Orthopedics Book

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Casting

Aka: Casting, Splinting, Fracture Splinting, Fracture Casting
  1. See Also
    1. Fracture Immobilization
  2. Precautions
    1. Confirm and document intact neurovascular status before and after immobilization
  3. Preparation
    1. Measure and prepare stockinette
      1. Choose stockinette that is 2-3 inches wide for arms and 4 inches wide for legs
      2. Stockinette width should not be too tight
      3. Stockinette should extend 10 cm beyond each end of cast or splint
      4. Create hole for thumb if Splinting or Casting hand
    2. Select padding and fiberglass widths
      1. Hands: 2 inches wide
      2. Arms: 2-4 inches wide
      3. Feet: 3 inches wide
      4. Legs: 4-6 inches wide
    3. Choose material
      1. Cast: Fiberglass
      2. Splint
        1. Ortho-glass (fiberglass strips encased in padding)
          1. Cut to size (and clamp supply so that it does not dry out)
          2. Pull padding over the ends of the splint
        2. Fiberglass Roll
          1. Unroll fiberglass to appropriate length for layer 1
          2. Fold the fiberglass back on itself to create layer 2
          3. Repeat process until appropriate number of layers is reached (see plaster below)
        3. Plaster
          1. Arms: 10 sheets or layers
          2. Legs: 12-15 sheets or layers
  4. Technique
    1. Step 1: Patient positioning
      1. Maintain position of function of each immobilized joint throughout process
        1. Examples
          1. Wrist in slight extension and ulnar deviation
          2. Ankle at 90 degrees
        2. Stockinette or padding will wrinkle and risk pressure points on repositioning
    2. Step 2: Apply stockinette and padding
      1. Apply stockinette to involved extremity, extending 10 cm beyond each intended end
        1. Ensure that stockinette is not wrinkled, especially over bony prominences
      2. Apply padding over area of intended splint or cast
        1. Padding should cover an area 2-3 cm longer than the intended splint or cast
        2. Unwrap padding circumferentially around the limb
        3. Each loop should overlap the prior loop by 50%
        4. Apply extra padding over pressure areas
          1. Bony prominence (esp. ulnar styloid, heel, olecranon, malleoli)
          2. Between fingers and toes
          3. Endpoints of cast or splint
        5. Avoid applying so much padding that the cast or splint support is undermined
      3. Fold the stockinette back over each end of the padding
    3. Step 3: Apply cast or splint
      1. Timing of wetting material
        1. Material (fiberglass, plaster) may be applied wet or
        2. Material may be applied dry and secured with a wet ace wrap
      2. Mold the material only with palm (avoid using fingers which create pressure points)
  5. Complications
    1. Compartment Syndrome
    2. Burn Injury
    3. Skin breakdown at pressure points
    4. Bacterial or fungal infection
    5. Pruritus
    6. Disuse atrophy and stiffness
  6. Course
    1. Follow-up 5-10 days after Splinting for Casting
    2. Casting duration is typically 4-8 weeks depending on the Fracture site
  7. Resources
    1. University of Ottawa Casting
      1. http://www.med.uottawa.ca/procedures/cast/
  8. References
    1. Boyd (2009) Am Fam Physician 79(1): 16-22 [PubMed]

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