![]() When water is added, the more soluble form of calcium sulfate returns to the relatively insoluble form, and heat is produced.Ģ (CaSO 4 Plaster of Paris is calcined gypsum (roasted gypsum), ground to a fine powder by milling. Plaster bandages consist of a cotton bandage that has been combined with plaster of paris, which hardens after it has been made wet. Both too much and too little padding are associated with potential complications and poor fit of the splint or cast ( Table 5).An orthopedic cast, or simply cast, is a shell, frequently made from plaster or fiberglass, that encases a limb (or, in some cases, large portions of the body) to stabilize and hold anatomical structures-most often a broken bone (or bones), in place until healing is confirmed. If significant swelling is anticipated, more padding may be used however, care must be taken not to compromise the support provided by the splint by using too many layers. Prominences at highest risk are the ulnar styloid, heel, olecranon, and malleoli. Extra padding is placed at each end of the intended splint border, between digits, and over areas of bony prominence. The padding should be at least two to three layers thick without being constrictive, and should extend 2 to 3 cm beyond the intended edges of the splint ( Figure 4). Extra layers may be added over the initial layers, if necessary. This technique will automatically provide two layers of padding. Padding is wrapped circumferentially around the extremity, rolling the material from one end of the extremity to the other, each new layer overlapping the previous layer by 50 percent. Next, layers of padding are placed over the stockinette to prevent maceration of the underlying skin and to accommodate for swelling. Patient education regarding swelling, signs of vascular compromise, and recommendations for follow-up is crucial after cast or splint application. Compartment syndrome, thermal injuries, pressure sores, skin infection and dermatitis, and joint stiffness are possible complications of splinting and casting. As such, casts provide superior immobilization, but they are more technically difficult to apply and less forgiving during the acute inflammatory stage they also carry a higher risk of complications. Casting involves circumferential application of plaster or fiberglass. Disadvantages of splinting include lack of patient compliance and increased motion at the injury site. Splints are faster and easier to apply allow for the natural swelling that occurs during the acute inflammatory phase of an injury are easily removed for inspection of the injury site and are often the preferred tool for immobilization in the acute care setting. ![]() ![]() Splinting involves subsequent application of a noncircumferential support held in place by an elastic bandage. Once the need for immobilization is ascertained, casting and splinting start with application of stockinette, followed by padding. The initial approach to casting and splinting requires a thorough assessment of the injured extremity for proper diagnosis. The ability to properly apply casts and splints is a technical skill easily mastered with practice and an understanding of basic principles. ![]()
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