PowerPoint Presentation

[Audio] Plaster and Orthopaedic Appliance Casting Material & Clinical Applications Prepared by :Mohammed A K Darwish RN & Orthopedic Plaster Technology.

[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 Goals: Know principles of splinting Know different types of splint 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 P.O.P casts and slabs, their advantages and disadvantages Understand the necessary follow-up and possible complications related to the application of circular P.O.P Know and master the fabrication procedures of P.O.P 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] PRINCIPLES OF CASTING: Casts are applied for a variety of reasons: For treating fractures After surgery To prevent and correct deformities For support and pain relief To aid the healing of pressure ulcers 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 Synthetic Resin : C6H5.NCO e.g. Scotchcast, Dynacast Paster of Paris (P.O.P) 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 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] Application of cast: Padding Activation of cast materials Immerse in luke warm water at a 30o angle to the vertical Gentle squeeze until no more bubbles appear Remove from the water and squeeze out excessive water Applications Circular Slab Pattern.

[Audio] Technique for applying a cast: a 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 fold smooth out every layer to remove air apply with continuous folds to cover at least half of the previous fold use the thenar areas of the hands for molding the cast must be fit the external anatomy of the limb, mold to create a three-point fixation..

[Audio] Complication: Circulatory disturbance Compression of peripheral nerves Edema Pressure sore Joint stiffness and muscle atrophy Allergy Infection Circulatory & Nerve Impairment Causes: Unexpected excessive swelling Insufficient padding to allow for expected swelling Cast being too tightly Local pressure on areas where the blood vessels or nerves are close to the skin.

[Audio] Circulatory & Nerve Impairment: Arterial compression check toe or finger nails for signs of ischaemia Venous compression Increase in swelling Nerve compression Numbness, loss of motion, pain Radial nerve palsy-cast impingement.

[Audio] Above Elbow Backslab Indication: Humeral fractures Elbow dislocations Forearm fractures pre-operatively Upper Limit : 2-3 fingers below the axillar Lower Limit: Distal palmar crease Position: Elbow at 90°, forearm and wrist in neutral, fingers free and shoulder relaxed.

[Audio] Gather materials: Measured length of slab Triangle plaster struts Soffban Crepe Brown tape (3x approximately 10cm lengths) Plaster shears Plaster shears Applying the cast: Measure the slab on the unaffected arm- place the child's shoulder and elbow at 90° as pictured, and measure from the upper limit to the lower limit. Cut 2 triangles to cover the lateral and medial aspects of the elbow. Wrap softban down the arm, completing 2 full rotations around the proximal aspect prior to advancing. Train track soft ban at the elbow and cut a semi-circle in the soft ban to advance the wrap between the thumb and for finger. Concertina the slab and submerge into lukewarm water..

[Audio] Apply slab from the proximal limit extending down the arm to the fingers and gently mould. Submerge and apply medial and lateral triangle plaster struts and gently mould. Overwrap with crepe and secure with brown tape. Apply an additional length of tape down the ventral aspect of the cast to prevent rolling. Allow to dry for 20minutes before applying a broad arm sling Discharging and documentation: Apply a broad arm sling, and provide education on elevation and slings. Refer to Cast Care Patient Advice sheet and family videos throughout your patient and whānau education. Families may prefer a collar and cuff style sling. This can be provided with clear instructions to only use the collar and cuff sling after the initial 48hr period as earlier will damage the cast. Provide whānau with copies of cast care and discharge advice. Document products used, position, cast type, skin integrity, and pressure injury risk assessment Discharge: Have the cast checked by a credentialed nurse. Discharge with cast care advice and on appropriate cast related pressure injury prevention bundle..

[Audio] Above Elbow Plaster of Paris Indication: Children with distal or midshaft radius and/or ulnar fractures. Children with distal radius and/or ulnar fracture over the age of 8 can be managed with a well molded Below Elbow P.O.P. Upper Limit: 2-3 fingers above the mid-shaft of the humerus. Lower Limit: Distal palmar crease Position: Elbow at 90°, forearm and wrist in neutral, fingers free, shoulder relaxed. Arm is held by thumb and across the finger tips Gather materials: Soffban Plaster of Paris rolls Measured plaster slab - See Above Elbow Backslab page for slab instructions Plaster sheers.

