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5959595959Rural Practice Preparation Workshop February 2003

PlasteringSkill Station

Mark BeamanJudy Beaman

Queensland Rural Medical Support Agency

6060606060 Rural Practice Preparation Workshop February 2003

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Casting and Trauma

Slabbing Manual

Mark Beaman – Plaster Technician Logan Hospital Judy Beaman – Plaster Technician QEII Hospital Craig Nean – Plaster Technician QEII Hospital

2003

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Manual ContentsCast careRegional Anaesthesia

Casting Techniques

Radial Thumb Spicca Slab ¾ Radial SlabGutter SlabColles’ SlabVolar SlabScaphoid SlabShort Arm CastHalf Mitchell’s Toe Spiker SlabShort Leg Back SlabShort Leg Plaster of ParisShort Leg Back Slab with Toe PlatformShort Leg Plaster of Paris with Toe PlatformLong Leg Backslab “Sandwich Slab”

Helpful Tips

Equipment ListTrimming of Plaster of Paris and Synthetic Short Leg Slabs / Short LegCastsCast SplittingTrimming of Plaster of Paris and Synthetic Short Arm Slabs / Casts

Splinting Techniques

Knee Immobiliser SplintBuddy StrappingZimmer splinting

Sling Techniques

Collar and Cuff - open ended high arm slingCollar and Cuff - one piece high arm slingBroad Arm sling

References

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CAST CARE FOR BACKSLABS AND FULL CASTS

PLASTER OF PARIS BACK SLAB- initial setting time (working / moulding time) is approximately 3 minutes using cold water.- curing time is 24 - 48 hours in fine weather.- this is a non weight bearing cast.

PLASTER OF PARIS FULL CAST- initial setting time (working / moulding time) is approximately 3 minutes using cold water.- curing, time is 24 - 48 hours in fine weather.- weight bearing after 48 hours with a cast shoe or walking heel.

SYNTHETIC CAST- setting, time is around 7 minutes using cold water.- curing time is 1 hour.- weight bearing / mobilization after 24 hours with a cast shoe or walking heel is preferable.

THINGS TO DO WHILE YOU ARE WEARING A CAST

Elevate the limb in the cast: if you have your arm in a slab / cast, you should wear the slingprovided.If you have a short arm slab / cast, your arm should be in a position higher than your heart.If you have your leg in a cast, you should have it elevated on 2 - 3 pillows, eg; above the level ofyour heart.

Exercise the limb in the cast: if you have an arm slab / cast on you should exercise your fingers,thumb, shoulder and elbow (if your cast allows) as often as possible to control the swelling andpain.If you have your leg in a cast you should exercise toes and knees as much as possible to controlthe swelling and pain.Exercise is a good way to encourage good blood flow in the affected limb.

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KEEPING YOUR BACKSLAB / CAST DRY

Do not wet Your Backslab / Cast - if Plaster of Paris becomes wet, it will soften and its condition willrapidly deteriorate.-Unlike Plaster of Paris casts, a synthetic cast will not be affected by moisture.However, the stockinette and the synthetic padding will retain the moisture and the skinunder the cast will macerate quickly. Areas most affected are the palm of the hand and the soleof the foot.

A plastic bag on its own is not an effective solution, as there will be:a) a condensation build-up inside the bagb) water will still pass the edge of the bag, regardless of how well it is sealed.

Preferred Procedure:

a) wrap a towel around the cast - this will absorb most excess moistureb) when applying, the plastic bag use a double tape system (electrical tape) at top of the bag. Thefirst wrap of tape overlapping onto the towel underneath, the second wrap of tape approximately2cm above first wrap of tape.

If your cast gets wet you should contact your local Doctor or the Plaster Technician at yourlocal hospital. They will advise you how to assess the wetness of your cast. If a cast get wet orcracks or softens it may not be doing the job it is supposed to (immobilise the limb). Youmay need to have a new cast applied.

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GUIDELINES FOR INTRAVENOUS REGIONAL ANAESTHESIA(BIER’S BLOCK)

INDICATIONS:The reduction of upper limb fractures or dislocations. Minor surgical procedures in the upper limb.Suitable for children old enough to co-operate with and comprehend an explanation of theprocedure.

CONTRAINDICATIONS:unstable epilepsyuncontrolled hypertensionsevere liver diseasesickle cell diseasesecond or third degree heart blockperipheral vascular diseaseallergy to amide local anaesthetics

PATIENT PREPARATION:Informed consent should be obtained. The patient should ideally be fasted for 4-6 hours. IVRAmay be performed in non-fasted patients. Wherever possible one physician should supervise IVRAand a second physician should perform the procedure. The patient’s blood pressure should bechecked beforehand in the uninjured limb. Webril should be applied from the axilla to the anticubitalfossa of the injured limb ensuring access to the brachial artery. The cliff should then be appliedsnugly over the Webril.

MONITORING:Monitoring should ideally consist of continuous ECG monitoring, continuous pulse oximetry andintermittent non-invasive blood pressure monitoring.

LOCAL ANAESTHETIC:Prilocaine is the ideal local anaesthetic for IVRA. The dose is 3mg/kg of 0.5% Prilocaine, or amaximum adult dose of 200mg or 40mls x 0.5% Prilocaine. Single dose preservative freePrilocaine should be employed.

In the absence of Prilocaine a low dose technique with Lignocaine may be employed. The regimeis as follows:- for those under 14 years old and over 65 years old, 1.5mg/kg of 1% Lignocaine,maximum dose 100mg. For those 14 to 65 years old, 100mg of 1% Lignocaine. This should bediluted to a 0.5% solution with an equal volume of normal saline. If after 15 minutes adequateanaesthesia is not present an equivalent amount of saline may be injected which often enhancesthe block, otherwise in children and the elderly an additional 0.5mg/kg of .5% Lignocaine may beinjected. In adults an additional 50mg of 0.5% Lignocaine may be given as a repeat dose. ThisLignocaine regime should only be employed where Prilocaine is unavailable.

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PROCEDURE:

Step l: Check all equipment connections and cuffs for leaks. Ensure you are familiar with cuffoperation.

Step 2: Ensure access to resuscitation equipment, drugs, oxygen supply and suction. Wherepossible employ continuous ECG, pulse oximetry and non-invasive blood pressure monitoring.

Step 3: Insert intravenous cannulae into both limbs, as distally as possible in the injured limb.Flush both cannulae with sterile saline to ensure patency.

