Au Wai Kin Tsang Wing Yan Department of Orthopaedics and ...slo.ort.cuhk.edu.hk/Media/59/med 3...
Transcript of Au Wai Kin Tsang Wing Yan Department of Orthopaedics and ...slo.ort.cuhk.edu.hk/Media/59/med 3...
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Plaster and Orthopaedic AppliancesPlaster and Orthopaedic Appliances
Au Wai Kin Tsang Wing Yan Department of Orthopaedics and
TraumatologyPWH
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Function of PlasterFunction of PlasterImmobilize of fracture or injured tissue to avoid further damageMaintain in proper body alignmentProvide support & rest for the injured partProtect repaired tissue to promote healing (e.g. tendon repair, SSG)Act as orthotic (e.g. u-slab / cylinder of stump)To promote healing & early weight bearingMaintain position(e.g. Hip spica)
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Plaster MaterialPlaster Material(1)Plaster of Paris: CaSO4.2H2O
e.g. Gypsonausually use as temporary measure
(2)Synthetic Resin: C6H5.NCOFiberglass casting materiale.g. Scotchcast, Dynacastusually use in cases planned with longer period of immobilization
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CharacteristicsCharacteristics
higherlowerPrice
shorterlongerDrying Time
goodfairRadiolucency
difficulteasyMoulding capacity
goodpoorPermeability
strongerweakerStrength
lightheavyWeight
Synthetic ResinPlaster of Paris
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Before Plaster ApplicationBefore Plaster ApplicationAssessment(1)History taking
-allergy-mechanism of injury
(2)Physical Assessment- vascular status- skin integrity- neurological status & ROM of the affected limb- alignment & position
Care of the skin lesion e.g. lacerationGive analgesicsClear explanation Padding to the bony prominence areaNo rings on finger & remove all nail-polish
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plaster + water Gypsum + HEAT
Exothermic reactionExothermic reaction
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Potential Complications After Potential Complications After CastingCasting
Allergic Reaction - cast materials Tissue Impingement Compartment Effect- Volkmann’s ischaemic contracture Pressure sore formationMuscle Wasting- lack of exerciseJoint Stiffness - prolonged casting
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Allergic ReactionAllergic Reactioncheck for allergic history before applicationexcessive irritation remove the cast, cleanse the skin thoroughly and re-apply other materials.
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Circulatory & Nerve ImpairmentCirculatory & Nerve Impairment
Causesinsufficient padding tight castexcessive swelling
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Compartment SyndromeCompartment SyndromeWithin a confined space (an osteofascial compartment) oedema leads to an increase of pressure; this reduce the capillary flow, which leads to more oedemaA vicious circle develops, resulting in ischaemia of the tissues within the compartments/s: 5 ‘P’s
ParaesthesiaPainPallorPulselessParalysis
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Circulatory & Nerve ImpairmentCirculatory & Nerve Impairment
Treatment• Elevation• Encourage movement of the extremities
Bivalve the cast
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Impaired Skin IntegrityImpaired Skin IntegrityDress wound properlyEnsure the edges of the cast are well paddedHandle the cast with the palms of the hands instead of the fingers to prevent indentations in the soft plasterAware of plaster sore
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Plaster SorePlaster SoreCauses
uneven bandaging techniqueInsufficient padding over bony areasCast is too tight or too looseForeign body inside the cast
S/Sitchingburning sensationfeversleep disturbancefoul smelldischarge
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Wire impinging on Cast lead to rotation of wire
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Adequate cushion to protect skinCover second layer of gauze to prevent knocking against castEnsure wire is parallel to wall of cast as possible
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Pressure SoresPressure Sores
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Cast indentation constriction
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Risk of Loss of AlignmentRisk of Loss of AlignmentMaintain the reduction and keep the affected part in a desired position during cast applicationPromote drying of the unconsolidated castUse pillow to support the cast
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Risk of Loss of AlignmentRisk of Loss of AlignmentSupport the cast with palms Check for cracks/ softening/ loosening
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Prepare for MobilizationPrepare for MobilizationWeight bearing is not allowed until cast is dry/ instructed by surgeon
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Muscle Wasting & Joint StiffnessMuscle Wasting & Joint Stiffness
• Muscle strengthening exercises • Exercise joints above and below the affected limb
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Window on Cast
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Body ImageAllow to choose the preferable colour, esp. in adolescenceDiscuss expectation of activity and appearance of cast
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Patient EducationPatient EducationDos & Don’tsDietary adviceCare after removal of cast
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Application of CastApplication of CastPaddingActivation of cast material- immerse in luke warm water at
a 30 degree angle to the vertical
- gentle squeeze until no more bubbles appear
- squeeze out excessive waterApplications- circular- slab
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Technique for applying a castTechnique for applying a castA stockinette - extending to the joint above and longer than the limb (fold back at the end to make a smooth edge)Take up the slack of every layer to be covered by the coming foldSmooth out every layer to remove airApply with continuous folds to cover at least half the previous foldUse the thenar areas of the hands for moldingThe cast must be fit the external anatomy of the limb, mold to create a three-point fixation
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How to apply a short arm How to apply a short arm dynacastdynacast
Cast application(click to see video)Bivalve cast (click to see video)
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TractionTractionDefinition :Traction is the use of pull to exert force
directly or indirectly to bones to overcome deformity or to help restore alignment following trauma
Aims- to reduce and stabilize a fracture or
dislocation- to relieve pain and reduce muscle spasm- to immobilize a joint or part of the body
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Skin Traction- Apply traction directly onto skin
Skeletal Traction - through skeleton via transosseous pin
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BuckBuck’’s Unilateral Leg Tractions Unilateral Leg TractionTemporally stabilization of hip fracture to relieve pain and muscle spasm
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Halter TractionHalter Traction
Indication: cervical spondylosis
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Pelvic TractionPelvic Traction
Indication: prolapsed lumbar intervertebral disc
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BryantBryant’’s (s (GallowGallow’’ss) Traction) TractionIndication: fracture of the femur in children
< 3 years old, B.W < 30 lbs
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Skeletal TractionSkeletal TractionIndication
fracture shaft of femurfracture acetabulum
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9090oo -- 9090oo skeletal traction for Paed caseskeletal traction for Paed case
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Halo tractionHalo tractionIndication
fracture or dislocation of cervical vertebrae
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Orthopaedic AppliancesOrthopaedic Appliances
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Arm Elevator
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90o-90o Elevation
Shoulder immobilizer
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Braun’s Frame
Thomas Splint
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Hi-lo chair
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Short Arm Hinge Brace
Long Arm Hinge Brace
Humeral Brace
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Spinal OrthosisSpinal OrthosisFunction
To relieve painTo support weakened or paralyzed muscles and unstable jointsTo immobilize the vertebral column in the best functional position while healing occursTo prevent the occurrence of deformity or correct deformity
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Foam collar
Thomas collar
Moulded polythenecervical orthosis
(Philadelphia neck collar)
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Halo-Body JacketKnight brace
soft lumbar corset
Underarm brace
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Thank You