Cast and Immobilization Techniques in Orthopedics

Cast and Immobilization
Techniques in
Orthopedics
CARLITO B. MANAOIS,RN,MANC
TOPIC OUTLINE
Ø Introduction
Ø History
Ø Cast Types
Ø Materials and Equipment
Ø Nursing Management
Ø Cast Application
Ø Advantages and Disadvantages of Casting
Ø Removal
Ø Complications
Ø Nursing Diagnosis
Ø Conclusion
Introduction
Ø Immobilization refers to the process of holding a
joint or bone in place with a splint, cast, or brace.
Ø Casts are generally used to immobilize a broken
bone.
Ø An orthopedic cast, or simply cast, is a shell,
frequently made from plaster or fiberglass, encasing
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.
Ø It is similar in function to a splint.
HISTORY
Ø The earliest methods of holding a reduced fracture involved using
splints.
Ø Ancient Greeks used waxes and resin to create stiffened bandages
Ø Roman Celsus AD 30 described how to use splints and bandages
stiffened with starch
Ø Arabian Doctors used lime derived from sea shells and albumen from
egg whites to stiffen bandages
Ø Italian school of Salemo (20th century) recommended bandages
hardened with flour and egg mixture
Ø Medieval European bonesetters used casts made of egg white, flour
and animal fat
Ø Ambroise Pare(1517-1590) used artificial limbs, made casts of wax,
cardboard, cloth and parchment that hardened as they dried
HISTORY
Ø Dominique Jean Larry (1768-1842) Concluded that undisturbed
wound had facilitated healing. Also stiffened bandages using
camphorated alcohol, lead acetate and egg whites beated in
water
Ø Louis Seutin (1793-1865) - Seutin's bandage amidonnee consisted of
cardboard splints and bandages soaked in starch solution
Ø 19th century- Velpeau substituted Dextrin for starch
Ø Consul William Eton described immobilization of patient with
gypsum plaster (POP)
Ø Antonius Mathijsen (1805-1878)- developed a method of POP
application
Cast Types
u Upper extremity casts

u Lower extremity casts
u Cylinder casts
u Body casts
u EDF (Elongation, Derotation, Flexion)Casts
u Spica cast
UPPER EXTREMITY CAST
Short Arm Cast
ü used for forearm and

wrist fractures
ü applied below the elbow
to the hand also
ü used to hold the forearm
or wrist muscles and
tendons in place after
surgery
Long Arm Cast
ü used for upper arm,

elbow, or forearm
fractures
ü applied from the upper
arm to the hand
ü also used to hold the arm
or elbow muscles and
tendons in place after
surgery
Arm Cylinder Cast
ü To hold the elbow muscle

and tendons in place after
a dislocation or surgery
ü Applied from the upper
arm to the wrist.
Shoulder Spica Cast
ü used for shoulder

dislocations, or after
surgery on the shoulder
area
ü applied around the trunk
of the body, the shoulder,
arm, and hand
Minerva Cast
ü used after surgery on the

neck or upper back
ü applied around the neck
and trunk of the body
LOWER EXTREMITY CAST
Short Leg Cast
ü used for lower leg fractures,

ankle fractures, and severe
ankle sprains and strains
ü also used to hold the leg or
foot muscles and tendons in
place after surgery to allow
for healing
ü applied to the area below
the knee down to the foot
Long Leg Cast
ü used for knee or lower leg

fractures, knee dislocations,
or after surgery on the leg or
knee
ü applied from the upper thigh
to the foot
Leg Cylinder Cast
ü used for knee or lower leg

fractures, knee dislocations,
or after surgery on the leg or
knee
ü applied from the upper thigh
to the ankle
Unilateral Hip
Spica Cast
ü used for thigh (femur)

fractures
ü also used to hold the hip or
thigh muscles and tendons
in place after surgery
ü applied from the chest to
the foot of the affected leg
One and one-half
Hip Spica Cast
ü used for thigh (femur) fractures
thigh muscles and tendons in
healing
ü applied from the chest to the
foot on one leg, and to the knee
on the other leg, with a bar
placed between both legs to
keep the hips and legs immobile
Bilateral Long Leg
Hip Spica Cast
ü used for pelvis, hip, or thigh
(femur) fractures
place after surgery
feet, with a bar between both
legs to keep the hips and legs
immobile
Short Leg Hip
Spica Cast
ü used for pelvis, hip, or thigh
(femur) fractures
healing
thighs or knees
Abduction boot
Cast
ü used to hold the hip muscles
and tendons in place after
surgery to allow time for
healing
ü applied from upper thighs to
the feet, with a bar placed
between both legs to keep
the legs and hips immobile
Materials and Equipment
Ø Adhesive tape (to prevent slippage of elastic wrap used with
splints)
Ø Elastic bandage (for splints)
Ø Bandage scissors
Ø Basin of water at room temperature (dipping water)
Ø Casting gloves (necessary for fiberglass)
Ø Padding
Ø Plaster or fiberglass casting material
Ø Sheets, under pads (to minimize soiling of the patient's clothing)
Ø Stockinette
Ø Cast saw and spread
Cast Material
Ø Plaster casts – mold very smoothly to the

body’s contours. The cast initially emits
heat and takes about 15 minutes to cool
and 24 to 72 hours to dry. It must be
handled carefully until dry.
Ø Fiberglass casts – are dry in 10 to 15 minutes

and can bear weight 30 minutes after
application.
Comparison
Plaster of Paris Fiberglass
Cost Lower Higher
Moldability Excellent Average
Strength Average Excellent
Weight Heavier Lighter
Curing Period 48 – 72 Hours Under 30 mins
Radiolucency Poor Good
Water Resistance Poor Excellent
Skin Complication Easily washes off skin and cloth Gloves are mandatory
Allergic Reaction Very Low Slightly Higher
Mano valve Spread Easily Spreads but recoils

Nursing Management
Ø Prepare the client for cast application.

