POP PLASTER AND CAST TECHNIQUES
- 1. POP (PLASTER) TECHNIQUES Dr. Kunal Arora PG Orthopaedics
- 2. CHEMICAL FORMULA : 2CaSO4·½H2O + 3H2O ==> 2CaSO4·2H2O + heat Hemi hydrated calcium sulphate (POP) Hydrated calcium sulphate (GYPSUM) PLASTER OF PARIS
- 3. ORTHOPAEDIC USES OF POP : • To support fractured bones •To stabilize joints in ligamentous injury •To immobilize joints and limbs after surgery. •To correct deformity as in CTEV
- 4. USED IN 4 FORMS MAINLY : • Slab • Cast • Spica • Functional Cast Brace.
- 5. Setting time : Time taken to change from powder form to crystalline form. Drying time : Time taken to change from crystalline form to anhydrous form. Average setting time : 3-9 minutes. Average drying time : 24-72 hours.
- 6. RULES OF APPLICATION OF POP •Correct size of the roll to be chosen •A joint above and a joint below the fracture/injury should be included. •Plaster should not be too tight or too loose. •Moulding should be done with palm not with fingers to avoid indentations.
- 7. PADDING : •Padding should be from distal to proximal with 50% overlap. •Extra over elbows and heels. •One should be generous over bony prominences. •Always pad between digits when splinting hands/ feet or when doing buddy strapping. •Not to be applied tightly- danger of ischemia !!
- 9. . Materials (prepared before the procedure)
- 10. . Positioning of the limb
- 11. STOCKINET •It protects skin and makes the bandge application to look nifty. •To be applied on the skin before the padding is done. •Always cut the stockinet longer than the splint to be applied. •Available in various width . •Not to be used in FRESH TRAUMA.
- 12. Application of the padding
- 13. BASIC PLASTERING TECHNIQUE : • Plastering is a form of craft. • It’s a skill not to be learned from books but by continuous practice. •A good manipulative reduction can be spoiled due to a clumsy plaster application.
- 14. SLAB : •Slab is a temporary splint made up of half by POP and half by bandage roll. •Used in initial stages of fracture treatment, during first aid and to immobilize the limbs post operatively. Steps in application of slab – •Slab is measured into required length •For upper extremities use 8-10 layers and for lower extremities use 12-15 layers or upto 20 depending on size of the person •Trimmed to the requirement of of the area of application
- 15. •Slab held carefully at both ends and immersed completely in tepid water. •Lift out and momentarily bunch up at an angle to expel excess water. •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.
- 16. Below Elbow Slab: Indications – •Wrist fractures •Metacarpal fractures •Colle’s fracture
- 17. Above elbow slab in elbow flexion : Indications •Fracture both bones forearm •Supracondylar # humerus of extension type •Unstable proximal radius or ulnar # Above elbow slab in elbow extension : Indications •Olecranon # •Supracondylar # humerus of flexion type.
- 18. U SLAB OR COAPTATION 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 and hydrostatic pressure to effect fracture reduction
- 19. Below knee slab Indications: •Ankle fractures and dislocations post reduction •Tarsal and Meta tarsal fractures. Position : Proximal end – upto tibial tuberosity. Distal end – upto MTP joints of foot. Foot in neutral position.
- 20. Above Knee Slab Indications • Proximal and mid shaft Tibial fractures. •Supra condylar # of femur Proximal end – as high in the groin as possible Distal End – to MTP joints of foot Knee in 15 degrees flexion. Foot in neutral position.
- 21. CAST : •In this form of splinting POP roll completely encircles the limb. •Casting is used as a definitive form of fracture management and also to correct deformity. Steps in application of cast : •After stockinet application and tidy uniform padding, appropriate width of POP roll is selected. (generally 4 inch or 6 inch) •Dip the roll in tepid water completely. •Secure the end of bandage to prevent it from getting lost. •Hold the bandage lightly with the other hand without compression.
- 22. •Immerse at an angle of 45o •Keep under the water until bubbles start rising. •Remove the excess water by compressing in axial direction.
- 23. Handling of plaster bandages
- 24. Application of plaster bandages
- 25. Final Manipulation Is Done And The Reduction Held, With Appropriate Molding, Until The Plaster Hardens.
- 26. During the evaporation period, the casted limb should remain exposed and not fully covered by blankets.
- 27. TRIPLE SEQUENCE IN PLASTER APPLICATION : Phase 1 : Examination And Rehearsal Phase 2 : Plastering Phase 3 : Reduction And Holding
- 28. Phase 1 : Examination And Rehearsal •Examination of the displacement and assessment of the forces required to reduce and hold the reduction. • Need to assess effect of gravity on the displacement. • Range of excursion from the position of greatest deformity to the position of apparent reduction.
