Dr.S.Senthil Sailesh-functional cast bracing,PTBcast,sarmiento principle

sarmiento principle,pascals law,indication,PTB cast,spica,illustrated

1. Functional Cast Bracing & Spica Dr.S.Senthil Sailesh Senior Assistant Professor IOT MMC RGGGH

2. Functional Cast The concept of Functional cast bracing was described in the early 18 th century Sarmiento re-established the ideology in late 60s It is a type of bracing where the limb is allowed to do restricted function with the brace in

3. PRINCIPLES Continuing function while a fracture is uniting encourages osteogenesis promotes the healing of tissues and prevents the development of joint stiffness thus accelerating rehabilitation

4. PRINCIPLES Not merely a method of fracture reduction but an attitude towards fracture healing. Requirements for fracture healing Stability Maintenance of reduction Blood supply

5. Stability Fluid is not compressible Fascia cannot be stretched beyond the confines of the cast “Hydraulic container theory”; Sarmiento et al 1974

6. Loading Stability is maintained by loading in a functional cast Pressure & Load is transmitted without further deformation Rotation is restricted by components of the brace

7. Muscle contraction Intermittent loading of the fracture area by muscle activity & weight bearing, promote local blood flow & development of electrical fields which are beneficial for healing

8. Muscle only Muscle with Fascia POP

9. Blood supply

10. Bridging callus & Blood supply

11. INDICATION All middle third shaft fractures and lower 3rd junction fractures in long bones in co-operative patients .

12. TIMING For # tibia following low energy injury, bracing can be done with in first 2 wks . High energy injuries with more pain & swelling needs an additional period of 1 or 2 more wks. For humerus fractures , most conditions bracing can be done by 7-10 days time. Median time of brace removal Tibia - 18.7 wks , Humerus - 10 wks.

13. TIME TO APPLY F racture ends sticky Assess the # , when pain and swelling subsided 1 . Minor movts at # site should be pain free 2. Any deformity should disappear once D.F removed 3 . Reasonable resistance to telescoping . 4 . Shortening should not exceed 6.0 mm for tibia, 1.25 cm for femur

14. CONTRAINDICATION Intraarticular fractures. Compound fractures Lack of co-operation by the pt. Patient with spastic disorders Bed-ridden & mentally incompetent pts. Deficient sensibility of the limb [D.M with P.N] Fractures of both bones forearm when reduction is difficult.

15. NOT USED IN Galeazzi fractures Monteggia fractures Proximal half of shaft of femur [tends to angulate in to varus only used by expert] Isolated # of tibia, fibula Tends to cause varus angulation and to delay in consolidation of #.

16. Acceptable reduction 50% cortical contact <5-10* of varus / valgus angulation <10-15* of anterior / posterior bowing <5-7* of internal / external rotation Not more than 10-15mm of shortening

17. Sarmiento cast / ptb cast - principle Described by Sarmiento Below knee cast extending to the upper pole of the patella and with a firm moulding over the medial flare of the tibia, the patellar tendon and the popliteal space and shaped in a triangular manner at the upper end of the tibia Knee free to move allowed early ambulation as weight bearing forces should be transmitted from the ground to the proximal end of tibia bypassing fracture site

18. Sarmiento cast Ending point Starting point Moulding area Proximal patellar tendon Tibial flares Patellar tendon Poplitela space Metatarsal head

19. PTB

20. Humeral FCB

21. Spica - Definition A bandage folded into a spiral arrangement resembling an ear of wheat or barley . It is applied where immobilisation is required at areas where there is difference in size

22. HIP SPICA Hip spicas are most commonly used to correct developmental hip dysplasia ( DDH) children with hip, femur and pelvic fractures Other orthopaedic conditions which require stabilization of the hip and leg . Eg : Abduction Cast in Post THR dislocation Hips spicas are generally used for children from 6 months to 6 years of age

23. Abdomial padding and space for breathing Diaper Care

24. Types

25. Positioning       P roximal 1/3 frx :                    - hip flexion       45 deg                    - hip abduction   30 deg                    - ext rotation      20 deg             M id shaft fractures :                    - hip flexion        30 deg                    - hip abduction 20 deg                    - ext rotation      15 deg             Distal 1/3 frx :                  - hip flexion        20 deg                  - hip abduction   20 deg                  - ext rotation       15 deg

26. COMPLICATIONS COMPARTMENT SYNDROME   decreased with applying smooth contours around popliteal fossa limiting knee flexion to  <   90° avoiding excessive traction monitored for by observing the child's neurovascular exam and level of comfort

27. Minerva cast

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