SPLINTING &
CASTING
SUPERVISOR : DR. GHUNA ARIOHARJO UTOYO,
SP.OT (K), AIFO-K
ORIGIN
• Different forms of the splint have been used sparingly throughout history
• The splint gained great popularity as a medical device during the French
and Indian War
• Generally consisting of two small wooden planks, the splint was
commonly tied around the fracture with rope, cloth, or even rawhide
during frontier times in American history.
• To this day, the splint is commonly used to secure small fractures and
breaks
DEFINITION
• A splint is a device used for support or immobilization of a limb or
the spine. It can be used in multiple situations, including temporary
immobilization of potentially broken bones or damaged joints and
support for joints during activity.
FUNCTION
Temporary immobilization of sprains, fractures and reduced dislocations
Control of pain
Facilitates patient transportation
Prevention of further soft tissue or neurovascular injuries
Decreases risk of converting a minor injury to a major injury
SPLINTING EQUIPMENTS
• Stockinette
• Padding
• Splinting material
• POP
• Prefabricated Splint Rolls
• Plaster
• Fiberglass
• Ace Wrap
• Bucket/receptacle of warm water
• Trauma sheers
TYPES OF SPLINT
• Fibreglass Splints
Advantage
Easier to apply
Set more quickly
Lighter
Water resistant
Disadvantage
More expensive
More difficult to mold
TYPES OF SPLINT
• Prefabricated splints
Plastic shells lined with air cells, foam, or
gel components
Same advantages and disadvantages as
fiber glass splints
TYPES OF SPLINT
O Air / Pneumatic splint
• Used to immobilize a fracture using an inflatable support
• They are plastic structures preformed in a factory to fit a specific part of the body
• Typically, an air splint wraps around an arm or leg and holds the bones still while
the patient is moved to hospital
• This type of splint is not generally used for long term support of a fracture as it is
less secure and provides less structural support than plaster splints or fiberglass
splints
TYPES OF SPLINT
O Air / Pneumatic splint
GENERAL SPLINTING PROCEDURE
1) Stockinette is applied
2) Webril is applied
3) The wet plaster is
positioned
4) Elastic bandage is
applied
5) The plaster is molded
LO N G A RM PO STERIO R SPLIN T
• Indications
• Elbow and fore arm injuries
• Distal humerus fx
• Both-bone fore arm fx
• Unstable proximal radius or ulna fx (sugar-tong
better)
• Doesn’t completely eliminate supination / pronation
-either add an anterior splint or use a double sugar-
tong if complex or unstable distal forearm fx
FOREARM SUGAR TONG
• Indications
• Distal radius and ulnar fx
• Prevents pronation / supination and
immobilizes elbow
DOUBLE SUGAR TONG
• Indications
• Elbow and forearm fx -prox/mid/distal radius and
ulnar fx
• Better for most distal forearm and elbow fx
because limits flex/extension and
pronation/supination.
FOREARM VOLAR SPLINT
AKA “COCKUP” SPLINT
• Indications
• Soft tissue hand / wrist injuries -sprain, carpal tunnel
night splints, etc
• Most wrist fx, 2nd-5th metacarpal fx
• Most add a dorsal splint for increased stability -
‘sandwich splint’ (B)
• Not used for distal radius or ulnar fx –can still
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RADIAL AND ULNAR GUTTER
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THUMB SPICA
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FINGER SPLINTS
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POSTERIOR ANKLE SPLINT
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STIRRUP SPLINT
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COMPLICATION
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CARE OF A PATIENT IN A SPLINT
• Splints should be properly applied, well padded at bony prominences
and at the fracture sites
• Bandage of the splint shouldn’t be too tight nor too loose
• Patient should been couraged to actively exercise the muscles and the
joints inside the splint as much as permitted
• Any compression of nerve or vessel should be detected early and
managed accordingly
• Daily checking and adjustments should be made
DEFINITION
CASTING
An orthopedic cast, body cast, plaster cast, or surgical 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.
It is similar in function to a splint.
PLASTER CAST
Consist of a cotton bandage plus plaster of paris,
which hardens after it has been made wet.
Plaster of paris is calcined gypsum(roasted
gypsum), ground to a fine powder by milling.
When water is added, the more soluble form of
calcium sulfate returns to the relatively insoluble
form, and heat is produced.
