2- Basic science of orthopaedic casting

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Questions and Answers

What is the recommended cuff thickness of padding to be placed proximal and distal to the plaster?

0.5-1 cm

2-4 cm

1-2 cm (correct)

1-3 cm

Which step should be completed after measuring the correct length of splinting material?

Sealing the edges of the cast

Cutting the splint to size (correct)

Placing the cast padding

Applying a plaster layer

Which of the following is an essential step before applying the plaster?

Heating the plaster

Wrapping the splint in gauze

Choosing the right cast color

Creating a padding layer (correct)

How many layers of cast padding are recommended?

Two layers Signup and view all the answers

What should the practitioner ensure when preparing to cut the splint material?

It matches the exact measurements previously taken Signup and view all the answers

What should be done immediately after performing a reduction maneuver?

Obtain postreduction radiographs with the patient in a sling. Signup and view all the answers

What equipment should the patient wear when obtaining postreduction radiographs?

The sling or the sling and swath. Signup and view all the answers

Why is it important to obtain postreduction radiographs?

To confirm the effectiveness of the reduction. Signup and view all the answers

What is the recommended patient position during postreduction radiograph acquisition?

Wearing a sling or sling and swath. Signup and view all the answers

Which of the following is NOT recommended after performing a reduction maneuver?

Removing the patient's sling. Signup and view all the answers

Where should the center of the figure-of-8 splint be positioned?

Between the shoulder blades Signup and view all the answers

What is the purpose of positioning the figure-of-8 splint in a specific location?

To provide adequate immobilization Signup and view all the answers

Which area of the body is targeted for the application of the figure-of-8 splint?

The upper back Signup and view all the answers

What anatomical landmark is used to determine the correct placement of the figure-of-8 splint?

The spine Signup and view all the answers

Why is it important for the figure-of-8 splint's center to rest between the shoulder blades?

To distribute pressure evenly Signup and view all the answers

What is the recommended patient positioning when using the Quigley maneuver?

The patient is supine on a stretcher with the leg elevated by traction. Signup and view all the answers

Which material is NOT listed as part of the equipment needed?

4-inch orthopedic splint Signup and view all the answers

Which of the following best describes the position of the patient during the Quigley maneuver?

Supine with the leg elevated. Signup and view all the answers

What is the purpose of using cast padding in the equipment list?

To protect the skin under the cast Signup and view all the answers

When performing the Quigley maneuver, what is an important factor in patient positioning?

The leg must be elevated using traction. Signup and view all the answers

What is a common mistake when positioning a patient using the Quigley maneuver?

Failing to elevate the leg. Signup and view all the answers

Which of the following sizes of bandages are included in the equipment list?

4-inch elastic bandage Signup and view all the answers

How many types of cast padding sizes are mentioned in the equipment list?

Two sizes Signup and view all the answers

Which positioning method is incorrect for the use of the Quigley maneuver?

Semi-reclining with the feet flat. Signup and view all the answers

Which item serves as the primary support structure in the equipment list?

4- or 6-inch plaster Signup and view all the answers

For intraarticular or periarticular fractures, what is the recommended span of immobilization?

One level above and one level below the joint Signup and view all the answers

When immobilizing an intraarticular fracture, which of the following bones must be included in the immobilization?

Both proximal and distal bones to the joint Signup and view all the answers

What is NOT included in the scope of immobilizing an intraarticular fracture?

Fractures located distant from the joint Signup and view all the answers

Which of the following best describes the recommended immobilization technique for fractures near a joint?

Extending immobilization to include both proximal and distal segments Signup and view all the answers

In cases of periarticular fractures, what is the primary purpose of immobilizing the area one above and one below the joint?

To maintain joint stability and prevent movement Signup and view all the answers

What is the primary function of placing the folded ABD pad in the axilla?

To absorb perspiration Signup and view all the answers

When applying the sling, what is the correct adjustment for the straps?

They should be loose while providing some support Signup and view all the answers

What should be done immediately after buckling the circumferential body strap?

Check the tightness across the abdomen Signup and view all the answers

What is an essential consideration when using the ABD pad in the axilla?

It should be made of breathable material to enhance comfort Signup and view all the answers

Which action should NOT be performed when adjusting the sling for arm support?

Securing it in a way that limits movement Signup and view all the answers

What is the primary reason for wrapping cast padding over the top of the plaster?

To prevent direct adhesion of plaster to bandages. Signup and view all the answers

What is the final action to secure the splint according to the procedure?

Utilize an elastic or self-adherent bandage. Signup and view all the answers

Which of the following actions should NOT be performed when preparing to secure a splint?

Leave gaps in the padding for ventilation. Signup and view all the answers

Why is it important to use a self-adherent bandage to secure the splint?

It provides a tighter fit that molds to the limb. Signup and view all the answers

What should be ensured before securing the splint with an elastic bandage?

The positioning of the splint should remain unchanged. Signup and view all the answers

What is the primary purpose of tearing cast padding before applying it around the thumb interspace?

