CAST FIXATION COURSE

DEPARTMENT OF TRAUMATOLOGY AND HAND SURGERY

INSTITUTE OF MUSCULOSKELETAL SURGERY

Manual Skill Course - 2014

 CAST FIXATION COURSE

DATE:
on 30/04/2014 afternoon: between 03:00 – 06:00 pm

LOCATION / MEETING POINT:

Conference Room (1st Floor), Department of Traumatology
Akác u 1, Pécs, HU

NUMBER OF PARTICIPANTS:
limited to 20 (5th year medical students)

ORGANIZERS:
László G Nöt, MD
Dept. of Traumatology & Hand Surgery
/email: laszlogn@gmail.com/
Sigrid Anna Vikjord
Repr. of 5th Year English Program Students
/sigrid@nmfutland.com/
 CAST FIXATION COURSE

PROGRAM SCHEDULE
(for manual practice: 4-5 students / groups)

I. PLANTAR SPLINT
45 minutes - manual practice

II. CIRCULAR-SPLIT PLANTAR CAST

45 minutes - manual practice

III. CIRCULAR BENNETT-CAST

45 minutes - manual practice

IV. DESAULT and GLICHRIST BANDAGE

15 minutes - demonstration only

V. CIRCULAR SHORT UPPER EXTREMITY CAST – FIBERGLASS

15 minutes - demonstration only
 HISTORY

Egypt - 5th Dynasty Egypt (2465-2323 BC)

First Splinting of Fractures.

Antonius Mathysen (1852): first cast fixation

X-ray machine (1895): reduction is available

Nowadays: fluoroscope (early 1960’s) and

portable extremity CT-scanner
 LEGACY OF LORENZ BÖHLER (1885 – 1973)

Lorenz Böhler (practicing in Vienna) gained expertise by treating injured

soldiers during the First and Second World Wars. Written on his
experience, Böhler’s Book series became the ‘gold-standard’ of
conservative treatment until the operative era…
 INDICATIONS

•  non-operative fracture treatment

•  ligament / tendon injuries
•  additional temporary support following operation
•  septic / aseptic inflammation

Böhler’s ‘3R’ principles:

I. Reduction
II. Retention
III. Rehabilitation
 DIFFERENT TYPES OF CASTING MATERIALS

1. Plaster of Paris (traditional orthopedic cast)

Cotton bandage that has been impregnated with plaster of
paris, which hardens after it has been made wet.
Chemical reaction: calcined gypsum (roasted gypsum) + water
is added  the more soluble form of calcium sulfate returns
to the relatively insoluble form by producing heat);
reaction: 2 (CaSO4·½ H2O) + 3 H2O → 2 (CaSO4.2H2O) + heat (!!)
“The water should be tepid, or lukewarm, with an ideal temperature
between 22° and 25° C.” /AO Manual/
Note: the setting of unmodified plaster starts about 10 minutes after mixing
and is complete in about 45 minutes; however, the cast is not fully dry for
72 hours.
 DIFFERENT TYPES OF CASTING MATERIALS

2. Fiberglass and polyurethane: bandages of synthetic

materials: knitted fiberglass bandages impregnated with
polyurethane
3. Thermoplastic bandages: synthetic rubber-based material
with the advantage of thermoforming condition (possibility of
readjustment)

Advantages:
-  lighter & dry much faster than plaster bandages
- thin, breathable, water-resistant (limited)
Disadvantages:
- conventional plaster can be more easily moulded to
make a snug and therefore more comfortable fit.
-  plaster is much smoother and does not snag clothing
or abrade the skin.
 APPLICATIONS

•  Splint
•  Circular split casting
•  Full circular cast /additional reduction: wedging of cast/
•  Upper extremity / lower extremity casts
•  Desault-bandage + cast fixation
•  Spica cast: shoulder spica, single hip spica
•  Body casts: Minerva cast
 CAST FIXATION TOOLS

padding

tools

casting material
 HOW TO AVOID MISTAKES ?

Circular-split casts and splints:

ALL LAYERS must be accurately cut through !!

Mistakes may lead to:

-  Strangulation
-  Volkmann’s ischemic contracture
- Contribution to Sudeck-dystrophy
HOW TO AVOID MISTAKES ?

Proper padding
 HOW TO AVOID MISTAKES ?

Proper application of bandage Proper positioning of joints

Proper moulding of cast Proper length of cast

 FAILURE OF CUTTING THROUGH ALL THE LAYERS…

STRANGULATION

PRESSURE TISSUE DAMAGE

BULLAE-FORM
SKIN LESION
 IMPORTANT PRE-COURSE VIDEO LECTURES

Please, watch these educational videos about the main types of

cast fixation methods.
During the course, the time will be limited only for a quick demonstration of the
manual practice (‘tricks and tips’).

Please, copy this link to the webpage-address line of your web-browser:

http://www.aovideo.ch/catalog/
Then, search for keyword: ‘circular cast’ → choose the following video tutorials:
a, Foot and Ankle - Fractures and Sprains - Lower Leg Backslab Splint
b, Foot and Ankle - Fractures and Sprains - Lower Leg Circular Cast
c, Tibia, Knee and Femur - Fractures and Soft-tissue Injuries - Upper Leg Circular Cast
d, Radius and Ulna - Fractures - Basic Forearm Circular Cast
e, Metacarpal and Phalanx - Fractures and Soft-tissue Injuries – Thumb Spica Leg
f, Radius and Ulna - Fractures - Above Elbow Circular Cast
 USEFUL LINKS TO FOLLOW:

If you are interested in, please, check the following links for
further information:

1. AO / ASIF
www.aotrauma.org: AO Surgery Reference & Online Education

2. Orthopaedic Trauma Association (OTA)

http://ota.org/about/

3. trauma.org
http://www.trauma.org/archive/traumabank.html

4. AAOS: www.aaos.org
THANKS FOR YOUR
ATTENTION!