PEDIATRIC CASTING AND SPLINTING HEATHER KONG, M.D. SHRINERS HOSPITAL FOR CHILDREN PORTLAND OCTOBER 7, 2017
DISCLOSURES I have no financial relationship with any company or product discussed in this presentation.
OUTLINE Goals Materials Complications Upper extremity Lower extremity
GOALS Pain control Easier mobilization Prevent further soft tissue injury Maintain bony alignment Cast circumferential Splint partial
MATERIALS Plaster (sheets or rolls) Fiberglass (rolls) Stockinette Cast padding Orthoglass Off-the-shelf brace Custom brace
MATERIALS Plaster (sheets or rolls) Fiberglass (rolls) Stockinette Cast padding Orthoglass Off-the-shelf brace Custom brace
MATERIALS Plaster (sheets or rolls) Fiberglass (rolls) Stockinette Cast padding Orthoglass Off-the-shelf brace Custom brace
MATERIALS Plaster (sheets or rolls) Fiberglass (rolls) Stockinette Cast padding Orthoglass Off-the-shelf brace Custom brace
COMPLICATIONS Dermatitis Wet Soiled Skin maceration Between fingers or toes Waterproof materials Cast covers Counsel families
COMPLICATIONS Pressure wounds Heel Olecranon Patella Not enough padding Loosening of splint Weightbearing Foreign objects
COMPLICATIONS Pressure wounds Antecubital fossa Dorsal ankle/foot Hand/fingers Ace bandage not too tight Padding under ace bandage
COMPLICATIONS Cast saw burns Usually thermal injury, not lacerations Keep saw moving and cool
COMPLICATIONS Joint stiffness Elbow Ankle Fingers Prolonged immobilization Position
COMPLICATIONS Compartment syndrome Forearm fractures Elbow fractures Tibia fractures Signs/symptoms Splint or bivalved cast Observe overnight
TAKE HOME POINTS Protect skin - padding Do not wrap too tightly Positioning Sufficient length for stability Counsel families
UPPER EXTREMITY Splinting Sugar tong Posterior long arm Ulnar gutter Thumb spica Volar wrist Coaptation Forearm fractures Elbow fx/dislocation 5th MC, small finger Scaphoid, thumb fx Buckle fx, sprains Humeral shaft fx
UPPER EXTREMITY Sugar tong splint Forearm fractures Elbow - 90 Forearm - neutral Wrist - 10 extension Leave fingers free
UPPER EXTREMITY Posterior long arm splint Distal humerus fx Elbow dislocations Elbow - 90 Forearm - neutral Wrist - 10 extension Leave fingers free
UPPER EXTREMITY Ulnar gutter splint 5th metacarpal fx Small finger fx Ulnar styloid fx Wrist - 10-20 extension MCP - 90 flexion PIP and DIP - full extension Include 4th & 5th digits
UPPER EXTREMITY Thumb spica splint Thumb fractures Scaphoid fractures Thumb in resting position Wrist - 10 extension
UPPER EXTREMITY Volar forearm splint Distal radius buckle fx Wrist sprains Wrist 10 extension Leave fingers free Leave elbow free
UPPER EXTREMITY Coaptation splint Humeral shaft fx Elbow - 90 flexion Valgus mold With sling or cuff & collar
UPPER EXTREMITY Casting Long arm Prox forearm, elbow Short arm Distal 1/3 forearm Thumb spica Scaphoid, thumb fx Ulnar gutter 5th MC, small finger
UPPER EXTREMITY Casting Minimal swelling Sufficient length Position Padding Fingers free
UPPER EXTREMITY Practice!
LOWER EXTREMITY Splinting Short leg posterior Distal tibia fx Ankle stirrup Ankle fx/dislocation Long posterior (tibia) Proximal/tibial shaft fx Long posterior (femur) Femur fx Medial/lateral slabs Knee injury, tibial plateau fx
LOWER EXTREMITY Short posterior leg splint Stable ankle fracture Distal tibia fracture Foot fracture Severe ankle sprain Ankle - 90 Leave knee free Leave toes free
LOWER EXTREMITY Ankle stirrup splint Unstable ankle fx/dislocations Unstable foot injuries More varus/valgus stability Ankle - 90 Leave knee free Leave toes free
LOWER EXTREMITY Long posterior leg splint Tibial shaft fracture Proximal tibia fracture Distal femur fracture Ankle - 90 Knee - 30-40 Extend to proximal thigh Leave toes free
LOWER EXTREMITY Long posterior leg splint Femoral shaft fractures Ankle - 90 Knee - 30-40 Extend above buttock Or traction device
LOWER EXTREMITY Medial/lateral slabs Tibial plateau fractures Patellar fractures Distal femur fractures More varus/valgus stability Knee - 10 Leave ankle free Or knee immobilizer
LOWER EXTREMITY Casting Short leg Distal tibia, ankle fx Long leg Tibial shaft, distal femur fx Cylinder Patella fractures Hip spica Femoral shaft fx
LOWER EXTREMITY Casting Minimal swelling Sufficient length Position Padding Reinforce bottom
LOWER EXTREMITY Practice!
TAKE HOME POINTS Protect skin - padding Do not wrap too tightly Positioning Sufficient length for stability Counsel families
RESOURCES Rockwell & Wilkins Fractures in Children, 8 th edition. Flynn JM, Skaggs DL, Waters PM, ed. 2015. AO Foundation Surgery reference app Casts, Splints, and Support Bandages Youtube videos