To allow the padding to conform properly Signup and view all the answers

Which direction should you wrap the cast padding after adequately padding the hand?

Proximally towards the forearm Signup and view all the answers

What is the significance of not going past the palmar flexion crease when applying cast padding?

To avoid restricting finger movement Signup and view all the answers

Why is it crucial to tear the cast padding carefully?

To prevent the padding from bunching up Signup and view all the answers

What is likely to occur if cast padding is positioned incorrectly beyond the palmar flexion crease?

Increased chances of skin irritation Signup and view all the answers

What is the initial step in preparing a long leg cast?

Wetting and laminating the plaster Signup and view all the answers

Which technique is standard for applying plaster in lower extremity casts?

Wetting and laminating technique Signup and view all the answers

What is the primary purpose of using plaster in lower extremity splints?

To immobilize fractures and protect the injured area Signup and view all the answers

Which of the following statements about the preparation of plaster for casting is accurate?

Wetting the plaster enhances its adherence and shape Signup and view all the answers

What critical aspect should be considered when laminating plaster for a leg cast?

Care must be taken to ensure it conforms correctly to the limb Signup and view all the answers

Which type of sling padding is recommended for use?

Well-padded sling Signup and view all the answers

What additional padding can be used for the neck besides a well-padded sling?

Cast padding Signup and view all the answers

Which of the following is NOT recommended for neck support?

Arm sling Signup and view all the answers

What is the purpose of using cast padding in the context provided?

To protect the skin Signup and view all the answers

In addition to a well-padded sling, which item is suggested for padding?

Army Battle Dressing Signup and view all the answers

What happens to the molding if the casting material has not hardened?

The molding may be lost. Signup and view all the answers

What is the common consequence of applying a splint or cast incorrectly?

Foot falling into equinus. Signup and view all the answers

When does molding become a concern in cast application?

When the casting material has not hardened. Signup and view all the answers

Which of the following indicates a successful cast application?

The casting material is fully hardened. Signup and view all the answers

What might happen if a cast is applied while the foot is in an incorrect position?

Equinus may occur. Signup and view all the answers

What is the purpose of running the strip of plaster between two fingers?

To remove air pockets or bubbles Signup and view all the answers

What should be done prior to applying the plaster slab to the limb?

Remove any excess moisture from the plaster Signup and view all the answers

Which step is critical for preparing the plaster before application?

Ensuring that the plaster is free of air pockets Signup and view all the answers

What consequence may occur if air pockets are not removed from plaster during preparation?

The plaster may not harden properly Signup and view all the answers

What is the recommended method for dealing with moisture in plaster?

Removing any excess moisture before using Signup and view all the answers

What position should the knee be in when the foot is placed on the thigh during the procedure?

Approximately 30 degrees of flexion Signup and view all the answers

What is the purpose of applying an axial load in this procedure?

To ensure the foot remains in equinus Signup and view all the answers

What happens to the foot when the axial load is applied?

The foot is stabilized on the thigh Signup and view all the answers

Which of the following best describes the action of placing the foot on the thigh?

It naturally aligns the knee at an angle Signup and view all the answers

What is a consequence of not ensuring the foot is not in equinus?

Proper alignment during the procedure may be compromised Signup and view all the answers

What is the primary reason for using a 6-foot-long piece of stockinette in the prevention of equinus?

To facilitate proper splint placement and support Signup and view all the answers

Why is gravity mentioned in relation to equinus prevention?

It contributes to but does not completely prevent equinus Signup and view all the answers

Which outcome is NOT achieved by cutting a stockinette for peripheral casting?

Ensuring adequate airflow around the limb Signup and view all the answers

What is the correct method to apply the stockinette during equinus prevention?

Position it in a way that supports the limb properly Signup and view all the answers

What might be a consequence of improperly using the stockinette during equinus prevention?

Increase in muscle tension around the joint Signup and view all the answers

What is the primary benefit of bivalving a cast in cases of edema?

To provide decompression and reduce swelling. Signup and view all the answers

How does splitting the cast padding contribute to patient care?

It maximizes decompression for the swollen area. Signup and view all the answers

In the context of a cast applied under acute conditions, what does the term 'bivalving' refer to?

Cutting the cast to allow for swelling. Signup and view all the answers

What should be considered when managing edema in a casted limb?

Providing ample space for swelling within the cast. Signup and view all the answers

What is a potential consequence of not performing bivalving on a cast when edema is present?

Necrosis of tissues due to pressure. Signup and view all the answers

What should be done to secure the end of the splint if necessary?

Use silk tape for added security Signup and view all the answers

For what purpose can a hole be cut out in the splint?

To accommodate the thumb Signup and view all the answers

What is a recommended technique to form a splint effectively?

Creating a three-point mold technique Signup and view all the answers

When would it be necessary to perform a three-point mold?

When a basic mold is inadequate Signup and view all the answers

Which step should be considered before finalizing a splint application?

Ensuring the splint is properly sized and molded Signup and view all the answers

At which point should side struts be applied when not using external struts?