Step 4: Exsatiguinate the limb by elevating for 2-5 minutes with direct occluding pressure over thebrachial artery.

Step 5: Inflate the upper tourniquet rapidly to systolic blood pressure + 100mmHg. Physicallyensure that the cuff is inflated and check for absence of the brachial or radial pulses.

Step 6: Inject 0.5% Prilocaine 3mg/kg or a maximum of 40mls x 0.5% Prilocaine (200mg)intravenously over 2 minutes. There is no need to employ a test dose.

Step 7: Assess for adequate anaesthesia which may take anywhere from 5-20 minutes. Observethe patient for:-

restlessnesslightheadednessdizzinesstinnitusparaesthesiamuscular excitationseizurehypotensionbradycardia

Inflate the lower tourniquet to systolic blood pressure + 100mmHg. Physically ensure inflation anddeflate the upper cuff. Finally, physically ensure that the lower cuff is inflated and that the inflationpressure is correct before proceeding.

Step 8: A second physician should then perform the procedure. If a repeat x-ray is required, thepatient should be carefully moved to x-ray with the cuff still inflated. The cuff should not be deflateduntil the repeat x-rays have been reviewed.

Step 9: Deflate the cuff no earlier than 20 minutes after completion of the injection of Prilocaine.There is no need to sequentially deflate and inflate the cuff.

Step 10: For at least 15 minutes after tourniquet deflation observe the patient for theabovementioned side effects and the return of normal sensation.

20 November 1996

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ReferencesLowen R & Taylor J.Bier’s Block - The Experience of Australian Emergency Departments.Med J Australia. 1994; 160:108-111.

Brown E M, McGriff J T, Malinowski R W.Intravenous Regional Anaesthesia (Bier’s Block): Review of 20 Years Experience.Can J Anaesthesia 1989; 36:307-310.

Farrell R G, Swanson S L, Walter J R.Safe and Effective IV Regional Anaesthesia for Use in the Emergency Department.Ann. Emerg Med 1985; 14:239-241.

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CASTING TECHNIQUES

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RADIAL THUMB SPICCA SLAB

Materials required:15cm Plaster of Paris slab material 15ply1 x 7.5cm natural padding1 x 5cm conforming bandage1 x 5cm light crepe bandagecold water

Procedure1. Set up work area. Ensure all materials have been removed from packaging and within reach.

2. Calculate length of slab, from base of thumb nail or proximal to IP joint and distal to elbowcrease (Fig 2).

3. Fold slab material three times to length required to achieve 15ply.

4. Mark and cut out template (Fig 1).

5. Apply padding to limb. Apply padding circumferentially around limb; overlapping, 1/2 width padding per wrap; to provide an even/flat bed for plaster. Ensure padding extends 1 - 2cm past expected distal/proximal edge of plaster, to act as turn back’.

6. Run slab material through water; then ‘strip’ excess water from material between thumb andindex finger. This reduces mess and evenly distributes plaster through slab material.

7. Apply slab onto radial aspect of arm; align distal edge of slab with palmar crease, ensuring slab material rests at base of thumb nail (Fig 2).

8. Quickly shape slab material to arm.

9. Secure slab while still wet with conforming bandage. The conforming bandage secures slab to limb. The conforming bandage also becomes impregnated into the Plaster of Paris, therefore adding strength to the slab.

10. Turn padding back to form soft edges. Ensure MCPs have full range of movement.

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11. Assume ‘Bikers Handshake’ position (Fig 3). Move wrist into functional position. 20 - 30 degree extension(Fig 5). Place patients thumb, IP and MPs into flexion pushing onto thumb nail withyour thumb. Keep your own fingers extended and clear of cast. NOTE: patient should be able to touch fingers to thumb on completion of cast to allow a pinch grip. eg: Holding a pencil. (Fig 4).

12. Allow slab material to set (approx. 3 minutes); release grip.

13. Apply light crepe bandage snugly. The light crepe bandage can be changed or loosened/tightened as required.

14. Ensure patient knows to exercise and elevate limb, to minimise swelling and pain.

15. Place arm in high arm sling.

Uses of Radial Thumb Spicea Slabtemporary splint - designed to last maximum 7 - 10 days.

used post - operatively/acute trauma to accommodate swelling bandage (light crepe bandageshould be re-applied when tension is lost).

common usess- soft tissue strain of thumb and wrist- swelling of thumb area- suspected Game keepers # with gross swelling- suspected # of Scaphoid with gross swelling- # Scaphoid with gross swelling- lacerations of the thumb when immobilisation is required

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RADIAL THUMB SPICCA SLAB TEMPLATE

Use your own arm as a guide, mark middle of slab material with a pencil, measure from base ofthumb nail or proximal to IP joint.Width for thumb is 3-4 fingers wide, depth of cut is approx 2fingers down.Cut slab material to length and shape as illustrated in Fig. 2.Distal edge follows Palmar Crease.Proximal edge is cut approx. 3 - 5cm distal to elbow crease, this allows full flexion of fingersand unhindered arm flexion.

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BIKERS HAND SHAKEFig. 3

PINCH GRIPFig. 4

FUNCTIONAL POSITIONFig. 5

Wrist - at 20-30 degree extensionThumb - aligned with radius

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3/4 RADIAL SLAB


Procedure

1 Set up work area. Ensure all materials have been removed from packaging and within reach.

2 Calculate length of limb/cast, from palmar crease to 4 - 5cm distal to elbow crease. (Fig 1).

3 Fold slab material double required length to achieve 10ply.

4 Mark and cut out template (Fig 2).

5 Apply padding to limb. Apply padding circumferentially and around limb; overlapping, 1/2 width padding per wrap; to provide an even/flat bed for plaster. Ensure padding extends 1 - 2cm past expected distal/proximal edge plaster, to act as ‘turn back’.

6 Run slab material through water, then ‘ strip ’excess water from material between thumb andindex finger. This reduces mess and evenly distributes plaster through slab material.

7 Apply slab onto limb (Fig 3).

8 Quickly shape slab material to arm.

9 On dorsal view ensure cast edges are behind the metacarpal heads (Fig 4). On volar view, slab is folded over to the same angle at the palmar crease to strengthencast in the palmal area (Fig 5). This allows full range of movement of MCPs. Radial slab when cut to the right size will ensure ulna border is left well exposed toaccommodate excess swelling (Fig 4).

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3/4 RADIAL SLAB TEMPLATE

Use your own arm as a guide, mark slab material with pencil and cut to length and shape asillustrated in Fig. 2Distal edge follows Palmar Crease to allow full flexion of fingers.Proximal edge is cut approx. 3-5cm distal to elbow crease, this allows unhindered arm flexion.

