PowerPoint Presentation

[Audio] Plaster and Orthopaedic Appliance Splinting & Casting Clinical Applications.

[Audio] Workshop Outline • Splint vs Cast • Principles of Splinting • Types of Splints • Compilations from Splints • To refer or not to refer: ER or Clinic • Patient education.

[Audio] Goals • Know principles of splinting • Know different types of splints • How to apply a splint • How to avoid errors in splint application • Happy splint, Happy patient.

[Audio] OBJECTIVES Understand the fabrication of different types of POP casts and slabs, their advantages and disadvantages. Understand the necessary follow-up and possible complications related to the application of circular POP. Know and master the fabrication procedures of POP casts for lower and upper limbs. Know and master the fabrication procedures of slabs for lower and upper limbs. Be capable of organizing a plaster room and giving instructions regarding. the care and maintenance of the plaster equipment..

[Audio] Functions • To maintain support • To protect realigned bone • To promote healing & early weight bearing • To prevent / correct deformity.

[Audio] Types of Cast P.O.P.: CaSO4.2H2O e.g. Gypsona 2. Synthetic Resin : C6H5.NCO e.g. Scotchcast, Dynacast.

[Audio] Paster of Paris (POP) Advantages: • Good moulding capacity • easy to handle • Inexpensive Disadvantages • Weaker than synthetic material • non-water resistant • Radiolucency fair.

[Audio] Synthetic Material Advantages : • light • short setting time • more radiolucent • water resistant • better ventilation • different colours available.

[Audio] Synthetic Material Disadvantages: • expensive • less moulding capability • sticky when applying.

[Audio] Assessment: • History taking: • allergic • mechanism of injury • medical history • social background • Physical assessment: • vascular status • neurological status • skin integrity • alignment and position.

[Audio] Splint vs Cast • First do no harm. • A splint can always be made into a cast. • Duration of treatment – Short term : splint – Long term : cast or splint.

[Audio] What do you think?. What do you think?.

[Audio] What do you think?. What do you think?.

[Audio] Indications for Splinting or Casting: • Fracture • Sprain • Post op • Infection • Acute inflammation.

[Audio] Principles of splinting: • Immobilize the joint above and below • Padding – not too much, not too little • Positioning – keep joints in functional position • Well molded – if the splint don't fit you must acquit • Hold splint until it fully cures • Plaster – 10 layers thick for upper extremity 15 layers for lower extremity.

[Audio] Molding: Interosseous Mold: Upper extremity fractures, especially forearm, and distal radius/ulna • Ideal Cast Index of <0.81 to prevent displacement.

[Audio] Cast Index Cast Index = X/Y • Sagittal width divided by coronal width. • Ideal Cast Index of <0.81 to prevent displacement.

[Audio] Extremity Positioning: Positioning is critical. Improperly positioned splints lead to poor outcomes. Upper Extremity: – MCP joints: leave free if not location of injury. – Wrist: neutral to intrinsic plus – Elbow: 90 deg. Or slight extension Lower Extremity – Ankle: neutral dorsiflexion – Knee: Depends on weight bearing status Slight flexion to clear foot when in crutches. If NWB may flex up to 80-90 deg. in noncompliant patient..

[Audio] Complications from splinting : • Blisters • Skin breakdown • Ulcers • Thumb prints Skin Breakdown • Creases • Burns • Lost objects • Skin Breakdown – Toys – Scratchers – Spoons Pressure Sores • Compartment Syndrome.

[Audio] Complications. Complications.

[Audio] Complications: Compartment Syndrome : – Too tight – Swelling under circumferential dressing • Roll webril, cast padding, ace bandage, coban LOOSE • Bivalve all casts placed in acute settingS.

[Audio] Types of splints: Upper Extremity: – Volar/Dorsal Slab – Sugar Tong – Thumb Spica – Long Arm Posterior slab – Coaptation – Ulnar Gutter – Radial Gutter – Finger Splilnt • Lower Extremity: Posterior slab Long or short Stirrup / U splint Sugar tong of leg.

[Audio] Sugar Tong Splint Place stockinette: • Unroll Webril from palmar crease around elbow to dorsal Metacarpal heads • 4-5 layers thick of Webril • Measure length of plaster/ortho glass to an inch short of Webril.

[Audio] • 10 layers thick of plaster • Wet plaster or ortho glass • Lay plaster on Webril • Place splint on arm • Wrap with Webril • Roll back stockinette • Wrap with Ace bandage.

