egg albumin.
• Plaster of Paris bandages were first used by
Antonius Matthysen,A Dutch military surgeon
in 1852.
• The name of the plaster of paris derived from
an accident to a house built on a deposit of
Gypsum,Near Paris.The house burnt
down.When rain fall on baked mud of the
floors it was noted that footprints in mud set
rock hard.
HISTORY
• Egypt - 5th Dynasty Egypt (2465-2323
BC)
First Splinting of Fractures.

• Antonius Mathysen (1852): first cast

fixation
• The plaster of Paris consists of roll of muslin
stiffened by dextrose or starch and impregnated
with the hemihydrate of calcium sulfate.
(CaSO4.1/2H2O)

• When watwer is added,the calcium sulfate takes up

its water of crystallization:
2(Caso4.1/2H2O) + 3 H 2 O - - - - 2 CaSO4.2H2O+Heat
This is the process of setting and is an Exothermic
Reaction

• Plaster Of Paris incorporates 20% of water its

soaks up,the remaining 80% lost during drying
 • The best plaster should be a fairly wide mesh starch
free crioline or muslin bandage,6 inches(15.2cm)
wide and 4.6 meter long.
• The completed plaster bandage should be elastic
and springy.An average 4 meter plaster bandage
should weigh 224gm and contain 85 to 90 percent by
weight of plaster.

Note: the setting of unmodified plaster starts about 10 minutes

after mixing,and is complete in about 45 minutes; however,
the cast is not fully dry for 72 hours.
• Setting time – Time taken to convert from powder form
to crystalline form.
• Average time is 3 - 1 0 minutes
• Reduced b y -
High Temperature
Salt solution
Borax Solution
Addition Of Resin
• Increased by
Low temperature
Sugar solution
• Setting time is three times longer at 5 C than at 50 C
• Movement of plaster while it is setting will cause gross
weakening
Drying time – Time taken for Plaster of Paris to
convert from crystalline from to anhydrous
form
Influenced by ambient temperature and
humidity
The optimum strength is achieved when it is
completely dry.
• To Support fractured bones,controlling
movement of fragments and resting the
damaged tissues.
• To stabilise and rest joints in
ligamentous injury.
• To support and immobilize joints and
limbs post operatively until healing
has occurred.
• To corresct a deformity.
• To ensure rest of infected tissues.
Plaster of Paris
Plaster Of Paris with Melamin Resin
Fiber glass or synthetic cast
Advantages
Slower setting
Infinitely moldable when wet
cheap
Disadvantages
Heavy
Significantly weakened if cast is wet
Partially radio-opaque
 Fiberglass Plaster
• Impregnated with polyurethane polymer
• Colorful and sticky
• Setting time -1 to 2 min
• Full strength in 2 to 4 hours
• Commonly available sizes 3 inch and 5 inch , length 6
meter
• Advantage
• Light weight
• Water proof
• Lesser setting time
• Disadvantage
• Costlier
Based on Pattern Of Application
-Slab: POP encloses partial circumference
-Cast :POP encloses full circumference
-Spica: includes trunk and one or more limbs
-Brace: Splintage which can allow motion at adjacent joint

Based on interposition of Material

Unpadded-No material interposed in between Plaster Of Paris
and skin.
Padded-Interposed material may be stokinette and wool or wool
alone.
A. Plaster Of Paris with melamine resin
B. Fibreglass
– Advantages
Lighter
Three times stronger than POP
Impervious to water
Radiolucent
– Disadvantages
Costly
Less pliable
Requires gloves
1. Examination and rehearsal
2. Plastering and molding
3. Reduction
 Examination and Rehearsal
The surgeon should examine the limb and fracture
site, documenting any skin lesions and neurovascular
status.

Radiographs should also be reviewed

thoroughly to determine fracture pattern.

