An orthopedic cast , or just cast , is a shell, often made of plaster or fiberglass, wrapping the limbs (or, in some cases, most of the body) to stabilize and hold anatomic structures, most commonly fractures (or bones), in place until healing is confirmed. It resembles its function with splints.
Plaster plaster consists of cotton bandages that have been combined with plaster paris, which hardened after being made wet. Plaster of Paris is calcined gypsum (roasted gypsum), ground into fine powder by grinding. When water is added, the more easily soluble form of calcium sulfate returns to its relatively insoluble form, and heat is generated.
- 2 (CaSO 4 O) 3 H 2 O -> 2 (CaSO < sub> 4 .2H 2 O) Heat
Unmodified plaster setting begins about 10 minutes after mixing and finishes in about 45 minutes; However, the cast is not completely dry for 72 hours.
Currently synthetic material bandages are often used, often fiberglass bandages knitted impregnated with polyurethane, occasionally thermoplastic bandages. It is lighter and drier faster than plaster. However, the plaster can be more easily shaped to make it comfortable and therefore more comfortable. In addition, the plaster is smoother and does not tear clothes or scrape the skin.
Video Orthopedic cast
Materials
Due to the nature of the pads because the limbs can not be reached during the treatment; the skin beneath the plaster becomes dry and scaly because the outer skin cells removed are not washed or brushed. Also, Paris plaster casts can cause skin complications including maceration, ulceration, infection, rash, itching, burns, and allergic contact dermatitis, which may also be due to formaldehyde in plaster bandages. In hot weather, staphylococcal infections of the hair follicles and sweat glands can cause severe and painful dermatitis.
Other limitations of the cast include their weight, which can be quite large, thus limiting movement, especially children. The removal of the cast requires destroying the player itself. The process is often noisy, utilizing special oscillating saws that can easily cut hard casting material but have difficulty cutting soft materials such as cast or leather pads. Although removal is often painless, it can be troublesome for patients, especially children. Chainsaws can cut, scrape, or burn the skin, but the results are rare. In addition, the Paris cast will be damaged if the patient makes it wet.
Due to the limitations of Paris plaster, surgeons also experimented with other types of materials to use as splints. Ingredients such as early plastics are gutter pepper obtained from tree sap found in Malaya. It resembles rubber, but contains more resins. When dry it is hard and not elastic, but when heated it becomes soft and soft. In 1851 Utterhoeven, described the use of splints made of this material for the treatment of fractures. In the 1970s, the development of fiberglass foundry tape made it possible to produce casts that were lighter and longer lasting than traditional casts and also resistant to water (although the underlying bandages did not) allow patients to be more active.
In the 1990s the introduction of a new cast coating meant that the fiberglass cub with this liner was completely waterproof, allowing patients to bathe, bathe, and swim while wearing a cast. However, the waterproof cast liner adds about 2 to 3 minutes longer to the app's timing of the player and increases player costs. Drying time, however, can be quite inconvenient to ensure cast protection inertia and sanitary napkins. This waterproof cover allows for bath and shower while wearing a plaster cast or gypsum. The waterproof cast cover still stays around the cast and prevents water from reaching when the patient comes into contact with water. The cover can be easily removed to dry, and can be reused frequently.
Maps Orthopedic cast
Cast Type
Upper extremity
The upper extremities are those that wrap the arms, wrists, and/or hands. Long-sleeved shirts wrap your arms out of your hands for about 2 inches under the arm hole, leaving your fingers and thumbs free. A short-sleeved cast, on the contrary, stops just below the elbow. Both varieties may, depending on the injury and the doctor's decision, including one or more fingers or thumbs, in this case called spica finger or thumb spica.
Lower-extremity leggings
The lower extremity casts are the same, with a cast that wraps the legs and legs up to the pelvis called the long limbs, while the cast that wraps the patient's legs, ankles and lower legs that ends below the knee is referred to as short-throwing legs. The walking heel can be applied to ambulation. This heel, when properly applied, raises the toe and offers the wearer the advantage of keeping the toes out of the dirt and moisture in the path. The walking heel provides a small contact patch for the cast and creates fluid motion during the move and allows the cast to rotate easily in all directions. Similarly, cast shoes/sandal/sandal slippers may be provided to the patient for use during ambulatory limb movements during the recovery period (referred to as weight bearing). In addition, castshoe can be used to protect only the patient's feet while helping to maintain a higher level of hygiene by preventing the cast from directly contacting potentially dirty or wet soil surfaces. Where the patient is not walking on a wounded branch, crutches or wheelchairs can be provided. The bottom legs of the foot can be extended ends at the tip of the patient's toes, to create rigid support that restricts metatarsal movement in both the load bearings and the non-weight bearing leg cast. This is referred to as toeplates in orthopedic disciplines. This addition can be applied to further support and stabilize the metatarsal by limiting motion through higher immobilization rates, and protecting the toes from additional blunt trauma. Usually foot prints that combine treads are prescribed for foot and metatarsal injuries. Typically, legs applied for stable ankle fracture treatments will not use toeplate design because there is no need to paralyze and restrict the movement of the patient's toes.
