Presentation1.pptx
- 2. Methods of plaster and splinting • What is a splint? • A splint is a rigid support with padding made from metal, plaster or plastic. It is used to support, protect,or immobilize an injured or inflamed part of the body. The splint is secured in place with an elastic bandage or an ACE wrap .The purpose of the splint is to prevent movement of the injured extremity which helps prevent further injury, and to minimize pain
- 3. Indications for Splinting • Fractures • Sprains • Joint infections • Tenosynovitis • Acute arthritis /gout • Lacerations over joints • Puncture wounds and animal bites of the hands or feet • To reduce/prevent contracture • To increase grip strength • To stabilize and rest joint in ligamentous injury • To correct deformity • To support and immobilize joints and limbs postoperatively until healing has occured
- 4. Contraindications of Splint • Compartment syndrome • Need for open reduction • Skin at high risk for infection
- 5. Splinting Materials • Plaster Of Paris Bandage • First used by Matthysen Dutch military • surgeon in year 1858. Characteristics: • – Plaster of Paris (POP) impregnated • bandage. • – Setting time: 4–5 minutes. • – Full strength of cast is achieved in 24–48 • hours
- 6. • Chemical reaction—plaster of Paris (calcium sulfate hemihydrate) is obtained by heating gypsum (calcium sulfate dihydrate). And again when plaster of Paris comes in contact of water, gypsum reappears with release of some heat (exothermic). 2(CaSO4. 2H2O) + heat—2(CaSO4. 1/2H2O) + 3H2O 2(CaSO4 . 1/2H2O) + 3H2O—2(CaSO4 .2H2O) + heat – Water resistant cast is prepared when melamine resin is mixed with plaster of Paris. • Commonly available sizes—4 inch, 6 inch × 2.7 meter. • Factors affecting setting time: – Temperature of water. – Manufacturers setting time. – Impurities in plaster. – Water condition (hard and soft) – Humidity. – Room temperature. • Uses of POP bandage: – As a slab for immobilization. • Extent of slab coverage—50–70% circumference (2/3rd) of limb. • For upper limb—6–8 layers and for lower limb—10–12 layers
- 7. • As definitive casting: • Wrapped around whole circumference of limb or part involved. • The overlapping of bandage is 1/3rd– 1/2 of previous turn. • Thickness of cast varies according to nature of fracture, limb type (upper or lower) and age of patient. – Functional cast bracing. – Deformity correction serial casting. – Partial weight relieving orthosis. – Spica. – Charlney’s traction unit. – Pin plaster technique. • Complications with POP bandage: • – Neurovascular compromise. • – Compartment syndrome. • – Pressure sore. • – Purulent dermatitis. • – Reactionary edema. • – Fracture disease. • – Wasting of limb. • – Joint stiffness. • – Loss of reduction
- 8. Fiberglass Plaster • Characteristics: – Composition: Fiber-glass impregnated with polyurethane polymer. – Colorful and sticky. ─ Setting time: 1–2 minutes. – Full strength of cast is achieved in 2–4 hours. – Activated by water or other agents. •Caution: Surgical gloves must be worn before using this cast. •Commonly available sizes 3" and 5" × 3.6 meter. •Advantages: Light weight, water proof, lesser setting time. •Disadvantage: Costlier
- 9. • STOCKINETTE • Characteristics: –Continuous tubular cotton fabrics. –Water repellent property. –Stretchable that can accommodate various girth of limb. • Extend it about 10 cm beyond each end of intended splint site. • Commonly available in size 3"(upper limb) and 5"(lower limb) × 20 meters. •Uses: Before application of slab and cast over limbs. •Advantages: Prevention from skin complication like allergy, dermatitis, etc
- 10. Cotton Roll • Properties: – 100% cotton and bleached to white. – High absorbent property. – Single and uniform lap without joints as thin long continuous layer. • Available in standard 500 g but 100, 200, 300, 400 g also found. • Various uses like: – For cleaning and swabbing of wounds. – For padding before applying slab and cast. – For wrapping around splints, etc. Cotton Roller Bandage • Properties: – 100% cotton fabrics with a loose open weave and bleached to white. – Quick absorbent property. – Number of holes per square centimeter of cotton gauze—4 × 4 = 16. •Cotton roller bandages are commonly available in 4" and 6" × 4 meters •Used for: – For POP slab application. – For wrapping around various splints. – During wound dressing. – The most common fastening article in ward. •Starch impregnated roller bandages becomes slimy when soaked in water and it becomes harder when dried. This property is utilized to provide extrastrength to POP slabs. •Why wet roller bandaging during POP slab application: – Wet bandages increase POP setting time and provide enough time for plaster molding and limb manipulation. Wet bandages well incorporated with slab and provide extrastrength. – Dry bandages absorbs water from POP and decreases the setting time and side by-side it does not incorporates well with slab
- 11. Principle Of Reduction and Casting • For fracture reduction appropriate amount of traction and countertraction is applied in proper direction. • Reduction is achieved by manipulation of distal fragment. • A perfect reduction is said when all cortices are in contact at fracture site or reduction is said to be acceptable when both fragments have at least 50% contact both in AP and lateral views. • Even minimal rotation at fracture site is hardly accepted. • Appropriate padding should be done around fractured limb especially over bony prominence. • Reduced position of limb should maintain before, during and after casting. • Any indentation during molding and wrinkles should be avoided during cast application. • A reduced fracture is maintained in such a way that one joint above and one joint below is fully immobilized. But exceptions are Colles’ fracture, fracture around ankle, etc. • The position of limb should be maintained in functional position or position of immobilization. For most of the joint these two are the same but for wrist and hand these stands differently.
