Casting

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CASTING

I P. Sukarna

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Casting is useful for :

• Immobilization

• Controle and maintain the position – fracture reduction

– inflammation

– infection

– after correction : CTEV-serial plastering

tendo transfer, arterial, nerve repair

post arthrodesis

– prevent contracture • post operative

• Poliomyelitis

– etc

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Material for casting

1. plaster (Plaster of Paris = POP)

2. fiberglass

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Price Water

resist

Weight Strength Molding Radiology Open

plaster cheap no heavy easily

broken

easy transparant + easy

fiberglass expensive yes light strong no transparant saw,

bevalve

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Preparation

• Basin for water (warm)

• Plaster (several sizes), not expired, setting

time

• Padding (cotton)

• Stockinet (several size)

• Elastic Bandage

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Preparation

• Instruments

– plaster opener (scissor), small & big size

– spreader

– plaster saw (electric)

– manual saw

– knife, scissor

– gloves

• Personels

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Technique plastering

• Slab : single slab, double slab, “U”slab

• Circular plaster

1. padding

2. skin tight

• Padding over bony prominance

• Px :

• lying, relax

• Over 2 joints : stable

• 3 point fixation

• functional position

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Technique plastering

• Technique soaking plaster in warm water

• Plaster size depend on size of the limb

• 3 layers

• more layers on the joint

• Don’t move until dry

• Don’t cover

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Casting according to

anatomy

• Upper extremity

a. short arm cast (below elbow)

b. long arm cast (above elbow)

• hanging cast

• U-Slab

c. hand cast, thumb spica, lumbrical position cast

d. shoulder-trunk : shoulder spica cast

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Casting according to

anatomy

• Lower extremity

a. short leg cast (below knee)

Sarmiento cast

b. long leg cast (above knee) • cylinder cast

• hip-pelvis : hemispica cast

double spica cast

c. spine : cervical : Minerva cast

th-L : body jacket

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Cast splitting

• Safe-cast

• Prevention

Single/double split -------------- skin is “free”

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Wound

• Trueta

• no circular bandage

• window

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Walking plaster

• Sarmiento

• Ankle fracture

• Foot fracture

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Wedging

• Angulation correction

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Instruction to out Px

Must be clear and written

• Undue pain

• Color

• Numbness

• Loss of active movement

fingers or toes

Return to the Hospital at any time day/night

Danger : “compartmental syndrome”

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Cast care

• Limb elevation

• Isometric muscle contraction

• Not contaminated : water, urine, foreign bodies, no scratching

• mobilization

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Cast removal

• Sometimes risky

• Avoid the prominent bone

• Use a piece of wood to protect skin (electrical saw)

• Must know how to use cast opener

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Plaster complication

A. Local • blood circulation (2x24 hrs)

• (compartment syndrome)

• DVT

• nerve palsy

• oedema

• infection

• late :

muscle atrophy

joint stiffness

osteoporosis (local)

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Plaster complication

B. General Prolonged immobilization

• CNS

• Tr. Respiratorius

• Tr. Digestivus

• Tr. U.G

• Musculoskeletal

• Skin

• psychis

Casting

Engineering

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