Mid-arm while angling obliquely Signup and view all the answers

What is a critical consideration when securing the splint with cast padding?

Ensure padding extends beyond the elbow Signup and view all the answers

What direction is recommended when securing cast padding around the thumb interspace?

Wrap from the thumb to the palm Signup and view all the answers

How should the initial application of cast padding be managed during the procedure?

Start laterally and ensure oblique angling Signup and view all the answers

What is a common mistake when preparing to secure the splint after the application of cast padding?

Skipping the requirement for oblique angles Signup and view all the answers

What is the first action to take when preparing to apply a figure-of-8 splint?

Hold one side of the gauze taut. Signup and view all the answers

Which step follows after placing the hand into the loop during splint application?

Spread your fingers and pull upward. Signup and view all the answers

What is the purpose of hooking each side around the great toe and second finger?

To ensure stability and proper immobilization. Signup and view all the answers

What should be done with the free end of the gauze once it is taut?

Pull it taut to finalize the splint position. Signup and view all the answers

Which of the following is an essential action when securing a splint?

Pull the gauze ends tight to immobilize effectively. Signup and view all the answers

What is the initial check required before applying a short-leg cast?

Confirm the correct cast length measurement Signup and view all the answers

What step is necessary if the cast material becomes too tight during application?

Perform a split in the cast Signup and view all the answers

After applying molding to the cast, what should follow?

Allow the cast to set without any movement Signup and view all the answers

What consideration should be made regarding the skin while applying a short-leg cast?

Ensure the skin is dry and clean Signup and view all the answers

What should be confirmed after splitting a cast if necessary?

The cast maintains its structural integrity Signup and view all the answers

Study Notes

Cast Padding

Place two layers of cast padding to allow a 1- to 2-cm cuff of padding proximal and distal to the plaster.

Splint Measurements

Measure out the correct length of splinting material.
Cut the splint to size.

Splint Application

Apply the figure-of-8 splint so that the center of the “8” comes to rest between the shoulder blades on the upper back.

Reduction Maneuver

If a reduction maneuver has been performed, obtain postreduction radiographs while the patient is wearing the sling or the sling and swath to ensure maintenance of the reduction.

Patient Positioning

The patient is supine on a stretcher with his or her leg elevated by traction.

Immobilizing Fractures

Immobilize the bone proximal and distal to the joint involved for intraarticular or periarticular fractures.
Place a folded ABD pad in the axilla to absorb perspiration.
Apply a sling and adjust the straps to provide some support for arm weight.
Secure the splint with an elastic or self-adherent bandage.
Carefully tear the cast padding to conform around the thumb interspace, stopping at the palmar flexion crease.
Wrap cast padding over the plaster to prevent plaster adhesion to the elastic or self-adherent bandage.
Continue wrapping proximally to the proximal forearm once the hand has been padded.
Prepare the plaster using the standard technique of wetting and laminating.

Long Leg Cast

Lower extremity splints and casts are a subject covered by Dr. Haythem Zein.

Plaster Casting Techniques

Remove excess moisture from the plaster before application.
Wring out any air pockets or bubbles from the plaster by running the strip between two fingers.
Apply the plaster slab to the limb ensuring it adheres properly.
Molding may be lost if the casting material hardens before completion, particularly around the ankle, resulting in equinus (foot pointing downwards).
Use a well-padded sling or neck padding with cast padding and/or an Army Battle Dressing to support the limb during casting.
During casting, the surgeon places the foot on the thigh and applies axial load to prevent equinus.
This naturally positions the knee at approximately 30 degrees of flexion.
Gravity can help, but not completely prevent equinus, particularly when the patient is prone.
To prevent equinus when the patient is prone, cut a 6-foot-long piece of 4- or 6-inch stockinette and use it to support the foot.

Bivalving a Cast

Bivalving is the process of splitting a cast longitudinally along two sides.
This is used when edema (swelling) is a concern in the acute setting.
Bivalving is done to decompress the limb.
Splitting the cast material and padding provides the most decompression.

Securing a Bivalve Cast

Cast padding can provisionally secure the cast at the wrist, forearm, and arm if necessary.
Side struts can be applied to further secure the cast.
Side struts are applied laterally at the mid-arm and angled obliquely towards the forearm.
A hole can be cut out for the thumb if desired.
The end of the strut can be secured with silk tape.

Applying a Three-Point Mold

A three-point mold may be desired.
The technique involves holding one side of the gauze taught while placing the other hand in a loop created by the gauze.
Spread the fingers and pull upward.
Hook each side of the gauze around the great toe and second finger.
Pull the free end taut.

AO Splint

The AO splint is a type of upper extremity splint.

Short-Leg Cast

Positioning the patient is an essential step in applying a short-arm cast.
Molding and reduction may be necessary before applying cast material.
Bivalving the cast may be necessary.

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Description

Test your knowledge on essential orthopedic splinting techniques including cast padding, splint measurements, and application. This quiz covers key principles such as patient positioning and post-reduction care. Ensure you're up to speed with proper methods for effective treatment.