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Ortho > Casting and Splinting > Flashcards

Casting and Splinting Flashcards

1
Q

1st step in assessing fx/dislocation?

A
  • assess neuromuscular and circulatory status
  • attempt to ascertain MOI, this may alert physicain to other possibly assoc injuries
  • as well as provide clues as to type of injury involved
  • Radiographs should be obtained if fx or dislocation is suspected
  • these should be obtained after reduction and immobilization of fx or dislocation
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2
Q

Steps of reducing finger dislocation?

A
  • exam to determine nerve and tendon fxn if possible
  • xray to confirm dx
  • anesthetize w/ digital block
  • reduce dislocation: apply traction in line w/ distal portion of finger, deformity should increase slightly just prior to jt going back in place, should be felt as a click
  • take further XRs if necessay to rule out chip fx
  • strap injured finger to adjacent finger, warn pt that swelling will persist for several months
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3
Q

Steps for shoulder dislocation tx?

A
  • take past medical hx (has this happened b/f?)
  • clinical exam (nerve fxn)
  • XR to r/o possible fx (head of humerus)
  • several methods for reduction:
    scapular rotation
    traction/counter traction
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4
Q

What is a greenstick fx?

A
  • incomplete fx in long bone of chid (bones aren’t calcified yet)
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5
Q

What is an open fx?

A
  • bone breaks and pierces overlying skin (osteomyelitis is more common)
  • 4 grades
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6
Q

Spiral fx?

A
  • spirals part of length of long bone
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7
Q

Describe diff b/t smith and colle’s fx?

A
  • smith: falling on flexed hand, radius moves volarly
  • colles: FOOSH - radius moves dorsally and head of radius moves volarly
  • in both cases: worry about median nerve
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8
Q

What are we concerned about w/ scaphoid fx? Dx? Tx?

A
  • tenuous blood supply, has high incidence of AVN in waist and proximal fx, often reqr bone grafting
  • dx: high clinicla suspicion even w/ normal XR
  • f/u impt: repeat XR and early bone scan in pts w/ persistent pain
  • thumb spica w/ prolonged immobilization
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9
Q

Why were circumferential casts abandoned in ED?

A
  • increased compartment syndrome and other complications
  • splints are ideal for ED: allows for swelling
  • splints easier to apply
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10
Q

Why are splints used?

A
  • to immobilize ortho injuries
  • to promote healing
  • maintain bone alignment
  • diminish pain
  • protect injury
  • help compensate for surrounding muscular weakness
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11
Q

What are the indications for splinting?

A
  • fx
  • sprains
  • jt infections
  • tenosynovitis
  • acute arthritis/gout
  • lacerations over jts
  • puncture wounds and animal bites of hands or ft
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12
Q

Conditions that benefit from immobilization?

A
  • fx
  • sprain
  • severe soft tissue injuries
  • reduced jt dislocations
  • inflammatory conidtions: arthritis, tendinopathy, tenosynovitis
  • deep laceration repairs across jts
  • tendon lacerations
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13
Q

Deciding on splinting vs casting?

A
  • assess stage and severity of injury
  • potential for instability
  • risk for complications
  • pt’s fxnl requirements
  • splints for:
    1. simple and stable fx
    2. sprains
    3. tendon injuries
    4. other soft tissue injuries
  • casting for definitive and/or complex fx management - can put buckle fx in cast (doesn’t swell up)
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14
Q

Advantages and disadvantages of splinting?

A

advantage:

  • faster and easier
  • static or dynamic
  • pressure related complications less likely: skin breakdown, necrosis, compartment syndrome
  • easy removal

disadvantage:

  • lack of pt compliance, and excessive motion at injury site
  • not for unstable or potentially unstable fx like segmental or spiral or dislocated fx
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15
Q

Advantages and disadvantages of casting?

A

advantages:

  • mainstay for tx for most fx
  • more effective immobilization

disadvantages:

  • reqr more skills
  • more time to apply
  • higher risk of complications (swelling, pressure sores)
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16
Q

How many layers of plaster of paris do you use for splinting?

A
  • UE: use 8-10 layers
  • LE: 12-15 layers, up to 20 if big person (but increased risk of burn)
  • can take up to 1 day to cure
  • exothermic rxn when wet: recrystallizes (can burn pt)
17
Q

Specific splints and orthoses used?

A 
UE:
- elbow/forearm:
long arm posterior
double sugartong
- forearm/wrist:
volar forearm/cockup
sugartong
- hands/fingers:
ulnar gutter
radial gutter
thumb spica
finger splints 
LE:
- knee:
knee imobilizer/bledsoe
 bulky jones
post knee splint 
- ankle: post ankle, stirrup
- foot: hard shoe (not used for jone's fx - needs ski boot (immobilize peroneals)
18
Q

Indications for long arm posterior splint?