Fig. 1

Fig. 3

Fig. 2

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10 Turn back padding to form soft edges. Secure slab while still wet with conforming bandage. The conforming bandage secures slab. The conforming bandage also becomes impregnated intothe Plaster of Paris, therefore adding strength to the slab.

11 Assume ‘bikers handshake’ position (Fig. 4). Move wrist into functional position (Fig.6). 20-30 degree extension: ensure alignment of carpal and forearm bones (Fig. 6).

12 Apply light crepe bandage snugly. The light crepe bandage can be changed or loosened/tightened as required.

13 Ensure patient knows to exercise and elevate limb, to minimise swelling and pain.

14 Place arm in high arm sling.

Uses for 3/4 Radial Slab- temporary splint- soft tissue swelling- displaced and non displaced # of the Distal Radius- # carpal bones- # of proximal metacarpals - excluding 1st metacarpal

THIS SLAB MAY BE TIGHTENED AND SEALED WITH A SYNTHETIC MATERIAL IF THE SLABBECOMES LOOSE.

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Fig. 4 Dorsal View and Bikers Hand Shake

Fig. 5 Volar view

Fig. 6 Functional View

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GUTTER SLAB


Procedure1 Set up work area. Ensure all materials have been removed from packaging and within reach.

2 Calculate length of limb/cast from 5th PIP joint to 4-5cm distal to elbow crease (Fig. 2).

3 Fold slab material three times to length required to achieve 15ply.

4 Mark and cut out template (Fig. 1).

5 After reduction and while maintaining traction, apply two layers of padding between 4th and 5th fingers, continue around fingers and circumferentially around limb; overlapping 1/2 width padding per wrap; to provide an even/flat bed for plaster. Ensure padding extends 1 - 2cm past expected distal / proximal edge of plaster to act as ‘turn back’. Ensure bony areas are well padded.

6 Place moulding pads (Fig 4). Moulding pad (Fig. 4-1) is approximately the length and width of your thumb pad and ispositioned over the metacarpal heads on the volar aspect side of the hand. This reduces the riskof pressure areas caused by pressure moulding when cast is applied. Moulding pad (Fig 4-2) is approximately the size of two finger width square, this pad is positioned over the proximal end of the metacarpal on the dorsal aspect of the hand.

7 Run slab material through water; then ‘strip’ excess water from material between thumb andindex finger. This reduces mess and evenly distributes plaster through slab material.

8 Keeping arm in a vertical position; apply slab evenly along the Ulna border, starting at the PIPjoints with the tapered end of the slab, smooth and shape slab to arm.

9 Secure slab while still wet with conforming bandage. The conforming bandage secures slab for moulding. The conforming bandage also becomes impregnated into the Plaster of Paris,therefore adding strength to the slab.

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GUTTER SLAB TEMPLATE

Use your own arm as a guide Fig. 2Mark slab material with a penciland cut to shape as illustrated inFig. 1.Distal edge from 5th PIP to 3 - 4cmdistal to elbow crease this allowsunhindered artn flexion.

Fig. 3

Fig. 2

Fig. 1Trim shaded arm

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10 Turn padding, back to form soft edges. Ensure distal and mid phalanxes have full range of movement.

11 While slab material is setting you must apply moulding in the direction shown in (Fig. 4 - 1 & 2). You must ensure MCP’s are at 90 degrees and that the wrist is in a neutral position. Do notrelease pressure until slab material is set! (approx. 3 minutes).




Uses for Gutter Slab

#’s of the 4th and 5th metacarpals#’s of the 4th and 5th phalanges#’s of the Ulna Styloid

Note

After any reduction performed, a check x - ray is required to confirm that the position of the boneand moulding sites are in an acceptable position.

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GUTTER SLAB MOULDING TECHNIQUE

Place moulding pads (Fig. 4)

Moulding pad (Fig. 4 -1) isapproximately the length andwidth of your thumb padand is positioned over themetacarpal heads on the volaraspect/side of the hand.

This reduces the risk of pressureareas caused by pressuremoulding when cast is applied.

Moulding pad (Fig 4 - 2) isapproximately the size of twofinger width square, this padis positioned over the proximalend of the metacarpal on thedorsal aspect of the hand.

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COLLES’ SLAB (3/4 RADIAL SLAB with two types of templates) Materials required:

20cm Plaster of Paris slab material 10 ply1 x 7.5cm natural padding1 x 5cm conforming bandage1 x 5cm light crepe bandagecold water

Procedure


2 Calculate length of limb/cast, from palmar crease to 4 - 5cm distal to elbow crease. (Fig 1).

3 Fold slab material double required length to achieve 10ply.

4 Choose which template suits you best then mark and cut out template (Fig 2).

5 Apply padding to limb. Apply padding circumferentially and around limb; overlapping, 1/2 width padding per wrap; to provide an even/flat bed for plaster. Ensure padding extends 1 - 2cm past expected distal / proximal edge plaster, to act as ‘turn back’.

6 Run slab material through water, then ‘strip’ excess water from material between thumb andindex finger. This reduces mess and evenly distributes plaster through slab material.

7 Slab is applied after reduction and while traction is maintained.

8 Apply slab onto limb (Fig 3).

9 Quickly shape slab material to arm (Fig 3).

10 On dorsal view ensure cast edges are behind the metacarpal heads (Fig 5.1). On volar view, slab is folded over to the same angle at the palmar crease to strengthencast in the palmal area (Fig 6.1). Not required if using the Diamond template. This allowsfull range of movement of MCPs. Colles’ slab when cut to the right size will ensure ulna border is left well exposed toaccommodate excess swelling (Fig 5.2).

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11 Turn back padding to form soft edges. Secure slab while still wet with conforming bandage.The conforming bandage secures slab for moulding (Fig 4). The conforming bandage alsobecomes impregnated into the Plaster of Paris, therefore adding strength to the slab.

12 Assume Colles’ moulding position, wrist in ulna deviation (Fig 5) and slight palmar flexion (Fig4).

13 Maintain traction and moulding until slab material is set (approx. 3 minutes).




Uses for Colles’ Slab- temporary splint- displaced and non displaced # of the Distal Radius

WHEN USED FOR A COLLES’ #:THIS SLAB MAY BE TIGHTENED AND SEALED BUT IS NOT USUALLY CHANGEDUNDER TWO WEEKS UNLESS AUTHORISED BY AN ORTHOPAEDIC SURGEONMEDICAL OFFICER

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COLLES’ SLAB TEMPLATE

Use your own arm as a guide, mark slab material with pencil and cut to length and shape as illustrated in Fig. 2 Distal edge follows Palmar Crease to allow full flexion of fingers. Proximal edge is cut approx. 3-5cm distal to elbow crease, this allows unhindered arm flexion.