[Audio] Applying the cast: Wrap softban down the arm, completing 2 full rotations around the proximal aspect prior to advancing. Train track soft ban at the elbow and cut a semi-circle in the soft ban to advance the wrap between the thumb and for finger. 50% overlap results in 2 layers. 66% overlap results in 3 layers. Apply the above elbow backslab and gently mould . Cut off any slab that extends beyond the cast limits Starting distally to the injury, unroll the plaster of Paris rolls over the limb, taking care not to pull excessive tension. The first layer of plaster should complete two full rotations directly over each other prior to advancing the roll down the limb. Upon reaching the hand, ensure the plaster layer don't extend beyond the distal palmar crease Advance the cast between the thumb and fore-finger by creating a curved cut..

[Audio] 2 layers of plaster between thumb and fore finger are sufficient. Upon completing the first roll of plaster fold the soft ban edges back over the plaster layer to create an edge at the distal and proximal aspects. Repeat the plaster roll wrap again starting proximally, capturing the rolled back softban edges, and advancing down the limb creating 6-8 layer total layers of plaster. Laminate plaster layers by rubbing plaster between flat palms. Place the drying cast on a pillow and allow to set for 20 minutes prior to application of a broad arm sling. Discharge: Have the cast checked by a credentialed nurse. Discharge with cast care advice and on appropriate cast related pressure injury prevention bundle.

[Audio] Below Elbow Plaster of Paris Indication: Buckle fractures are ideally treated with wrist splintsDistal radial or ulnar fractures in children over 8 years of age Upper Limit: 3-4 fingers below the ACF Lower Limit: Distal palmar crease Position: Elbow at 90°, forearm and wrist in neutral, fingers free Gather materials: Soffban Plaster of Paris rolls Plaster sheers Lukewarm water bucket Clean the skin gently with soap and warm water and gently dry..

[Audio] Applying the cast: The first layer of padding should wrap around the limb in two complete rotations prior to advancing the roll, creating 2 layers of padding at the proximal most aspect. Commence plaster wrapping. Start distally to the injury ensuring not to breech the limits of the softban wrap. Unroll the plaster of Paris rolls over the limb, taking care not to pull excessive tension on the roll. The first layer of plaster should complete two full rotations directly over each other prior to advancing the roll down the limb. Continue to advance the plaster roll down the limb, wrapping 66% to create 3 layers of cast. Upon reaching the hand, ensure casting terminates prior to the distal palmar crease. Advance the cast between the thumb and fore-finger by creating a curved cut and continue. 2 Layers of plaster between thumb and fore finger are sufficient..

[Audio] Upon completing the first roll of plaster fold the soft ban edges back over the plaster layer to create an edge at the distal and proximal aspects. Repeat the plaster roll wrap again starting proximally, capturing the rolled back softban edges, and advancing down the limb creating 6-8 layers of plaster. Laminate plaster layers by rubbing plaster between flat palms. As the plaster hardens and dries, it warms up. Place the drying cast on a pillow and allow to set for 20 minutes prior to application of sling. Families may prefer a collar and cuff style sling. This can be provided with clear instructions to only use the collar and cuff sling after the initial 48hr period as any earlier will damage the cast. Discharge: Have your cast checked by a credentialed nurse. Discharge with cast care advice and on appropriate cast related pressure injury prevention bundle..

