Casting and splinting

1. Casting & Splinting
Najla M. Bedaiwi
Orthopedic Surgery

2. Indications
• Fractures.
• Sprains.
• Reduced joint dislocations.
• Inflammatory conditions:
(e.g. Arthritis, Tendinopathy, Tenosynovitis)
• Deep laceration repairs across joints.
• Tendon lacerations.

3. The Initial Approach
• Full Assessment :
o Stage and severity of the injury
o Skin
o Soft tissues
o Neurovascular status
o Risk of complications
o Patient's functional requirements.

4. Splint vs. Cast

5. Splint
• Splinting is the preferred method of
immobilization in the acute care setting.
• Faster and easier to apply.
• May be static or dynamic.
• Noncircumferential 
• Allows for regular inspection of the injury site.
• Allows for the swelling that occurs during the
initial inflammatory phase of the injury.
• Less pressure-related complications.

6. Cast
• Casting is the definitive treatment for most
fractures.
• Provides more effective immobilization.
• Require more skill and time to apply.
• Higher risk of complications if not applied
properly.

7. Plaster vs. Fiberglass

8. Plaster
• Made from gypsum ‐ calcium sulfate dihydrate.
• When water is added :
Calcium sulfate .. Soluble  Insoluble.
• Warm water ‐ faster set, ↑ Risk of burns.
• Fast drying ( 5 ‐ 8 minutes ).
• Can take up to 72 hours to cure.
• Upper extremities ‐ 8‐10 layers.
• Lower extremities ‐ 12‐15 layers.

9. Fiberglass
• Synthetic material.
• Fiberglass bandages  Polyurethane.
• Cures rapidly (20 minutes).
• Stronger, lighter.
• Less messy.
• Less moldable.
• More expensive.

10. Splints - Upper Limb
• Elbow/Forearm
o Long Arm Posterior.
o Double Sugar ‐ Tong.
• Forearm/Wrist
o Volar Forearm / Cockup.
o Sugar ‐ Tong.
• Hand/Fingers
o Ulnar + Radial Gutter.
o Thumb Spica.
o Finger Splints.

11. Long Arm Posterior Double Sugar ‐ Tong Sugar ‐ Tong
Volar Forearm / Cockup
Ulnar + Radial Gutter

12. Splints - Lower Limb
• Knee
o Knee Immobilizer / Bledsoe.
o Bulky Jones.
o Posterior Knee Splint.
• Ankle
o Posterior Ankle.
o Stirrup.
• Foot
o Hard Shoe.
Posterior Ankle Splint

13. Circumferential Cast
• Short Arm.
• Long Arm.
• Short Leg.
• Long Leg.
• Cylinder.

16. Materials and Equipment
• Adhesive tape.
• Bandage scissors.
• Basin of water at room temperature.
• Casting gloves.
• Elastic bandage.
• Cotton padding.
• Plaster or fiberglass casting material.
• Stockinette.

17. Setting Time Factors
• Factors that speed setting times.
• Higher temperature of dipping water.
• Reuse of dipping water.
• Use of fiberglass.
• Factors that slow setting times.
• Cooler temperature of dipping water.
• Use of plaster.

18. Guidelines for Proper Application
• Use appropriate amount and type of padding
• Place from distal to proximal with a 50% overlap.
• Properly pad bony prominences and high-pressure
areas.
• Properly position the extremity before, during,
and after application of materials
• Avoid tension and wrinkles on padding, plaster,
and fiberglass
• Avoid excessive molding and indentations

21. Complications
• Loss of reduction.
• Tight cast or compartment syndrome :
o Univalving  30% pressure drop
o Bivalving  60% pressure drop
o Cutting of cast padding to further reduce pressure
• Pressure necrosis  As early as 2 hours after
cast/splint application.

22. Complications
• Thermal injury
o Avoid plaster thicker than 10 layers
o Avoid water hotter than 24°C
o Unusual with fiberglass
• Cuts and burns during cast removal
• Joint stiffness  Joints should be left free
when possible .

23. Follow Up
• Patient education.
• Elevation of the injured extremity to decrease pain and
swelling.
• Continuous checking for signs of compartment
syndrome.
• Strong opioids should be used with caution during the
first 2-3 days after splinting.
• Avoidance of getting the material wet or pushing
objects inside a cast to scratch.
• Most splints and casts require initial follow-up within 1
week after application.

24. Thank You
Special thanks to Mr. Mohamed Hassen
Senior Orthopedic Technician