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COLLES’ ‘DIAMOND’, 3/4 RADIAL SLAB TEMPLATE

Use your own arm as a guide,mark middle of the slab materialwith a pencil, one finger width downfrom the distal edge this gives youthe material width which sits in thethumb space.The diamond shape is three fingerswidth from the marked edge of thethumb space, cut out in diamond shape.Cut to length and shape asillustrated in Fig. 2Distal edge follows Palmar Creaseto allow full flexion of fingers.Proximal edge is cut approx. 3-5cmdistal to elbow crease, this allowsunhindered arm flexion.

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TYPICAL MOULDING POINTS OF A COLLES’SLAB/CAST

Fig 4 Radial View

Fig 5 Dorsal View

Fig 6 Volar View

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VOLAR SLAB

Materials required:

15cm Plaster of Paris slab material 15ply1 x 7.5cm natural padding1 x 5cm conforming bandage1 x 5cm light crepe bandagecold water

Procedure


2 Calculate length of limb/cast, from palmar crease to 4 - 5cm distal to elbow crease (Fig. 2).


4 Mark and cut out template (Fig. 1).

5 Apply padding to limb. Apply padding circumferentially around limb; overlapping, 1/2 width padding per wrap; to provide an even/flat bed for plaster. Ensure padding extends 1 - 2 cm past expected distal/proximal edge of plaster, to act as ‘turn back’.


7 Supinate patients forearm.

8 Apple slab onto volar aspect of arm; align distal edge of slab with palmar crease.



11 Turn padding back to form soft edges. Ensure joints (MCPs; thenar joints) have full range of movement.

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VOLAR SLAB TEMPLATE

Use your own arm as a guide,mark slab material with a penciland cut to length and shape asillustrated in Fig. 1Distal edge follows Palmar Creaseto allow full flexion of fingers.Proximal edge is cut approx. 3 - 5cmdistal to elbow crease, this allowsunhindered arm flexion.

Fig. 2

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12 Assume ‘Bikers Handshake’ position (Fig 3). Move wrist into functional position. 20 - 30 degree extension; ensure alignment of carpal and forearm bones (Fig 4).

13 Allow slab material to set (approx. 3 minutes); release grip.




Uses for Volar Slab

temporary splint - designed to last maximum 7 - 10 days

used post - operatively / acute trauma to accommodate swelling, (light crepe bandage) should be re - applied when tension is lost).

Common cases - carpal bone or MCP#- soft tissue strain of wrist- injuries distal of the distal third of the Radius and Ulna

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‘BIKERS HANDSHAKE’

FUNCTIONAL POSITIONFig. 4Wrist: 20 - 30 degrees extensionThumb: Aligned with radius

Fig. 3

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SCAPHOID SLAB

Materials required:

15cm Plaster of Paris slab material 15ply1 x 7.5cm natural padding.1 x 5cm conforming bandage1 x 5cm light crepe bandage cold water

Procedure


2 Calculate length of slab, from base of thumb nail or proximal to IP joint and distal to elbowcrease (Fig 2).


4 Mark and cut out template (Fig 1).

5 Apply padding, to limb. Apply padding, circumferentially around limb; overlapping, 1/2 width padding per wrap; to provide an even/flat bed for plaster. Ensure padding extends 1 - 2cm past expected distal/proximal edge of plaster, to act as ‘turn back’.


7 Supinate patients forearm.

8 Apply slab onto volar aspect of arm; align distal edge of slab with palmar crease, ensuring slab material rests at base of thumb nail (Fig. 2).



11 Turn padding back to form soft edges. Ensure MCPs have full range of movement.

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SCAPHOID SLAB TEMPLATE

Use your own arm as a guide, mark slab material with a pencil and cut to length and shape as illustrated in Fig. 2 Distal edge follows Palmar Crease Fig. 2 to allow full flexion of fingers and base of thumb nail or proximal to IP joint. Proximal edge is cut approx. 3 - 5cm distal to elbow crease, this allows unhindered arm flexion.

Fig. 1 Trim shaded area

Base of thumb

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12. Assume ‘Bikers Handshake’ position (Fig. 3). Move wrist into functional position. 20 - 30degree extension. Place patients thumb, IP and MPs into flexion pushing onto thumb nailwith your thumb. Keep your own fingers extended and clear of cast.

NOTE: patient should be able to touch fingers to thumb on completion of cast to allow a pinchgrip. eg: Holding a pencil (Fig. 3).

13. Allow slab material to set (approx. 3 minutes); release grip.

14. Apply light crepe bandage snugly. The crepe bandage can be changed or loosened/tightenedas required.



Uses of Scaphoid Slab

temporary splint - designed to last maximum 7 - 10 days

used post - operatively/acute trauma to accommodate swelling (light crepe bandage) shouldbe re-applied when tension is lost.

common cases - soft tissue strain of thumb and wrist- swelling of thumb area- suspected Game keepers # with gross swelling- suspected # of Scaphoid with gross swelling- # Scaphoid with gross swelling

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PINCH GRIP

Fig.3


Wrist: 20 - 30 degree extensionThumb: Aligned with radius

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SHORT ARM CAST

Materials:

Average Arm

2 x 10cm roll of Plaster of Paris bandage1 x 7.5cm natural paddingcold water

Procedure


2 Apply padding to limb. Apply padding circumferentially and around limb; overlapping 1/2 width padding per wrap; to provide an even/flat bed for plaster. Ensure padding extends 1 - 2cm past expected distal/proximal edge of plaster, to act as ‘turn back’.

3 Place first roll of Plaster of Paris in water for approx. 5 seconds.

4 Remove Plaster of Paris bandage from water and gently squeeze excess water from Plaster ofParis bandage.

5 Begin application at wrist, unwrapping Plaster of Paris bandage once circumferentially to ‘lock’on at wrist (Fig. 1).

6 Travel towards thumb and index finger, pinch (do not twist) Plaster of Paris bandage togetherand lower through thumb web space (Fig. 1 & 2) below 2nd MC head.

7 Continue to apply Plaster of Paris bandage by pinning Plaster of Paris bandage with your thumbor forefinger and bring Plaster of Paris bandage below base of thumb (Fig 3 & 4).

