THIS PRESESNTATION DESCRIBES INDAIATIONS AND APPLICATION PROCEURES OF COMMON TYPES OF PLASTERS FOR FRACTURE IMMOBILIZATION.

1. MASIRAH HOSPITAL
ORTHOPEDIC SURGERY DEPARTMENT
WORKSHOP ABOUT
PLASTER OF
PARIS
BY:
Dr. Adam Ismail Abobakr

2. HISTORICAL BACKGROUND

3. INDICATIONS
• Fractures.
• Sprains.
• Reduced joint dislocations.
• Inflammatory conditions: (e .g. Arthritis, Tendinopathy,
Tenosynovitis)
• Deep laceration repairs across joints.
• Tendon lacerations

5. PRINCIPLES OF SPLINTING AND CASTING
• The ability to properly apply casts and splints is a technical skill
easily mastered with practice and an understanding of basic
principles.
• The initial approach to casting and splinting requires a thorough
assessment of the skin, neurovascular status, soft tissues, and
bony structures to accurately assess and diagnose the injury.
• Once the need for immobilization has been determined, the
physician must decide whether to apply a splint or a cast.

6. IMMOBILZATION TECHNIQUES
• Casts and splints serve to immobilize orthopedic injuries
• They promote healing,
• Maintain bone alignment,
• Diminish pain,
• Protect the injury, and
• Help compensate for surrounding muscular weakness
• Improper or prolonged application can increase the risk of
complications from immobilization.

7. Splinting V.S. Casting
• When considering whether to apply a splint or a cast, the
physician must assess
• The stage and severity of the injury,
• The potential for instability,
• The risk of complications, and
• The patient’s functional requirements
• Splinting is more widely used in PHC for management of acute
orthopedic injuries.
• Casting is usually reserved for definitive management of
fractures.

8. Splinting V.S. Casting

9. SPLINT
• Splinting is the preferred method of immobilization in the acute
care setting.
• Faster and easier to apply.
• May be static or dynamic.
• Noncircumferential .
• Allows for regular inspection of the injury site.
• Allows for the swelling that occurs during the initial
inflammatory phase of the injury.
• Less pressure-related complications

10. CAST
• Casting is the definitive treatment for most fractures.
• Provides more effective immobilization.
• Require more skill and time to apply.
• Higher risk of complications if not applied properly.

11. PLASTER:
• Made from gypsum ‐ calcium sulfate dihydrate.
• When water is added : Calcium sulfate .. Soluble -- Insoluble.
• Warm water ‐ faster set, ↑ Risk of burns.
• Fast drying ( 5 ‐ 8 minutes ).
• Can take up to 72 hours to cure.
• Upper extremities ‐ 8‐10 layers.
• Lower extremities ‐ 12‐15 layers

12. FIBERGLASS:
• Synthetic material.
• Fiberglass bandages -- Polyurethane.
• Cures rapidly (20 minutes).
• Stronger, lighter.
• Less messy.
• Less moldable.
• More expensive

13. Splints - Upper Limb
• Elbow/Forearm:
- Long Arm Posterior.
- Double Sugar ‐ Tong.
• Forearm/Wrist :
- Volar Forearm / Cockup.
- Sugar ‐ Tong.
• Hand/Fingers :
- Ulnar + Radial Gutter.
- Thumb Spica.
- Finger Splints.

14. ABOVE ELBOW SPLINT

15. ABOVE ELBOW SPLINT

16. BELOW ELBOW CAST

17. SUGAR TONG SPLINT

18. THUMB SPICA SLAB & ULNAR GUTTER
SLAB

19. Splints - Lower Limb
• Knee joint:
o Knee Immobilizer / Bledsoe.
o Bulky Jones.
o Posterior Knee Splint.
• Ankle :
o Posterior Ankle.
o Stirrup.
• Foot
o Hard Shoe.
15

22. Guidelines for Proper Application
• Use appropriate amount and type of padding
• Place from distal to proximal with a 50% overlap.
• Properly pad bony prominences and high-pressure areas.
• Properly position the extremity before, during, and after
application of materials.
• Avoid tension and wrinkles on padding, plaster, and fiberglass.
• Avoid excessive molding and indentation.

23. Complications:
• Loss of reduction.
• Tight cast or compartment syndrome :
o Univalving -- 30% pressure drop
o Bivalving --60% pressure drop
o Cutting of cast padding to further reduce pressure
• Pressure necrosis --As early as 2 hours after cast/splint application

24. Complications
• Thermal injury
- Avoid plaster thicker than 10 layers
- Avoid water hotter than 24°C
- Unusual with fiberglass.
• Cuts and burns during cast removal
• Joint stiffness : Joints should be left free when possible.

25. Follow up of patient
• Patient education.
• Elevation of the injured extremity to decrease pain and swelling.
• Continuous checking for signs of compartment syndrome.
• Strong opioids should be used with caution during the first 2-3
days after splinting.
• Avoidance of getting the material wet or pushing objects inside a
cast to scratch.
• Most splints and casts require initial follow-up within 1 week
after application.

26. THANK YOU !!