Closed Reduction, Casting, and Traction

Question 1

goals of reducing all displaced fractures (2)

Answer 1

minimize soft tissue trauma, provide patient comfort

Question 2

ways to make splints respect soft tissues (2)

Answer 2

pad all bony prominences, allow for post injury swelling

Question 3

basic principle to correct and reduce a fracture (2)

Answer 3

axial traction, reversal of mechanism of injury

Question 4

parameters to restore with reduction (3)

Answer 4

length, rotation, angulation

Question 5

joint immobilization along with closed reduction

Answer 5

joint above and below injury

Question 6

minimum point-contact for stable closed reduction

Answer 6

3-point contact

Question 7

which extremity is a “bulky” jones splint typically used for

Answer 7

lower extremity

Question 8

what two slabs make up the “bulky” jones

Answer 8

posterior slab, u-shaped slab medial and lateral

Question 9

how is the u-shaped slab applied in a “bulky” jones

Answer 9

applied from medial to lateral around the malleoli

Question 10

which extremity and fracture location are sugar-tong splints used on

Answer 10

upper extremity distal forearm fractures

Question 11

how is the u-shaped slab applied in a sugar-tong splint

Answer 11

applied to the volar and dorsal aspects of the forearm encircling the elbow

Question 12

which fracture location are coaptations splints used on

Answer 12

humerus fractures

Question 13

how is the u-shaped slab applied in a coaptation splint

Answer 13

applied to medial and lateral aspects of the arm encircling the elbow and overlapping the shoulder

Question 14

casting goals (2)

Answer 14

semirigid immobilization, avoidance of pressure or skin complications

Question 15

padding a cast things to know (4)

Answer 15

distal to proximal, 50% overlap, minimum 2 layers, extra padding for bony prominences

Question 16

cold water effect on plaster

Answer 16

maximizes molding time

Question 17

hot water effect on plaster

Answer 17

decreased molding time

Question 18

danger with hot water-soaked plaster

Answer 18

burning the skin

Question 19

preferred water temperature for plaster

Answer 19

room temperature

Question 20

plaster width for thigh

Answer 20

6-inch

Question 21

plaster width for leg

Answer 21

4- to 6-inch

Question 22

plaster width for arm

Answer 22

4- to 6-inch

Question 23

plaster width for forearm

Answer 23

2- to 4-inch

Question 24

fiberglass pro’s (2) and con (1)

Answer 24

more resistant to moisture (breakdown), 2-3x stronger for any given thickness, more difficult to mold

Question 25

general ankle position in below knee cast (short leg cast)

Answer 25

neutral

Question 26

knee position when applying short leg cast

Answer 26

flexion

Question 27

action required when constructing a walking cast

Answer 27

build up plantar surface

Question 28

preferred casting material for walking cast

Answer 28

fiberglass

Question 29

general approach to above knee cast (long leg cast)

Answer 29

apply below the knee first

Question 30

how to add rotational stability to long leg cast

Answer 30

mold supracondylar femur

Question 31

distal volar extent of short and long arm casts

Answer 31

palmar crease

Question 32

earliest pressure necrosis can occur after cast/splint application

Answer 32

2 hours

Question 33

ways to treat/prevent tight cast or compartment syndrome (2)

Answer 33

uni/bivalving, cut cast padding

Question 34

upper limit of plaster thickness to prevent thermal injury

Answer 34

10 ply

Question 35

ankle position of function

Answer 35

neutral dorsiflexion

Question 36

hand position of function (intrinsic plus)

Answer 36

mcp flexed (70-90 degrees) and ip joints in extension

Question 37

maximum force applied with skin traction

Answer 37

10 lbs

Question 38

bucks traction definition

Answer 38

soft dressing around calf and foot attached to weight off foot of bed

Question 39

bucks traction maximum weight

Answer 39

7-10 lbs

Question 40

patients at risk for skin complications from skin traction (2)

Answer 40

elderly and rheumatoid

Question 41

weight limit for lower extremity skeletal traction

Answer 41

20% of body weight

Question 42

local anesthesia trick with skeletal traction pin insertion

Answer 42

anesthetize the sensitive periosteum

Question 43

pin options for skeletal traction

Answer 43

thin wire or steinmann pin (smooth or threaded)

Question 44

general size of steinmann pin for skeletal traction

Answer 44

largest pin (5-6mm)

Question 45

where is the pin placed with tibial skeletal traction

Answer 45

2cm posterior and 1cm distal to tibial tubercle

Question 46

with tibial skeletal traction, in which direction is the pin drilled and why

Answer 46

lateral to medial to avoid common peroneal nerve

Question 47

with femoral skeletal traction, in which direction is the pin drilled and why

Answer 47

medial to lateral to avoid neurovascular bundle

Question 48

where is the pin placed with calcaneal skeletal traction

Answer 48

medial to lateral, 2 to 2.5cm posterior and inferior to medial malleolus

Question 49

anterior halo pin sites

Answer 49

above eyebrow

Question 50

posterior halo pin sites

Answer 50

superior and posterior to ear

Question 51

structures to avoid with anterior halo pin sites (3)

Answer 51

supraorbital artery, nerve, sinus