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![CONTRAINDICATION
• Intraarticular fractures.
• Compound fractures
• Lack of co-operation by the pt.
• Patient with spastic disorders
• Bed-ridden & mentally incompetent pts.
• Deficient sensibility of the limb [D.M with P.N]
• Fractures of both bones forearm when reduction is difficult.](https://image.slidesharecdn.com/dr-171010183241/75/Dr-S-Senthil-Sailesh-functional-cast-bracing-PTBcast-sarmiento-principle-14-2048.jpg)
![NOT USED IN
• Galeazzi fractures
• Monteggia fractures
• Proximal half of shaft of femur [tends to angulate in to varus
only used by expert]
• Isolated # of tibia, fibula
• Tends to cause varus angulation and to delay in consolidation
of #.](https://image.slidesharecdn.com/dr-171010183241/75/Dr-S-Senthil-Sailesh-functional-cast-bracing-PTBcast-sarmiento-principle-15-2048.jpg)
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Dr.S.Senthil Sailesh-functional cast bracing,PTBcast,sarmiento principle
- 1. FUNCTIONAL CAST BRACING &SPICA DR.S.SENTHIL SAILESH SENIOR ASSISTANT PROFESSOR IOT MMC RGGGH
- 2. FUNCTIONAL CAST • Theconcept of Functional cast bracing was described in the early 18th century • Sarmiento re-established the ideology in late 60s • It is a type of bracing where the limb is allowed to do restricted function with the brace in
- 3. PRINCIPLES Continuing function whilea fracture is uniting encourages osteogenesis promotes the healing of tissues and prevents the development of joint stiffness thus accelerating rehabilitation
- 4. PRINCIPLES • Not merelya method of fracture reduction but an attitude towards fracture healing. • Requirements for fracture healing • Stability • Maintenance of reduction • Blood supply
- 5. STABILITY • Fluid isnot compressible • Fascia cannot be stretched beyond the confines of the cast • “Hydraulic container theory”; Sarmiento et al 1974
- 6. LOADING • Stability ismaintained by loading in a functional cast • Pressure & Load is transmitted without further deformation • Rotation is restricted by components of the brace
- 7. MUSCLE CONTRACTION Intermittent loading ofthe fracture area by muscle activity & weight bearing, promote local blood flow & development of electrical fields which are beneficial for healing
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- 9. BLOOD SUPPLY Loading Contraction of muscle Micromotion at# site Increases Blood supply Bridging callus
- 10. BRIDGING CALLUS &BLOOD SUPPLY
- 11. INDICATION • All middlethird shaft fractures and lower 3rd junction fractures in long bones in co-operative patients.
- 12. TIMING • For #tibia following low energy injury, bracing can be done with in first 2 wks. • High energy injuries with more pain & swelling needs an additional period of 1 or 2 more wks. • For humerus fractures , most conditions bracing can be done by 7-10 days time. • Median time of brace removal • Tibia - 18.7 wks, • Humerus - 10 wks.
- 13. TIME TO APPLY •Fracture ends sticky • Assess the # , when pain and swelling subsided 1. Minor movts at # site should be pain free 2. Any deformity should disappear once D.F removed 3. Reasonable resistance to telescoping. 4. Shortening should not exceed 6.0 mm for tibia, 1.25 cm for femur
- 14. CONTRAINDICATION • Intraarticular fractures. •Compound fractures • Lack of co-operation by the pt. • Patient with spastic disorders • Bed-ridden & mentally incompetent pts. • Deficient sensibility of the limb [D.M with P.N] • Fractures of both bones forearm when reduction is difficult.
- 15. NOT USED IN •Galeazzi fractures • Monteggia fractures • Proximal half of shaft of femur [tends to angulate in to varus only used by expert] • Isolated # of tibia, fibula • Tends to cause varus angulation and to delay in consolidation of #.
- 16. ACCEPTABLE REDUCTION • 50%cortical contact • <5-10* of varus / valgus angulation • <10-15* of anterior / posterior bowing • <5-7* of internal / external rotation • Not more than 10-15mm of shortening
- 17. SARMIENTO CAST /PTB CAST - PRINCIPLE • Described by Sarmiento • Below knee cast extending to the upper pole of the patella and with a firm moulding over the medial flare of the tibia, the patellar tendon and the popliteal space and shaped in a triangular manner at the upper end of the tibia • Knee free to move allowed early ambulation as weight bearing forces should be transmitted from the ground to the proximal end of tibia bypassing fracture site
- 18. SARMIENTO CAST Ending point Starting point Moulding area Proximal patellartendon Tibial flares Patellar tendon Poplitela space Metatarsal head
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- 23. SPICA - DEFINITION •A bandage folded into a spiral arrangement resembling an ear of wheat or barley. • It is applied where immobilisation is required at areas where there is difference in size
- 24. HIP SPICA • Hipspicas are most commonly used to • correct developmental hip dysplasia (DDH) • children with hip, femur and pelvic fractures • Other orthopaedic conditions which require stabilization of the hip and leg. Eg: Abduction Cast in Post THR dislocation • Hips spicas are generally used for children from 6 months to 6 years of age
- 25. Abdomial padding and spacefor breathing Diaper Care
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- 27. POSITIONING Proximal 1/3 frx: -hip flexion 45 deg - hip abduction 30 deg - ext rotation 20 deg Mid shaft fractures: - hip flexion 30 deg - hip abduction 20 deg - ext rotation 15 deg Distal 1/3 frx: - hip flexion 20 deg - hip abduction 20 deg - ext rotation 15 deg
- 28. COMPLICATIONS COMPARTMENT SYNDROME •decreased with •applyingsmooth contours around popliteal fossa •limiting knee flexion to < 90° •avoiding excessive traction •monitored for by observing the child's neurovascular exam and level of comfort
- 29.
- 30. t Diaphyseal fractures Initial POP for 2-4weeks Functional casting done Maintenance of reduction External bridging callus Loading & Muscle contration Restoration of vascularity Fracture union
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