1) Casting is used to immobilize fractures and correct deformities by applying uniform pressure. 2) Plaster of Paris and fiberglass are common casting materials, with fiberglass preferred for distal limbs and children due to its lighter weight. 3) Ben, a 3-year old, wore a removable splint instead of a conventional cast to mend his fractured wrist, as removable splints are replacing casts.

1. Casting --- Cast splintage
By: Ms. S. Peter

2. • To immobilize a reduced fracture, correct
deformity.
• Apply uniform pressure to underlying soft
tissue or support and stabilize weakened
joints

3. Cast Splintage
Methods:
– Plaster of Paris
– Fiberglass
• Especially for distal limb # and for most children #
Disadvantage: joint encased in plaster cannot move
and liable to stiffen
• Can be minimized:
– Delayed splintage (traction initially)
– Replace cast by functional brace after few weeks

4. Three-year-old Ben , wears a Velcro bandage strapped to
his arm. Removable splints, like the one helping mend
Ben's fractured wrist, are replacing conventional plaster
or fiberglass casts.
Cumbersome casts
3-D Cortex casts

5. • Application ---
• Care
• Health Teaching –
• Removal -

6. Implementation
• Keep cast & extremity elevated
• Allow cast to dry- POP 24-48 hrs synthetic –
20mins
• Handle the wet cast with palms until dry
• Heat can be used to dry the cast
• Color of the dry cast is shiny – wet dull
• Examine the cast and skin for pressure areas
• Observe the extremity for circulatory
impairment- color, pain, swelling, tingling,
numbness, coolness, or diminished pulse—notify
immediately

7. …implementation…
• Cutting/bivalving the cast – if circ. impairment
• Petal the cast:--- maintain smooth edges around- to
prevent crumbling of the cast material
• Monitor pt temp
• Observe for foul odor- (infection ), drainage –
( circle the area on the cast)
• Monitor warmth on the cast
• Monitor for wet spots – need for drying /drainage
under the cast
• If open drainage present – keep a window…
• Teach to keep the cast clean and dry ---
• Isometric exercises to prevent muscle atrophy

8. Assessment
• Physical assessment of the part to be
immobilized must include – neurovascular
status ( Swelling- degree & location, bruise,
skin abrasion etc) -- along with the-
psychological--- general health …

9. Diagnosis: Based on the assessment data –
• Knowledge deficit related to treatment regimen
• Pain related to M/S disorder
• Impaired physical mobility related to cast
• Self care deficit: hygiene- bathing, feeding
dressing, grooming, toileting due to restricted
mobility
• Impaired skin integrity related to lacerations and
abrasions
• Risk for peripheral Neurovascular dysfunction
related to physiologic responses to injury and
compression effect of cast

10. Pot. complications
• Compartment syndrome, Pressure ulcer
• Disuse syndrome
• Prepare pt – describe – anticipated sensations
– heaviness, heat guidelines foe POP
• Relieve pain; exact site – exact character and
intensity .. ( most pain relieved by elevating the
limb . apply cold, analgesics ) report unrelieved
pain ( possible paralysis or necrosis)
• pain controlled --- with immobilization
• Swelling, surgery – edema – apply cold ( ice
caps on side of the casts ( not to intent the cast)
If edema – elevate – or modify the cast

11. Pain – indication of complications
• Pain on comp. syndrome--- relentless – not
controlled by any of these or analgesics
• Pain of body prominence--- impending pressure
ulcer – pain decrease when ulcer is formed
• Never ignore pain --- potential to impaired tissue
perfusion or pressure ulcer
Improve mobility
• All other free – uninvolved joints should be
exercised to maintain function- finger/toe
exercise

12. Neuro – Vascular functions –
• Oedema is normal stage …
• Monitor- circulation motion, and sensation of the
affected extremity—compare with the other
extremity
• If c/o too tight – cast- vasc insufficiency, nerve
compression, due to unrelieved swelling –
compartment syndrome
( normal findings – minimal swelling, minimal
discomfort, pink color, warm to touch, rapid
capillary refill, normal sensations able to exercise
toes/fingers Make frequent regular exercises –
assessments

13. Monitoring for pot complications
Compartment syndrome – increased tissue
pressure within a limited apace—cast—muscle
compartment
Relieve pressure
• Bivalve the cast , maintain alignment and elevate
extremity
• If not relieved – faciotomy – to relieve pressure
• Close observations and recording of neuro-
vascular response –….. reporting

14. Pressure ulcer : Pressure of the cast on soft tissues –
tissue anoxia – pres ulcer
( Low ext . more susceptible—heel malleoli, dorsum of
the foot, head of fibula, and ant surf of patella ..
Upper ext . pres areas --- medial epicondyle of
humerus, and ulnar styloid
• C/o pain and tightness – a warm area on the cast –
area may break down – drainage – may stain cast –
emit odor ( after tissue break down pain less. Ext
loss of tissue
• To inspect pres area—bivalve the cast – or window –
treat the site – the portion of the cast is replaced or
pressure dressing

15. DISUSE SYNDROME- isometric exercise – muscle
contraction – without moving the part – this helps
to reduce muscle atrophy and maintain muscle
strength –
• Teach push down the knee or clenching the fist
etc ( hourly …
• Muscle stimulators may attach to skin over large
muscle – electrically stimulated 8hrs /day to
prevent disuse

16. Health Teaching
• Encourage to participate in self care – and use
assistive devices –
• Help to give self care -- -- participate pt ADLs

17. When the cast is dry instruct the patient---
• Move about as normally as possible – avoid
excessive use of injured part – avoid walking
on wet slippery floors or side walks
• Perform the exercises –
• Elevate the casted extremity to heart level –
to prevent swelling
• Do not scratch the skin under the cast – it may
form skin ulcer – cool air from hair dryer
alleviate itching
• Cushion the rough edges with tape

18. • Keep the cast dry—not to cover with plastic or rubber –
as it causes condensation and dampens the cast and skin
----- thoroughly dry with hair dryer – cool setting
• If the dry cast become wet- may use blow dryer slow
setting – if are area is wet—report
• Clean the surface of plaster cast with slightly damp cloth
( synthetic cast—mild soap can be used – white shoe
polish – to brighten the cast
• Report—persistent pain, swelling that does not respond
to elevation, changes in sensation
• Decreased ability to move fingers /toes and changes in
color and temp
• Note odors around cast – stained area or warm spots,
pressure areas
• Report broken cast – do not attempt to fix
• Isometric exercises ---

19. Cast removal
• Explain---
• Cutter vibrate feel --- -- it will not cut skin---
padding is cut with scissors
• The casted part is weak—disuse—stiff …look
atrophied – need support
• skin – dry scaly ( from accumulated dead skin –
wash gently and lubricate with emollient
• Resume activities slowly and gradually
• Elevate extremity if swelling

20. We’ll Continue …………..
on
traction