The document outlines the principles and techniques of fracture management, emphasizing the importance of reducing and immobilizing fractures for effective healing. It details various types of casts and splints, their applications, and the indications for their use, as well as the care and potential complications associated with casting. Additionally, it discusses the role of modern materials and methods in improving patient outcomes and the significance of proper assessment and monitoring to prevent complications.

1. • Principles of fracture
management are:
•1. Reduce the fracture
•2. Immobilize the
fracture fragments long
enough to allow union

2. • The standard method for the healing of
fractures however was
1.bed rest
2.restriction of activity.

3. • An orthopedic cast is made from
plaster, encasing a limb to hold a
broken bone (or bones) in place
until it has healed.

4. The earliest
The earliest
methods of
methods of
holding a reduced
holding a reduced
fracture involved
fracture involved
using splints
using splints
HISTORY

5. These dressings required 2 to 3 days to
dry, depending on the
temperature and humidity of
the surroundings.
The bandages were then moistened
with a wet sponge or brush as they
were applied and rubbed by hand
until they hardened.

6. • Plaster of Paris
• Is calcined Gypsum, ground to a fine powder by
milling.
• When water is added, the more soluble form of
calcium sulfate returns to the relatively insoluble
form, and heat is produced.
• 2 (CaSO4·½ H2O) + 3 H2O → 2
(CaSO4.2H2O) + Heat
•
• The settin starts about 10 minutes after mixing
• complete in about 45 minutes,
• fully dry though for 72 hours.

7. THE NEW FIBER GLASS CAST CONSIST OF
KINTTED FIBERGLASS IMPRENATED
WITH POLYURETHNE RESIN
IT WILL BE RIGID IF MIXED WITH WATER
OR LIVED IN AIR.

8. • As a plaster cast is applied
• it expands by approximately % ½
• The less water is used
• the more linear expansion occurs.
• Potassium Sulphate can be used as an
accelerator and sodium borate as a
retarder in order that the plaster can be
caused to set more quickly or slowly.

9. The search for a
simpler less time consuming method
lead to the development of the first
modern occlusive dressings,
stiffened at first with starch and
later with plaster-of-paris. The
ambulatory treatment of fractures
was the direct result of these
innovations

11. A. Indications for Splinting
Incomplit cast

12. 1. Fractures,
2. Sprains,
3. Joint infections,
4. Tenosynovitis,
5. Acute arthritis / gout,
6. Lacerations over joints,
7. Puncture wounds and animal bites
of the hands or feet

13. Long Arm Posterior Splint
1. Elbow and forearm injuries,
2. Distal humerus fx,
3. Both-bone forearm fx,
4. Unstable proximal radius or
ulna fx (sugar-tong better)
Indications

14. Double Sugar Tong
1. Elbow and forearm fx -
prox/mid/distal radius
and ulnar fx.
2. Better for most distal
forearm and elbow fx,
because limits
flex/extension and
pronation / supination,
• Most frequently used
Indications

15. Forearm Volar Splint
Splint
1. Soft tissue hand / wrist
injuries - sprain, carpal
tunnel, etc,.
2. Most wrist fx, 2nd -5th
metacarpal fx.
Indications
3. Most add a dorsal splint for increased
stability - ‘sandwich splint’ (B).
4. Not used for distal radius or ulnar fx - can
still supinate and pronate.

16. Forearm Sugar Tong
1. Distal radius and ulnar fx.
Indications

17. Hand Splinting
• The correct position for most hand splints is the
position of function.
• Wrist slightly extended (10-25°).
• Fingers flexed as shown.
When immobilizing metacarpal neck fractures, the
MCP joint should be flexed to 90°.

18. Radial and Ulnar Gutter
•Fractures, phalangeal
and metacarpal, and soft
tissue injuries of the little
and ring fingers.
•Fractures, phalangeal
and metacarpal, and soft
tissue injuries of index
and long fingers.
Indications

19. Thumb Spica
1. Navicular fx - seen or
suspected (check
snuffbox tenderness)
2. Lunate fx, lunate or
perilunate dislocation
3. All thumb fx.
4. De Quervain
tenosynovitis
Indications

20. Finger Splints
• Sprains - dynamic splinting
(buddy taping).
• Dorsal/Volar finger splints -
phalangeal fx, though gutter
splints probably better for
proximal fxs.

21. Posterior Ankle Splint
1. Distal tibia/fibula fx.,
2. Reduced dislocations,
3. Severe sprains,
4. Tarsal / metatarsal fx.
Indications

23. B. COMPLIT CAST

24. • Reduce pain, post injuries of bone and
soft tissues.
• Prevent damage to muscle, nerves, &
blood vessels post fracture.
• Prevent close fracture from becoming an
open fracture.
• Reduce bleeding & swelling post trauma.
• In Treatment of Osteomyelitis & Septic-
arthritis elevate immunity.