Examination of the displacement and assessment of

the forces required to reduce and hold reduction.
Need to assess
Effect of gravity on the displacement
Amount of force needed to correct the displacement
Range of excursion from the position of greatest
deformity to the position of apparent reduction
•Plaster Of Paris bandage
•Rolled Gauze (for slabs)
• Casting gloves
•Basin of water
• Bandage scissors
•Padding (Simple cotton)
• Sheets
• Adhesive tape
PADDING :
1 - 2 layers or more depending on the amount of swelling.
Extra over elbows and heels.
Be generous over bony prominences.
Always pad between digits when splinting hands/ feet or
when doing buddy strapping.
Avoid wrinkles and lumps.
Not to be applied tightly- danger of ischemia !!
Just before completion of plaster application make sure
that padding material(cotton) is turned back and loose
edges are secured.
Slab is measured into required length
For upper extremities use 1 0 - 1 4 layers
and for lower extremities use 1 2 - 1 6
layers or upto 20 depending on size of
the person
One joint above and one joint below.
Joints should be immobilized in functional
position.
Not too tight or too loose i.e. adequate
padding
Uniform thickness of plaster is preferred.
Trimmed to the requirement of of the area
of application.
 Moulded with palm and not with fingers to
avoid indentation.
Consolidate the layers of the slab to remove
excess of air as retained air causes reduction of
plaster strength.
Slab is positioned and smoothened out with the
hands so that the slab fits closely to the contours
of the limb.
Wet bandage is applied to avoid tightening from
shrinkage after coming in contact with the slab.
A layer of cotton-wool is interposed between the skin and
plaster, which is firmly compressed against the limb by
applying wet plaster bandage under tension.
The elastic pressure of the cotton enhances the fixation of
limb by compensating for shrinkage in tissues.
Plaster is applied in distal to proximal with 50% overlap
Plaster is applied gently, compressing padding thickness
by 50%
The padding is rolled over and the final turns of Plaster
are rolled over it
Bandage is pressed and pushed round the limb by the
pressure of thenar eminence under a strong pushing force
directed in length of surgeon’s forearm.
Pressure is applied at the middle of width of bandage so
that no excess of pressure can fall on either edge .
After applying sufficient plaster,surgeon
prepares to apply the rehearsed movement of
reduction.
Should be able to clearly recognize sensation
of reduction.
After applying rehearsed reduction, surgeon
holds on, without further movement to allow
to put cast.
Patient should inform about thermal changes after
application of plaster.
When a plaster has been applied over a fresh fracture or
after operation upon a limb,careful watch must always be
kept for possible impairment of the circulation.Undue
swelling within a closely fitting plaster or splint may be
sufficient to impede the arterial flow to the distal part of
the limb.So Must check the vascular supply distal to the
slab or cast.
Whenever possible,the injured limb should be elevated.In
case of arm and forearm a sling may be used,provided the
arm is kept high enough.In case of lower limb the leg
may be elevated on pillows and the end of the bed raised
Check X Ray should be done after application of each cast
to confirm the acceptability of reduction.
 Attempting to plaster at the same time as
attempting to hold a precise reduction.
Applying wool carelessly in shapeless
lumps
Loose bandaging
Failing to recognize sensation of reduction
through the plaster
Below Elbow Slab
Indications –
•Wrist fractures
•Metacarpal fractures
•Colle’s fracture
Extends from a point about 5 cm below the tip of the olecranon
or 2 fingers breadth distal to elbow crease to the level just
proximal to the knuckles in the dorsum of the hand and the
distal crease in the palmar aspect.

The forearm is held with the elbow in a 90 degree flexed and

the wrist in the position of function of 25-30 degree
dorsiflexion for wrist fractures.

The fingers should be free to move fully at the

metacarpophalangeal joints.
Above elbow slab in elbow flexion
Indications
Fracture both bones forearm
Supracondylar fracture humerus of extension type
Unstable proximal radius or ulnar #
Above elbow slab in elbow extension :
Indications
Olecranon Fracture
Supracondylar fracture of humerus of flexion type.
Extends from the middle of the upper arm to the
point just proximal to the knuckles in the dorsum of
the hand.patient's forearm is held in mid prone
position with the elbow in 90 flexed position or full
extension depending on the type of fracture.
U-Slab
Indications :
For Proximal and shaft of humerus fractures.
Applied to the medial and lateral aspects of the
arm, encircling the elbow and overlapping the
shoulder.
Utilizes dependency traction
Above Knee Slab/Long leg back slab
Indications
Proximal and mid shaft Tibial fractures.
Supra condylar # of femur
Proximal end – as high in the groin as
possible
Distal End – to mp joints of foot
Knee in 5 to 15 degrees flexion
Foot in neutral position
Some common cast
Long arm cast
Indications:
-Forearm fractures
-Elbow fractures

# Applied just below the axilla and extend upto MCP

joint, leaving the thumb free.

# Elbow at 90 degree flexion and wrist in 30 degree

dorsiflexion
COLLES CAST

- Fracture distal end radius

- Extend from distal elbow crease to distal palmar
crease in ulnar deviation (30 degree) and palmar
flexion (10 degree).
SCAPHOID CAST

- Scaphoid fracture
- Wrist is in slight dorsiflexion and the thumb is in
abduction and slight flexion
- Cast extend from below the elbow to proximal to
metacarpal neck.
- Thumb cast extend to just proximal to inter phalangeal
joint.
- Modified scaphoid cast done in fractures distal to MCP
joint of thumb.
BURKHALTER CAST

- For Metacarpal # and phalanges #

- Wrist is placed in 40 degree extension and MCP joint in 70
to 90 degree flexion.
BELOW KNEE CAST

- Ankle # / foot #
- Below the level of fibular neck proximally to the level of
metatarsal head distally with the ankle at 90 degree and
foot in plantigrade position.
LONG LEG CAST

-done in unstable tibial diaphyseal #

- First below knee cast is applied then 10 degree of
flexion of knee, extension of cast upto mid thigh.
PATELLA TENDON BEARING CAST

