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The Role of plaster of Paris in fracture management

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					  THE ROLE OF
PLASTER OF PARIS
       IN
   FRACTURE
 MANAGEMENT
      Its History :
The name POP originated from an accident to a house built on
       GYPSUM (semi hydrated Calsium sulphate) near the city of paris.
This house was accidentally burnt down.
On the following day it was rained, it was noted that the
      footprints of the people in the mud has set rocked hard
POP was first used in orthopedics by Mathysen, A Dutch surgeon
      in 1852
It is commercially available since 1931
Since then POP is used for immobilization of fracture site
  Its chemical formula
It is hemihydrate Calsium Sulphate

To make POP, GYPSUM is heated to drive off water

When water is added to the resulting powder it is set hard

   CaSO4 .H2O + H2O                 CaSO4 .2H2O + Heat

As this reaction is exothermic plaster becomes warm as it sets

POP bandages consist of a tough open-weave fabric coated
       with hemihydrated CaSO4 powder
                         Incomplete
                          •Slabs (Back slabs/Front slabs/U slabs)



POP types

                         Complete

Casts (completely encircle the limb)

Spica (Encircles a part of the trunk also)

Functional cast brace (Used for # tibia after initial immobilization)
Slabs types
              Back slabs
Types of casts




  Type of Cast                    Location

  Short arm cast:       Applied below the elbow
                              to the hand.




           Forearm or wrist fractures. Also used to hold the
               forearm or wrist muscles and tendons in place
               after surgery.
Types of casts cont…




   Type of Cast              Location

  Long arm cast:         Applied from the
                       upper arm to the hand.
Types of casts cont…




   Type of Cast              Location

 Arm cylinder cast:    Applied from the upper
                          arm to the wrist
Types of casts cont…




   Type of Cast             Location

   Short leg cast:      Applied to the area
                       below the knee to the
                               foot.
Types of casts cont…




   Type of Cast              Location

 Leg cylinder cast:    Applied from the upper
 (above knee cast)       thigh to the ankle.
Types of casts cont…




   Type of Cast              Location
   Long leg cast       Applied from the upper
                          thigh to the foot
Types of casts cont…




   Type of Cast              Location

Unilateral hip spica   Applied from the chest
       cast:           to the foot on one leg.
Types of casts cont…




   Type of Cast               Location

 One and one-half      Applied from the chest
  hip spica cast:      to the foot on one leg to
                       the knee of the other
                       leg. A bar is placed
                       between both legs to
                       keep the hips and legs
                       immobilized
Types of casts cont…




   Type of Cast              Location

 Bilateral long leg    Applied from the chest
  hip spica cast:        to the feet. A bar is
                        placed between both
                        legs to keep the hips
                       and legs immobilized.
Types of casts cont…




   Type of Cast              Location

 Short leg hip spica   Applied from the chest
        cast:          to the thighs or knees.
Types of casts cont…




   Type of Cast              Location

  Abduction boot       Applied from the upper
      cast             thighs to the feet. A bar
                       is placed between both
                        legs to keep the hips
                        and legs immobilized.
      Type of Cast           Location                      Uses

Short arm cast:      Applied below the elbow to Forearm or wrist fractures.
                        the hand.                  Also used to hold the
                                                   forearm or wrist
                                                   muscles and tendons
                                                   in place after surgery.

Long arm cast:       Applied from the upper      Upper arm, elbow, or
                        arm to the hand.            forearm fractures. Also
                                                    used to hold the arm or
                                                    elbow muscles and
                                                    tendons in place after
                                                    surgery.
Arm cylinder cast:   Applied from the upper      To hold the elbow muscles
                        arm to the wrist.            and tendons in place
                                                     after a dislocation or
                                                     surgery
       Type of Cast             Location                        Uses

Shoulder spica cast:   Applied around the trunk of   Shoulder dislocations or
                          the body to the               after surgery on the
                          shoulder, arm, and            shoulder area.
                          hand.
Minerva cast:          Applied around the neck       After surgery on the neck
                          and trunk of the body.         or upper back area.

Short leg cast:        Applied to the area below     Lower leg fractures, severe
                          the knee to the foot.         ankle sprains/strains, or
                                                        fractures. Also used to
                                                        hold the leg or foot
                                                        muscles and tendons in
                                                        place after surgery to
                                                        allow healing.
       Type of Cast                   Location                          Uses

Leg cylinder cast:           Applied from the upper          Knee, or lower leg
                                thigh to the ankle.             fractures, knee
                                                                dislocations, or after
                                                                surgery on the leg or
                                                                knee area.
Unilateral hip spica cast:   Applied from the chest to       Thigh fractures. Also used
                                the foot on one leg.            to hold the hip or thigh
                                                                muscles and tendons
                                                                in place after surgery
                                                                to allow healing.
One and one-half hip         Applied from the chest to the   Thigh fracture. Also used
   spica cast:                  foot on one leg to the          to hold the hip or thigh
                                knee of the other leg. A        muscles and tendons
                                bar is placed between           in place after surgery
                                both legs to keep the
                                hips and legs
                                                                to allow healing.
                                immobilized.
      Type of Cast                   Location                       Uses