25. • Saving of ligaments and tendons post
reconstructions.
• Reduction and stabilization of bone
fracture # for heeling proses.
• Prevention contraction after
Amputation.
• Reduce (pain, bleeding) post operative
of bone and soft tissues.

26. corrections of deformities of extremities.

27. Types of Casts
Upper Extremity Casts

28. Finger spica
or thumb spica
cast , include
one or more
fingers or the
thumb.

29. Types of Casts
Lower
Extremity
Casts

30. Cast Modifications
 A cast window
A cast window is a square or rectangular
is a square or rectangular
area cut and removed from the cast, often
area cut and removed from the cast, often
to expose a surgical wound or areas
to expose a surgical wound or areas
where symptoms of pressure develop.
where symptoms of pressure develop.
 A walking heel or cast shoe may be
applied to protect the cast when the
patient walks.

31. • Rubber cast soles
can be wrapped
directly into walking
casts when formed or
held in position with
adjustable straps.
They support the toes
and foot, improve
walking ability.
• Cast hinges can be
added for joint
mobility.

32. Spica cast: A cast which includes the trunk of the
body and one or more limbs is called.

33. Body casts, which cover the trunk of the body,
and in some cases the neck up to or including
the head.
(Minerva cast and Risser cast)

35. C. Fracture Bracing
• Allows for early functional ROM and weight
bearing
• Relies on intact soft tissues and muscle
envelope to maintain alignment and length
• Most commonly used for humeral shaft and
tibia shaft fractures

37. Patient must tolerate a snug fit for brace to be functional
•Convert to humeral
fracture brace 7-10 days
after fracture
•Allows for early elbow
ROM
•Fracture reduction
maintained by hydrostatic
column principle
•Co-contraction of muscles
–- Snug brace during the
day
–- Do not rest elbow on
table

39. D. BUILT
(SPLINTS)

41. Figure of eight
Bandage
arm sling

52. Definition of Complication
Definition of Complication.
.
•
Complication : In medicine, an
additional problem that arises
following. a procedure,
treatment or
illness and is secondary to it.
• A complication complicates the
situation

53. • 1. Thermal Injury -
avoid plaster > 10 ply,
water >24°C, unusual with
fiberglass.
• 2. Cuts and burns
during removal.

54. 3. Deep Venous Thrombosis &
Pulmonary Embolism
•increased in lower
extremity fracture
–Ask about previous
history.
– and family history.
–Indications for
prophylaxis debated.
Leg pain or tenderness
. Swelling of the leg
. Reddening the leg

55. A
l
t
e
r
a
t
i
o
n
s
o
f
B
l
o
o
d
C
o
a
g
u
l
a
t
i
o
n
A
l
t
e
r
a
t
i
o
n
s
o
f
B
l
o
o
d
C
o
a
g
u
l
a
t
i
o
n
A
l
t
e
r
a
t
i
o
n
s
o
f
B
l
o
o
d
F
l
o
w
A
l
t
e
r
a
t
i
o
n
s
o
f
B
l
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o
d
F
l
o
w
Alterations of Vessel Wall
Alterations of Vessel Wall
Thrombus Formation according
to Virchow’s Triad for thrombogenesis

56. • 4 Joint stiffness
–Leave joints free
when it possible.
–Place joint in position
at anatomical function position

57. 5. Loss of reduction
once the swelling has subsided, the cast
may no longer hold the fracture securely
if it’s loose the cast should be replaced.

58. x x
6. Pressure necrosis –
•may occur as early as 2 hours

59. • 7 Tight cast
• Need to cut cast padding.
• the cast may be put on too tightly.
the cast may be put on too tightly.
• or it may become tight
or it may become tight if the limb swells.
if the limb swells.
• It may become compartment syndrome
patient complains of diffuse pain only later
patient complains of diffuse pain only later
sometime the signs of vascular compression appear.
sometime the signs of vascular compression appear.
the limb should be elevated but if the pain persisted the
the limb should be elevated but if the pain persisted the
only safe course is to split the cast & ease it open.

60. • 8 Compartment syndrome
– Compartment syndrome is a very serious
complication that can happen because of a tight
cast or a rigid cast that restricts severe swelling.
– Compartment syndrome happens when pressure
builds within a closed space that cannot be
released. This elevated pressure can cause
damage to the structures inside that closed
space or compartment—in this case, the
muscles, nerves, blood vessels, and other
tissues under the cast.
– This syndrome can cause permanent and
irreversible damage if it is not discovered and
corrected in time.

