Casting/Splint

Question 1

When and why do we want to immobilize a patient?

Answer 1

It decreases pain and allows the injury or Fx to heal in a the correct anatomical position.

Question 2

What is a buddy splint used for?

Answer 2

Fractured or injury of the toe and finger.

Question 3

Rule of thumb for buddy splints?

Answer 3

Temporary splint, esp. if a fracture; need to place a gauze in-between the fingers or toes to decrease friction of the skin and DO NOT make it extremely tight. Also, be cautious of putting tape directly onto the skin.

Question 4

What is the Ulnar Gutter Splint used for?

Answer 4

Boxer’s Fracture

Question 5

How is the ulnar gutter splint applied?

Answer 5

Applied in neutral position or position of function (like holding a soda can); the wrist is about 15-35 degrees of extension, MCP at 45-90 degrees and PIP/DIP in full extension.

Have your pt hold something while applying the splint.

Question 6

What is the Radial Gutter Splint?

Answer 6

Not as common but for an injury to the wrist or forearm on the radial side; applied the same as the ulnar gutter w/a hole created for the thumb.

Question 7

What is the Volar Splint?

Answer 7

The splint or immobilization is on the volar side to not allow flexion of the wrist; mainly used for Carpal Tunnel Syndrom.

It is also useful to rest the wrist extensors.

Question 8

What is the Sugar Tong Splint and what is it used for?

Answer 8

Aka “U” Splint; used to stable a distal wrist Fx, ankle injuries and also double, wrist and arm injuries.

Question 9

Indication for a Cylinder Cast?

Answer 9

Patellar Dislocation; it does not incorporate the ankle or foot.

Question 10

What is the general rule for immobilization and further recommendations?

Answer 10

Immobilize the joint above and below the injury site (ex. Radial mid-shaft - immobilize wrist and elbow).
Must control displacement BOTH longitudinally and rotationally.
There are many rules that apply depending on the bone and fracture type.
Recommendations: post-reduction films to compare with pre-reduction film.

Question 11

What is external fixation?

Answer 11

Closed Reduction = non-operative manipulation of bone, usually in which the proximal fragment is held stable and the distal fragment is moved into position.

Casts/Splints/External fixation devices that require pins.

Question 12

What is internal fixation?

Answer 12

Intra-operative pins, wires, screws, plates, intramedullary rod, ORIF.

Question 13

What does ORIF stand for?

Answer 13

Open Reduction Internal Fixation.

Question 14

What is traction?

Answer 14

Brief application used for rapid reduction or prolonged application used for gradual reduction, sometimes requires pins.

Question 15

What is the difference between Casts and Splints?

Answer 15

Casts = circumferential; usually not placed initially due to swelling.

Splint = NOT circumferential; good for initial injury immobilization because it allows for swelling.

Question 16

What is the Thumb Spica Splint/Cast used for and applied?

Answer 16

Injuries that involve the thumb; it incorporates the thumb MCP and sometimes the IP.

Question 17

Important landmarks in the forearm, hand and lower extremity? Why are they important?

Answer 17

Forearm - lat/med epicondyle. If not involving the elbow, splint or cast 2 finger width from the anterior elbow crease.

Hand - distal palmar crease.

LE - Tibial Tuberosity, lat/med malleolus, heel and plantar side of foot.

All bony prominences need to be carefully padded including the heel to decrease rubbing and pain. These landmarks are important to allow for adequate range of motion of uninjured joints during the healing period.

Question 18

Posterior Leg Splint?

Answer 18

Not-commonly used; used for mid-shaft and distal fractures of the LE.

Question 19

Cadillac Splint?

Answer 19

Used more often; it is a short-leg, sugar tong splint with posterior reinforcement, 3/4th cast.

Question 20

Long Leg Splint?

Answer 20

Fractures or dislocations of the ankle and knee or Fx of the tibia, fibula and distal femur.

It extends from the Metatarsal heads to high thigh, 15-30 degrees of knee flexion.

Question 21

Jones Splint and indication?

Answer 21

A long leg splint that does not involve the ankle or foot.

Used for patellar dislocation.

Question 22

Short arm cast indications?

Answer 22

MCP Fx, stable distal radius and ulnar Fx, Fx and Dislocations of the carpal bones.

Position the hand in a position of comfort.

Question 23

Long arm cast?

Answer 23

Elbow dislocations, Fx of the radius, ulna or humerus.

Position 90 degrees at elbow w/hand in position of comfort.

Question 24

Short Leg Cast and important for this casting?

Answer 24

For ankle Fx or Foot Fx; it must extend from the Tibial tuberosity to MTP heads.

It is important to keep the ankle at 90 degrees throughout splinting.

Question 25

Which injury is the only injury to immobilize the foot in plantar flexion?

Answer 25

Achilles tendon injuries.

Question 26

What is an Equinous Deformity?

Answer 26

A condition of the foot and ankle where the foot is held in a downward position and the individual has difficulty with dorsiflexion.

Result of prolonged immobilization where the ankle was not properly held at 90 degrees.

Question 27

Long Leg Cast?

Answer 27

Distal femur, knee injuries.

Question 28

Plaster Adv. and Disadv/Limitations?

Answer 28

Advantages:
-cheap, less allergenic, easy to store, long-shelf life.

Disadvantages:
-heavy, falls apart when water applied after initial hardening, clogs sinks, long drying time.

Question 29

Synthetic/Fiberglass Adv. and Disadv/Limitations?

Answer 29

Advantages:
-not as messy or heavy as plaster, water resistant, high strength to weight ratio, better X-ray transmission.

Disadvantages:
-expensive, sm. % allergic.

Question 30

Purpose of stockinet?

Answer 30

To protect the skin from moisture and not as itchy as padding. It is not required, but highly recommended.

Question 31

Purpose of Padding/Webril?

Answer 31

It provides cushion, protects bony prominences, protects from exothermic reactions and saw protection.

Question 32

What are some cast modifications or accessories?

Answer 32

Cast window, Bivalved, Cast boot, Walking heels, Cast hinges.

Question 33

What is a bi-valved modification?

Answer 33

Split down both sides of a cast to relieve pressure from swelling; may be secured w/velcro straps or ace wrap over cast.

Question 34

What is a Cast Window modification?

Answer 34

An area cut out of cast to allow for observation of surgical wounds, suture removal, wound mgmt.
The cut out must be replaced and secured back in place.

Question 35

What is a Cast boot?

Answer 35

protects the cast and improves the pt’s gait and stability when walking.

Question 36

What are cast hinges?

Answer 36

provides joint mobility.

Question 37

What are walking heels?

Answer 37

Built into cast permanently; protects the cast bottom, improves gait and stability.

Question 38

What’s important to know about a Sling/Swathe?

Answer 38

Instruct the pt to remove often to move the shoulder (depends on injury type); may develop frozen shoulder syndrome.

Question 39

Common causes of exothermic burns?

Answer 39

warm or hot dip water, high room temp or humidity, undersaturation of bandage, too thick application of plaster, overwrapping w/material that restricts air circ. while drying, covering or supporting the cast (blanket or pillow) while it is still setting.

Question 40

Cast instructions for the pt?

Answer 40

Elevate, allow cast to stay open to air to facilitate drying, do not get wet or remove unless instructed, avoid excessive heat or humidity, avoid excessive activity, do not alter the cast or put things into the cast.

Question 41

Call or Return if what type of problems?

Answer 41

• Loose, cracked or broken cast.
• Cast rubs skin causing irritation.
• Uncomfortably snug or tight.
• Excessive pruritus.
• Finger or toes numb or discolored.
• moderate discomfort develops into severe or constant pain.