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Questions and Answers

What is the first step in preparing the plaster as described?

Measure the thickness of the plaster

Roll out the plaster slab

Mark the length on the plaster (correct)

Cut the plaster into smaller pieces

How thick should the plaster slab be when rolled out?

10 to 12 sheets thick (correct)

8 to 10 sheets thick

15 to 18 sheets thick

5 to 7 sheets thick

Which step directly follows marking the length on the plaster?

Measure the plaster thickness

Roll out the cast padding

Cut the plaster to size

Roll out the plaster (correct)

What action should be taken after rolling out the plaster slab?

Roll out the cast padding Signup and view all the answers

What is an essential characteristic of the plaster slab during preparation?

It should use the previously measured length Signup and view all the answers

What technique can help older children adjust to wearing a short arm cast?

Having them pretend to be a 'drama queen' Signup and view all the answers

What position should the patient be in to complete the long arm portion of the cast?

With the dorsal aspect of their hand on their forehead Signup and view all the answers

What is the first step after applying the short arm cast according to the technique described?

Position the patient as a 'drama queen' Signup and view all the answers

Which statement accurately reflects the procedure after applying the short arm cast?

The long arm portion cannot be added without the patient adjusting their position Signup and view all the answers

What is the purpose of encouraging older children to adopt the 'drama queen' pose?

To distract them from the discomfort of the cast Signup and view all the answers

What are potential consequences of immobilizing fewer joints than necessary?

Fracture displacement and neurovascular injury Signup and view all the answers

Why is it important to immobilize the correct number of joints during casting?

To prevent unnecessary pain and suffering Signup and view all the answers

Which of the following is NOT a consequence of inadequate joint immobilization?

Improved range of motion Signup and view all the answers

What can be a direct impact of fracture displacement due to improper immobilization?

Complications in neurovascular integrity Signup and view all the answers

What is a common risk associated with inadequate joint immobilization during casting?

Increased pain and potential injury Signup and view all the answers

What is the recommended position for the patient during the casting process?

Supine on the stretcher with the shoulder girdle off the side Signup and view all the answers

Which technique facilitates the padding to be folded over during casting?

Employing a technique that allows folding of the padding Signup and view all the answers

Why is positioning the shoulder girdle off the side important during casting?

To allow better access to the limb being casted Signup and view all the answers

What could happen if the patient is not properly positioned during the casting procedure?

The patient may feel discomfort and restrict movement Signup and view all the answers

What is the primary focus when positioning a patient for casting?

Maintaining a stable and safe posture during the procedure Signup and view all the answers

What is crucial to prevent during the casting of a wrist fracture?

Radial rotation at the wrist Signup and view all the answers

Where should the cast or splint begin when immobilizing a wrist fracture?

Above the elbow Signup and view all the answers

What bone is located above the radius at the site of a wrist fracture?

Ulna Signup and view all the answers

What might occur if the cast/splint does not begin above the elbow?

Forearm rotation complications Signup and view all the answers

Why is preventing forearm rotation significant when casting a wrist fracture?

It ensures stability during healing Signup and view all the answers

What is the purpose of applying cast padding before the plaster slab?

To protect the skin from the plaster Signup and view all the answers

Which of the following describes the sequence of applying plaster in the casting process?

Cast padding is applied, then the slab of plaster, and finally more padding Signup and view all the answers

How does the technique of layering cast padding and plaster benefit the splint?

It ensures a tighter fit and increases versatility Signup and view all the answers

What is a potential downside of using only plaster without cast padding?

The splint may not conform to the limb properly Signup and view all the answers

Which characteristic is a primary benefit of the described casting technique?

It creates the best conforming and versatile splint Signup and view all the answers

What is the primary material used in a fiberglass prepadded splint?

Fiberglass Signup and view all the answers

How is a fiberglass prepadded splint adjusted for use?

It can be cut to any desired length. Signup and view all the answers

What does the structure of a fiberglass prepadded splint consist of?

A strip of fiberglass inside cast padding material. Signup and view all the answers

Which characteristic of the fiberglass prepadded splint provides effective immobilization?

It is strong and can be customized in length. Signup and view all the answers

What advantage does the fiberglass layering provide in casting?

It offers a balance of strength and flexibility. Signup and view all the answers

What is a key advantage of elastic casting material compared to traditional plaster casts?

It allows some motion. Signup and view all the answers

Which characteristic makes elastic casting material preferable for certain patients?

It is easier to apply than plaster casts. Signup and view all the answers

Why might elastic casting material be considered a better option for children?

It allows for ongoing movement during recovery. Signup and view all the answers

What is a disadvantage of using traditional plaster casts that elastic casting material addresses?

Weight and ease of application. Signup and view all the answers

Which statement about elastic casting material is incorrect?

It provides complete immobilization of the limb. Signup and view all the answers

What should be done if the splint material extends beyond the required length?

Fold it back or cut it to size. Signup and view all the answers

What is the final step in the process of applying the prepadded splint?

Overwrap the splint with an elastic or self-adherent bandage. Signup and view all the answers

What size consideration is important when using prepadded splints?

Material should be cut or folded if it is too long. Signup and view all the answers

Which material is suggested for the overwrapping of the prepadded splint?

Elastic or self-adherent bandage. Signup and view all the answers

What is the primary purpose of applying the prepadded splint to a limb?