61. Clinical Features of an ischaemic limb:
Severe pain, Numbness or tingling
Cold, pale, or blue-colored skin Difficulty moving
the joint or fingers and toes below the affecte
area.
Pain
Pallor
Pressingly cold
Pulse less
Paralysis
Paraesthesia

63. Volkmann's Ischemic
Contracture

64. Hippocrates:, recommending
wooden splints plus exercise to
prevent muscle atrophy during
the immobilization.
9. Atrophy
of Muscle

65. • 10 Pressure sores :
even a well fitting cast may press upon the
skin over a bony prominence (patella, heel,
elbow or the head of the ulna )
the patient complains of localized pain precisely
over the pressure spot such localized pain
demands immediate inspection through a
window in the cast
.

66. • 11. Loose cast :
once the swelling has subsided, the cast may
no longer hold the fracture securely if it’s
loose the cast should be replaced.

67. 12. Blood splay cute

68. plaster of Paris casts can result in cutaneous
complications including
•macerations,
• ulcerations,
•infections,
•rashes,
•itching,
13. Skin Complication

69. plaster of Paris casts can result in cutaneous
complications including
•and allergic contact dermatitis,
) which may also be due to the presence of
formaldehyde within the plaster bandages(
•In hot weather, staphylococcal infection of the hair
follicles and sweat glands can lead to severe and
painful dermatitis
13. Skin Complication

70. • Skin abrasion or laceration :
this is really a complication
of removing the cast
especially if an electric saw
is used complains of
nipping or pinching during
plaster removal should be
never be ignored a ripped forearm is a good
reason for litigation .
13. Skin Complication

71. Taking Care of Your Cast
• Always keep the cast
clean and dry.
• Cover the cast with a
plastic bag or wrap the
cast to bathe (and check
the bag for holes before
using the bag a second
time).
• Do not lower the cast
down into the water.

72. Basic Cast Care
• The nurse is responsible for caring for
the cast and making appropriate
assessments to prevent complications.

73. Assessing capillary refill

74. Checking mobility.
exercise to prevent muscle atrophy during the immobilization.

75. Assessing sensation in exposed fingers

76. Soft edges of cast minimize
risk for skin irritation.

77. Applying ice pack to minimize pain

78. Cast Removal
• casts are removed when they need to be
changed and reapplied or when the injury
has healed sufficiently that the cast is no
longer necessary. A cast is removed
prematurely if complications develop.
• Most casts are removed with an electric
cast cutter, an instrument that looks like a
circular saw

79. Cast removal.
A) The cast is bivalved with an electric cast cutter. (
B) The cast is split.
C) The padding is manually cut.
Also
need to
cut
padding

80. 80

82. ‫الجبس‬ ‫حول‬ ‫معرفتها‬ ‫يجب‬ ‫نصائح‬
‫الجبس‬
‫من‬ ‫تحول‬ ‫الماء‬ ‫إليه‬ ‫أضيف‬ ‫أذا‬ ‫شاش‬ ‫مع‬ ‫الجبس‬ ‫ماده‬ ‫من‬ ‫ناعمة‬ ‫بدره‬ ‫عن‬ ‫عبارة‬
‫ويوجد‬ ‫عالية‬ ‫حرارة‬ ‫مع‬ ‫صلبه‬ ‫حاله‬ ‫إلى‬ ‫ذائبة‬ ‫حاله‬
‫يث‬x‫د‬‫ح‬ ‫نوع‬
‫ماده‬ ‫مع‬ ‫شاش‬ ‫من‬ ‫مكون‬
.)‫ليه‬ ‫كرستا‬ ‫زجاجيه‬
:‫يلي‬ ‫ما‬ ‫مراعاة‬ ‫المريض‬ ‫وعلى‬
1
.
‫مرور‬ ‫يجب‬ ‫جافا‬ ‫الجبس‬ ‫ليصبح‬
45
.‫دقيقه‬
1
. .
‫المعالج‬ ‫الطبيب‬ ‫من‬ ‫بنصيحة‬ ‫إال‬ ‫الجبس‬ ‫على‬ ‫المشي‬ ‫عدم‬
2
. .
‫للحرارة‬ ‫يتعرض‬ ‫أو‬ ‫بالماء‬ ‫الجبس‬ ‫يبتل‬ ‫ال‬ ‫أن‬ ‫على‬ ‫المحافظة‬
3
. / .
‫باستمرار‬ ‫القدمين‬ ‫اليدين‬ ‫أصابع‬ ‫تحريك‬
4
.
‫في‬ ‫األخرى‬ ‫المفاصل‬ ‫تحريك‬
‫المصاب‬ ‫الطرف‬
.‫الجبس‬ ‫يغطيها‬ ‫ال‬ ‫والتي‬
5
.
‫الجوس‬ ‫أو‬ ‫النوم‬ ‫أثناء‬ ‫أمكن‬ ‫ما‬ ‫مرفوعا‬ ‫المصاب‬ ‫الطرف‬ ‫يكون‬ ‫أن‬ ‫مراعاة‬
6
, ( .
‫إال‬ ‫األشكال‬ ‫من‬ ‫شكل‬ ‫بأي‬ ‫إليه‬ ‫الزيادة‬ ‫أو‬ ‫منه‬ ‫القطع‬ ‫إزالته‬ ‫الجبس‬ ‫في‬ ‫التدخل‬ ‫عدم‬
.)‫المعالج‬ ‫الطبيب‬ ‫بمشورة‬
7
.
‫له‬ ‫تعطى‬ ‫أخرى‬ ‫إرشادات‬ ‫أية‬ ‫وإتباع‬ ‫القادمة‬ ‫الزيارة‬ ‫ميعاد‬ ‫على‬ ‫المحافظة‬
.

