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Plastering Techniques: NHS Modernisation Agency
- 1. A cast is a well fitting, rigid support to the soft tissues of a limb, maintaining correct alignment of a broken bone Plastering Principles
- 2. Features Of A Good Cast • Fits well • Does not cause restriction • Is smooth inside • Is light in weight.
- 3. Above Elbow Synthetic Cast
- 4. Plaster of Paris Advantages • Moulds easily • Porous - allows limb to breathe • Can be split easily to accommodate swelling • Absorbent – blood / wound exudate • Very few people are allergic to it.
- 5. Diagnosis of Fractures Fracture = Break = Fracture
- 6. Diagnosis Includes • History of incident • Clinical examination • X-rays to confirm.
- 7. Signs and Symptoms • Pain • Swelling • Deformity • Loss of function • Abnormal mobility • Crepitus.
- 8. Prior to Application Ensure • Procedure explained and understood by patient • Adequate analgesia • There are enough staff available to ensure safe application – some casts may require more than two members of staff.
- 9. Removal Of Ring Prior To Cast Application
- 11. Casting Materials For Below Elbow Backslab
- 13. Application Of Plaster Wool
- 15. Secured With Cotton Bandage
- 17. After Application • Check edges of cast- not restricting movement of digits / surrounding joints • Clean patient • Elevate limb / provide walking aid and instruction on use.
- 18. Elevation Of Limb In Broad Arm Sling
- 19. Use Of Synthetic Casting Material
- 20. Care In Positioning Of Limb During Application Of Cast
- 21. Below Knee Synthetic Cast
- 22. Discharge And Follow-up • Plaster instructions verbal and written • Plaster check appointment for next day • Prescription for analgesia? • Brief assessment patients social needs. May need referral to an intermediate care team.
- 23. Complications • Swelling of digits • Loss of extension of the digits • Diminished sensibility • Cool or dusky skin.
- 24. Action To Be Taken If Complications Present • Split cast and padding down to skin • Spread cast and apply strip of wool • Apply crepe bandage • Elevate.
- 25. Splitting Cast Using Plaster Saw
- 26. Compartment Syndrome • Muscles are surrounded by fibrous tissue – fascial sheath, forming a closed compartment • Bleeding into compartment causes raised fluid pressure – reducing blood flow – ischaemia = death of muscle.
- 27. Compartment Syndrome Most Commonly Occurs In Limbs • Lower limb in the calf • Upper limb in the Volar compartment of forearm • Delay in treatment may result in loss of a limb.
- 28. Compartment Syndrome Indications • Pain: increasing pain not controlled by normal levels of analgesia • Tenseness; skin looks shiny and stretched, muscle becomes tight and bulging • Change of sensation: parasthesia • Muscle weakness: pressure within the muscle compartment may result in loss of movement • Pulse; may be present, gradually weakening or absent • Absent pulse is a late sign.
- 29. Compartment Syndrome Prevention And Management • Observe: regular observations of patients in casts • Listen: accept what the patient is saying • Lower: consider reducing elevation if you suspect compartment Syndrome • Splitting bi-valve: to relieve exacerbation of symptoms caused by the cast, the limb may need to be inspected and circumference measured • Fasciotomy: once compartment syndrome is diagnosed a fasciotomy may be undertaken to relieve the pressure.
- 30. Following Fasciotomy: Reveals Ischaemic Muscle
- 31. Following Fasciotomy Muscle Returns To Pink Healthy Colour
- 32. Plaster Sore Caused By Pencil Under The Cast
- 33. • Safety issues in the plaster room • Use and preparation of equipment • Preparation of patient • Application of following: below elbow backslab below knee backslab volar slab correct support of a fractured limb whilst assisting with cast application advice on discharge pop checks. Practical Session: