Casting and Splinting

Question 1

Is a plaster or fiberglass cast easier to mold to the extremity?

Answer 1

Plaster

Question 2

Is a plaster or fiberglass cast messier to apply?

Answer 2

Plaster

Question 3

Which is hotter as it is curing, a plaster or fiberglass cast?

Answer 3

Plaster

Question 4

What is the risk (temperature related) associated with a plaster cast?

Answer 4

1. Exothermic reaction- (USE COOL WATER)

2. Potential burn risk in patients with sensory deficit, cognitive impairment, children

Question 5

Which is heavier, a plaster or fiberglass cast?

Answer 5

Plaster

Question 6

Which is more durable, a plaster or fiberglass cast?

Answer 6

1. Fiberglass

2. Plaster, Once hardened, will soften and crack when it gets wet

Question 7

What is the advantage of plaster casts in underlying wound drainage?

Answer 7

1. “Wicks” underlying wound drainage

2. desirable in trauma and postoperative settings

Question 8

What temperature of water should be used with a fiberglass cast?

Answer 8

Exothermic reaction but smaller so than plaster (USE COOL TO LUKE WARM WATER)

Question 9

What are the advantages to a fiberglass cast?

Answer 9

1. Light weight with excellent durability
2. Once hardened, water-resistant, but underlying cast padding is not
3. Available in many colors

Question 10

What are the disadvantages to a fiberglass cast?

Answer 10

1. Expensive
2. Need to wear gloves when applying
3. When exposed to air, it begins to cure
   A. cannot open package until ready to use

Question 11

What are the indications for casts and splints?

Answer 11

1. Treat simple, acute, nondisplaced fractures
2. Treat soft tissue injuries, such as severe ligament sprains and muscle strains
3. Immobilize a dislocation after it has been reduced
4. Treat some congenital deformities, i.e. clubfoot
5. Help manage chronic foot and ankle ulcers and Charcot foot

Question 12

What are the contraindications for circumferential casts?

Answer 12

1. During acute injury phase (usually 3-4 days), when acute swelling of the extremity is expected
2. When cast would cover or conceal a known skin or soft tissue infection (sometimes, a “cast window” is made)
3. When the cast would cover an open wound, where infection may occur (“cast window” possibly)

Question 13

What are the potential complications of circumferential casting?

Answer 13

1. Compartment syndrome
2. DVT
3. Cast dermatitis
4. Pressure sores
5. Nerve injuries

Question 14

How can compartment syndrome be prevented?

Answer 14

Prevent by “bivalving” the cast

Question 15

Why are DVTs a risk during splinting?

Answer 15

1. Lack of ambulation and immobilization

Question 16

Why is cast dermatitis a risk during splinting?

Answer 16

Decreased air circulation and moisture trapped

Question 17

Why are pressure sores a risk during splinting?

Answer 17

Caused by not padding bony prominences well or from finger indentations that occur from improper handling of a cast or splint during application (use palms to mold cast, not fingertips)

Question 18

Why are nerve injuries a risk during splinting? How can it be prevented?

Answer 18

1. Pressure over superficial nerves, i.e. common peroneal nerve at fibular head, can cause nerve palsy
2. Pad areas well

Question 19

What materials are needed to cast an extremity?

Answer 19

1. Stockinette 2”, 3”, 4”, 5”, or 6”
2. Cast padding (same sizes): Webril (cotton) or synthetic padding
3. Cast material: plaster or fiberglass or Orthoglass

Question 20

What cast padding is used for the arm?

Answer 20

usually 2” or 3”

Question 21

What cast padding is used for the lower leg?

Answer 21

usually 3” or 4”

Question 22

What cast padding is used for the upper leg?

Answer 22

4” or 5”

Question 23

What is included in the evaluation after casting?

Answer 23

1. Perform careful assessment of cast or splint before sending the patient away
2. Make sure cast or splint extends to proper boundaries, but does not interfere with the range of motion of necessary joints
3. Check for finger indentations or sharp edges. A. Can use cast saw or bandage scissors to trim back the cast and repad or recast if necessary
4. Be sure to ask patient how the cast/splint feels
   A. It is feels too tight to the patient, reassess it

Question 24

How is a cast removed with an oscillating saw?

Answer 24

1. Blade vibrates instead of spinning
2. Does not cut the skin usually
3. Keep in mind, blade gets hot, if skin is touched after breaking through cast, can burn patient
4. Press saw blade firmly against cast at 90 degree angle until you feel it break through cast shell. Use vertical “in and out” motion adjacently
5. Cut cast on both sides, use cast spreader, then use scissors to cut cast padding and stockinette

Question 25

What are the indications for a volar wrist splint?