To immobilize the limb for healing. Signup and view all the answers

What is the purpose of applying small strips of cast padding over the bony prominences?

To enhance comfort and reduce pressure Signup and view all the answers

Which areas of the body should the cast padding specifically be applied to?

The olecranon and ulnar styloid Signup and view all the answers

What is a possible consequence of neglecting to apply proper padding during the casting process?

There could be increased risk of skin irritation Signup and view all the answers

What additional benefit does applying padding provide during the casting procedure?

Increases the effectiveness of the immobilization Signup and view all the answers

When should the strips of cast padding be applied in relation to plaster application?

Before applying any plaster at all Signup and view all the answers

Where should the mold for an ankle fracture be positioned?

Distal to the lateral malleolus over the calcaneus Signup and view all the answers

Which preparation step involves measuring before applying a splint?

Measuring the length of the splint using plaster Signup and view all the answers

What is the main benefit of ensuring correct mold placement for an ankle fracture?

Effective immobilization and support Signup and view all the answers

What is the primary purpose of using plaster for molding in an ankle fracture?

To ensure the fracture is properly aligned Signup and view all the answers

Where should the splint begin when immobilizing an ankle fracture?

Immediately proximal to the medial malleolus Signup and view all the answers

Study Notes

Applying Plaster Casts

Mark the plaster length by tearing one side
Roll out the plaster slab 10-12 sheets thick
Use the measured length to roll out the plaster
To alleviate difficulty, have older children pretend to be a "drama queen" by placing the dorsal aspect of their hand on their forehead after applying the short arm cast
Apply long arm cast after short arm cast
Surgeon should hold the limb, place the foot on the thigh, and apply axial load to ensure the foot is not in equinus
This positioning naturally places the knee at approximately 30 degrees of flexion
Span the ankle joint line with cast padding but do not cover the heel
Leaving the foot in equinus for prolonged periods can lead to Achilles tendon contraction and ankle stiffness
Roll out the cast padding

Immobilization

Immobilizing fewer joints than necessary can lead to complications, including fracture displacement, neurovascular injury, and unnecessary pain and suffering.

Casting Techniques

Thumb spica casts: Begin just distal to the wrist crease and extend to cover the entire thumb.
Hand-based thumb spica casts: Allow wrist motion.
Plaster roll application: Twist 360 degrees in the interspace, then pinch to narrow it at the web space.

Patient Positioning

Shoulder girdle: Patient should be supine on the stretcher with the shoulder girdle entirely off the side.
Pelvis: Patient is supine with pelvis halfway onto a padded crutch placed beneath the mattress.

Plaster Cast Setup

Activate the plaster by placing it in tepid water.
Allow the plaster to soak until it is softened.
Be prepared to open the cast (bivalve) to prevent compartment syndrome if postreduction swelling occurs.

Cylinder Cast

Apply a mold if desired.
For a fracture of both bones of the forearm use a cylinder cast.

Cylinder Cast Indications

Patellar fractures
Patellar dislocations

Cylinder Cast Precautions

Pad the malleoli thickly to avoid pressure sores on the ankle.
Limit distal migration of the cast.

Plaster Casts

Use very wet plaster for optimal application.
Always roll the plaster on the cast.
Fiberglass casts do not expand to accommodate swelling.

Elastic Casts

Too much padding can lead to inadequate immobilization and won't accommodate swelling.
Wrinkled padding can cause pressure necrosis.
To activate plaster in hot water, the patient should be seated upright with their shoulder off the side of the bed.
The elbow should be positioned in the desired flexion and pronation/supination.
Start applying plaster proximal to the palmar flexion crease.

Foot Positioning

Two techniques to prevent equinus (foot pointing downwards) when a reduction maneuver is not used:
- The patient lies prone with their knee bent at 90 degrees.

Wrist Fracture (Distal Radius) Treatment

Cast/splint should begin above the elbow to prevent forearm rotation at the wrist
Cast padding is applied to the limb followed by a layer of plaster
Cast padding is then rolled over the plaster to create a conforming and versatile splint
Four layers of cast padding should be rolled out on a flat surface longer and wider than the plaster slab

Clavicle Fracture Treatment

Figure-of-8 splints are commercially prepared devices that reduce force on the clavicle
There is no difference in outcome between a figure-of-8 splint and a sling for closed clavicle fracture management

Other splints

Splints should allow free movement of the thenar eminence (thumb)
A hematoma block can be performed before measuring a splint to allow the block to become effective while the splint is being measured

Fiberglass Prepadded Splint

Fiberglass prepadded splint is a strip of fiberglass inside cast padding material
Can be cut to any desired length
Fiberglass prepadded splint is applied to the limb
If the splint material is too long, fold it back or cut it to size
Overwrap the splint with an elastic or self-adherent bandage

Fiberglass Prepadded Splint Advantages

Elastic casting material allows some motion
Elastic casting material is easier to apply than a plaster cast

Posterior Elbow Splint

Apply small strips of cast padding over the bony prominences of the olecranon and ulnar styloid to provide additional padding

Ankle Fracture Molding Location

Distal to the lateral malleolus over the calcaneus
Immediately proximal to the medial malleolus

AO Splint

Measure the length of the splint using plaster

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Description

This quiz covers essential techniques for applying plaster casts, including the steps for short and long arm casts. It also addresses positioning considerations to prevent complications like Achilles tendon contraction. Test your knowledge on proper cast application procedures and patient positioning.