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
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
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
4
Q
What is a greenstick fx?
A
- incomplete fx in long bone of chid (bones aren’t calcified yet)
5
Q
What is an open fx?
A
- bone breaks and pierces overlying skin (osteomyelitis is more common)
- 4 grades
6
Q
Spiral fx?
A
- spirals part of length of long bone
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
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
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
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
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
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
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)
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
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)
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