83. ‫الجبس‬ ‫حول‬ ‫معرفتها‬ ‫يجب‬ ‫نصائح‬
‫الحاالت‬ ‫في‬ ‫طبيب‬ ‫اقرب‬ ‫أو‬ ‫المستشفى‬ ‫مراجعه‬ ‫سرعه‬ ‫جبس‬ ‫لديه‬ ‫الذي‬ ‫المصاب‬ ‫على‬
:‫التالية‬
1
.
‫مريح‬ ‫غير‬ ‫أو‬ ‫الجلد‬ ‫على‬ ‫وضاغط‬ ‫ضيق‬ ‫الجبس‬ ‫أن‬ ‫المريض‬ ‫شعر‬ ‫إذا‬
2
‫مقدار‬ ‫أن‬ ‫أو‬ ‫األزرق‬ ‫اللون‬ ‫إلى‬ ‫األصابع‬ ‫لون‬ ‫في‬ ‫تغير‬ ‫غيره‬ ‫أو‬ ‫المصاب‬ ‫الحظ‬ ‫إذا‬ .
.‫اآلخر‬ ‫الطرف‬ ‫أصابع‬ ‫في‬ ‫منه‬ ‫أقل‬ ‫المصاب‬ ‫الطرف‬ ‫أصابع‬ ‫في‬ ‫اإلحساس‬
3
.‫اآلخر‬ ‫الطرف‬ ‫في‬ ‫األصابع‬ ‫من‬ ‫أبرد‬ ‫لمسها‬ ‫عند‬ ‫وكانت‬ ‫األصابع‬ ‫تورمت‬ ‫إذا‬ .
4
.‫اإلصابة‬ ‫عن‬ ‫الناتج‬ ‫األلم‬ ‫عن‬ ‫يختلف‬ ‫شديدا‬ ‫ألما‬ ‫تسبب‬ ‫األصابع‬ ‫حركه‬ ‫كانت‬ ‫أذا‬ .
5
.‫كريهة‬ ‫رائحة‬ ‫أو‬ ‫الجبس‬ ‫تحت‬ ‫من‬ ‫إفرازات‬ ‫أية‬ ‫ظهور‬ ‫غيره‬ ‫أو‬ ‫المريض‬ ‫الحظ‬ ‫إذا‬ .
6
‫األسباب‬ ‫من‬ ‫سبب‬ ‫ألي‬ ‫منه‬ ‫موضع‬ ‫أي‬ ‫في‬ ‫الجبس‬ ‫انكسر‬ ‫إذا‬ .
.
‫العاجل‬ ‫بالشفاء‬ ‫تمنياتنا‬ ‫أطيب‬ ‫مع‬
:‫أعداد‬
‫بامشموس‬ ‫اهلل‬ ‫عبد‬ ‫سعيد‬ .‫د‬
‫والكسور‬ ‫العظام‬ ‫جراحه‬ ‫اول‬ ‫استشاري‬

85. T H A N K S
T H A N K S
F O R
F O R
Y O U R
Y O U R
L I S T E N I N
L I S T E N I N
G . . . . . .
G . . . . . .
‫اليك‬ ‫ونتوب‬ ‫نستغفرك‬ ‫انت‬ ‫إال‬ ‫اله‬ ‫ال‬ ‫ان‬ ‫نشهد‬ ‫وبحمدك‬ ‫اللهم‬ ‫سبحانك‬