Cast Immobilization Techniques PDF

Tema 3 Cast immobilization. Basic principles • All patients, who support bandage or fixing is applied, it must be submitted the following day to control plaster. • Those patients, who support bandage is applied, should be given an information sheet regarding how to treat plaster 2 Basic princip...

Tema 3 Cast immobilization. Basic principles • All patients, who support bandage or fixing is applied, it must be submitted the following day to control plaster. • Those patients, who support bandage is applied, should be given an information sheet regarding how to treat plaster 2 Basic principles • In cases of fractures, the X-ray control should be generally in conformity with arrangement "days 1, 7, 14, 28”. • After each change bandage support, there should be a control x-ray • Plaster bandages those that cause pain should be immediately removed "The patient plastering is always right" 3 Basic principles • In all cases immobilizations of the lower extremities, the need for medical thrombosis prophylaxis with drugs should be evaluated. • Must perform at least two controls per week thrombotic PT prophylaxis ??????? 4 Indications for Plaster • • • • • • • • • fractures Injury capsule-ligament-tendon luxation Soft tissue injury infections Nerve damage After surgery Detection of postoperative bleeding Pain relief The purpose of each rest should be the prompt mobilization and at the same time the best possible recovery 5 Complications plastering • Own elements: •Sensitivity reactions •Own cast of placements •Compression syndromes •Nervous •Vascular Limitations irreversible movements (Volkmann) Thrombosis dermonecrosis Pressure damage Compartment syndrome nerve damage 6 Protocol • Analgesia • Reduction • Immobilization – Splint or cast 7 ANALGESIA • The two most commonly local anesthetics used lidocaine and bupivacaine. (+ Adrenaline for vasoconstrictor.) •Techniques for analgesia: – intraarticular injection. – Blocking anesthetic fracture hematoma – nerve block ----------------- Caution ----------------8 REDUCTION • Principle of the three points – Increase deformity – Traction 9 IMMOBILIZATION • Splint – Splint apposition – Pre padded splint • Cast – Plaster bivalve: acute phase if concerned edema. – Placing a wedge: If excessive angulation after reduction 10 11 Plaster room 12 Plaster room 13 Conditions for good Plastering •appropriate extension. •Lightweight and durable. •No nerve and / or vascular compression •In functional position. 14 Materials for plastering Tubular mesh Bandage Gypsum Laminate Cotton Water 15 Applying plaster 1. Place materials close 2. Place the affected limb in one position 3. Protect the member with cotton (Left-right) 4. Always keep in touch with the member 5. Smooth 6. Dip the plaster bandage 16 Applying plaster Conditions to wet plaster bandage: 1. Open 10-20 cm 2. Keep it in the water for at least 5 seconds. or until bubbling stops 3. Remove from water and compress the ends 4. Place from left to right as the padding 17 Applying plaster • Make circular and spiral turns. • Don’t Make inverted loops. • Place the band distal to proximal. • Let dry. 18 speed Setting 1. Extra fast: 2-4 min. Fast: 5-8 min. Slow: 10-18 min. Measures to accelerate the setting time Ex.- Hot water 19 Care plastering • You must not have contact with any hard object • A cast is not dry until fulfilled made 48 hours • Outpatients with plaster casts of the upper limbs should wear a sling until the plaster is dry • Lower limb or the patient should not walk or use crutches (management Crutches ??) • Do not wet plaster • The cast is given the name citing the edges including 20 How to remove the plaster •It must be made in the soft tissues avoiding bony prominences •On the upper limb for the ventral region •In the lower limb for the lateral region Dry Wet 21 Plaster splints They are cotton bandages impregnated with plaster, used to immobilize an injury of the musculoskeletal system body. Indications • open or closed fractures • Preoperative and postoperative • amputations • grafts • Burns • Bruises, injuries and dislocations • pain syndromes • orthopedic corrections 22 Plaster splints Material • elastic bandage • padding • Plaster • water 23 Plaster splints Importance: 1. Analgesic 2. Antiinflammatory 3. avoid complications 4. Decreases bleeding 5. Easy handling 24 Placement technique 1. Should they be to explain simply and clearly how to proceed. 2. Have enough material to use. 3. Measure the splint. 4. Immobilize the joint one above and one below. 5. Padding and bands distal to proximal region. 25 Fundamental principles for the treatment of fractures Böhler 1941 • In each fracture, anatomic reduction should be performed • The fracture should be immobilized in that position until the end of the healing process of the body • To prevent circulation problems, muscular atrophy and stiffness, they must mobilize a lot and if possible, all of the affected joints and the whole body during the immobilization 26 Bracing according A. Sarmiento • In 1967 the bandage support for walking as SARMIENTO enabling functional treatment by allowing early weight bearing, allowing free movement of the knee joint is introduced. • Supports the patellar tendon and the femoral condyles • Ideal for treatment of long bone fractures • The brace uses the hydrostatic effect as the soft parts of an incompressible liquid avoiding shear forces and rotary 27 28 Ilizarov Fixator with wires twisted transfixión for treatment: – fractures – pseudarthrosis – To perform bone elongations. 29 functional positions of the joints for immobilization 30 31 32 33 34 35 36 Immobilization with fiberglass Synthetic bandage Description – Mesh formed by flexible glass fiber in two directions – Impregnated with polyurethane resin which is polymerized with water and moisture. – They are X-Ray transparent, breathable and are accepted by C.E. % polymer changes so varies the resistance of immobilization. 38 Synthetic bandage • Characteristics: – Great formability, molding and laminating. – Control setting time based on the moisture provided allowing for quick and easy application. – Greater patient comfort and ease of application for healthcare professionals. – Quickly setting in 4-5 minutes, a complete immobilization is obtained. – It allows charging 30 minutes. – Much lighter than plaster, allowing patient mobility. – waterproof and lasting bandage. – It does not contain latex 39 Venda Sintética • Characteristics: – variable stiffness: the stiffness can be increased by inserting a rigid reinforcing bands at the point where we need greater fracture stabilization, keeping the rest of the semi-rigid dressing and allowing isometric muscle work – In many applications you do not need the protective padding, reducing the volume of the dressing. – The edges of the bandage remain soft and atraumatic favoring patient comfort. – The compressive effect deriving from the elasticity of the band promotes the reabsorption of posttraumatic edema. – Removal of the dressing with scissors or simply unwinding the bandage. No dust, to be removed with scissors. BENEFITS for PT 40 Synthetic bandage • Cautions: – All bands are valid for 3 years from the date of manufacture, provided they have been stored at room temperature (15-25 degrees), without sudden changes in temperature and provided the container is intact. – The polyurethane resin adheres strongly to the skin and to clothing. Gloves should be worn during application of the product, taking special care with the patient's skin that has not been protected. – Prolonged humidity of the pad without a proper and thorough drying (dryer with cold air) can cause skin maceration. 41 Immobilization of the ankle joint 42 Immobilization of the ankle joint Indications 1. Rupture of the lateral and medial ankle ligaments 2. Sprained ankle, syndesmotic ankle sprains 3. lateral malleolar fractures treated surgically 4. First aid with great swelling ankles. 5. Broken metatarsal stem and neck. 6. Fractures of the base of the fifth metatarsal. 7. Fractures Weber A and B 43 Immobilization of the ankle joint 44 Immobilization of the ankle joint 45