[Audio] Above Knee Plaster of Paris Indication: Distal femoral fractures unstable lower limb fractures proximal tib +/- fib fractures knee injuries. Upper Limit: 2-3 fingers distal to groin crease Lower Limit: Base of toes Position: Ankle in neutral and flexed to 90°, knee slightly flexed (approximately 10−15°) Gather materials: Soffban Plaster of Paris rolls Plaster slab and struts Plaster sheers Lukewarm water bucket Knee rest (optional) HPS input Wedge or folded blanket Clean the skin gently with soap and warm water and gently dry. The slab is measured from 4 fingers below the gluteal crease to the base of the toes along the posterior of the leg. The slab is then cut double the length and folded in half for double thickness. Cut long sided triangles to cover the ankle both medially and laterally..

[Audio] Applying the cast: The first layer of padding should wrap around the limb in two complete rotations prior to advancing the roll, creating 2 layers of padding at the proximal most aspect. Inspect padding for gaps, and fill in thin spots with softban strips. Apply measured backslab to the limb starting on the proximal aspect of the leg and gently mould as you extend down towards the toes. Cut any excess slab that extends beyond the toes rather than folding. Apply the measured struts medially and laterally along the foot, covering the malleoli and extending up the leg. Laminate the layers together with the flats of your hands by rubbing the plaster in a circular motion. Apply the plaster rolls, starting 3 fingers from the upper limit of the softban. The first layer of plaster should complete two full rotations directly over each other prior to advancing the roll down the limb. Unroll the plaster, taking care not to pull excessive tension as it is advanced down the leg..

[Audio] Cut any excess slab that extends beyond the toes rather than folding. Apply the measured struts medially and laterally along the foot, covering the malleoli and extending up the leg. Laminate the layers together with the flats of your hands by rubbing the plaster in a circular motion. Apply the plaster rolls, starting 3 fingers from the upper limit of the softban. The first layer of plaster should complete two full rotations directly over each other prior to advancing the roll down the limb. Unroll the plaster, taking care not to pull excessive tension as it is advanced down the leg. The first layer of plaster roll should be concertinaed over the knee to create additional strength..

[Audio] Continue to advance the roll in circumferential wraps down the lower leg to the base of the toes. Fold the padding edges smoothly over the first layer of plaster. Apply a second layer of plaster roll starting proximally and terminating at the base of the toes, this time wrapping circumferentially over the knee. Laminate the layers together with the flats of your hands by rubbing the plaster in a circular motion. Place the cast on pillows and allow to dry for 20 minutes. Discharge: Have your cast checked by a credentialed nurse. Discharge with crutches and cast care information and on appropriate cast related pressure injury prevention.

[Audio] Above Knee Backslap Indication: Typically in the pre-operative period prior to definitive management of unstable or grossly swollen lower limb fractures Upper Limit :2-3 fingers distal to groin crease Lower Limit: Base of toes Position: Ankle in neutral and flexed to 90°, knee slightly flexed (approximately 10° - 15°) Gather materials: Soffban Measured plaster slab and struts Plaster sheers Crepe bandage Lukewarm water bucket Knee rest (optional) Folded blanket Brown tape Clean the skin gently with soap and warm water and gently dry..

[Audio] Applying the cast: The slab is measured from 4 fingers below the gluteal crease to the base of the toes along the posterior aspect of the limb. The first layer of padding should wrap around the limb in two complete rotations prior to advancing the roll, creating 2 layers of padding at the proximal most aspect. Inspect padding for gaps, and fill in thin spots with softban strips. Concertina the slab and submerge it the in bucket of lukewarm water for 5 seconds. Remove the slab from the bucket, extend it to its full length and remove excess water. Apply measured backslab to the limb starting 1-2 fingers below the upper limit of the padding and gently mould as you extend down towards the toes. Cut any excess slab that extends beyond the toes rather than folding. Apply the measured struts medially and laterally along the foot, covering the malleoli and extending up the leg..

[Audio] Fold the softban edges smoothly over the backslab. Gently mould the slab over the ankle and sides of the knee. Overwrap with crepe bandage. Tape the crepe edges with brown tape and apply an additional strip anteriorly and medially down the length of the cast to prevent rolling. Place the cast on pillows and also to dry for 20 minutes. Discharge: Have your cast checked by a credentialed nurse. Discharge with crutches and cast care information and on appropriate cast related pressure injury prevention bundle. Consider an OT/PT referral..