- 29. Phase 2 : Plastering • Limb held by assistant in position of approximate reduction. • Surgeon himself should apply the bandage. •Quick application is more important than holding precise reduction. •Plaster should still be completely soft after completion to allow final touches
- 30. Phase 3 : Reduction And Holding •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 the cast to set. •In the last few minutes, he should obliterate any abrupt impression that might invite pressure sores. •NOT TO FORGET CHECK XRAY should be done after application of each cast to confirm the acceptability of reduction.
- 31. SPICA : A cast of layers overlapping in a V pattern, covering two body parts of greatly different in size, as the hip and waist, thumb and wrist, etc. Eg : Hip spica cast Thumb spica cast
- 32. Advantages Of POP : •Cost effective •Non allergic •Easily moulded to different forms. Disadvantages of POP : •Radio-opaque , may occlude # lines •Heavy •Easily breaks when comes in contact with water.
- 33. AFTER CARE OF POP : • Keep the plaster cast dry. • Mobilize all the joints which are not incorporated in the plaster to their full range of motion once it becomes dry. • Come immediately if any of the following symptoms develop Excessive pain Excessive swelling Bluish or white discoloration of fingers or toes •Notice any cracks in the plaster. •Graduated weight bearing for lower limb # •Physiotherapy of muscles within the plaster and joints outside the plaster is necessary to ensure early rehabilation.
- 34. 3. COMPLICATIONS OF POP Due to tight cast •Pain •Pressure sores – The patient’s complaints of a painful cast should never be ignored, and the cast should be changed promptly. Often, this may reveal an area of early skin pressure or irritation that could progress to full-thickness skin loss. Compartment syndrome and the resulting sequelae Volkmann's Ischaemic contracture. • Peripheral nerve injuries
- 35. Due to improper applications : • Joint stiffness and malposition of limb. • Plaster blisters and sores. 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
- 36. Disuse Atrophy and Muscle Weakness – •Muscles that do not function when under cover of plaster will atrophy •Not only can this result in cast loosening, but there may also be functional loss. • Motion and isometric exercises should be encouraged. •Prolonged non–weight-bearing treatment in a cast can also result in disuse osteopenia, which can complicate recovery. •Typically, radiographic features include loss of trabecular pattern, a speckled or mottled appearance of the periarticular surface, and a generalized “WASHED-OUT” appearance
- 37. When a limb is put into POP and the joints immobilized for a long period joint stiffness, muscle wasting and osteoporosis are unavoidable. This 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.
- 38. FRACTURE DISEASE : •A constellation of symptoms and physical changes has been called “fracture disease.” • Prolonged immobilization, especially in a nonfunctional cast, can lead to a vicious cycle of pain, swelling, and unresolved edema. •Edema fluid is a proteinaceous exudate that will congeal and gets converted to a gelatinous material and deposited as a scar tissue around joints and tendons causing joint stiffness, contracture and tendon adhesions. • Muscle atrophy, brawny skin /induration, and osteoporosis follow •Reflex sympathetic dystrophy may sometimes occur and further complicate the picture
- 39. CAST SYNDROME : •Cast syndrome is a rare complication that is seen related to hip spica cast •The syndrome occurs due to arteriomesenteric duodenal obstruction, and it is a result of excessive abdomen and chest coverage. • Symptoms are severe, and if left untreated, can be potentially lethal. •Compression of the third part of the duodenum between the lumbar spine and the aorta posteriorly and the mesentry and vessels anteriorly. • This syndrome is precipitated by recumbency and increased lumbar lordosis. •Avoiding constrictive body casts that increase lumbar lordosis prevents cast syndrome. • Nausea, epigastric fullness, and regurgitation should be carefully evaluated.
- 40. FIBRE GLASS CAST : •A fiberglass cast is a lighter, synthetic alternative to the more traditional plaster version. •It is created by padding the extremity with cotton or waterproof padding material, followed by wrapping several layers of knitted fiberglass bandages impregnated with a water-soluble, quick- setting resin
- 41. Advantages : •Short setting time •Immediate weight bearing •Strong but weighs light • Radiolucent •Water resistance •Wicks moisture better. Disadvantages : • High cost • Can’t be applied over wet wounds or immediately after trauma • Difficult to remove • Leaves sharp edges • Less mouldable
- 42. PROPERTIES OF AN IDEAL CAST : •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
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