8 Repeat steps 6 & 7 to achieve 2 layers between thumb and forefinger.

9 Travel up arm with Plaster of Paris bandage, overlapping, 1/2 Plaster of Paris bandage per turnto ensure 2 layer consistency.

10 Drop second roll of Plaster of Paris bandage into water.

11 While Plaster of Paris bandage is soaking, turn padding back to form soft edges. Ensure joints (MCPs & thenar joints) have full range of movement.

12 Prepare second Plaster of Paris bandage as per step 4.

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BANDAGE TECHNIQUE

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13. Starting at the roximal end of the limb, apply second roll of Plaster of Paris bandage to secureedges of padding. Continue in a distal direction overlapping 1/2 Plaster of Paris bandageper turn, repeat steps 6 & 7 only once ensuring a maximum of 3 layers in this area this allowsgreater movement of thumb and forefinger. Proximal to wrist area should have a minimum oflayer thickness when cast is complete.

14. Assume ‘Bikers Handshake’ position (Fig. 5). Move wrist into functional position (Fig. 5). 20 -30 degree extension; ensure alignment of carpal and forearm bones (Fig. 6).

15. Smoothing cast surface with free han while continuing to maintain ‘Bikers Handshake’ with the other hand, (using a trowelling motion, smooth edges of cast along MCPs, Palmar Crease and

round thumb with the back of your thumb nail). Ensuring Plaster of Paris does notoverlap edge of padding.



Uses for Short Arm Cast

# of the Distal Radius and Ultra# Carpal bones# of the Proximal metacarpals - excluding 1st metacarpalsoft tisue injuries ofthe hand and wrist

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‘BIKERS HANDSHAKE’Fig. 5


Wrist: 20 - 30 degree extensionThumb: Aligned with radius

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HALF MITCHELL’S TOE SPIKER SLAB

Materials required:

15cm Plaster of Paris slab material 10ply1 x 7.5cm natural padding1 x 5cm conforming bandage1 x 5cm light crepe bandagecold water

Procedure


2 Calculate length of limb/cast, from tip of 1st DMTP (Fig. 1a) to base of 1st MT (Fig. 1b).

3 Using 15cm slab material fold, double required length to achieve 10 ply.

4 Calculate width of cast by doubling the width of patients foot (Fig. 1c).

5 Mark and cut slab (Fig. 2).

6 Apply padding to limb. Apply padding circumferentially and around limb; overlapping, 1/2 width padding per wrap; to provide an even/flat bed for plaster. Ensure padding extends 1 - 2cm past expected distal/proximal edge of plaster, to act as ‘turn back’.

7 Run slab material through water, then ‘strip’ excess water from material between thumb andindex finger. This reduces mess and evenly distributes plaster through slab material.

8 Apply slab material to limb (Fig. 4). Quickly shape slab material to foot. (Fig. 5)

9 Turn back padding to form soft edges. Secure slab while still wet with conforming bandage. The conforming bandage also becomes impregnated into the Plaster of Paris, therefore addingstrength to the slab.

10 Careful moulding under the arch of the foot will ensure that the slab will be a snug fit.



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HALF MITCHELL’S TOE SPIKER SLAB TEMPLATE

Calculate length of limb/cast, fromtip of 1st DMTP (Fig. 1a) to base of1st MT (Fig. 1b).

Calculate width of cast by doublingthe width of patients foot (Fig. 1c).

Uses for Half Mitchell’s Toe Spiker Slab:

Mitchell’s Osteotomy# between Distal end of the 1st Metatarsal and the Distal phalanx.

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Padding Technique:

Apply padding circumferentiallyand around limb; overlapping,1/2 width padding per wrap;to provide an even/flat bed forplaster (Fig. 3a - 3b).Extend padding to include1st MT (Fig. 3c - 3d).Ensure padding extends1 - 2cm past expecteddistal/proximal edge of plaster,to act as ‘turn back’.

* NOTE:Ensure shaped slab material doesn’t join on the lateral aspect of the foot and1st MTP, this allows an open border for swelling. The slab can be tightenedwhen swelling has subsided. This open border allows for easy removal of slab.

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SHORT LEG BACK SLAB

Materials required;

20cm Plaster of Paris slab material 10ply 1 x 15cm conforming bandage 15cm Plaster of Paris slab material 5ply 1 x 15cm soft crepe bandage 2 x 10cm natural padding Knee block Cold water

Procedure


2 Place Knee block under Knee.

3 With the foot at 90o, calculate length of limb/cast from the ball of the foot, this allows fullmovement of MTP’S (Fig. 1a) to within 2 - 3 fingers width of the underneath of the knee, onefinger width below the Fibula head (Fig. 1b). This allows the patient to bend his kneewithout discomfort.

4 Using 20cm slab material mark and cut template (Slab 1).

5 With the foot at 90o calculate length of reinforcing strip (Slab 2). Using 15cm slab material markand cut length required.

6 Lock padding on at distal end of limb (Fig. 2). Ensure padding extends 1 – 2cm past expecteddistal/ proximal edge of plaster, to act as ‘turn back’.

7 Continue circumferentially overlapping 1/2 width padding per wrap towards proximal end of limb (Fig. 3).

8 Using the figure 8 technique continue around ankle (Fig. 4 - 5 - 6).


10 Apply extra strips of padding (Stirrup’s) to cover boney prominences. Ensure Stirrup’s do not cover dorsal aspect of foot, excess bulk over this area creates pressure. (Fig. 8 - 9 - 10).

11 Run 20cm slab material through water, then ‘strip’ excess water from material between thumband index finger. This reduces mess and evenly distributes plaster through slab material.

12 Apply 20cm slab material to limb (Fig. 11). Quickly shape slab material to limb (Fig. 12).

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SHORT LEG BACKSLAB TEMPLATE

With the foot at 90°calculate length of limb/castfrom the ball of the foot, thisallows full movement ofMTP’S (Fig. 1a) to within2 - 3 fingers width of theunderneath of the knee, onefinger width below theFibula head (Fig. 1b).This allows the patient tobend his knee without discomfort.

Mark and cut template, Slab 1.

With the foot at 90° calculatelength of reinforcing strip, Slab 2.Mark and cut length required.

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14 Apply 15cm reinforcing slab material to limb (Fig. 13). Quickly shape slab material to limb.Folding edges back to the edges of the malleoli, this gives a 20ply coverage to weakest areaof the slab (Fig. 15).