The setting of unmodified plaster starts about 10
minutes after mixing and is complete in about 45
minutes; however, the cast is not fully dry for 72
hours
L I M I TAT I O N O F P L A S T E R C A S T
Plaster of paris casts can result in cutaneous
complications:
Dry Skin & scaly
Macerations & ulcerations,
Figure 1: (a) Skin atrophy
Infections, and scarring. (b) Exfoliati
Rashes & itching,
Burns,
Allergic contact dermatitis, which may also be due to
the presence of formaldehyde within the plaster
Leg is wrapped in plastic
bandages
Other limitations of plaster casts include their weight,
which can be quite considerable, thus restricting
movement, especially of a child. Removal of the cast
requires destroying the cast itself
Plaster of paris casts break down if patients get them
S YNTHET IC C AS T
In the 1970s Development of fibreglass casting.
Lighter, more durable and also resistant to water
(although the bandages underneath were not)
In the 1990s New fiberglass casts that’re completely
waterproof, allowing patients to bathe, shower, and swim
while wearing a cast
Nowadays bandages of synthetic materials are often
used, often knitted fiberglass bandages impregnated
with polyurethane, sometimes bandages of thermoplastic
. These are lighter and dry much faster than plaster
bandages
REMOVAL CASTING
Scissor Cast • SPEADE • OSCILAT
R CAST OR
I N D I C AT I O N S
American family physician, 2009
S U P P O RT I N G I T E M S
• A 'cast' usually consists of three distinct
parts:
• The first is some 'stockinette' to protect
the underlying skin
• The second is some form of padding,
often 'webril' or 'soft roll'. This layer is
very important. It supplies the tension
and is responsible for the fit of the cast
• The third layer is the plaster of paris,
or synthetic tape, which provides the
protection and rigidity
American family physician, 2009
UPPER EXTREMITIES CAST
Upper extremity casts are those which encase the arm, wrist,
and/or hand
Varieties may, depending on the injury and the doctor's
Upper Extremities Cast
decision
Long Arm Cast Short Arm Cast Thumb Spica Cast
Encases the arm from the hand to about In contrast, stops just below the elbow Include one or more fingers or the thumb, in which
2 inches below the arm pit, leaving the fingers case it is called a finger spica or thumb spica cast
and thumbs free
The cast is applied from just bellow the axilla Immobilize the wrist & the base of finger Use primarily for fracture of the scaphoid and other
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to just proximal to the metacarpophalangeal metacarpals disorder. Maintain the instabilities of the carpal bones amenable to cast
joints of the digits but leaving the tumb free reduction of a relatively stable Colles' treatment. Also used for fracture involving all
fracture elements of the thumb itself
LOWER EXTREMITIES CAST
Lower Extremities Cast (part. 1)
Long Leg Cast Short Leg Walking Cast Non-Weight Bearing Short Leg Cast Cylinder Cast
A cast encasing both the foot and the A cast encasing the patient's foot, ankle and A cast encasing the patient's foot, ankle and lower leg Same as a long leg cast except there
leg to the hip lower leg ending below the knee. Cast shoe ending below the knee. NO cast shoe is given is no foot portion. Cast stops above
is given the ankle
Primarily used for treatment of Ankle Fractures and Sprains Applied the same as a weight bearing cast. Ankle may not Used some times for patella
fractures of the tibia and/or fibula Some Foot fractures/Sprains necessarily need to be placed at 90 degrees depending fractures, tendon/ligament injuries
shafts, ankle fractures, ligament upon type of injury. Use same amount of material. No
injuries cast shoe is given as patient should not be weight bearing
and should be either on crutches or walker
LOWER EXTREMITIES CAST
Patellar Tendon Bearing (PTB) Cast
Lower Extremities Cast (part.2)
Patellar Tendon Bearing (PTB) Cast Equinous Cast
Modified short leg cast with top of cast having “wings” that Same as a short leg with difference being foot
encompass medial and lateral side of knee and back of cast is is allowed to drop to an equinous position with
cut down in the back to allow flexion at the patellar crease ankle relaxed and foot/toe allowed to point
towards the floor
This is used as a transitional cast after patient has come out of a Primarily used in treatment for Achilles tendon
long leg cast for partially healed tibia or tib/fib fracture and rupture or post repair of Achilles tendon
patient may begin weight bearing in a cast that allows motion rupture
at the knee but prohibits rotational forces at the knee which
may harm the fracture. The weight bearing forces are also
changed because of the wings and cast covering distal 1/3 of
the patella which shifts the weight bearing forces from the
shaft of the long bone to the proximal end of the tibia and the
knee