- 12. Principle Of Reduction and Casting – Functional position: The position in which limb can be maximally utilized even after its stiffness, e.g. glass holding position of wrist. This position is used for arthrodesis of a joint. – Position of immobilization: The position in which the ligaments and tendons around joints remains maximally stretched, so that the contracture of joint could be prevented, e.g. James position of hand (lumbrical plus hand posture). • The fracture reduction and maintenance under cast also follows the “three-point molding principle of Charnley’s”. Out of these three points two point lies proximal and distal to fracture site. The third point lies at the site of fracture site but the direction of molding force working here is apposite to the above two points . • Ask the patient to follow the instructions like: – Keep the limb elevated. Why we ask the patient lying on bed with a cast in his either of the limb to keep over pillow or hang it with some cord or bandage? • Just to maintain the limb above the patient heart level to ensure easy venous drainage and this act minimizes the swelling. – Ask the patient to do finger or toe movement—this improves the circulation in the respective limb and side-by-side keep the muscle active and finally minimize postcast stiffness. – Removal of cast is done immediately • if any sign of cast tightness develops in the limb—like continuous pain, discoloration of finger, etc.
- 13. Casting in James Position • (radial gutter, ulnar gutter and volar splintage with POP) • Position: – Wrist joint: 30°–40° extension. – Metacarpophalangeal joint: 70° flexion. – Proximal interphalangeal joint: 20° flexion. – Distal interphalangeal joint: 10° flexion. • Extent: – Proximally: Cover lower 2/3rd of forearm. – Distally: Proximal to distal interphalangeal joint. • Uses: – Metacarpals fractures. – Proximal phalanx fracture of fingers. – Metacarpophalangeal joint injury – For preventing clawing. – After tendon repair and tendon transfer Radial Gutter in James position Ulnar Gutter in James Position Volar Splint in James position
- 14. • Scaphoid Cast and thumb spica • Position: Glass holding – Wrist attitude: Radially deviated and moderately dorsiflexed – Thumb attitude: Mild abduction. • Extent of cast: – Proximally: Cover lower 2/3rd of forearm. – Distally: Up to proximal palmar crease and proximal to interphalangeal joint of thumb. • Uses: Fracture scaphoid • Thumb spica : – It maintains the wrist in 10°–20° of extension and thumb in slight flexion and palmar abduction. – It is used for immobilization of thumb in injuries around first carpometacarpal joint, metacarpophalangeal joint and interphalangeal joint.
- 15. • Colles’ Cast • Position: – Wrist attitude: Approx. 25° ulnar deviation with slight palmar flexion. – Forearm attitude: Full pronation. • Extent of cast: – Proximally: Cover lower 2/3rd of forearm. – Distally: Proximal to palmar crease in volar aspect and just short of knuckle in dorsal aspect. • Used: – For Colles’ fracture. – For unstable fractures like fracture distal radius with ulna, intra-articular fracture • or fracture dislocation; Colle’s cast must extended above elbow. For smith fracture: – Full supinated forearm. – Ulnar deviation and dorsiflexion at wrist. – Extent of cast is above elbow. • For Barton fracture—Volar Barton: Wristflexion attitude and in Dorsal Barton— wrist-extension attitude.
- 16. U-Slab or Cast • Position of limb: – Arm by the side of trunk. – Elbow 90° flexion and pronated. • Extent of cast: – Stretch form inside of arm – Run around the elbow – End over the junction of shoulder and neck. • Uses: For fracture shaft of humerus
- 17. Above elbow Cast • Position of limb: • – Elbow: 90° flexion • – Forearm: • Fully supinated—for proximal 1/3rd fracture. • Midpronated—for middle 1/3rd fracture. • Full pronated—for distal 1/3rd fracture. • Extent of cast: • – Proximally: Up to midarm. • – Distally: Just proximal to metacarpophalangeal joint of hand. • Uses: For fracture both bone forearms