15 Turn back padding to form soft edges. Secure slab while still wet with conforming bandage. The conforming bandage also becomes impregnated into the Plaster of Paris, therefore addingstrength to the slab.

16 Keep Limb in position until Plaster of Paris slab material is dry, this ensures that the limb is inthe correct position.



Uses for Cast:# distal Tibia and Fibula

Ligament injuriesSoft tissue injuries

NOTE:

Plaster of Paris has a setting time of 3 minutes in cold water, therefore it is necessary toapply Plaster of Paris bandages as quickly as possible. It has a curing time of 24 - 48 hours.

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APPLICATION OF PADDING

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SHORT LEG PLASTER OF PARIS

Materials required:

3 x 15cm rolls of Plaster of Paris15cm Plaster of Paris slab material 5ply2 x 10cm natural paddingKnee blockCold water

Procedure


2 Place Knee block under Knee. Ensure the ankle is at 90° before application.

3 Lock padding on at distal end of limb (Fig. 1). Ensure padding extends 1 – 2cm past expecteddistal/ proximal edge of plaster, to act as ‘turn back’.

4 Continue circumferentially overlapping 1/2 width padding per wrap towards proximal end oflimb (Fig. 2).


6 Continue circumferentially overlapping l/2 width padding per wrap towards proximal end of limb (Fig. 6).

7 Apply extra strips of padding (Stirrup’s) to cover boney prominences. Ensure Stirrup’s do not cover dorsal aspect of foot, excess bulk over this area creates pressure. (Fig 7 - 8 - 9). Add an extra strip of padding along the Tibial blade if required.

8 Leaving 5 - 10cm of the roll free, place 1st roll of 15cm Plaster of Paris bandage in bowl of cold water for 5 - 15 seconds, remove from water and squeeze lightly to remove excess water.

9 Lock Plaster of Paris bandage on at distal end of limb (Fig. 1) leaving 1 - 2cm of paddingexposed.

10 Continue around back of heel ensuring middle of bandage is across the middle of the ankle(Fig. 2).

11 Bring bandage around in a figure 8 pattern, middle of bandage comes over the point of the heel (Fig. 3).

12 Continue circumferentially overlapping l/2 width bandage per wrap towards proximal end of limb (Fig. 4 - 5 - 6 - 7).

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13 Finishing the proximal end of the limb with a 2 layer coverage of bandage, 2cm below the Fibula head (Fig. 8 - 9). Continue left over bandage down the limb.

14 Place 2nd roll of 15cm Plaster of Paris bandage in bowl of cold water for 5 - 15 seconds, remove from water and squeeze lightly to remove excess water. Continue as per first roll.


16 Apply 15cm slab material to limb (Fig. 10). Quickly shape slab material to limb.

17 Turn back edges of padding (Fig. 11). Ensuring full movement of MTP’s and one finger width below the Fibula head. This allows the patient to exercise toes and knee without discomfort.

18 Place 3rd roll of 15cm Plaster of Paris bandage in bowl of cold water for 5 - 15 seconds, removefrom water and squeeze tightly to remove excess water. Lock padding in place with Plaster ofParis bandage on the distal end of the limb not overlapping the edge of the padding.

19 Continue as per 1st and 2nd roll of Plaster of Paris bandage. Ensuring padding is locked on the proximal end, not overlapping the edge of the padding.

20 Using your hands in a trowel like fashion, smooth and shape Plaster to limb.

21 Clean all excess Plaster from limb. This ensures no Plaster gets inside the cast.


Uses for Cast:#distal Tibia and Fibula

Ligament injuriesSoft tissue injuries

NOTE:Plaster of Paris has a setting time of 3 minutes in cold water, therefore it is necessary toapply Plaster of Paris bandages as quickly as possible. It has a curing time of 24 - 48 hours.

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APPLICATION OF PLASTER OF PARIS

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SHORT LEG BACK SLAB WITH TOE PLATFORM

Materials required:

20cm Plaster of Paris slab material 10ply 1 x 15cm conforming bandage15cm Plaster of Paris slab material 5ply 1 x 15cm soft crepe bandage2 x 10cm natural paddingKnee blockCold water

Procedure


2 Place Knee block under Knee.

3 With the foot at 90o calculate length of limb/cast from the MTP’s (Fig. 1a) to within 2 - 3 fingers width of the underneath of the knee, one finger width below the Fibula head (Fig. 1b). Thisallows the patient to bend his knee without discomfort.

4 Using 20cm slab material mark and cut template (Slab 1).

5 With the foot at 90o, calculate length of reinforcing strip (Slab 2). Using 15cm slab material mark and cut length required.

6 Lock padding on at distal end of limb (Fig. 2). Ensure padding extends 1 - 2cm past expecteddistal proximal edge of plaster, to act as ‘turn back’.




10 Apply extra strips of padding (Stirrup’s) to cover boney prominence’s. Ensure Stirrup’s do not cover dorsal aspect of foot, excess bulk over this area creates pressure. (Fig. 8 - 9 - 10). Add2 - 3 layers of padding to cover toe area extending past toes (Fig. 11). Add an extra strip ofpadding along the Tibial blade if required.


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SHORT LEG BACKSLAB WITH TOE PLATFORM TEMPLATE

With the foot at 90° calculate length of limb/cast from the MTP’S (Fig. 1a) to within 2 - 3 finger width of the underneath of the knee, one finger width below the Fibula head (Fig. 1b). This allows the patient to bend his knee without discomfort.

Mark and cut template, Slab 1.

With the foot at 90° calculate length of reinforcing strip, Slab 2. Mark and cut length required.

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SHORT LEG PLASTER OF PARIS WITH TOE PLATFORM

Materials required:

3 x 15cm rolls of Plaster of Paris15cm Plaster of Paris stab material 5ply2 x 10cm natural paddingKnee blockCold water

Procedure


2 Place Knee block under Knee. Ensure the ankle is at 90° before application.

3 Lock padding on at distal end of limb (Fig. 1). Ensure padding extends 1 - 2cm past expecteddistal proximal edge of plaster, to act as ‘turn back’.




7 Apply extra strips of padding (Stirrup’s) to cover boney prominences. Ensure Stirrup’s do notcover dorsal aspect of foot, excess bulk over this area creates pressure. (Fig. 7 - 8 - 9).Add 2 - 3 layers of padding to cover toe area extending past toes (Fig. 10). Add an extra stripof padding along the Tibial blade if required.