Cylinder cast
In some cases, the cast may include the upper and lower arms and elbows, but leave the wrist and hands free, or the upper and lower legs and knees, leaving the feet and ankle free. Such diggers can be called cylinder rollers. Where the wrist or ankle is inserted, it can be called a long sleeve or a long leg actor.
Body cast
Body cast, which covers the trunk of the body, and in some cases the neck up to or including the head (see Minerva Cast, below) or one or more limbs, rarely used today, and most often used in cases of small children, can be trusted to adhere to a back clamp, or in case of radical surgery to repair injuries or other defects. A body cast that wraps the stem (with a "strap" over the shoulder) is usually referred to as a body jacket. This is often very uncomfortable.
EDF cast
EDF extraction (elongation, derotation, flexion) is used for the treatment of infantile idiopathic scoliosis. The method of treatment for this correction was developed by the English scoliosis specialist, Min Mehta. Scoliosis is a 3-dimensional problem that needs to be fixed on all 3 aircraft. The EDF foundry method has the ability to elongate the spine through traction, hypothesize the spine/pelvis, and to improve lordosis and overall body shape and alignment.
EDF is different from Risser foundry. The EDF casts either above or below the shoulders, and have a large mushroom opening on the front to allow for proper chest expansion. At the back, there are small pieces in the concave curve, not past the midline. It was found that the spine becomes more aligned with this piece than without, and it helps the correct rotation.
Spica cast
A cast includes the torso and one or more limbs called a spica cast, such as a cast including the "rod" of the arm and one or more fingers or thumbs. For example, the shoulder spica includes the torso and one arm, usually to the wrist or hand. Shoulder spicas are almost never seen today, have been replaced with special splints and slings that allow early mobility of the injury so as to avoid joint stiffness after healing.
Spica hips cover the torso and one or more legs. Spica hips that cover only one foot to the ankle or leg can be referred to as a single hip spica, while that covering both legs is called a double hip spica. A one and a half foot hip spica wraps one foot to the ankle or leg and the other just above the knee. The extent to which the hip spica covers the stem is heavily dependent on the injury and the surgeon; spica may extend only to the navel, allowing spinal mobility and the possibility of walking with the help of crutches, or may extend to the ribs or even to the armpits in rare cases. Hip spicas were formerly common in reducing femoral fracture, but are currently rarely used except for congenital pelvic dislocations, and then mostly when the child is a baby.
In some cases, the hip spica may only extend one or more feet up to the knee. Such cast, called pantaloon casts, is sometimes seen to paralyze the injured lumbar spine or pelvis, where the stem part of the cast usually extends to the armpits.
Mobility and cleanliness
Mobility is severely limited by a hip spica cast and walking without crutches or walkers is not possible because the hips can not bend. There is a serious danger of falling if the patient in a hip spica casts try to stand upright without help as they do not have the ability to control their balance. Patients are usually confined to a reclining bed or wheelchair, or children's stroller. Children in spica casts can sometimes learn to get a cell phone by playing on a skateboard, or withdrawing on the floor. Some children even learn to walk with restraint on furniture. A child in cast spica should always be watched and safety should always be considered when they are in their healing phase to prevent reinjury or damage to the cast. Many spica casts have spreading rods between the legs to help strengthen the cast and support the foot in the right position. This is important when removing the casted patient not to lift them with this dispersing rod, as it can rupture and this can cause injury to the patient. To facilitate toilets or changed diapers and hygienic cleaning, the opening is made in plaster cast in crotch. The opening is usually referred to as the "opening of the perineum". These are formed either during cast applications or after cast applications by cutting a hole with a saw. The opening should then be hung or coated to keep the cast part clean and dry. Because the hips can not be bent, using the toilet is difficult, if not impossible. It is therefore necessary for patients to use diapers, pots, or catheters to manage the elimination of body waste. Toiletries should be done with a sponge bath. Hair can be washed with a plastic washbasin under your head. For a child's washing shampoo, the child can be lifted and placed on the kitchen table and their heads are held above the kitchen sink.
