Plaster and splints are used to immobilize fractures and injuries. They provide stabilization and prevent further soft tissue damage. Advantages include being readily applied, reasonably comfortable, and allowing immobilization. Complications can include pressure sores, burns, stiffness, edema, and malpositioning if not applied properly. It is important to ensure adequate padding and molding without wrinkles or tension to prevent complications and allow for inspection of the injury. Patients should be monitored for neurovascular issues and given instructions to return if new symptoms arise.

1. Pros and Cons of Plaster and
Splint application
Department of Orthopaedics
Sri Venkateshwaraa Medical College and Research Center

2. • Fractures.
• Sprains.
• Severe soft tissue injuries.
• Reduced joint dislocations.
• Inflammatory conditions: arthritis,
tendinopathy, tenosynovitis.
• Deep laceration repair across joints.
• Tendon lacerations.

3. Advantages of Plaster application
• Versatile, readily applied and fashioned.
• Reasonably comfortable.
• Absorbs secretions to some extent.
• Fairly strong.
• Radio translucent.
• Immediate Stabilisation of fracture fragments and
prevent further soft tissue damage.
• Non invasive procedure: Acceptance of patient is
good.
• Cheap and easily available.

4. Indications
• In polytrauma, splinting causes temporary
stabilisation of bone and soft tissue, aids in
control of haemorrhage and helps reduce pain
and prevent further injury.
• Fractures with minimal or no displacement
merely require some type of external support
or protection to prevent displacement.
• Displaced fractures with initially unacceptable
position require some type of reduction to
achieve acceptable alignment.

5. Indications
• Temporary Stabilisation of fracture till definitive
procedure is done.
• Immobilisation following operative procedures
• In highly communited fractures where operative
reduction is not possible.
• In patients with other comorbidities which make
operative treatment not possible.
• Osteoporotic fractures.
• Paediatric fractures in acceptable position with
high potential for remodelling.

6. .

7. Complications of splint and cast
• Heaviness and ease of water damage
• Difficult to inspect the limb
• Pressure sores
• Burns
• Dermatitis
• Cast window Blisters
• Muscle atrophy
• Joint stiffness
• Distal edema
• Malpositioning/Displacement
• Deep vein Thrombosis
• Reflex sympathetic dystrophy
• Compartment syndrome

8. Pressure sores
• Skin breakdown is the most common
complication
– Casts that are applied too tight with out proper
padding will lead to pressure sores over bony
prominences
– Loosening and distal migration of casts will lead to
friction and blisters
• Focal pressure from a wrinkled, unpadded, or
underpadded area over a bony prominence or
underlying soft tissue causes pressure sores.

10. • Can be minimized by ensuring that the
padding is adequate and smooth, without
indentations during application.

11. Burns
• Setting of plaster is an exothermic reaction
• In patients with sensitive skin this exothermic
reaction can cause burns if not adequately
padded.
• Factors
– Speed of setting: faster more heat generation.
– Thickness of plaster: more thickness more heat
generation
– Increased temperature of dipping water

12. Dermatitis
• Allergic dermatitis.
• Bacterial and fungal infections or a pruritic
dermatitis can develop beneath a splint or
cast.
• Is more common with an open wound, but the
moist, warm environment of a splint or cast
can be ideal for infection.

13. Muscle Atrophy

14. Joint stiffnes
• The periarticular structures of human joint
adaptively shorten under any circumstance in
which the joint is not carried through the full
range of motion.
• Exercise the joints that are not held in a cast
as much as possible.

15. Distal Edema
• Due to decreased venous return.
• Do not let the affected limb hang down unless
it is being used. Keep it elevated, especially
during the first few days.

16. Malposition/Displacement
• With the resolution of initial fracture swelling,
the extremity no longer fits well inside the
cast. The forces required to maintain fracture
position are diminished, and loss of reduction
may ensue.

17. A cast that is too large for the current volume of the
extremity needs to be changed to one that fits
properly. Ignoring this fact because of a fear that the
reduction will be lost if the cast is changed is
irrational.

18. Deep vein thrombosis
• Reduced rate of blood flow due to immobility of
extermity.
• Risk factors:
– Previous DVT or pulmonary embolism (PE)
– Trauma
– Family history of DVT or PE.
– Smoking
– Obesity/overweight
– Pregnancy.
– Age over 40 years.
– contraceptive pill or HRT which contain oestrogen.
– Very large varicose veins
– Recent medical illness

20. Compartment Syndrome
• Compartment syndrome is a potentially
devastating entity that may develop when injury
induces increased pressure within a closed
space.
• Cast application causes decrease in compartment
volume.
• It is a condition of increased pressure within a
closed space that compromises blood flow and
tissue perfusion and causes ischemia and
potentially irreversible damage to the soft tissues
within that space.

21. The best treatment of a compartment syndrome
is avoidance.

23. • If an immobilized patient experiences
worsening pain, tingling, numbness, or any
sign of vascular compromise such as severe
swelling, delayed capillary refill, or dusky
appearance of exposed extremities, an
immediate visit to the nearest emergency
department is indicated for prompt removal of
the cast.

24. Take home message
• Properly position the extremity before, during and
after application of materials
• A well-applied cast has only two layers of cast
padding on all areas except bony prominences,
which require a third or fourth. A cast with too
much padding will fail to hold a reduction, whereas
one with too little may result in pressure sores.
• Once a cast has been applied it should be molded
to provide three-point fixation of the fracture. Avoid
excessive molding and indentations.

25. Take home message
• Avoid tension and wrinkles on padding,
plaster, and fiberglass.
• Instruct patient should return if numbness,
tingling, increased pain and impaired
sensation
• Re-evaluate in 48 hours for neurovascular
compromise 5 P’s : Pain, Pallor, Paresthesia,
Pulselessness, and Paralysis.
• Orthopedic evaluation in 7-10 days for casting.

27. Thank You
Applying a well-molded cast or splint
is an Acquired Skill.