[Audio] Long Arm Posterior Splint Indications: Elbow, forearm, distal humerus injuries Immobilizes elbow and wrist. Steps: • Place stockinette • Measure Webril from 5th metacarpal head to a few inches below axilla • 4-5 layers Webril • Measure plaster/ ortho glass slightly shorter than Webril • 10 layers plaster • Wrist in neutral rotation • Roll back stockinette • Lay on and wrap with Webril and Ace bandage.

[Audio] Patient education: • Don't get the cast or splint wet. • Don't stick anything in the cast or splint. • If it itches: Hair dryer on cool setting, Tap on cast • Elevation of extremity to reduce swelling • Signs and symptoms of compartment syndrome.

[Audio] Key indicators in the HPI: • Monkey Bars – Supracondylar Humerus, Lateral Condyle, Both bone forearm • FOOSH – Distal Radius/Ulna, Buckle fractures, BBFA • Trampoline – Proximal tibia, Toddler's Fracture • Unwitnessed fall/injury - NAT • Refusal to bear weight – Recent trauma? Illness? Transient synovitis, buckle fracture.

[Audio] When to refer: Emergency Room: • Obvious deformity or Displaced fracture • Functional deficit, nerve palsy • Suspect compartment syndrome Clinic: • Clavicle Fracture – sling and swathe, safety pin affected arm to clothes at 90 deg. flexion. • Buckle Fracture – Velcro wrist brace • Toddler's Fracture – initial x-ray can be negative. Positive exam = fracture until proven otherwise. • Metatarsal/Toe – Hard sole shoe.

[Audio] All of this in one slide: • Cant go wrong with a Sugar Tong.

[Audio] Care of cast or splint? You must protect your cast from damage so it can protect your injury while it heals. If you have broken your foot or leg, you will probably get crutches to help you walk. A sling will help support your cast or splint if it is on your arm. Keep your splint or cast dry. Moisture can weaken it and it may not be able to keep your injured bone in place. Wet cotton padding next to your skin can cause a rash or other irritation. Use two layers of plastic or purchase waterproof shields to keep your splint or cast dry while you bathe. Even with protection, never submerge your cast in water. Because keeping a cast dry may be harder for children, many doctors recommend sponge baths until a child's cast is removed. Walking casts. Do not walk on a walking cast until your doctor says it is safe. It takes time for casts to become hard enough to walk on. Using a cast shoe over your cast may prevent slipping..

[Audio] Avoid dirt. Keep dirt, sand, and powder away from the inside of your splint or cast. Padding. Do not pull out the padding from your splint or cast. Itching. Do not stick objects inside the splint or cast to scratch itching skin. Do not squirt cream or anything else inside it to soothe the itch. In some cases, blowing cool air from a hand-held hair dryer into the cast may help relieve itching. If itching persists, talk to your doctor. Inspect the skin around the cast. If it becomes red or raw, contact your doctor. Inspect your cast regularly.If it becomes cracked or has soft spots, contact your doctor's office. X-rays. Your doctor will probably schedule additional x-rays during your recovery to make sure your cast or splint is doing its job. X-rays can show whether the bones are healing well or have moved out of place..

[Audio] warning signs should watch for? Swelling can create a lot of pressure under your cast. This can lead to problems. That's why it is so important to keep the swelling down. If you experience any of the following symptoms, contact your doctor's office immediately for advice. Your pain is getting worse. Pain may worsen if swelling makes your cast or splint feel too tight. It may also worsen if you have developed an infection or another problem. Numbness. Too much pressure on your nerves can cause numbness or tingling in your hand or foot. Burning. Too much pressure on your skin can cause burning or stinging under your cast. Severe swelling. If you have a lot of swelling below your cast in your fingers or toes, it may mean your cast is slowing your blood circulation. No movement. You cannot move your toes or fingers..

[Audio] BASELINE MATERIALS: Stockinette Splinting material Plaster Upper extremity: 8–10 layers Lower extremity: 10–12 layers Fiberglass Padding Elastic bandaging Bucket/receptacle of water (the warmer the water, the faster the splint sets) Trauma shears BASELINE PROCEDURE: Measure and prepare the splinting material. Length: Measure out the dry splint on the contralateral extremity Width: Slightly greater than the diameter of the limb.

[Audio] 1- apply the stockinette to extend 2" beyond the splinting material. 2- apply 2-3 layers of padding over the area to be splinted and between digits being splinted. Add an extra 2-3 layers over bony prominences. 3- Lightly moisten the splinting material. Place it and fold the ends of stockinette over the splinting material. 4-Apply the elastic bandaging. 5- While still wet, use palms to mold the splint to the desired shape. 6- Once hardened, check neurovascular status and motor function..

