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Casting

Casting

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  • 1. 1 CASTING I P. Sukarna
  • 2. 2 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
  • 3. 3 Material for casting 1. plaster (Plaster of Paris = POP) 2. fiberglass
  • 4. 4 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
  • 5. 5 Preparation • Basin for water (warm) • Plaster (several sizes), not expired, setting time • Padding (cotton) • Stockinet (several size) • Elastic Bandage
  • 6. 6 Preparation • Instruments – plaster opener (scissor), small & big size – spreader – plaster saw (electric) – manual saw – knife, scissor – gloves • Personels
  • 7. 7 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
  • 8. 8 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
  • 9. 9 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
  • 10. 10 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
  • 11. 11 Cast splitting • Safe-cast • Prevention Single/double split -------------- skin is “free”
  • 12. 12 Wound • Trueta • no circular bandage • window
  • 13. 13 Walking plaster • Sarmiento • Ankle fracture • Foot fracture
  • 14. 14 Wedging • Angulation correction
  • 15. 15 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”
  • 16. 16 Cast care • Limb elevation • Isometric muscle contraction • Not contaminated : water, urine, foreign bodies, no scratching • mobilization
  • 17. 17 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
  • 18. 18 Plaster complication A. Local • blood circulation (2x24 hrs) • (compartment syndrome) • DVT • nerve palsy • oedema • infection • late : muscle atrophy joint stiffness osteoporosis (local)
  • 19. 19 Plaster complication B. General Prolonged immobilization • CNS • Tr. Respiratorius • Tr. Digestivus • Tr. U.G • Musculoskeletal • Skin • psychis
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