A

elbow and forearm fx:

  • distal humerus fx
  • both bone forearm fx
  • unstable proximal radius or ulna fx (sugar-tong better)
  • doesn’t completely eliminate supination/pronation so either add on anterior spint or use a double sugar tong if complex or unstable distal forearm fx
19
Q

Indications for double sugar-tong?

A
  • elbow and forearm fx: prox/mid/distal radius and ulnar fx

- better for most distal foreamr and elbow fx b/c limits flex/extension and pronation/supination

20
Q

Indications for forearm volar spint aka cockup splint?

A
  • soft tissue hand/wrist injuries- sprain, carpal tunnel night splints, etc
  • most wrist fx, 2nd-5th metacarpal fx
  • most add a dorsal splint for increased stability: sandwich splint
  • not used for distal radius or ulnar fx (still can supinate and pronate) - need to use posterior splint/sugartong in this case
21
Q

Use of forearm sugar tong?

A
  • distal radius and ulnar fx

- prevents pronation/supination and immobilizes elbow

22
Q

Correct position for splinting?

A
  • most hand splints: neutral position or position of fxn
  • hand in beer position (wrist slightly extended/ fingers flexed)
  • if immobilizing metacarpal neck fx: MCP jt should be flexed to 90 degrees
  • for thumb fx: immobilize thumb as if holding a wine glass
23
Q

Indications for ulnar and radial gutter?

A
  • ulnar:
    fx, phalangeal and metacarpal and soft tissue injuries of little and ring fingers
  • radial:
    fx, phalangeal and metacarpal, and soft tissue injuries of index and long fingers
24
Q

Indications for thumb spica?

A
  • scaphoid fx: seen or suspected (check for snuffbux tenderness)
  • De quervain tenosynovitis
  • notching plaster prevents buckling when wrapping around thumb, wine glass position
25
Q

Indications for finger splints?

A
  • sprains: dynamic splinting (buddy tapping)

- dorsal/volar finger splints - phalangeal fx, though gutter splints probably better for proximal fx

26
Q

Jones compression dressing (aka Bulky Jones) indications and procedure?

A
  • short term immobilization of soft tissues and ligamentous injuries to knee or calf
  • allows slight flexion and extension - may add posterior knee splint to further immobolize the knee
    (post op tibial fx, olecranon bursitis)
  • procedure:
    stockinette and webril
    1-2 layers of thick cotton padding, 6 inch ace wrap
27
Q

Indications for posterior ankle splint?

A
  • distal tibia/fibula fx
  • reduced dislocations
  • severe sprains
  • tarsal/metatarsal fx
  • use at least 12-15 layers of plaster
  • adding a coaptation splint (stirrup) to posterior splint eliminates inversion/eversion especially useful for unstable fx and sprains
28
Q

Indications for stirrup splint?

A
  • similar to post splint ( distal tibia/fibular fx, tarsal/metatarsal fx, severe sprains, dislocations)
  • less inversion/eversion and actually less plantar flexion compared to posterior splint (still allows for dorsiflexion)
  • great for ankle sprains
  • 12-15 layers of 4-6 inch plaster
29
Q

What is a bledose brace?

A
  • articulated knee brace
  • amt of allowed flexion and extension can be adjusted
  • used for ligamentous knee injuries and post-op
30
Q

When is a hard shoe used?

A
  • for foot fx and soft tissue injuries (except jones)
31
Q

CI to casting?

A
  • early (premature casting): casting b/f maximal swelling has occurred can cause necrosis and possibly compartment syndrome
  • open wound: never place cast over an open wound as potential for infection
  • unstable fx: need surgical repair
32
Q

Complications of casts or splints?

A
  • compartment syndrome
  • ischemia (reduced risk for splinting, don’t apply webril and ace tightly, instruct to ice and elevate)
  • heat injury (thermal injury as plaster dries, hot water, increased number of layers, extra fast drying, poor padding all increase risks)
  • pressure sores or skin breakdown (smooth webril and plaster well)
  • infection (clean, debride and dress all wounds b/f splint, recheck if sig wound or increasing pain)
  • dermatitis
  • jt stiffness
  • neuro injury

** any complaints of worsening pain: take splint off and look!

33
Q

What instructions should you give to your pt?

A
  • elevate limb
  • check circulation
  • watch for increased swelling
  • check mobility distally
  • protect skin from rough edges
  • keep cast dry
  • don’t remove cast
  • don’t put anything inside cast
34
Q

When should you tell pt to return to ER or physician?

A
  • pain
  • skin color changes
  • sensation changes
  • inability to move fingers
  • bad odor or staining
  • too tight or too loose
  • foreign objects in cast

Ortho (24 decks)

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