Casting --- Cast splintage

By: Ms. S. Peter

• To immobilize a reduced fracture, correct deformity.

• Apply uniform pressure to underlying soft tissue or support and stabilize weakened joints

Cast Splintage

Methods:– Plaster of Paris – Fiberglass

• Especially for distal limb # and for most children #Disadvantage: joint encased in plaster cannot move and liable to stiffen• Can be minimized:– Delayed splintage (traction initially)– Replace cast by functional brace after few weeks

Three-year-old Ben , wears a Velcro bandage strapped to his arm. Removable splints, like the one helping mend Ben's fractured wrist, are replacing conventional plaster or fiberglass casts.

Cumbersome casts 3-D Cortex casts

• Application --- • Care • Health Teaching – • Removal -

Implementation• Keep cast & extremity elevated• Allow cast to dry- POP 24-48 hrs synthetic –

20mins• Handle the wet cast with palms until dry• Heat can be used to dry the cast• Color of the dry cast is shiny – wet dull• Examine the cast and skin for pressure areas• Observe the extremity for circulatory

impairment- color, pain, swelling, tingling, numbness, coolness, or diminished pulse—notify immediately

…implementation…• Cutting/bivalving the cast – if circ. impairment • Petal the cast:--- maintain smooth edges around- to

prevent crumbling of the cast material• Monitor pt temp• Observe for foul odor- (infection ), drainage – ( circle the area on the cast)• Monitor warmth on the cast• Monitor for wet spots – need for drying /drainage

under the cast • If open drainage present – keep a window… • Teach to keep the cast clean and dry --- • Isometric exercises to prevent muscle atrophy

Assessment• Physical assessment of the part to be

immobilized must include – neurovascular status ( Swelling- degree & location, bruise, skin abrasion etc) -- along with the- psychological--- general health …

Diagnosis: Based on the assessment data – • Knowledge deficit related to treatment regimen• Pain related to M/S disorder• Impaired physical mobility related to cast• Self care deficit: hygiene- bathing, feeding

dressing, grooming, toileting due to restricted mobility

• Impaired skin integrity related to lacerations and abrasions

• Risk for peripheral Neurovascular dysfunction related to physiologic responses to injury and compression effect of cast

Pot. complications • Compartment syndrome, Pressure ulcer• Disuse syndrome • Prepare pt – describe – anticipated sensations –

heaviness, heat guidelines foe POP• Relieve pain; exact site – exact character and

intensity .. ( most pain relieved by elevating the limb . apply cold, analgesics ) report unrelieved pain ( possible paralysis or necrosis)

• pain controlled --- with immobilization • Swelling, surgery – edema – apply cold ( ice

caps on side of the casts ( not to intent the cast) If edema – elevate – or modify the cast

Pain – indication of complications • Pain on comp. syndrome--- relentless – not

controlled by any of these or analgesics• Pain of body prominence--- impending pressure

ulcer – pain decrease when ulcer is formed • Never ignore pain --- potential to impaired tissue

perfusion or pressure ulcer Improve mobility • All other free – uninvolved joints should be

exercised to maintain function- finger/toe exercise

Neuro – Vascular functions – • Oedema is normal stage … • Monitor- circulation motion, and sensation of the

affected extremity—compare with the other extremity

• If c/o too tight – cast- vasc insufficiency, nerve compression, due to unrelieved swelling – compartment syndrome

( normal findings – minimal swelling, minimal discomfort, pink color, warm to touch, rapid capillary refill, normal sensations able to exercise toes/fingers Make frequent regular exercises – assessments

Monitoring for pot complications

Compartment syndrome – increased tissue pressure within a limited apace—cast—muscle compartmentRelieve pressure • Bivalve the cast , maintain alignment and elevate

extremity • If not relieved – faciotomy – to relieve pressure • Close observations and recording of neuro-

vascular response –….. reporting

Pressure ulcer : Pressure of the cast on soft tissues – tissue anoxia – pres ulcer ( Low ext . more susceptible—heel malleoli, dorsum of the foot, head of fibula, and ant surf of patella ..Upper ext . pres areas --- medial epicondyle of humerus, and ulnar styloid• C/o pain and tightness – a warm area on the cast –

area may break down – drainage – may stain cast – emit odor ( after tissue break down pain less. Ext loss of tissue

• To inspect pres area—bivalve the cast – or window – treat the site – the portion of the cast is replaced or pressure dressing

DISUSE SYNDROME- isometric exercise – muscle contraction – without moving the part – this helps to reduce muscle atrophy and maintain muscle strength – • Teach push down the knee or clenching the fist

etc ( hourly … • Muscle stimulators may attach to skin over large

muscle – electrically stimulated 8hrs /day to prevent disuse

Health Teaching • Encourage to participate in self care – and use

assistive devices – • Help to give self care -- -- participate pt ADLs

When the cast is dry instruct the patient---• Move about as normally as possible – avoid

excessive use of injured part – avoid walking on wet slippery floors or side walks

• Perform the exercises –• Elevate the casted extremity to heart level –

to prevent swelling• Do not scratch the skin under the cast – it may

form skin ulcer – cool air from hair dryer alleviate itching

• Cushion the rough edges with tape

• Keep the cast dry—not to cover with plastic or rubber – as it causes condensation and dampens the cast and skin ----- thoroughly dry with hair dryer – cool setting

• If the dry cast become wet- may use blow dryer slow setting – if are area is wet—report

• Clean the surface of plaster cast with slightly damp cloth ( synthetic cast—mild soap can be used – white shoe polish – to brighten the cast

• Report—persistent pain, swelling that does not respond to elevation, changes in sensation

• Decreased ability to move fingers /toes and changes in color and temp

• Note odors around cast – stained area or warm spots, pressure areas

• Report broken cast – do not attempt to fix • Isometric exercises ---

Cast removal• Explain--- • Cutter vibrate feel --- -- it will not cut skin---

padding is cut with scissors • The casted part is weak—disuse—stiff …look

atrophied – need support • skin – dry scaly ( from accumulated dead skin –

wash gently and lubricate with emollient • Resume activities slowly and gradually • Elevate extremity if swelling

We’ll Continue ………….. on

traction