[Audio] Below Kneel Plaster of Paris: Indication: Stable distal tib +/- fib fractures Foot fractures Malleoli fractures not involving the growth plate Upper Limit: 2 fingers distal to the popliteal fossa Lower Limit: Base of toes. Position: Ankle in neutral, child lies on stomach with knee at 90° or with foot held by casting assistant.

[Audio] Consider a moonboot in lieu of a plaster whenever appropriate. Gather materials: Soffban Plaster of Paris rolls Plaster slab measured Lukewarm water bucket Knee rest (optional) Plaster sheers Clean the skin gently with soap and warm water and gently dry. Preparing the slabs: The slab is measured from 4 fingers below the gluteal crease to the base of the toes along the ventral aspect of the limb. Cut a slab double the length then folded in half to double the thickness, using plaster slab wide enough to cover the child's malleoli when applied..

[Audio] Applying the cast: Apply softban padding. The first layer of padding should wrap around the limb in two complete rotations prior to advancing the roll, creating 2 layers of padding at the proximal most aspect. Apply measured backslab to the leg starting on the proximal aspect. Gently mould as you extend down towards the base of the toes. Cut any excess slab that extends beyond the toes rather than folding. Apply the measured struts medially and laterally to the foot, covering the malleoli and extending up the leg. Apply the plaster rolls, starting 2-3 fingers from the upper limit of the softban..

[Audio] The first layer of plaster should complete two full rotations directly over each other prior to advancing the roll down the leg. Unroll the plaster, taking care not to pull excessive tension as it is advanced terminating at the base of the toes. Fold the padding edges smoothly over the first layer of plaster. Apply a second roll of plaster. Laminate the layers together with the flats of your hands by rubbing the plaster in a circular motion. Place the cast on pillows and also to dry for 20 minutes. Discharge: Have your cast checked by a credentialed nurse. Discharge with crutches and cast care information and on appropriate cast related pressure injury prevention bundle..

[Audio] Ulnar Gutter Indication: Phalanx and metacarpal fractures Upper Limit: 3 fingers below the ACF Lower Limit: Finger tips Position: Wrist slightly ventrally angled and fingers at 90 bent MCPs. Elbow can rest on bed. Gather Materials: Crepe Brown tape Plaster shears Plaster Slab Soffban Clean the skin gently with soap and warm water and gently dry. The slab is measured on the unaffected hand and shaped as pictured..

[Audio] Applying the cast: The first layer of padding should wrap around the limb in two complete rotations prior to advancing the roll, creating 2 layers of padding at the proximal most aspect. Place the arm in correct position, Entonox may facilitate ideal positioning. Concertina the slab and submerge into lukewarm water. Apply slab to the forearm ensuring the thumb remains free, and extend to the finger tips. Gently mould the cast to ensure the MCPs are flexed at 90 and the wrist is slightly cocked back. Overwrap with crepe and secure with brown tape. Apply an additional length of tape down the dorsal aspect of the cast to prevent rolling. Allow to dry for 20minutes before applying a broad arm or triangular high elevation. Discharge: Have your cast checked by a credentialed nurse Discharge with cast care advice and on appropriate cast related pressure injury prevention bundle.

[Audio] Thumb Spica Splint Indication: Injuries of the thumb requiring splinting managed by Hand Works Upper Limit: 3-4 fingers distal to ACF Lower Limit: Thumb tip visible, DPJ immobilised. Distal palmar crease visible Position: Slight ulnar deviation or wrist in neutral. Thumb in relaxed extension.

[Audio] Gather Materials: Soffban Plaster slab Crepe bandage Plaster sheers or scissors Lukewarm water bucket Brown tape Thumb stockinette.