Ø Assist the health care provider during application of the cast as
needed.
Ø After the cast application, provide cast care.
Ø Initiate pain relief measure if indicated.
Ø Observe for signs and symptoms of cast syndrome with clients
who are immobilized in large casts, such as a body or hip spica
cast.
Ø Provide nursing care for compartment syndrome, if indicated.
Observe for signs and symptoms and discuss and assist with
treatments.
Nursing Management
Ø Notify the health care provider immediately if signs or

symptoms of other neurovascular complications occur.
Ø Notify the health care provider if “hot spots” occur along
the cast; they may indicate infection under cast.
Ø Notify the health care provider if “hot spots” occur along
the cast; they may indicate infection under cast.
Ø Provide client and family teaching.
Cast Application
Cast Care
ü Keep the cast clean and dry.

ü Check for cracks or breaks in the cast.
ü Rough edges can be padded to protect the skin
from scratches.
ü Do not scratch the skin under the cast by inserting
objects inside the cast.
ü Can use a hairdryer placed on a cool setting to blow
air under the cast and cool down the hot, itchy skin.
Never blow warm or hot air into the cast.
Cast Care
ü Do not put powders or lotion inside the cast.
ü Cover the cast while your child is eating to prevent food
spills and crumbs from entering the cast.
ü Prevent small toys or objects from being put inside the
cast.
ü Elevate the cast above the level of the heart to
decrease swelling.
ü Encourage to move his or her fingers or toes to promote
circulation.
ü Do not use the abduction bar on the cast to lift or carry
the child
Cast Care
ü Use a diaper or sanitary napkin around the

genital area to prevent leakage or splashing of
urine.
ü Place toilet paper inside the bedpan to prevent
urine from splashing onto the cast or bed.
ü Keep the genital area as clean and dry as
possible to prevent skin irritation.
Cast Removal
Advantages and Disadvantages of
Casting
ADVANTAGES DISADVANTAGES
Main stay treatment of most fractures Requires more skills
Provides more effective immobilization More time to apply
Protect the injury site High risk of complications from improper

application
Prevent further injury
Decrease Pain
Complications
IMMEDIATE LATE
Compartment Syndrome Delayed Union
Pain Malunion
Heat Injury Non-union
Hypersensitivity reactions Pressure Sore and skin breakdown
Infections
Joint Stiffness
Neurologic Injury
Nursing Diagnosis
ü Deficient knowledge related to the treatment regimen

ü Acute pain related to the musculoskeletal disorder
ü Impaired physical mobility related to the cast
ü Self-care deficit: bathing/hygiene, feeding,
dressing/grooming due to restricted mobility
ü Impaired skin integrity related to lacerations and abrasions
ü Risk for peripheral neurovascular dysfunction and related to
physiologic responses to injury and compression effect of cast
Conclusion
ü Cast and splints serve to immobilize orthopedic

injuries.
ü They promote healing, maintain bone alignment,
diminish pain, protect the injury and help
compensate for surrounding muscular weakness
ü Proper application technique, vigilance for
complications and timely follow-up are essential
ü Improper or prolonged application can increase
the risk of complication from immobilization
Thank You!

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Cast and Immobilization

u Upper extremity casts

ü used for forearm and

ü used for upper arm,

ü To hold the elbow muscle

ü used for shoulder

ü used after surgery on the

ü used for lower leg fractures,

ü used for knee or lower leg

ü used for knee or lower leg

ü used for thigh (femur)

Ø Plaster casts – mold very smoothly to the

Ø Fiberglass casts – are dry in 10 to 15 minutes

Cost Lower Higher

Moldability Excellent Average

Strength Average Excellent

Weight Heavier Lighter

Curing Period 48 – 72 Hours Under 30 mins

Radiolucency Poor Good

Water Resistance Poor Excellent

Allergic Reaction Very Low Slightly Higher

Mano valve Spread Easily Spreads but recoils

Ø Prepare the client for cast application.

Ø Notify the health care provider immediately if signs or

ü Keep the cast clean and dry.

ü Use a diaper or sanitary napkin around the

Main stay treatment of most fractures Requires more skills

Provides more effective immobilization More time to apply

Protect the injury site High risk of complications from improper

Compartment Syndrome Delayed Union

Heat Injury Non-union

Hypersensitivity reactions Pressure Sore and skin breakdown

ü Deficient knowledge related to the treatment regimen

ü Cast and splints serve to immobilize orthopedic

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