22: Casts and Wraps - Frush

Question 1

cast vs. splint

Answer 1

cast

• circumferential
• allows for greater stabilization
• does not allow for edema as much

splint

• posterior with possible stirrup
• not as stable
• allow for edema
• good in acute trauma

Question 2

why does plaster get hot when setting?

Answer 2

exothermic reaction due to gypsum

Question 3

plaster v. fiberglass

Answer 3

plaster
- slower setting, heavy, hot when setting
+ excellent moldability, inexpensive

fiberglass
-/+ quick setting
- good moldability, more expensive
+ light weight, less exothermic reaction

Question 4

how do you apply a splint?

Answer 4

1. stockinette to knee
2. cast padding from toes to knee (1 roll for foot, 1 roll for ankle)
3. dip fiberglass/plaster in water
4. apply posteriorly and/or medially and laterally
5. fold stockinee tover splint material ends
6. apply thin layer of cast padding (sometimes)
7. apply 4” ace to foot, 6” ace to leg

Question 5

steps for fiberglass cast application

Answer 5

1. stockinette from past toes to knee
2. cast padding from toes to knees (1 foll foot and 1 roll leg to pad bony prominences)
3. apply 3” fiberglass roll to foot
4. apply 4” fiberglass roll to leg
5. fold down stockinette
6. apply 3” fiberglass roll from toes to knee (colored)

Question 6

special rules for a weightbearing cast

Answer 6

• must be at 90 degrees

- accordion layer about half 3” fiberglass roll the length of foot and apply plantarly, secure with remainder of roll

Question 7

good technique for cast saw

Answer 7

taking saw in and out of cast to allow blade to cool

poor - keeping saw uniformly in cast while removing

Question 8

putting cast up too high can cause…

Answer 8

damage to common peroneal n.

should be 2-3 finger widths below

too short of a calf will cause too much movement and could lead to ulceration

Question 9

risk factors for cast complication

Answer 9

• local anesthesia
• neuropathy
• difficulties with communication
• chronic edema
• improperly applied cast
• dipping water greater than 50 C

Question 10

what might indicate an improperly applied cast

Answer 10

• too tight
• too loose
• goes past MPJ
• goes above tibial tuberosity
• wrinkles or indentations
• not enough padding

Question 11

what is a jones compression wrap?

Answer 11

layered dressing for edema control

traditionally 3 layers, sometimes only 2 due to edema and bulk

one layer = 1 roll of cast padding from met heads to tibial tuberosity
- 4” ace on foot and 6” ace on leg

Question 12

“soft cast”

Answer 12

unna boot

• zinc oxide impregnated gauze wrap
• apply ace, tape or coban over top
• applied from met heads to tibial tuberosity

Question 13

indications for unna boot

Answer 13

• venous stasis ulcers
• edema control (sprains, acute injuries)
• more tolerable in hot climates than Jones Compression