Orthopaedic Cast and

Braces

By Lisa Paxton MSN, RN, CPN

Cast Petalling
Why

do we do it?

Preserve skin integrity by smoothing rough

edges of the cast
Reduce soiling of any cast near the groin area
How

to petal:

Cut moleskin padding approximately 3x3 inches,

rounded at one end
Place tape about 1.5 inches from cast edge and
fold over the edge of cast. Take care to keep
tape smooth and even.
Follow with a second piece of tape, overlapping
the first.

Cast Petalling
When

to petal cast
Petal casts within 2 hours of patient reaching the
unit to prevent edema from hampering ability to
petal the cast. It will be very hard to petal if the
extremity is edematous.
Pre medicate the child prior to petalling the cast
Even if a cast is well padded, it may still need to
be petalled if there is a chance of the padding
becoming soiled- such as the diaper area edges of
a hip spica.
Parents should be taught how to petal cast
at home and be given extra petals to use if
needed.

Diapering with a spica

cast
How

To:

Use a smaller size diaper than usual and tuck

between skin and cast. Use a Poise pad inside the
diaper for extra absorption, particularly at night.
Check the diaper every one to 2 hours while awake
and at least twice at night. Change diaper as soon
as it is wet or soiled.
Teach parents/ caregivers how to diaper and
instruct on changing times
This is extremely important!! Cast will not be
changed due to soiling.

Spica & Petrie Cast

Petrie Cast
Bilateral Spica Cast

Unilateral
Spica cast

Resources
Health

topics

Cast care
http://www.cincinnatichildrens.org/h
ealth/info/orthopaedics/home/cast-ca
re.htm
Hip Spica cast care
http://www.cincinnatichildrens.org/h
ealth/info/orthopaedics/home/hip-spi
ca.htm
Petri Cast care
http://www.cincinnatichildrens.org/h
ealth/info/orthopaedics/home/petrie-

Body Cast
Types

Minerva Cast (restricts cervical and upper back movement)

Applied around the neck and trunk of the body
Cervical spine injuries
Torticollis release

Pantaloon Cast (Hips will not move. No sitting or walking)

Applied around the trunk and to the knees of the body
Spondylolysis
Spondyliothesis
Lumbar spine injuries

Risser Cast (Can sit and walk)

Applied from the neck to the waist of the body
Scoliosis
Kyphosis
Thoracic spine injuries

Minerva Cast

Photo. Courtesy of
http://www.flickr.com/photos/casts/3817050453/in/set72157622028529562/

Risser & Pantaloon Cast

Body Cast
Health

topics

Risser & Pantaloon Cast

http://www.cincinnatichildrens.org/he
alth/info/orthopaedics/treatment/riss
er-pantaloon.htm

Orthopaedic Braces
Underarm

Orthosis (TLSO)

Prevents progression of spinal

deformity
Thoracic-Lumbo-Sacral-Orthosis

Protection after surgery

Prevent progressive scoliosis
Pavlik

Harness

Babies with hip disorders

Milwaukee

Brace

Deformity of the spine

Orthopaedic Braces
TLSO Brace

Pavlik Harness

TLSO Brace

Orthopaedic Braces
Follow

the links to find out more

information on the following braces
Health Topics
Milwaukee Brace
http://www.cincinnatichildrens.org/he
alth/info/orthopaedics/home/milwaukee
.htm
Pavlik Harness
http://www.cincinnatichildrens.org/he
alth/info/orthopaedics/home/pavlik-ha
rness.htm
Underarm Orthosis (TLSO)

Orthopaedic patient and muscle

spasms
Muscle Spasms:
Spasms can occur when a muscle is
overused and tired, particularly if it is
overstretched or if it has been held in the
same position for a prolonged period of time.
In effect, the muscle cell runs out of energy
and fluid and becomes hyper excitable and
develops a forceful contraction. This spasm
may involve part of a muscle, the whole
muscle, or even adjacent muscles.

Signs & Symptoms

Abnormal

muscle rigidity
Pain in the affected area
Unrelieved pain after pain meds given
Could also be painless, just bothersome to
patient
Increased heart rate
Increased respiratory rate
Inability to sleep or interrupted sleep
Irritability
Tightness in the muscle of the extremity
Throbbing or grabbing

Questions to ask the

patient/parent
Are

you having pain?

What does it feel like?
Does he/she always wake up this
frequently or have difficulty with
sleeping?
Is the pain medicine not relieving
the pain?

Medication for Spasms

Valium

Most of the time ordered PRN for

spasms
If pain medication is not relieving the
pain:
Assess the patient
Determine if it could be muscle spasms
Give valium or ask the MD to order
valium
Re assess after valium given

What is Valium
A

muscle relaxant
Generally 0.075 mg/kg Q4 every 4-6 hrs. PRN

Be

proactive w/ treatment

You have the ability to give PRN pain medication

Round the Clock . (Hold for sedation)

Its

easier to prevent pain

before it becomes worse

IV Valium
IV

Rapid injection may cause respiratory

depression or hypotension
Infants and children: Do not exceed 1-2
mg/minute I.V. push
Adults: Maximum infusion rate: 5 mg/minute;
maximum concentration for administration: 5
mg/mL
Avoid extravasation (tissue necrosis may
occur)
Injection solution available as 5 mg/mL
Is not compatible with any IVFs

How to administer Valium

IV
Stop

the IVFs
Flush with one ml NS
Slowly push Valium as directed in the
previous slide
Flush with one ml of NS
Restart fluids
Valium will burn at the IV site. Prepare
patient.

References

CCHMC Health topics. Retrieved on November 2, 2009 from

http://www.cincinnatichildrens.org/health/info/default.htm

Debra Wolf RN, MSN (2009). Post-op Pain in the Orthopedic

Patient. Presented to A3N in October 2009

Minerva Cast/Brace. Retrieved November 2,2009 from:

http://www.mayfieldclinic.com/PE-brace.htm

Pediatric Lexi-Drugs Online:

http://www.crlonline.com/crlsql/servlet/crlonline

Pictures courtesy of :
http://images.google.com/images?hl=en&rlz=1R2ADRA_
enUS345&q=picture+of+petrie+spica+cast&um=1&ie=UTF
-8&ei=ISPvStLsKYv6MbesmYQM&sa=X&oi=image_result_gr
oup&ct=title&resnum=1&ved=0CBkQsAQwAA