Plaster and Orthopaedic AppliancesPlaster and Orthopaedic Appliances

Au Wai Kin Tsang Wing Yan Department of Orthopaedics and

TraumatologyPWH

Function of PlasterFunction of PlasterImmobilize of fracture or injured tissue to avoid further damageMaintain in proper body alignmentProvide support & rest for the injured partProtect repaired tissue to promote healing (e.g. tendon repair, SSG)Act as orthotic (e.g. u-slab / cylinder of stump)To promote healing & early weight bearingMaintain position(e.g. Hip spica)

Plaster MaterialPlaster Material(1)Plaster of Paris: CaSO4.2H2O

e.g. Gypsonausually use as temporary measure

(2)Synthetic Resin: C6H5.NCOFiberglass casting materiale.g. Scotchcast, Dynacastusually use in cases planned with longer period of immobilization

CharacteristicsCharacteristics

higherlowerPrice

shorterlongerDrying Time

goodfairRadiolucency

difficulteasyMoulding capacity

goodpoorPermeability

strongerweakerStrength

lightheavyWeight

Synthetic ResinPlaster of Paris

Before Plaster ApplicationBefore Plaster ApplicationAssessment(1)History taking

-allergy-mechanism of injury

(2)Physical Assessment- vascular status- skin integrity- neurological status & ROM of the affected limb- alignment & position

Care of the skin lesion e.g. lacerationGive analgesicsClear explanation Padding to the bony prominence areaNo rings on finger & remove all nail-polish

plaster + water Gypsum + HEAT

Exothermic reactionExothermic reaction

Potential Complications After Potential Complications After CastingCasting

Allergic Reaction - cast materials Tissue Impingement Compartment Effect- Volkmann’s ischaemic contracture Pressure sore formationMuscle Wasting- lack of exerciseJoint Stiffness - prolonged casting

Allergic ReactionAllergic Reactioncheck for allergic history before applicationexcessive irritation remove the cast, cleanse the skin thoroughly and re-apply other materials.

Circulatory & Nerve ImpairmentCirculatory & Nerve Impairment

Causesinsufficient padding tight castexcessive swelling

Compartment SyndromeCompartment SyndromeWithin a confined space (an osteofascial compartment) oedema leads to an increase of pressure; this reduce the capillary flow, which leads to more oedemaA vicious circle develops, resulting in ischaemia of the tissues within the compartments/s: 5 ‘P’s

ParaesthesiaPainPallorPulselessParalysis

Circulatory & Nerve ImpairmentCirculatory & Nerve Impairment

Treatment• Elevation• Encourage movement of the extremities

Bivalve the cast

Impaired Skin IntegrityImpaired Skin IntegrityDress wound properlyEnsure the edges of the cast are well paddedHandle the cast with the palms of the hands instead of the fingers to prevent indentations in the soft plasterAware of plaster sore

Plaster SorePlaster SoreCauses

uneven bandaging techniqueInsufficient padding over bony areasCast is too tight or too looseForeign body inside the cast

S/Sitchingburning sensationfeversleep disturbancefoul smelldischarge

Wire impinging on Cast lead to rotation of wire

Adequate cushion to protect skinCover second layer of gauze to prevent knocking against castEnsure wire is parallel to wall of cast as possible

Pressure SoresPressure Sores

Cast indentation constriction

Risk of Loss of AlignmentRisk of Loss of AlignmentMaintain the reduction and keep the affected part in a desired position during cast applicationPromote drying of the unconsolidated castUse pillow to support the cast

Risk of Loss of AlignmentRisk of Loss of AlignmentSupport the cast with palms Check for cracks/ softening/ loosening

Prepare for MobilizationPrepare for MobilizationWeight bearing is not allowed until cast is dry/ instructed by surgeon

Muscle Wasting & Joint StiffnessMuscle Wasting & Joint Stiffness

• Muscle strengthening exercises • Exercise joints above and below the affected limb

Window on Cast

Body ImageAllow to choose the preferable colour, esp. in adolescenceDiscuss expectation of activity and appearance of cast

Patient EducationPatient EducationDos & Don’tsDietary adviceCare after removal of cast

Application of CastApplication of CastPaddingActivation of cast material- immerse in luke warm water at

a 30 degree angle to the vertical

- gentle squeeze until no more bubbles appear

- squeeze out excessive waterApplications- circular- slab

Technique for applying a castTechnique for applying a castA stockinette - extending to the joint above and longer than the limb (fold back at the end to make a smooth edge)Take up the slack of every layer to be covered by the coming foldSmooth out every layer to remove airApply with continuous folds to cover at least half the previous foldUse the thenar areas of the hands for moldingThe cast must be fit the external anatomy of the limb, mold to create a three-point fixation

How to apply a short arm How to apply a short arm dynacastdynacast

Cast application(click to see video)Bivalve cast (click to see video)

TractionTractionDefinition :Traction is the use of pull to exert force

directly or indirectly to bones to overcome deformity or to help restore alignment following trauma

Aims- to reduce and stabilize a fracture or

dislocation- to relieve pain and reduce muscle spasm- to immobilize a joint or part of the body

Skin Traction- Apply traction directly onto skin

Skeletal Traction - through skeleton via transosseous pin

BuckBuck’’s Unilateral Leg Tractions Unilateral Leg TractionTemporally stabilization of hip fracture to relieve pain and muscle spasm

Halter TractionHalter Traction

Indication: cervical spondylosis

Pelvic TractionPelvic Traction

Indication: prolapsed lumbar intervertebral disc

BryantBryant’’s (s (GallowGallow’’ss) Traction) TractionIndication: fracture of the femur in children

< 3 years old, B.W < 30 lbs

Skeletal TractionSkeletal TractionIndication

fracture shaft of femurfracture acetabulum

9090oo -- 9090oo skeletal traction for Paed caseskeletal traction for Paed case

Halo tractionHalo tractionIndication

fracture or dislocation of cervical vertebrae

Orthopaedic AppliancesOrthopaedic Appliances

Arm Elevator

90o-90o Elevation

Shoulder immobilizer

Braun’s Frame

Thomas Splint

Hi-lo chair

Short Arm Hinge Brace

Long Arm Hinge Brace

Humeral Brace

Spinal OrthosisSpinal OrthosisFunction

To relieve painTo support weakened or paralyzed muscles and unstable jointsTo immobilize the vertebral column in the best functional position while healing occursTo prevent the occurrence of deformity or correct deformity

Foam collar

Thomas collar

Moulded polythenecervical orthosis

(Philadelphia neck collar)

Halo-Body JacketKnight brace

soft lumbar corset

Underarm brace

Thank You