AADO Workshop Trauma Management with Cast Applications 5th July Dr. SHA, Wai-leung Department of Orthopaedics & Traumatology Tuen Mun Hospital

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Christine Baldwin
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1 AADO Workshop Trauma Management with Cast Applications 5th July 2009 Dr. SHA, Wai-leung Department of Orthopaedics & Traumatology Tuen Mun Hospital

2 Plaster cast

3 Good method

5 Cheap

6 Safe

7 Safe??

8 Hazards & Complications of Casting

9 What Can Go Wrong? From beginning till removal Lots of pitfall If you done NOT properly If you monitor NOT closely If you remove it NOT correctly

10 Complications Skin burns Circulatory disturbance- compartment syndrome Nerve compression- common peroneal nerve Pressure sore Allergy- Velband Itchiness- skin marceration Joint stiffness & muscle atrophy Excessive hair growth Malreduction

11 Start from beginning Plaster casts can burn!!

12 POP generates heat during hardening Exothermic reaction Heat generated depends on thickness of cast Type of material Immersion water temperature

13 Exothermic reaction Rehydration of anhydrous calcium sulfate Setting times are affected by ambient temperature, humidity, thoroughness of wetting, and water temperature Ideal water temperature 22 C C

14 Warm water fasten set rate Never above 35 C The fact is avoid warm water!!

15 Cast burn Depends on patient circulation Level of consciousness Cooling method after casting Observation & monitoring

16 Precautions POP slabs should be dipped in cold water before application The patient should be monitored closely for the first 30 minutes after application The slab should be removed if patient complain of burning pain

17 Timing of casting Slab allows increasing swelling first days However Slab cannot replace cast Slab can cover up dangers- wounds, fracture site impingement Slab can create sores

18 Malreduction - insufficient relaxation (sedation, haematoma block, GA)

19 Malreduction - poor understanding of mechanics - inadequate planning and drill - poor cooperation - poor timing, too early or too late

20 Plan & drill

22 Pitfalls in casting Techniques - padding - molding - lamination

23 Padding Avoids in-foldings Padding at bony prominences

25 Padding at edges Padding

27 Padding Extra precautions to k-wiresk

29 Molding NO finger pressure Reinforcement at corner area

31 Molding Joint buckling- late molding

33 Molding Physiological position of immobilisation

36 Lamination After each roll is applied, rub thoroughly until gauze pattern disappear Lamination can weaken the cast

38 After setting Too tight- Compartment syndrome Nerve injury sensory or motor deficit Persistent localised pain unrelieved by elevation All are indications for cast removal, inspection and reapplication

40 After setting Too loose- After reduction of swelling Displacement of fracture Circulation obstruction Cast telescopic migration- point loading- pressure sore

41 Change or wedge

42 Or operate

43 Beware Prevent skin maceration Piriton helps if itchiness occurs

44 Beware infected k-wirek Beware

45 Beware Beware sore, split and check if persistent point tenderness

$fracture$

46 Fragile ladies with fracture distal femur can lose a leg

47 Beware Open all smelly/discharging or soiled casts

49 Removal of cast Skin burn from saw Beware when cast is very thick Poor cutting technique Blunt blade Do not run the oscillating saw along the cut line continuously Make multiple join up cuts- stop to cool Bivalving completely down to Velband

50 Conclusion Best conservative treatment First develop by ancient Egyptians First plaster bandages by Andonius Mathijsen, 1852 Do it right, do it SAFE

Principles of Casting

Principles of Casting Trauma Management with Cast Application AADO Dr K B Lee Queen Elizabeth Hospital 3 Nov 2013 Introduction Basic Principles of Fracture Treatment: Reduce (Reduction) Hold (Immobilization)