1- Basic science of orthopaedic casting

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Questions and Answers

What is the first step in preparing a splint according to the process outlined?

Prepare layers of splinting material of the measured length and width. (correct)

Soak the plaster in hot water.

Allow the plaster to set until it hardens.

Activate the plaster by placing it in cold water.

How should plaster be activated for splint preparation?

By using boiling water.

By mixing it with other substances.

By placing it in tepid water. (correct)

By applying it directly without water.

What is the recommended condition of water for soaking plaster?

Ice-cold water.

Distilled water.

Hot water.

Tepid water. (correct)

What is the purpose of soaking plaster before application?

To soften it for easier application. Signup and view all the answers

After preparing the splinting materials, what action must be taken with the plaster?

Soak it in tepid water until softened. Signup and view all the answers

What is the minimum degree of flexion required for the metacarpophalangeal (MCP) joints?

70 degrees Signup and view all the answers

What should not be allowed within the borders of the antecubital fossa?

Cast padding edges Signup and view all the answers

Why is it important to have at least 70 degrees of flexion in the MCP joints?

To ensure dexterity Signup and view all the answers

What anatomical area is specifically mentioned regarding cast padding?

Antecubital fossa Signup and view all the answers

Which of the following is a requirement for manipulating MCP joints effectively?

Adequate flexion of at least 70 degrees Signup and view all the answers

What is the first step in the process outlined?

Prepare the stockinette. Signup and view all the answers

Which step involves positioning the stockinette?

Position the stockinette. Signup and view all the answers

After wrapping the extremity in cast padding, what is the next step?

Create three cast padding cuffs. Signup and view all the answers

What is emphasized in the last steps of the process?

Preparing the plaster roll. Signup and view all the answers

Which of the following steps is not listed in the process?

Creating a waterproof layer. Signup and view all the answers

What position can the patient take to rest their elbow comfortably?

Rest on a stretcher Signup and view all the answers

Which method is suggested to support the patient's arm at a comfortable level?

Utilize a bedside table Signup and view all the answers

What starting point is indicated for positioning the arm?

Palmar flexion crease Signup and view all the answers

In which orientation should the patient's arm be when using a bedside table?

Upright Signup and view all the answers

Which of these positions is NOT suitable for resting the patient's arm?

Standing with support Signup and view all the answers

What material can be used to increase the stability of a spica cast?

Twisted bar of fiberglass casting material Signup and view all the answers

Which of the following is NOT mentioned as a method to stabilize a spica cast?

Adding padding around the cast Signup and view all the answers

What is the primary purpose of the materials mentioned for the spica cast?

To confer additional stability and strength Signup and view all the answers

Which option is likely to be used as a connecting bar for a spica cast?

A broomstick Signup and view all the answers

What is a characteristic of the materials suggested for the spica cast?

They confer additional stability. Signup and view all the answers

What should be applied to the ABD pad before folding it?

Talcum powder Signup and view all the answers

Why is pad material applied to the neck strap of the sling?

To prevent pressure complications at the back of the neck Signup and view all the answers

In the correct sequence for sling preparation, which step should be performed after having the patient stand?

Pad the neck strap Signup and view all the answers

What is the focus of placing talcum powder on the ABD pad?

To ease application and reduce friction Signup and view all the answers

Which of the following is a necessary action to enhance patient comfort when using a sling?

Pad the neck strap to prevent pressure Signup and view all the answers

What is the specific position recommended for padding in a cylinder cast?

Posterior aspect of the knee Signup and view all the answers

Where should a thick cuff of cast padding be applied for effective cylinder casting?

At the ankle Signup and view all the answers

Which step is critical before applying the cast padding in the casting process?

Ensure the joint line is spanned correctly Signup and view all the answers

What is the primary consideration when applying padding to the joint areas in casting?

To avoid pressure points Signup and view all the answers

What technique is indicated for ensuring an effective mold of the extremity in a cylinder cast?

Applying a thick, even layer of cast padding Signup and view all the answers

What is a significant limitation of a posterior elbow slab?

It does not prevent flexion and extension. Signup and view all the answers

What must be incorporated to ensure immobilization in addition to a posterior elbow slab?

A form of strut Signup and view all the answers

Which factor is least likely to enhance the effectiveness of a posterior elbow slab?

Flexibility within the slab structure Signup and view all the answers

How can the effectiveness of a posterior elbow slab be increased during immobilization?

Preventing movement with a strut Signup and view all the answers

Why might a posterior elbow slab not be sufficient on its own?

It fails to immobilize all elbow motions. Signup and view all the answers

What is the primary function of external struts applied to a splint?

To provide resistance to extension only Signup and view all the answers

Which statement is true regarding the material used for external struts?

They are made of tape to ensure weight reduction Signup and view all the answers

How do external struts affect joint movement?

They limit extension but allow full flexion Signup and view all the answers

When are external struts applied in the splinting process?