8 Leaving 5 - 10cm of the roll free, place 1st roll of 15cm Plaster of Paris bandage in bowl of cold water for 5 - 15 seconds, remove from water and squeeze lightly to remove excess water.

9 Bringing the Plaster of Paris bandage around the tips of the toes (Fig. 1), locking trailing edge in place by continuing circumferentially around foot (Fig. 1a) leaving 1 - 2cm of padding exposed.

10 Continue around back of heel ensuring middle of bandage is across the middle of the ankle (Fig.2)

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13 Finishing the proximal end of the limb with a 2 layer coverage of bandage, 2cm below the Fibula head (Fig. 8 - 9). Continue left over bandage down the limb.

14 Place 2nd roll of 15cm Plaster of Paris bandage in bowl of cold water for 5 - 15 seconds, remove from water and squeeze lightly to remove excess water. Continue as per first roll.


16 Apply 15cm slab material to limb (Fig. 10). Quickly shape slab material to limb.

17 Turn back edges of padding (Fig. 11). Ensuring no movement of MTP’S and one finger width below the Fibula head. This allows the patient to exercise knee without discomfort.

18 Place 3rd roll of 15cm Plaster of Paris bandage in bowl of cold water for 5 - 1 5 seconds,-remove from water and squeeze lightly to remove excess water. Lock padding in place withPlaster of Paris bandage on the distal end of the limb not overlapping the edge of the padding.

19 Continue as per 1st and 2nd roll of Plaster of Paris bandage. Ensuring padding is locked on the proximal end, not overlapping the edge of the padding.

20 Using your hands in a trowel like fashion, smooth and shape Plaster to limb.

21 Clean all excess Plaster from limb. This ensures no Plaster gets inside the cast.


Uses for Cast;# of Metatarsal and Tarsal bone

Metatarsal and Tarsal bone injuriesTendon and ligament injuriesSoft tissue injuries

NOTE:Plaster of Paris has a setting time of 3 minutes in cold water, therefore it is necessary

to apply Plaster of Paris bandages as quickly as possible. It has a curing time of 24 -48 hours.

11. Bring bandage around in a figure 8 pattern, middle of bandage comes over the point of the heel (Fig. 3)12. Continue circumferentially overlapping 1/2 width bandage per wrap towards proximal end oflimb (Fig. 4 - 5 - 6 - 7).

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APPLICATION OF PLASTER OF PARIS

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LONG LEG BACKSLAB“SANDWICH SLAB”

Materials required:

20cm Plaster of Paris slab material 10ply15cm Plaster of Paris slab material 10ply8 x 10cm natural padding2 x 15cm light crepe bandagecold waterPillow’s x 2

Procedure

Top Slab


2 Calculate length of limb/cast, from MTH’S to within 5cm from groin. Check length of slab on the good leg to avoid unnecessary discomfort to the patient.

3 Using 15cm slab material fold double required length to achieve 10ply.

4 Position patient on pillows (Fig. 1)

5 Apply padding to top of leg. Lay padding on top of leg - 2-3 layers thick. (Fig. 1a). Allow a smallcap between leg and bed to allow a half roll of padding through (Fig. 1b)

6 Run slab material through water, then ‘strip’ excess water from material between thumb and index finger. This reduces mess and evenly distributes plaster through slab material.

7 Apply slab material to the top of the leg, smooth out slab material to conform to the leg and allowslab to set (Fig. 2).

8 Secure top slab with padding at proximal and distal ends of limb (Fig. 2a - 2b). This splints thelimb to allow lifting for the second part of the slab to be applied.

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SANDWICH SLAB TEMPLATE

Top Slab

Calculate length oflimb/cast from MTH’Sto within 5cm of groincrease. Check lengthof Slab on the good legto avoid discomfort to the patient.

Bottom Slab

Calculate length oflimb/cast from MTH’Sto within 5cm of groincrease on the undersideof limb. Check lengthof Slab on the goodleg to avoid discomfortto the patient.

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Bottom Slab

1 Calculate length of limb/cast, from MTH’s to within 5cm from groin on the under side of the limb. This slab will be slightly longer than top slab. Check length of slab on the good leg to avoid unnecessary discomfort to the patient.

2 Using 20cm slab material, fold double required length to achieve 10ply.

3 Lift leg, supporting the leg.

4 Apply padding circumferentially around limb and top slab, overlapping 1/2 width padding perwrap; to provide an even/flat bed for the plaster slab. (Fig. 3).

5 Run slab material through water, then ‘strip’ excess water from material between thumb and index finger. This reduces mess and evenly distributes plaster through slab material.

6 Apply slab material to the bottom of the leg (Fig. 4).

7 Secure the slab material with padding, covering both slabs (Fig. 5).

8 Apply the light crepe bandage over the limb, this will act as a neat finish at the same time keepingall parts of the slab in place.

Uses for the Sandwich Slab:

- Temporary splint - displaced and non – displaced # of Tibia and Fibula

- This slab can be sealed with FIBREGLASS if the # is in good alignment and an operation isnot required and swelling has subsided

NOTE:These slabs do not overlap - this slab is designed to have an open edge to allow for swelling (Fig.5).

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HELPFUL TIPS

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EQUIPMENT LISTEQUIPMENT LISTEQUIPMENT LISTEQUIPMENT LISTEQUIPMENT LIST

1. Bandage Scissors.

2. Small Sprung fine Blade Cast Spreaders.

3. Electric Oscillating Saw.

4. Plaster Knife

- straight blade or - fold away pocket knife with tip broken off (cheaper and Safer) note: diagram below.

5. Fine and Coarse Sharpening stone and knife steel or emery block.

6. Deep stainless steel or glazed plastic bowl. Plastic bag inserts are convenient if Plaster traps are not installed under sinks. Water can be poured out and residue plaster left inplastic bag can be discarded appropriately in waste bin.

7. Power Safety Pack if not built into existing saw.

Fold - up Pocket Knife Break Tip off Square

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TRIMMING PLASTER OF PTRIMMING PLASTER OF PTRIMMING PLASTER OF PTRIMMING PLASTER OF PTRIMMING PLASTER OF PARIS AND SYNTHETIC SHORARIS AND SYNTHETIC SHORARIS AND SYNTHETIC SHORARIS AND SYNTHETIC SHORARIS AND SYNTHETIC SHORT LEG SLABS /T LEG SLABS /T LEG SLABS /T LEG SLABS /T LEG SLABS /SHORSHORSHORSHORSHORT LEG CASTST LEG CASTST LEG CASTST LEG CASTST LEG CASTS

Trim to allow full flexion of MTCP’s and extension of the knee (Short Leg Cast)

The distal end of the Short Leg/Long Leg cast should:

a) finish proximal to the MTCP’s Fig. 1a

The proximal end of the Short Leg cast should:

b) allow extension of knee Fig. 1b

Note:After trimming a Plaster of Paris cast, turn back padding and apply a strip of adhesive tapecompletely around the trimmed edge to prevent flaking of the trimmed areas.After trimming synthetic cast, turn the padding and stockinet back over the edge and seal usingadhesive tape.

