Casting and splinting

Casting and splinting

1. Casting & Splinting
Najla M. Bedaiwi
Orthopedic Surgery

2. Indications
•Fractures.
•Sprains.
•Reduced joint dislocations.
•Inflammatory conditions:
(e.g. Arthritis, Tendinopathy, Tenosynovitis)
•Deep laceration repairs across joints.
•Tendon lacerations.

3. The Initial Approach
•Full Assessment :
oStage and severity of the injury
oSkin
oSoft tissues
oNeurovascular status
oRisk of complications
oPatient's functional requirements.

4. Splint vs. Cast

5. Splint
•Splinting is the preferred method of
immobilization in the acute care setting.
•Faster and easier to apply.
•May be static or dynamic.
•Noncircumferential 
•Allows for regular inspection of the injury site.
•Allows for the swelling that occurs during the
initial inflammatory phase of the injury.
•Less pressure-related complications.

6. Cast
•Casting is the definitive treatment for most
fractures.
•Provides more effective immobilization.
•Require more skill and time to apply.
•Higher risk of complications if not applied
properly.

7. Plastervs. Fiberglass

8. Plaster
•Made from gypsum ‐calcium sulfate dihydrate.
•When water is added :
Calcium sulfate .. Soluble Insoluble.
•Warm water ‐faster set, ↑ Risk of burns.
•Fast drying ( 5 ‐8 minutes ).
•Can take up to 72 hours to cure.
•Upper extremities ‐8‐10 layers.
•Lower extremities ‐12‐15 layers.

9. Fiberglass
•Synthetic material.
•Fiberglass bandages Polyurethane.
•Cures rapidly (20 minutes).
•Stronger, lighter.
•Less messy.
•Less moldable.
•More expensive.

10. Splints -Upper Limb
•Elbow/Forearm
oLong Arm Posterior.
oDouble Sugar ‐Tong.
•Forearm/Wrist
oVolar Forearm / Cockup.
oSugar ‐Tong.
•Hand/Fingers
oUlnar + Radial Gutter.
oThumb Spica.
oFinger Splints.

11. Long Arm Posterior
Double Sugar ‐ Tong
Sugar ‐ Tong
Volar Forearm / Cockup
Ulnar + Radial Gutter

12. Splints -Lower Limb
•Knee
oKnee Immobilizer / Bledsoe.
oBulky Jones.
oPosterior Knee Splint.
•Ankle
oPosterior Ankle.
oStirrup.
•Foot
oHard Shoe.
Posterior Ankle Splint

13. Circumferential Cast
•Short Arm.
•Long Arm.
•Short Leg.
•Long Leg.
•Cylinder.

16. Materials and Equipment
•Adhesive tape.
•Bandage scissors.
•Basin of water at room temperature.
•Casting gloves.
•Elastic bandage.
•Cotton padding.
•Plaster or fiberglass casting material.
•Stockinette.

17. Setting Time Factors
•Factors that speed setting times.
•Higher temperature of dipping water.
•Reuse of dipping water.
•Use of fiberglass.
•Factors that slow setting times.
•Cooler temperature of dipping water.
•Use of plaster.

18. Guidelines for Proper Application
•Use appropriate amount and type of padding
•Place from distal to proximal with a 50% overlap.
•Properly pad bony prominences and high-pressure
areas.
•Properly position the extremity before, during,
and after application of materials
•Avoid tension and wrinkles on padding, plaster,
and fiberglass
•Avoid excessive molding and indentations

21. Complications
•Loss of reduction.
•Tight cast or compartment syndrome :
oUnivalving 30% pressure drop
oBivalving 60% pressure drop
oCutting of cast padding to further reduce pressure
•Pressure necrosis As early as 2 hours after
cast/splint application.

22. Complications
•Thermal injury
oAvoid plaster thicker than 10 layers
oAvoid water hotter than 24°C
oUnusual with fiberglass
•Cuts and burns during cast removal
•Joint stiffness Joints should be left free
when possible .

23. Follow Up
•Patient education.
•Elevation of the injured extremity to decrease pain and
swelling.
•Continuous checking for signs of compartment
syndrome.
•Strong opioids should be used with caution during the
first 2-3 days after splinting.
•Avoidance of getting the material wet or pushing
objects inside a cast to scratch.
•Most splints and casts require initial follow-up within 1
week after application.

24. Thank You
Special thanks to Mr. Mohamed Hassen
Senior Orthopedic Technician