After the splint is definitively secured Signup and view all the answers

What type of movement do external struts not provide resistance to?

Flexion of the joints Signup and view all the answers

What may occur if a splint is too long and extends beyond the metacarpal heads?

Permanent finger stiffness or contractures Signup and view all the answers

Which statement is true regarding the length of a splint?

It should not be too long or too short to avoid impairments. Signup and view all the answers

What is the primary role of a correctly sized splint?

To prevent permanent contractures and stiffness Signup and view all the answers

What is a potential consequence of a splint that is too short?

Lack of support for the fingers Signup and view all the answers

How does the length of a splint affect finger function?

An appropriately sized splint prevents complications. Signup and view all the answers

What should be done if the splint material is excessively long for the limb?

Cut it to a smaller size. Signup and view all the answers

What type of bandage should be used to overwrap the splint?

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

In the splint application process, what is crucial to ensure for the patient's comfort?

There should be proper limb positioning and splint fit. Signup and view all the answers

During the application of a splint, what happens if the splint material is not cut or folded appropriately?

Patient comfort may be compromised. Signup and view all the answers

What is the primary aim of applying an overwrap to a splint?

To provide additional support to the splint and injured limb. Signup and view all the answers

What are the indicators of a poorly constructed plaster cast?

Uneven plaster thickness Signup and view all the answers

Which of the following characteristics does NOT describe a badly made plaster cast?

Uniform thickness Signup and view all the answers

What is the recommended thickness of the cuff of padding to be allowed proximal and distal to plaster during cast application?

1 to 2 cm Signup and view all the answers

How many layers of cast padding should be applied as part of the process outlined?

Two layers Signup and view all the answers

Which issue is NOT typically associated with inadequate plaster application techniques?

Consistent coloration Signup and view all the answers

In what manner should cast padding be positioned in relation to the plaster for effective application?

With a 1 to 2 cm cuff both proximal and distal Signup and view all the answers

What visual characteristic is indicative of frustration with plaster quality during cast application?

Onion skinning Signup and view all the answers

Which of the following statements is a common misconception about plaster cast quality?

Fuzzy texture indicates a properly made cast Signup and view all the answers

Which of the following is least likely to be a concern when applying cast padding?

Type of plaster used for casting Signup and view all the answers

What is the primary purpose of allowing adequate padding when applying a cast?

To prevent skin irritation and ensure comfort Signup and view all the answers

What is the ideal position for a patient to rest their elbow comfortably while ensuring optimal arm support?

Using a bedside table Signup and view all the answers

Which part of the arm is designated as the starting point for proper positioning during the splinting process?

Palmar flexion crease Signup and view all the answers

In what position should the patient's arm be arranged when utilizing a bedside table?

With a slight flexion angle Signup and view all the answers

What additional support can be provided to enhance comfort for a patient resting their arm on a bedside table?

Using a folded towel Signup and view all the answers

Which action is NOT commonly performed to promote proper arm positioning during splinting?

Extending the wrist fully back Signup and view all the answers

What position should a patient be in if no reduction is necessary for ankle positioning?

Prone with knees bent to 90 degrees Signup and view all the answers

Which statement accurately describes the position of a patient when facilitating proper ankle positioning?

The patient can lay prone with the knees flexed. Signup and view all the answers

Which of the following describes a recommended patient position for ankle alignment?

Laying prone with a knee angle of 90 degrees Signup and view all the answers

When positioning a patient for ankle facilitation, which position is discouraged?

Lying supine with legs extended Signup and view all the answers

In the context of ankle positioning, what does 'prone position' refer to?

Lying face down with the knees flexed Signup and view all the answers

What is the recommended practice for applying padding around a joint?

Avoid seams on the concave side of the joint. Signup and view all the answers

Which technique is suggested to avoid complications in joint padding?

Avoid wrinkles in padding. Signup and view all the answers

What is the purpose of applying a two-ply cuff of cast padding?

To prevent slips and enhance immobilization. Signup and view all the answers

How should cast padding be positioned in relation to the fossa?

It should span the fossa. Signup and view all the answers

Which is a common mistake to avoid when applying cast padding?

Leaving gaps without padding. Signup and view all the answers

Which anatomical areas are identified as having the highest risk of compartment syndrome after cast application?

Elbows, forearms, and the lower leg and foot Signup and view all the answers

What caution should be taken when applying a cast in an acute setting?

Monitor for symptoms of compartment syndrome Signup and view all the answers

What is the implication of the highest risk areas mentioned concerning cast application?

These areas should be regularly checked for circulation and swelling Signup and view all the answers

Which of the following statements is true regarding compartment syndrome risk post-cast application?

It is most prevalent in certain anatomical areas Signup and view all the answers

In which scenario should extreme caution be exercised when applying a cast?

In the acute setting after injury Signup and view all the answers

What is the minimum degree of flexion required in the metacarpophalangeal (MCP) joints?

70 degrees Signup and view all the answers

What should not be permitted within the borders of the antecubital fossa?

