Semester 6 – Orthopedic Tutorial

Tutorial 10 – Ortho 2
Mrs.Lim is a 72-year-old housewife who slipped and fell in her bathroom this morning. She
was immediately taken to the hospital by her daughter. At the casualty department she was
diagnosed to have sustained a close fracture of her right distal end radius (Colles’ fracture)

1)What else would you like to ask in the history?

Pain Description: Can you describe the pain you are experiencing? When did it start,
and has it changed since the injury occurred?

Mechanism of Injury: How exactly did you fall? Did you try to catch yourself with
your hands?

Medical History: Do you have any previous history of osteoporosis or other bone
diseases? Are you currently on any medications like corticosteroids?

Functional Status: What is your level of independence at home? Were there any
previous issues with mobility or balance?

Other Symptoms: Have you noticed any swelling, bruising, or changes in skin color?
Are you experiencing pain elsewhere?

2)How will you examine this patient?

Visual Inspection: Look for deformity, swelling, bruising, and skin integrity around
the injured area.
Palpation: Gently palpate around the wrist and forearm to assess for tenderness,
warmth, or any obvious deformity.
Range of Motion: Carefully assess the range of motion of the wrist and fingers if the
patient can tolerate movement.
Neurovascular Assessment: Check the capillary refill time, pulse distal to the fracture
(e.g., radial pulse), and sensory and motor function of the hand and fingers to assess
for nerve compression or vascular injury.
Functionality: Assess the functionality of the hand and fingers, checking for the
ability to perform basic movements like finger flexion and extension.

Her right radius and ulna fractures were treated by close manual reduction with below elbow
Plaster of Paris Cast application.

3)What is Plaster of Paris (POP) made up of?

Plaster of Paris is composed of calcium sulfate hemihydrate. When mixed with water
(last time use vinegar or sugar in the water), it hardens through an exothermic
 reaction, setting into a solid, stable matrix useful for immobilizing broken bones as it
conforms well to the body's contours.
4)State the principles in applying a POP cast?
Padding: Proper padding using soft materials around bony prominences to prevent
pressure sores.
Skin Protection: Ensure the skin is clean and dry before application to prevent
irritation and infection.
Layering: Apply the POP in smooth, overlapping layers to ensure even thickness and
strength.
Molding: While the POP is still wet, mold it to the contours of the limb to provide
effective immobilization without being too tight.
Setting: Allow the POP to set completely and avoid weight-bearing or excessive
movement until fully hardened.
5)What is the difference between a backslap and a full cast? State its individual uses
Backslap: Partial cast that covers only a portion of the circumference of the limb.
Used initially to allow for swelling and to provide some support without full
immobilization.
Full Cast: Encircles the entire limb, providing complete immobilization. Used after
swelling has reduced or for definitive treatment.
6)What is POP care/advise?
Elevation: Keep the limb elevated to reduce swelling.
Monitoring: Regularly check for changes in sensation, temperature, and color in the
limb or digits.
Dryness: Keep the cast dry to maintain its integrity. Use a waterproof cover during
bathing.
Avoid Inserting Objects: Do not insert objects inside the cast to scratch itches, as this
could cause injury or infection.

A few hours after the cast application, Mrs. Lim developed severe pain over her right arm
and forearm along with numbness of her fingers on the same side.

7)What do you think happened to her?

The symptoms suggest acute compartment syndrome, a serious condition where
increased pressure within a muscle compartment in the arm impairs blood flow and
nerve function.
8)What are the other complications of POP?
Skin breakdown and pressure sores
 Circulatory impairment
Nerve compression
Joint stiffness
Cast syndrome (psychological or physiological issues due to prolonged
immobilization)
9)What are the stages of fracture healing?

Hematoma Formation: Immediately after the fracture, a blood clot forms.

Fibrocartilaginous Callus Formation: A soft callus of cartilage and fibrous tissue forms within
a few days.
Bony Callus Formation: The soft callus is replaced by a hard bony callus of new bone over
several weeks.
Bone Remodeling: Over months, the healed bone slowly remodels to the normal bone
architecture depending on stress placed upon it.
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