Bilateral long leg hip spica Applied from the chest to   Pelvis, hip, or thigh
    cast:                       the feet. A bar is          fractures. Also used to
                                placed between both         hold the hip or thigh
                                legs to keep the hips       muscles and tendons
                                and legs immobilized.       in place after surgery
                                                            to allow healing.
Abduction boot cast:        Applied from the upper       To hold the hip muscles
                               thighs to the feet. A bar     and tendons in place
                               is placed between both        after surgery to allow
                               legs to keep the hips         healing.
                               and legs immobilized.
Application of a plaster
1.Padding       : Apply light padding of soft wool/ cotton/ Stockinettes
                 To avoid pressure sores,
                 Should apply distal to proximal
2.Dipping       : The hotter the water the faster the plaster sets
                 Salts fastens the setting
                 Hold it until the bubbles stop
                 Drain it until the drips stops
3.Application : Lay the bandage carefully and evenly
                 Should apply distal to proximal
                 Leave 3cm of padding at either end to protect the skin
                 against frction
                 Mould the plaster evenly
4.Once the plaster is applied and set check the followings
                 Edges
                 Circulation
     Instructions to be given to the patient
A)     1. If fingers or toes become swollen,blue,painful or stiff raise the limb
       2. If no improve in half an hour call in doctor or return to hospital
         immediately
B)     1. Exercise all joints not involved in plaster, especially fingers and toes
       2. If you have been fitted with a walking plaster walk in it once it dried.
       3. If plaster becomes loose or cracked, report to the hospital as soon
         as possible
       4. Sleep on a mattress placed on a hard bed or floor
       5. Keep the limb in plaster elevated when you are at rest
       6. Warn him that limb will be stiff and much hard work will be needed to
         restore normal functions
After care by the Doctor
1.Is there swelling:
     Look for features of circulatory impairment : If no
                Elevate the limb
                Encourage the movements of other joints

2.Is there discoloration of the toes/fingers : If yes
   Compare with the other side
   If bluish discolouration associate with oedema, indicate
         impaired venous return- Intervene to release pressure

3.Is there any evidence of arterial obstruction
   5 P’s to look       Pain
                       Paralysis(Fingers/Toes),
                       Paraesthesia(Fingers/Toes
                       Pallor,
                       Perising cold
Complications of POP
Due to tight fit       Due to improper                Others
                       application
   Pain               Joint stiffness              Plaster allergies
   Pressure sores     Loosening of   the cast      Increased
   Compartment                                              sweating
                       Plaster blisters and sores
    syndrome
                                                     Bugs may    enter
   Peripheral nerve   Breakage
    injuries
     How to prevent complications
   Pressure sores
            Adequate padding specially over bony points
            Cut a hinge window over bony prominences and pad it with cotton wool
            Treat to ulcers

   Oedema and compartment syndrome
          If edema persists more than 2-3 days and not settle with elevation of the
          limb and exercise-Split the plaster along its full length and keep it open
         1-2 cm along its length
          Cut the padding up to the skin

   Elevation of the limb and exercise-

   Plaster allergies
            Antihistamines
            Adopt an alternate method
Plaster removal
   Shears




   Electrical saws
    SLINGS





        SLINGS
    Are used to support an injured arm
    4 common types
Broad arm    Made out of triangular bandage
   sling     Support forearm and elbow
(Tiangular   Takes the   weight of the upper arm
bandage)
             Does not support the elbow
Collar and   Allows upper arm to hang free
   cuff      Wight of the limb maintains alignment


              EX: # Humerus
             Holds the hand up
High sling
             Used in hand injuries
             Combining of asling & a swathe
Swathe and   Worn under the clothes

  body       Prevents movement of arm

 bandage     Used after   shoulder operations
Cosmetically accepted slings
FIXATION ( EXTERNAL / INTERNAL)
              vs
 NON OPERATIVE MANAGEMENT
External fixation
 Advantages


Can be used in skin loss/infection
Easy to manipulate
Simply to apply than internal fixations
Applicable to maxillofacial #
Less preplanning than internal fixation
Rigid fixation
Early mobilization
External fixation
  Disdvantages
 Pintrack infections
                Seropurulent drainage
                Superficial cellulitis
                Deep infections
                Osteomyelitis
 Pin loosening
 Discomfort to patient
 Malalignment( Angulation)
 Soft tissue impalement & Complications due to a surgery
 Compartment sydrome
                ? Pin causing bleeding
                ? Underlying preexisting injury
Internal fixation
Advantages


Rigid fixation ( High quality reduction)
Early mobilization
Early discharge from hospital
Comfortable to patient
Internal fixation
Disdvantages
 High risk of infections
 Additional trauma during operation
 Avascular necrosis(Pins may damage retinacular vessels)
 Osteoporosis adjacent to fixator
 Expensive than other modalities
 Need careful preplanning
 Tight rigidity may delay natural healing
 Complications due to a surgery
 Scar is ugly
Non operative management
Advantages

Cheap
Easily available
Minimal infectious risk
Less planning is needed
Easy to remove
Not contraindicated in MRI
Minimal allergic reactions
No operative complications
Non operative management
Disdvantages
 Not a rigid fixation
 Delayed mobilization
 Skin irritation
 Manipulation is difficult
 Uncomfortable to patient
 Malunions are common
 Cosmetic?
 Complications

				
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