4-conservative treatment fx , casting

8/13/2019 4-Conservative Treatment Fx , Casting

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CONSERVATIVE

TREATMENT OFFRACTURES

Dr. Muhammad ASIF

Orthopedic Surgeon

Department of Orthopaedics

College of Medicine

King Khalid University Hospital


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Fracture management

The ideal goal of fracture management is

anatomical reduction and function restoration

compatible with the severity of injury, age,

occupation and activity of daily living of injuredpatient.

Either

Operative Non operative (Conservative)

Traction

Splint (Cast / Slab)


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Traction

Tractionis the application of a pulling

force to a part of the body

Purpose:

to reduce, align, and immobilize fractures;

Unstable and unfixable

When reduction and/or proper length cannot

be maintained by static immobilization

to minimize muscle spasm

to prevent or reduce skeletal deformities or

muscle contractures.


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Classification of Traction

Skin Traction : is maintained by direct

application of a pulling force on the patients skin

. Generally temporary measure.

To reduce muscle spasms To maintain immobilization before surgery

In children

Skeletal Traction : applied to bone by means ofa pin or wire surgically inserted into the bone,

providing a strong steady, continuous pull, and

can be used for prolonged periods .


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Complications of traction

Neurovascular compromise.

Inadequate fracture alignment..

Skin breakdown .

Soft tissue injury

Pin tract infection .

Osteomyelitis can occur with skeletal traction.


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Complications of traction

complications from immobility especially with

long term traction and in elder pt.

Pressure ulcer

Pneumonia Constipation

Anorexia

Urinary stasis and infection

Venous stasis with DVT


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General Indications for CAST

1. Most fractures in children:

a. Tremendous capacity of remodeling.

b. Non union and stiffness is unlikely.

2. Undisplaced fracture

3. Poor bone Quality: Osteoporosis.

4. Unfixable fracture e.g. severe comminuted.

5. Systemic contraindication.

6. Local contraindication.

7. Psychosocial problem.


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Splint / Cast

Principle:

To stabilize joint above and joint below the

site of injury whenever and wherever is

possible

Objectives:

To hold broken bone anatomically to prevent

malunion. To reduce excessive movements to prevent

non union.

To get early function


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How to Preserve Function?

Immobilize only joint necessary,

Range of motion of uninvolved joints.

Isometric exercise. Physiotherapy after cast removal.

Weight bearing whenever possible in case

of lower limb fracture.


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What are casts made of ?

The outside, or hard part of the cast,two different kinds of casting materials.

Plaster (POP)- white in color.

hemihydrated calcium sulphate.On adding water it solidifies by an exothermic

reaction into hydrated calcium sulphate

fiberglass- variety of colors, patterns, and designs.

inside of the castCotton and other synthetic materials are used to

line theinside of the cast to make it soft and to

provide padding around bony areas.


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Plaster is usually used in the early stagesof treatment,

Displaced Fracture that need manipulation

can be molded more precisely. heavy

must remain dry, water will distort the cast

Fiberglass

Can be used in Undisplaced Fx if swelling not

expected

healing process has already started.

lighter weight, durable, require less maintenance.


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Different types of casts

Type of Cast/Slab Location Uses

Short arm Applied below the elbow

to the hand.

Distal Forearm or wrist

Fx. Also used to hold the

forearm or wrist muscles

and tendons in place aftersurgery.

Long arm Applied from the upper

arm to the hand.

Distal humerus, elbow, or

proximal forearm

fractures. Also used to

hold the arm or elbowmuscles and tendons in

place after surgery.

Scaphoid cast/ thumb

spica

Below elbow to hand

including thumb

Scaphoid Fx, thumb FX

U slab From shoulder to elbow

and then to armpit

Humerus shaft fx


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Type of Cast / Slab Location Uses

Short leg cast: Applied to the area below

the knee to the foot.

Distal T/F Fx,

ankle Fx,

severe anklesprains/strains.

