lower extremity casting

8/16/2019 Lower extremity casting

1/39

Departement of Orthopaedi and TraumatologiDr. Moewardi Hospital/ Prof. Dr. dr. R. Soeharso

Hospital

UNS Medical acult!

SUR"#"RT"$


2/39

%ower &'tremit! (astDespite the man! ad)antages of operati)e

care* nonoperati)e care remains the

foundation on which treatment ofmusculos+eletal trauma is ,ased.

Nonperati)e treatment for lowere'tremit! - reposition and immo,iliationusing cast.


3/39

%ower &'tremit! (astal+ing Shoes and Heel

Shoe (ast

(!linder (astDel,et (ast

0elow #nee (ast

Sarmiento (ast

%ong %eg (astHip Spica / dou,le hip spica

eight 0earing Spica


4/39

al+ing Shoe and Heelal+ing shoe and heel pro)ide some

protection for the foot portion of the

cast.


5/39

0oot (ast0oot cast can ,e used for support and

immo,iliation

Used for metatarsal and tarsal fracture"plied ,elow gastrocnemius muscle


6/39

0oot cast

Fabricated Boot Cast


7/39

(!linder (astor +nee in1uries 2ligament 3 fracture4

Uncontrolled rotation


8/39

Del,et (astUsuall! for sta,le midshaft ti,ial fr

Tend to slip down

Hinge o)er maleoli


9/39

0elow #nee (astMost common cast use for an+le

fractures* foot fractures* and softtissue in1uries

Occasionall! use to tread undisplacedlower ti,ial diaph!seal fracture or

minor pilon fracture


10/39

"plication StepTwo team person, with an assistant


11/39

Positioning in undisplaced fracture Application of the padding


12/39

First, apply the padding above and bellow the knee, this needs to be thicker

over the maleolar and around the fibular head.


13/39

The principle of !point fi"ation within the cast

needed to be aplied. The two main molding points

are created by gentle pressure over the lateral hind

foot and above over the medial supramaleolar part

of the lower leg.

The third point is created later by mmolding the

upper end of the cast firmly around the lateral

aspect of the leg.


14/39

Completed Below #nee Cast


15/39

Sarmiento 2PT04 (ast

5ndication-

" Sarmiento cast or ,race can ,e used

initiall! in sta,le fractures in the distal halfof the ti,ia.

"lso used to treat ti,ial diaph!sal fracture

after a few wee+s in long leg cast.


16/39


17/39

The surgeon is seated on a low chair. The patient’s knee is flexed over

the end of the table; the thigh is supported with padding.


18/39

"plication StepPositioning


19/39

Padding


20/39

(ast application


21/39

Mold

Trimm


22/39

$ %old in the transverse and longitudinal arches of the foot, and around the

malleoli, and mold a posterior bulge for the Achilles tendon.$ &mooth the cast along the entire anteromedial border of the tibia.


23/39

(ompleted Sarmiento cast


24/39


25/39

%ong %eg (ast"ppl! short leg


26/39

"pplication Step

The patient should be lying supine, with the ankle over the edge of the table.


27/39

The patient's knee should be fle"ed to appro"imately ()!*+, which will rela"

the gastrocnemius muscle. This will reduce the hypere"tension.


28/39

Apply a stockinette and cut it slightly longer than the final cast will be.

ind the cast padding towards the knee, with an overlap of *)-.


29/39

&tarting with the bottom of the foot, wrap the plaster bandage around the ankle

in a figure!of!eight.

Fold the loose end of the stockinette over the pro"imal edge of the cast.


30/39

hile the plaster is still soft, mold it gently to the curve of the tibia and

around the knee. n addition, a supracondylar mold is important for the

cast to control the length of the limb.


31/39

The application of the long leg circular cast is now complete.


32/39

Hip SpicaSeldom to use in adults

(hildren - fracture* hip d!splasia* post opimmo,iliation

Use fracture ta,le

Reinforce lateral aspect rolls from chestcage > pel)is

Hole for eas! ,reathing 3 comfort


33/39


34/39

ndication/ fracture, hip

dysplasia, post op immobili0ation


35/39

ndication/ fracture, hip dysplasia,

post op immobili0ation, withcontralateral hip or pelvic problem


36/39


37/39

eight ,earing spica The weight>,earing single>hip spica

cast is useful for adults. Sometimes itis necessar! to immo,ilie the hip andfemur in a hip spica cast that will ,eused for wal+ing.

it much ,etter in weight ,earingposition

Stand ,etween two chairs

Stop a,o)e an+le distal!


38/39


39/39

THANK YOU

lower extremity casting

Documents