Other cast
Other body cast used in recent decades to protect the injured spine or as part of treatment for spinal deformities (see scoliosis) that are rarely seen today include cast Minerva and cast Risser. The Minerva cast includes the torso (sometimes extending only as far as the ribs) as well as the patient's head, with openings provided for the patient's face, ears, and usually the top of the head and hair. The cast of Risser is similar, extending from the patient's hip to the neck and occasionally including the head. Both of these casts can, with care and permission from doctors, can run during the recovery period. However, in some cases, Risser players will expand into one or more pantaloons, where case mobility is much more limited.
Apart from the above common forms, body molds can come in different sizes and configurations. For example, from the 1910s to the 1970s, the use of a turnbuckle cast, which uses metal turnbuckle to rotate two parts of the cast so as to forcibly straighten the spine before surgery, is common. The turnbuckle cast has no single configuration, and can be as small as a body jacket split into two, or it can include a head, one or both feet to the knee or leg, and/or one arm to the elbow or wrist depending on the doctor's choice.
Despite the immense size and extreme immobilization of some casts, especially those used in or before the 1970s, the full term popular body is a misnomer. The popular and media-driven concept of a large cast covering all four limbs, trunk, and head - sometimes leaving only a small gap for the eyes, nose and mouth - is a true scarcity in recorded medical history, and this type of Cast large scale appear more common in various Hollywood movies and on television shows. The term body cast (or full body cast) is sometimes used by ordinary people to describe a number of spica bodies and/or cast, from simple body jackets to broader hip spores.
History
The earliest method of holding a fracture that is reduced involves the use of splints. This is a rigid strip that is placed parallel to each other beside the bone. Ancient Egyptians used wooden splints made of leather wrapped in linen. They also use stiff bandages for support that may come from embalming techniques. The use of Paris plaster to cover the walls is proven, but apparently it was never used for bandages. Ancient Hindus treated fractures with bamboo splints, and Hippocrates's writing discusses the management of fractures in detail, recommends wood splints plus exercise to prevent muscle atrophy during immobilization. The ancient Greeks also used wax and resin to make stiff bandages and Roman Celsus, writing in 30 AD, explains how to use splints and stiff bandages with starch. Arabic doctors use lime that comes from sea shells and albumen from egg whites to stiff bandages. The Italian School of Salerno in the twelfth century recommended a hardened bandage with a mixture of flour and eggs like the bones of medieval Europe, using molds made of egg whites, flour, and animal fats. In the sixteenth century, the famous French surgeon Ambroise ParÃÆ'Â © (1517-1590), who fought for more humane treatment in the field of medicine and promoted the use of artificial limbs, made wax prints, cardboard, cloth, and hardened parchment when dried.
All of these methods have benefits, but the standard methods for healing fractures are bed rest and activity restrictions. The search for a simpler, less time-consuming method leads to the development of the first modern occlusive dressing, which was initially stiff with starch and later with plaster-of-paris. The treatment of ambulatory fractures is a direct result of this innovation. Modern casting innovations can be traced to, among others, four military surgeons, Dominique Jean Larrey, Louis Seutin, Antonius Mathijsen, and Nikolai Ivanovich Pirogov.
Dominique Jean Larrey (1768-1842) was born in a small town in southern France. He first studied medicine with his uncle, a surgeon in Toulouse. After a brief visit as a naval surgeon, he returned to Paris, where he was caught in the chaos of the Revolution, present at Storming of the Bastille. Since then, he has made his career as a surgeon in revolutionary forces and French Napoleon, who was accompanied throughout Europe and the Middle East. As a result, Larrey accumulated extensive experience of military treatment and surgery. One of his patients after the Battle of Borodino in 1812 was an infantry officer whose arms had to be amputated on the shoulders. The patient was evacuated immediately after surgery and graduated from Russia, through Poland and Germany. Arriving at his home in France, the clothes were removed and the wound was found healed. Larrey concludes that the fact that the wound was undisturbed has facilitated healing. After the war, Larrey began dressing bandages using camphor alcohol, acetate lead and egg whites were beaten with water.
The improved method was introduced by Louis Seutin, (1793-1865) from Brussels. In 1815 Seutin had served in the allied army in the war against Napoleon and was in the field of Waterloo. At the time of the development of his bandage he was the chief surgeon in the Belgian army. Seutin "bandage amidonnee" consists of cardboard splints and bandages soaked in a solution of starch and applied wet. This dressing takes 2 to 3 days to dry, depending on the temperature and humidity around it. Dextrin substitution for starch, recommended by Velpeau, a man widely regarded as a leading French surgeon in the early 19th century, reduced the drying time to 6 hours. Although this is a huge improvement, it's still long, especially in harsh environments on the battlefield.