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CAST SPLITTING

Equipment required:

Cast cutting saw

Small spreaders

Bandage scissors

Roll of 7.5cm Cotton padding

Light crepe bandage

PROCEDURE

1. Make a cut along appropriate border with saw. Arm cast’s, are always split on the opposite side of #, EG. Radial # - cut along ulna border. Theonly exception is a long arm cast - a long arm cast is always split to point of the elbow onthe ulna border. Leg cast’s are split just off center of the Tibial blade.

2. Gently open slit (approximately 1cm with spreaders). Allow split to close slightly.

3. Cut padding with bandage scissors so the skin can be seen along the full length of the split.

4. Lay a length of padding 6ply the same length as the cast along the split. Next, gently and evenly pack the padding into the split using the blade of the spreaders. This will: a) hold the split open

b) prevent, the skin from swelling into the split.

5. Apply light crepe bandage around cast. This is done to: a) to prevent the split from opening further.

b) to keep the padding in the split intact. c) to prevent the patient from interfering with both of the above.

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TRIMMING PLASTER OF PARIS AND SYNTHETICSHORT ARM SLABS / CASTS

Trim to allow full flexion and extension of digits and elbow.

The distal end of the cast should:a) finish proximal to the metacarpal heads. Fig. 1Ab) along the palmar crease Fig. 3Bc) allow easy circular motion of the thumb Fig. 3CCast material between the thumb and index finger Fig. 1C should not impair theability of all fingers to oppose the thumb Fig. 3.

The proximal end of the cast should allow full flexion an extension of the elbow Fig. 2D.Remember that excessive trimming could hinder immobilisation of the fracture.

Note:After trimming a Plaster of Paris cast, turn back padding and apply a strip of adhesive tape completely aroundthe trimmed edge to prevent flaking of the trimmed areas.After trimming a synthetic cast, turn the padding and stockinet back over the edge and seal using adhesivetape.

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SPLINTING TECHNIQUES

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KNEE IMMOBILISER SPLINT

Ensure that the central contoured area of the splint is directly around the outside edge of thePatella.

The straps on either side of the knee should be placed on and tightened first, this gives stability tothe injured area.

Straps should be firmly in place around the Patella to maximise support of the knee.

Check tightness regularly to minimise circulatory problems.

Limb should be elevated and foot exercised regularly, to relieve swelling and pain.

Uses for the Knee Immobiliser

Temporary splint for: # Patella Dislocated Patella Soft tissue damage Ligament damage Pain control

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BUDDY STRAPPING

You will require:Cotton paddingBrown ½" tape

Fig. 1

Place 2-3 layers of paddingbetween fingers

Fig. 2a & 2b

Use strips of brown tape to securethe injured finger and the fingernext to it together

Fig. 2a

Fig. 2b

Uses for Buddy Strapping:Protection of injured fingerProtection post healing of # finger

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ZIMMER SPLINTING

You will require: Aluminium Splint Cotton padding Brown tape ¼” tape Brown tape ½” tape

Fig. 1

Place 2-3 layers of padding between fingers

Fig. 2

Use strips of 1/4" tape to secure, the injured finger and the finger next to it together

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ZIMMER SPLINTING continued:

Fig. 3

Shape Zimmer Splint to injuredfinger and tape with ¼” browntape as with Buddy Strapping

Fig. 4

Secure to hand with ½” brown tape over palm and around thumbNote: Splint is shaped around tip of finger for protection

Uses for Zimmer Splinting:Stabilising of undisplaced #Post dislocation

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SLING TECHNIQUES

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COLLAR ‘N’ CUFFOPEN ENDEDHIGH ARM SLING

Fig. 1You will require approx 1.5m of sling materialPlace affected arm at 120º maintain positionSupport the wrist in this positionTake cut end of padded sling materialPlace material around the handPlace both ends of sling material togetherFasten with a safety pin

Fig. 2

Place the padded sling material aroundthe neck and across the back to the oppositeside of the body

Fig. 3

Bring loose end through,and over the arm at the elbowSecure sling material and tie behindwith cable tieTrim excess sling material

Uses for this type of sling:Soft tissue injury# Distal Radius/UlnaLaceration injury

This sling may be extended for use with a Long Arm Cast

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COLLAR ‘N’ CUFFONE PIECE SLINGHIGH ARM SLING

Fig. 1

You will require approx 75cm of sling material

Place affected arm at approx 120º and maintain positionSupport the wrist in this positionTake cut end of padded sling materialPlace material around the hand

Fig. 2Place the padded sling material around the neck

Fig. 3

Bring the two ends of sling material togetherFasten with a cable tieCut off excess sling material

This type of sling is used for:#Undisplaced Radial Head#Undisplaced Oloertran#Humeral Head

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BROARD ARM SLING

You will require: Sling Safety pin

Fig. 1

Place patient in a sitting position Place the long side of sling under the injured arm parallel with other arm that is hanging down And place injured arm over sling

Fig. 2

Fold sling upward and over injured limb Tie ends just off centre of base of neck

Fig. 3

Secure sling at elbow with safety pin

Uses for Broad Arm Sling: Soft tissue injury Immobilise and support

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REFERENCES

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REFERENCES

Techniques in Surgical Casting and SplintingK. WhuLea and Febiger 1987Philadelphia

Practical Fracture Management 2nd EditionR. McReaChurchill LivingstoneEdinburgh 1909

Contents of Manual has been correlated by the following people:

MARK BEAMANSENIOR PLASTER TECHNICIANGOLD COAST HOSPITAL

CRAIG NEANSENIOR PLASTER TECHNICIANQEII HOSPITAL

JUDY BEAMANPLASTER TECHNICIANQEII HOSPITAL

Manual illustrated by:

MR. M.R. GINTRAC

MANY THANKS:

John O’Brien for allowing the use of his knowledge and techniques.

plastering skill station - tpched.org · - curing time is 24 - 48 hours in fine weather. - this is...

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