Answer 25

1. wrist sprain 2. distal radius fracture 3. Lacerations 4. night splints 5. Carpal tunnel

Question 26

What are the indications for an ulnar gutter/boxer splint?

Answer 26

1. immobilize boxer fx A. 5th metacarpal fx B. 4th metacarpal fx

Question 27

What are the indications for a posterior leg splint and stirrup (U) splint?

Answer 27

``` Ankle must be neutral 90 degrees of flexion! 1. Distal tib/fib fx 2. Ankle sprains 3. Achilles tendon tears 4. Metatarsal fx ```

Question 28

What are the indications for a finger trap?

Answer 28

1. For closed reduction of displaced Colles’ or Smith frx | 2. Hematoma block performed first

Question 29

What are the indications for a sugar tong splint?

Answer 29

1. displaced Colles’ fracture | 2. Ulnar/radial shaft fractures

Question 30

What are the indications for a thumb spica splint?

Answer 30

1. suspect scaphoid fracture or UCL tear (gamekeeper’s thumb), splint, and refer to ORTHO

Question 31

What are the indications for a alumafoam splint?

Answer 31

1. Initial immobilization of mallet finger | 2. : Proximal phalanx fracture, metacarpal neck fracture index finger, post finger reduction for finger dislocation

Question 32

What are the indications for a stack (stax) splint?

Answer 32

Mallet finger

Question 33

What pt instructions/education needs to be performed?

Answer 33

1. Swelling in first 48 hrs is normal and may cause the casted arm or leg to feel tight A. Severe pain, numbness/tingling pt should call you and be seen to assess 2. Elevate extremity above heart level to reduce swelling 3. Move fingers (or toes) frequently for first 72 hrs, then several times a day 4. Call if increased pain that is not relieved by rest, elevation and pain meds. A. Feeling of numbness/tingling and tightness does not go away after elevating it for 30 mins B. Unable to wiggle or move the fingers/toes C. Fingers or toes are cold or turn purple or white D. The cast becomes damaged, wet or cracked

Question 34

What is included in cast care?

Answer 34

1. Keep cast clean and dry unless waterproof cast 2. Do not pull out padding from splint or cast 3. If cast causes an itch, try blowing COOL air from a hair dryer into the cast 4. Never pour baby powder, lotion or oils into cast 5. Do NOT try to reach the itch w/ a long object, such as a pencil or hanger 6. No running or jumping or playing sports

Question 35

What is the procedure for applying a posterior ankle splint?

Answer 35

1. Measure from 2 inches below the popliteal to 2 inches beyond the toes. Prepare splint as directed and roll twice in a towel 2. Fold the splint under 1 inch at the toes to make a reinforcing toe plate. PLace the splint under the foot, extending slightly beyond the toes and wrap as follows: start at the toes, work up the foot, skip the ankle, and wrap behind the achilles 3. Below the malleolus, overlap the corners of the splint. Do not push in and cause a pressure point 4. Wrap the heel and continue wrapping the rest of the leg. Mold and position as prescribe by the dr. To hold the position, wrap splint with a figure 8 position 5. Recommended width: 4"-5" for most pts

Question 36

What is the procedure for placing a boxer splint?

Answer 36

1. Measure from the tip of the 5th figner to 2 inches from the antecubital. Prepare splint as directed. 2. Place padding between the 4th and 5th figners 3. Apply the splint to the ulnar side of the hand, creating a gutter 5. Wrap the elastic bandage to secure the splint. Mold and position as prescribed.

Question 37

What are the procedures for volar splints?

Answer 37

1. Measure from 1 inch above the palmar crease to 2 inches form the antecubital. Prepare splint as directed 2. Fold one edge of the splint over one inch. Place fold at the angle of the palmar crease (follow the life line) 3. Wrap with elastic bandage to secure the splint. Mold and position as prescribe

Question 38

What is the procedure for a sugar tong splint?

Answer 38

1. Measure from behind the elbow coming up both sides of the arm to the tips of the fingers 2. Fold the splint in half. Cut across the splint at the fold leaving approximately 1/2 inch attached. Pad the edges with tape. Prepare splint as directed 3. Place the splint on the pt's arm by sliding the cut section over the fingers, with the attached section in the web spaces, between the thumb and forefinger 4. Wrap the elastic bandage to secure the splint. At the elbow, fold one side of the excess material behind the elbow and over lap with the other side. Lock in place with a series of figure-8 wrap