Cast padding edges Signup and view all the answers

Why is it important for the patient to achieve at least 70 degrees of flexion in the MCP joints?

To facilitate hand function Signup and view all the answers

What is a critical aspect when applying cast padding at the antecubital fossa?

Avoid placing edges immediately within the fossa borders. Signup and view all the answers

What is a potential complication of improperly positioned cast padding in the antecubital fossa?

Nerve compression Signup and view all the answers

What is the recommended location for applying a thick cuff of cast padding in a cylinder cast?

On the posterior aspect of the knee Signup and view all the answers

Which area is specifically mentioned for padding in the casting process?

The posterior aspect of the knee Signup and view all the answers

What is the primary purpose of applying cast padding at the ankle when using a cylinder cast?

To provide comfort and prevent pressure points Signup and view all the answers

What must be considered when spanning the joint line with a cast?

Proper alignment and support must be maintained Signup and view all the answers

In the context of preparing a cylinder cast, what is essential after applying cast padding at the knee?

Ensuring that the padding is flat and evenly distributed Signup and view all the answers

What is the initial step when securing plaster with an elastic bandage?

Begin at the thumb and work distally. Signup and view all the answers

Which statement is true about preparing the thumb web space during plaster application?

An opening for the thumb web space can be cut into the bandage. Signup and view all the answers

What is the direction of wrapping the elastic bandage when securing the plaster?

Work distally to the mid forearm. Signup and view all the answers

Which of the following options is NOT a correct step when securing plaster?

Work proximally towards the shoulder. Signup and view all the answers

What is the main consideration when using an elastic bandage after applying plaster?

It should be wrapped in overlapping layers for stability. Signup and view all the answers

Study Notes

Plaster Onlay Splint

Prepare 10 to 12 layers of splinting material of the measured length and adequate width
Activate plaster by placing it in tepid water
Allow plaster to soak until it is softened
Patients must be able to flex their metacarpophalangeal joints to at least 70 degrees

Creating a Splint

Prepare the stockinette
Position the stockinette
Wrap the extremity in cast padding
Create three cast padding cuffs
Fold the stockinette over proximally and distally
Prepare the plaster roll in the usual fashion
Do not allow edges of cast padding to lay immediately within the antecubital fossa borders

Position for Splint

Supine: The patient's forearm should be resting at a 90-degree angle at the elbow
Prone: The patient's forearm should be resting at a 90-degree angle at the elbow
Upright: Use a bedside table to allow the patient to place his or her arm at a comfortable level

Splint Placement

Start at the palmar flexion crease
A broomstick, twisted fiberglass casting material, or another connecting bar can be used to increase stability and strength to the spica cast

Sling and Swath

Have the patient stand
Pad the neck strap of the sling to prevent pressure complications at the back of the neck.
Place talcum powder on the ABD pad and fold the pad in half, with the talcum side facing out.
A posterior elbow slab is very weak and does not provide significant immobilization.
Some form of strut must be made to prevent flexion/extension
External struts are made of tape and applied to the splint after it is definitively secured, providing resistance to extension but not flexion.
It is crucial that the splint be neither too long nor too short.
If the splint is too long and extends beyond the metacarpal heads, finger flexion is significantly impaired and permanent finger stiffness or contractures may ensue.
Span the joint line with cast padding at the posterior aspect of the knee
Apply a thick cuff of cast padding at the ankle.

Cylinder Cast

Plaster Cast

A poorly made cast will have uneven plaster thickness, appear fuzzy and display "onion skinning"
To allow for padding, place two layers of cast padding to create a 1-2cm cuff of padding proximal and distal to the plaster.
For upright positioning, utilize a bedside table to position the patient's arm comfortably.
Begin application at the palmar flexion crease.
Placing a patient in a prone position with a 90 degree bend in the knee may aid in proper ankle positioning when reduction is unnecessary.

Cast Application Precautions

Elbows, forearms, lower legs, and feet have the highest risk of compartment syndrome after cast application, use caution when applying casts in acute situations.
Avoid seams on the concave side of joints, use padding to span the fossa.
Avoid wrinkles in padding.
Apply a two-ply cuff of cast padding at the terminal portions of the cast.
The patient must be able to flex their metacarpophalangeal (MCP) joints to at least 70 degrees.
At the antecubital fossa, do not allow edges of cast padding to lay immediately within the fossa borders.
Secure the plaster with an elastic bandage, begin at the thumb and work distally.
An opening for the thumb web space can be cut into the elastic or self-adherent bandage.
Work distally to the mid forearm.
Span the joint line with cast padding at the posterior aspect of the knee.
Apply a thick cuff of cast padding at the ankle.

Cylinder Cast Application

Apply a thick cuff of cast padding at the ankle.

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Description

This quiz covers essential techniques for creating and applying plaster onlay splints. It includes preparation steps, patient positioning, and safety considerations. Test your knowledge on the proper procedures for effective splint placement.