A good description of Seutin's technique was provided by Sampson Gamgee who studied it from Seutin in France during the winter of 1851-52 and continued to promote its use in the UK. The extremity was originally wrapped in wool, especially on the bony bulge. The pasteboard is then cut into a shape to provide a splint and damp so it can be formed for the extremities. The limbs are then wrapped in bandages before the coating of starch is applied to the outer surface. The Seutin technique for the application of starch equipment forms the basis of the techniques used with Paris plaster dressing today. Use of this method leads to early mobilization of patients with fractures and marked reduction in time in hospital.
Cast casts
Although these bandages are an improvement over the Larrey method, they are far from ideal. They take a long time to apply and dry and often there is shrinkage and distortion. Much interest has been raised in Europe around 1800 by a British diplomat, consul William Eton, who described the method of treating the fractures he observed in Turkey. He notes that plaster gypsum (Paris plaster) is formed around the patient's feet to cause immobilization. If the cast becomes loose due to atrophy or reduction of swelling, additional plaster gypsum is added to fill the space. However, adapting the use of Paris plaster for hospital use takes time. In 1828, doctors in Berlin treated a broken leg bone by aligning the bones in a long narrow box which was then filled with wet sand. The substitution of Paris plaster for sand is the next logical step. However, such a cast was unsuccessful because the patient was confined in bed because the cast was heavy and impractical.
The Paris Bandage plaster was introduced in various forms by 2 army surgeons, one in a peacetime station and another in active service on the front. Antonius Mathijsen (1805-1878) was born in Budel, The Netherlands, where his father was a village doctor. He was educated in Brussels, Maastricht and Utrecht obtained a medical doctorate in Gissen in 1837. He spent his entire career as a medical officer in the Dutch Army. When he was stationed in Haarlem in 1851, he developed the method of applying Paris bandage plaster. A brief note describing his method was published on January 30, 1852; it was followed immediately by a more complete account. In this account Mathijsen emphasizes that only simple materials are needed and bandages can be quickly applied without help. The bandage hardens quickly, provided it is appropriate and can be windowed or bivalved (cut to provide strain relief) easily. Mathijsen uses harsh wicker materials, usually linen, where the dried Paris cast is rubbed thoroughly. The bandage is then moistened with a damp sponge or brush as they are applied and rubbed by hand until it hardens.
Paris plaster dressings were first used in mass casualty care in the 1850s during the Crimean War by Nikolai Ivanovich Pirogov (1810-1881). Pirogov was born in Moscow and received his early education there. After obtaining a medical degree at Dorpat, he studied in Berlin and GÃÆ'¶ttingen before returning to Dorpat as professor of Surgery. In 1840, he became professor of surgery at the Academy of Military Medicine in St. Louis. Petersburg. Pirogov introduced the use of ether anesthesia to Russia and made an important contribution to the study of cross-sectional human anatomy. With the help of his patron, grand duke Helene Pavlovna, she introduced a female nurse to a military hospital at the same time as Florence Nightingale started a similar program at a British military hospital.
Seutin had traveled through Russia showing his 'stiff bandage', and his technique had been adopted by Russian army and navy in 1837. Pirogov had observed the use of plaster bandages in a sculpting studio using a strip of wetted linen. in Paris liquid plaster to make a model (this technique, called "modroc," is still popular). Pirogov went on to develop his own method, though he was aware of Mathijsen's work. The Pirogov method involves soaking rough fabrics in a Paris plaster mixture immediately prior to application to the limbs, which are protected by either the stockings or the cotton. Large dressings reinforced with wood pieces.
With the passage of time and methods moving more into the mainstream some disagreements arose for problems related to cutting air to skin contact, as well as some improvements made. Finally the method of Pirogov gave way to Mathijsen. Among the suggested improvements in early 1860 was making water-resistant sauces by painting dry Paris plaster with a mixture of lacquers dissolved in alcohol. The first commercial band was not produced until 1931 in Germany, and was called Cellona. Prior to that the bandages were made by hand in the hospital.
As the cast is applied, it expands about ½%. The less water used, the more linear expansion occurs. Potassium sulfate can be used as an accelerator and sodium borate as a retarder to allow the plaster to cause to regulate more quickly or slowly.
Deletion
The cast is usually removed by perforation using a circular saw, oscillating saw designed to cut rigid materials such as plaster or fiberglass while not damaging soft tissue. Manually operated scissors, patented in 1950 by Neil McKay, may be used in children or other patients who may be disturbed by a chainsaw sound.
See also
- Buddy wrap
- H. Winnett Orr, a US Army surgeon who developed an orthopedic cast
References
External links
- Cast & amp; Sam's injury on the Periodic Video Table (University of Nottingham)
Source of the article : Wikipedia
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