- Tibia diaphyseal #
- Proximal end of below knee cast is extended upward
as far as the lower pole of patella and moulded
around the patellar tendon to provide rotational
stability.
Hip Spica
• It encompasses trunk with the lower limb
• Position of the limb
• Hip- 45 degree flexion and slight abduction
• Knee- 45 degree flexion
• Ankle- Neutral position
• Extent
• Proximally- upto nipple and rest on the rib cage
• Distally- depending upon distal extension
• Single hip spica
• One and half spica
• Double hip spica
• Uses
• Fracture femur in children
• After pediatric hip surgeries
• Complications
• Urinary retention
• Plaster cast syndrome
A complete plaster cast that is applied within a
few hours of injury or immediately after
operation,in cases when extensive swelling can
be expected should be split throughout its
length.The limb must be elevated until the
circulation is re established and the swelling
and oedema controlled
It is of great value to be able to correct minor degrees
of angulation without completely changing the
plaster.Yet even small degrees of angulations can be
corrected by a simple device of wedging and this can
be done with perfect control.
Under the guidance of X-rays fracture site is identified
and A linear cut is made round two thirds of the
plaster at the level of fracture on the concave side of
the angle. The linear division is opened to a wedge
which is held open by a small block of cork placed
between the two cut edges.Another radiograph is
taken and degree of correction may be increased or
decreased by inserting larger or smaller cork.When
the final radiograph proves alingment is perfect,the
gap in the plaster is filled and reinforced.
 Not usually encouraged
Danger of edematous tissue herniating
through the window
Indicated i n -
Compound fractures discharging copious pus
Compound fractures with graft
Counsel the patient on signs of neurovascular
compromise
Warning signs
You should contact your doctor immediately if you
develop any of the following warning signs:
•Cast/splint is too tight
•Fingers or toes are swollen (a little is normal;a
lot is bad)
•Numbness (loss of feeling) in fingers or toes
•Can’t move fingers or toes
• Pain keeps getting worse
•“Hot spot” (burning and/or rubbing) under the
cast.
How to prevent swelling
To reduce the swelling, rest and elevate the injured
area above the level of heart.An injured foot or ankle
should be up on pillows while you are lying or sitting
partially upright.

How to prevent stiffness

As soon as patient can, completely bend and

straighten the fingers/toes of injured limb for
a few seconds every hour while patient is
awake. Gentle stretching of the joints above
the cast (elbow, shoulder, knee, hip) is also a
good idea in most cases.
Keep your cast dry:
Plaster casts “melt” if they get wet, and your skin can be harmed
from wet padding. Always use a waterproof cover or heavy
plastic bag when showering (no swimming or baths), and use a
hair dryer set to a low temperature if it becomes damp. Contact
your doctor if the cast becomes significantly wet.
Keep your cast clean:
Avoid dirty or dusty places, beaches, fields, etc, and avoid
activities that might soil your cast.
Don’t overheat your cast:
If your cast is near a heater or fireplace it can become
overheated and burn you.
Don’t put anything inside your cast:
Sometimes your skin itches inside the cast.This can be relieved
by applying an ice pack,or placing a hair dryer or vacuum cleaner
against one of the ends of the cast to drawair through it and
across your skin.
Due to improper applications :
Joint stiffness and malposition of lim b.
Plaster blisters and sores.
Pressure Sores
Plaster sore in paraplegia
Due to plaster allergy :
Allergic contact dermatitis –
The skin symptoms of irritation were all mild and
temporary.Quaternary ammonium compound
BENZALKONIUM CHLORIDE is the allergen responsible for
plaster of Paris-induced allergic contact dermatitis
Purulent dermatitis
Due To Tight Cast
Oedema distal to the plaster
Compartment syndrome
Nerve Palsy
Circulatory Complications
Others
Gangrene complicating fractures with burns
Deep vein Thrombosis
Hypostatic pneumonia
Disuse osteoporesis and renal calculus formation
STRANGULATION

BULLAE-
FORM
SKIN LESION
PRESSURE TISSUE
DAMAGE
When a limb is put into Plaster and the joints
immobilized for a long period , joint stiffness,
muscle wasting and osteoporosis are
unavoidable.
This syndrome can be reduced to a minimum by
the early use of functional braces, isometric
exercise and early weight bearing.
These in turn promote a rapid retrieval of
function.
Duration to keep Plaster or cast in situ:
The time duration is much dependent upon the
fracture site,type,soft tissue condition and proper
follow up with radiograph and functional
condition of the limb
Roughly the time duration assume:
For children:
Upper limb -3 weeks
Lower limb -6 weeks
For adult:
Upper limb -6 weeks
Lower limb -12 weeks
 Slabs are removed by cutting the bandage, carefully avoiding
nicking
the skin
For casts
– Using shears
» Heel of the shears must lie between plaster and skin, avoiding
bony prominences
» Avoid cutting over concavities
» The route of the shears should lie over compressible soft tissue
» The lower handle should be parallel to the plaster
– Using electric saw
» Do not use unless there’s wool padding
» Do not use over bony prominences
» The cutting movement should be up and down not lateral
» Do not use blade if bent, broken or blunt
Suitable for direct application
Easy to mould or remould
Nontoxic for patient
Unaffected by water
Transparent to x-rays
Quick setting
Able to transmits air, water, odour and pus
Strong but light in weight
Non-inflammable
Non messy application and removal
Long shelf life
cheap
Thank you