[Audio] Preparing the slab: Measure the slab from the tip of the thumb to 3-4 fingers distally to the ACF along the lateral boarder of the arm. Cut a single thickness slab. In smaller children 4-6 layers may suffice. Older children require 6-10. Cut out a small flap on one side of the slab (depicted above) to create the thumb piece. The remaining plaster extension should be able to wrap the thumb circumferentially. Positioning: Have the child sit on an arm-restless chair next to the bed. Raise the bed height so that the child can rest their affected arm on the bed with their shoulder neutral. Position the patient's hand in comfortable ulnar deviation with thumb in comfortable extension..

[Audio] Padding: Cut a length of the thumb stockinette that fits approximately from the proximal wrist crease to about 2 fingers above the thumb tip. Cut a slit in the stockinette approximately 1/3rd the length of the stockinette, and fit as pictured. Wrap soffban padding distally to proximally ensuring an even 2 layers throughout the cast. Inspect the padding layer and fill any gaps before applying the cast..

[Audio] Applying the cast: Gather the slab and concertina it. Hold the edges and submerge the slab in bucket of water for 5 seconds. Remove the slab from the bucket, extend it to its full length and remove any creases Apply the slab to the limb. Place cut out side of the slab over the thumb, ensuring the thumb tip remains visible, and continue to trace the slab along the lateral aspect of the forearm. As the slab sets, ensure the it is well fitted by holding the slab over the thumb firmly with a closed fist until the cast is partially set. Overwrap with crepe bandage and secure with brown tape. Discharge: Have your cast checked by a credentialed nurse. Discharge with cast care advice and on appropriate cast related pressure injury prevention bundle.

[Audio] After Casting inspection Inspect: Before casting view the patient's X-ray ü Is this the correct cast for this injury? Is it in the correct position? Are the distal joints mobile? Are there any cracks, splits or dents in the cast? Are the child's fingers/ toes pink? Ask: "Are you comfortable in your cast?" Do you have any pain under your cast? Patients and whānau about their understanding of discharge advice If the patient or family have any questions Feel: For warm peripheries For brisk capillary refill and sensation The cast to ensure there are no dents or soft spots.

[Audio] Orthotics Orthotic device can be fitted by any clinician who has undergone appropriate instruction. If you are unsure how to fit a splint, sling or orthotic device, please ask a senior. Device: Wrist splints Indication: Buckle fracture (distal radius or ulna) Suspected scaphoid fracture Wrist sprains Fitting: Measure circumference of wrist and match to measurement on box Open straps wide and gently place arm in Secure straps Device: Zimmer Splint (Finger) Indication: Finger soft tissue injuries (over dressing if required) Volar plate avulsions Phlanyx fractures as directed by clinician This can be done in conjunction with buddy strapping, be guided by clinician. Fitting: Cut 7cm length of stretchy brown tape-cut crescent shape to fit around base of finger Place disc of splint over volar MCP head and mould over tip of injured finger Secure with cross-over of tape.

[Audio] Cast Related Pressure Injury Risk Device Indication assessment Device: Cast boot Indication: NWB sprained ankle Avulsion fractures of the ankle Non-displaced distal single bone fractures of the lower leg Sizing and Fitting: • Measure the length of the sole of the foot- half tear paper to mark. Measure from the heel to the popliteal fossa and tear off tape • Undo the velcro straps and remove sock. (leave pleastic sleeves on velcro). • Fit 'sock' to injured limb • Pull open the rigid arms with the plastic sleeves and place socked foot into boot with heel as far back as possible • Secure the straps Device: Cast Shoe Indication: • Foot fractures • Toe injuries Sizing and Fitting: • Measure the length of the sole of the foot, or ask the patient's shoe size • Open velcro straps and place the injured foot into the shoe with the foot as you would a shoe Device: Knee brace Indication: • Knee injuries requiring management in extension • Soft tissue injuries requiring sutures over the knee or calf Sizing and Fitting: • Remove medial metal bar • Apply soffban and crepe from thigh to Achilles and affix with brown tape • Split should run from mid thigh to mid calf • Stick to the splint where it will sit behind the knee • Place leg in splint and secure straps closest to knee first.

[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 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. iiinox )tueqx.