Long leg cast From above knee to foot Proximal T/F Fx,

trauma around knee

Hip spica From lower chest to oneor both feet

Femur fracture in children

PTB cast From knee to foot For weight bearing in

healing Fx T/F


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Closed Reduction Method


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After Closed Reduction and

Casting

must have circulation check

Plaster takes 48 hours to become fully dryand harden so take care.

Weekly radiographs for 3 weeks to confirmacceptable reduction.

Can re-manipulate within 3 weeks after

injury if displaced.


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Excellent Reduction with Well

Molded Cast


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Colles Fracture

Displaced

dorsolaterrally

Treatment:

Cast +/- surgery,depending on

shortening and

displacement


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Scaphoid Bone FX

Retrograde blood

supply

Total healing time of

10-12 weeks or more


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Boxers Fracture

Classically neck of

the fifth metacarpal

bump over the back

of palm just below thesmall finger knuckle

Treatment: casting or

surgery (pins)
http://en.wikipedia.org/wiki/Fifth_metacarpal_bonehttp://en.wikipedia.org/wiki/Fifth_metacarpal_bone


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Patellar Fracture

Fall onto kneecap or

when quadriceps is

contracting

Attempt straight legraise

If Extensor mechanism

intact / undisplaced Fx

Cast / Slab


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Fracture of 5thMetatarsal

Avulsion Fracture

base of 5th metatarsal from pull of attached

tendon;

heal well in cast

Jones Fracture

Transverse fracture through base of 5th

metatarsal, about 1-2 cm from tip;

cast for 6-8 wks if undisplaced


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Fracture of 5thMetatarsal


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Avulsion Fx


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Jones fracture


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30 year old patient


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Torus Fracture

Buckle

fracture

mostly in

children;metaphysis

cast for 2-4

weeks


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Type 1 S/C Fx humerus:

non-displaced

conservative

Note the non-displaced fracture(Red Arrow)

Note the posterior fatpad (Yellow Arrows)


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Type 2: Angulated/displaced fracture with intact

posterior cortex;

close reduction and K-wires fixation


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Post Cast instructions

Keep your limb elevated to prevent swelling.

Apply an ice bag to injured area.

Keep the cast clean and dry.

Check for cracks or breaks in the cast. Rough edges should be padded to protect the skin

from scratches.

Do not scratch the skin under the cast by inserting

sticks.

Encourage patient to move his/her fingers or toes to

promote circulation


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Contd

Prevent small toys or objects from being put inside

the cast.

Do not put powders or lotion inside the cast.

Cover the cast while your child is eating to preventfood spills and crumbs from entering the cast.

Do not use the abduction bar on the cast to lift or

carry the child.

Use a diaper or sanitary napkin around the genitalarea to prevent leakage or splashing of urine.


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How To Know if Something Is

Wrong With Your Cast Pain that is not adequately controlled with

medication prescribed by your doctor.

Increasingswelling

Numbness or tingling in the extremity (hand or foot). Inability to move your fingers or toes beyond the

cast.

Circulation problems in your hand or foot.

Loosening, splitting or breaking of the cast.

Unusual odors, sensations, or woundsbeneath the

cast.

If you develop a feveror generalized illness


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Complications of cast

Compartment syndrome, tight cast that restricts

swelling.

Impaired distal neurovascular.

most serious is deep venous thrombosis leadingto pulmonary embolism----calf pain.

Re displacement of fracture.

stiff joints, muscle wasting. Plaster Sores.

Malunion, Nonunion, Delayed union


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Cast Burns- can

occur during cast

removal if blade dull

or improper techniqueused.


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Fracture distal Radius & ulna


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Fracture Healed


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Fx distal Radius ulna in a Child


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After Close reduction and casting


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One week follow up; Angulated


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Surgery; close reduction and fixation


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Healed


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21 year old patient


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THANKS

4-conservative treatment fx , casting

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