Prof. Md ShahiduzzamanHead, Department of Orthopaedics and Traumatology

Dhaka Medical college Hospital

Recognise the fracture….always Reduce the fracture…..If possible Maintain reduction…..always Reahabilitation….always

Clinical LOOK, ASK, FEEL. Look for nerve damage. Look for impaired circulation

X-ray: (Rongentogram) At least two views See joints above and below the affected limb. Define the type of the fracture…

Displacement, Angulation, Shortening, Rotation. Number of fragments. Joint involvements.

Not all fractures need reduction Fracture needs Reduction

Fracture involving joints. Angulation more than 15 degree With any rotation deformities.

Aim to get correct alignment. Before manipulation—study x-ray carefully Manipulate gently, firmly and purposefully. Check reduction with x-ray

If dislocation, check stability after reduction

BANDAGE

BACK SLAB

TRACTION

EXTERNAL FIXATION

INTERNAL FIXATION

It begins soon after injury. Speak to the patient gently, tenderly and

confidently. Remove anxiety and fear. Do not cause pain by handling the limb

carelessly.

Plaster of Paris is prepared from Gypsum, which is a crystalline form of calcium sulphate, by heating to 130°C. The heat drives off water of crystallization leaving white plaster of Paris powder.

CaSO4.2H2O+ Heat (130°C)---> CaSO4.½H2O + 1. ½ H2O

When P/P is immersed in water , it is gradually converted back into Gypsum as water is absorbed by it to re-form crystals. Then there is production of Heat which can be felt as the cast is setting.

CaSO4.½H2O + 1. ½ H2O---------> CaSO4.2H2O+ Heat

Plaster of Paris Powder Commercial Pack

Immobilization of fractures Post-operative fixation To prevent or correct deformity As a supporting splintage To immobilize infected limbs, e.g.

osteomyelities, cellulitis To take a cast for splint moulding or for

record purposes.

Advantages: It can be used individualized. It is durable , if taken proper care. It is disposable It is partially X-ray translucent.

Disadvantages: The skin cannot ‘breathe’, become scaly and

itchy. It is heavy and difficult to keep clean and dry. There can be complication like osteoporosis,

pressure sore, muscle wasting and joint stiffness.

Cast is Translucent

under X-ray

Plaster Sore

Contact Doctor immediately if you feel.. The toes or fingers become blue or swollen. You are unable to move your limb The limbs become painful You feel ‘ pins and needle’ or numbness. Any blister like pain Discharge or wetness under the cast If you drop any object under the cast.

Exercise the joints not under the cast. Do not let the limb hang down especially

first few days. Do not wet the cast If the cast becomes cracked, soft or loose

conact the Doctor.

Plaster for the upper limbPlaster for the upper limb

From½ “ proximal to MP

Joints

To1” below bend of the

elbow, diagonally if necessary to allow unimpeded flexion of elbow joint

Dorsal Slab or Back Slab

Plaster for the upper limbPlaster for the upper limb

From½ “ proximal to MP

Joints and distal Palmar crease.

To1” below bend of the

elbow, diagonally if necessary to allow unimpeded flexion of elbow joint

Fore-arm Plaster