[Audio] POSTERIOR LONG ARM SPLINT: INDICATIONSL: Olecranon fractures Humerus fractures Radial head and neck fractures CONSTRUCTION: Start at posterior proximal arm Down the ulnar forearm End at the metacarpophalangeal joints APPLICATION: Cut hole in stockinette for thumb Elbow at 90º Forearm neutral position with thumb up Neutral or slightly extended wrist (10–20º) VOLAR SPLINT: INDICATIONS: Soft tissue injuries of the hand and wrist Carpal bone fractures 2nd–5th metacarpal head fractures CONSTRUCTION: Start at palm at the metacarpal heads Down the volar forearm End at distal forearm APPLICATION: Cut hole in stockinette for thumb Forearm in neutral position with thumb up Wrist slightly extended (10–20º) Like holding a can.

[Audio] SUGAR TONG SPLINT: INDICATIONS: Distal radius and ulna fractures CONSTRUCTION: Metacarpal heads on the dorsal hand Around elbow End at volar metacarpal phalangeal joints APPLICATION: Cut hole in stockinette for thumb Elbow at 90º Forearm neutral with thumb up Slightly extended wrist (10–20º) DOUBLE SUGAR TONG SPLINT: INDICATIONS: Complex and unstable forearm and elbow fractures CONSTRUCTION: Forearm splint: as above Arm splint — Start at anterior proximal humerus — Around elbow End at posterior proximal humerus APPLICATION: Cut hole in stockinette for thumb Elbow at 90º Forearm neutral with thumb up Slightly extended wrist (10–20º).

[Audio] RADIAL GUTTER SPLINT: INDICATIONS: Fractures and soft tissue injuries of index and 3rd digits Fractures of the neck, shaft and base of the 2nd and 3rd metacarpals CONSTRUCTION: Starts at mid-forearm Down the radial forearm End mid-distal phalanx of 2nd and 3rd digits APPLICATION: Cut hole in stockinette and splinting material for the thumb Hand in position of function Forearm in neutral position Wrist slightly extended MCP 50º of flexion Proximal interphalangeal and distal interphalangeal joints 5º–10º flexion THUMB SPICA SPLINT: INDICATIONS: Injuries to scaphoid, lunate, thumb and 1st metacarpal Gamekeeper's/Skier's thumb De Quervain tenosynovitis CONSTRUCTION: Start at mid-distal phalanx of thumb End at mid-forearm APPLICATION: Cut hole in stockinette for thumb Cut wedges on both sides of splinting material at MCP joint Forearm in neutral position with thumb in wineglass position.

[Audio] ULNAR GUTTER SPLINT: INDICATIONS: Fractures and soft tissue injuries of 5th digit Fractures of the neck, shaft, and base of 4th and 5th metacarpals CONSTRUCTION: Start at mid-forearm Extend down ulnar forearm End at mid-distal phalanx Include the 4th and 5th digits APPLICATION: Hand in position of function Forearm in neutral position Wrist slightly extended MCP 50º of flexion Proximal interphalangeal and distal interphalangeal joints 5–10º flexion l If boxer's fracture: flex the metacarpal phalangeal joints to 90º MALLET FINGER: INDICATION: Mallet Finger CONSTRUCTION: Splint only the distal interphalangeal joint APPLICATION: Splint distal interphalangeal joint in hyperextension DIP must remain in continuous extension for 6–8 weeks FINGER SPLINTS: INDICATION: Phalanx fractures Tendon repairs CONSTRUCTIONL: Splint across fractured phalanx or repaired tendon APPLICATION: If tendon repair: splint in flexion or extension, depending on tendon repaired.

[Audio] POSTERIOR KNEE SPLINT STIRRUP SPLINTS: INDICATIONS: Patients with legs too large for knee immobilizer Angulated fractures Injuries that require urgent operative fixation CONSTRUCTION: Start just inferior to buttocks crease Down the posterior leg End approximately 6cm above the malleoli APPLICATION: Slightly flexed knee POSTERIOR & ANKLE: INDICATIONS: Grade 2–Grade 3 ankle sprains Fractures of distal fibula and tibia Reduced ankle dislocations Can add stirrup splint for unstable ankle fractures CONSTRUCTION—POSTERIOR ANKLE: Start at plantar surface of the metatarsal heads Extend up posterior leg End at the level of the fibular head CONSTRUCTION—STIRRUP: Laterally, start 3–4cm below the level of fibular head Extend under the plantar surface of foot End at medial and lateral side of leg to just below fibular head APPLICATION: Place with the patient in the prone position Ankle at 90º Place posterior ankle splint first.

[Audio] SPLINTING COMPLICATIONS: Compartment syndrome Ischemia Neurologic injury Thermal injury Pressure sores, skin breakdown Infection Dermatitis Joint stiffness.

[Audio] Thank you. Thank You!!!.