The design and thickness of the cast must be appropriate to the king of mechanical stresses which will be imposed on it. The amount of plaster applied depends upon the condition to be treated, and the use to which the cast will be put. Before padding or constructing a cast one must ensure that he has an adequate supply of materials and instruments within easy reach.
Inadequate preparation can cause future cast weakness and breakdown.
Padding
Soft resilient material such as wool, felt and special orthopaedic padding is placed on the skin before plater application.Padding serves to
- prevent sores
- increase comfort
- act as a “spacer” to aid removal.
Padding is extremely important in following situations
- When swelling is present or expected, i.e.,in almost every acute condition
- When limb is thin and bones are very superficial
- When the electric plaster cutters are used for removal
- When wedging is contemplated
How To Apply
- Apply stockinette over the area to be plastered. Unroll soft padding of the required width firmly over the area. Overlap each turn by one third in order to secure layers. If plaster slabs are to be incorporated in padded cast it is advisable to secure the padding with a complete layers of circular bandage first.
- With the equipment ready and either buckets or bowls filled with water (250-350C), the patient is settled in comfortable position with clothing protected.
It is important that the patient is relaxed, comfortable, and understands what is going to happen. If the patient is tense the finished cast can be loose and inefficient.
- The affected part should covered with suitable padding and the desired position secured and held correctly. While maintaining the position, the assistant’s hands must not obstruct the technician.
- Bandages of the correct size are immersed in water, one at a time, and held there until bubbling stops. The bandage is removed by holding it at the ends. The ends are gently squeezed towards the center then pulled back to shapte.
Wringing expels too much water and the bandage will become unworkable before application is complete and not set properly.
- Keep the leading end free when handing the bandage to the operator. Immerse a further bandage held gently in the water. Meanwhile the operator unrolls the wet bandage around the limb in an even manner. Minimum tension should be exercised and this should be directed towards the centre of the bandage-not at the edges. Only circular and spiral turns should be used.
Reverse turns will lead to ridges inside the cast.
- Moulding of the bandages to the contours of the limb should be done by constant smoothing with the palms of the wet hands and by pleating at the upper or lower edges of the bandages, being careful to avoid bony prominences. Pleating will ensure that the centreal area of the bandage lies smoothly in the correct direction.
The tendency to build up a cast which is thick centrally and paper thin at the extremities, can be prevented by making a double circular turn at the extremities.
- When the required thickness has been obtained, the extremities of the cast may require trimming to ensure that a free range of movement is possible at joints which are not immobilized. This should be done while the cast is wet and not left until it is fully dried out.
- The completed wet cast is handled carefully and supported correctly to protect it from damage. The patient is suitably instructed about taking care of the cast.
Slabs
When the required length and width have been decided, the slab is lightly folded from each end to the centre. It is immersed in water immediately removed, then carefully and quickly smoothed on the flat surface. The layers must be pressed together and the bubbles excluded. If this is not done, the layers become brittle when dry and can separate, giving an inefficient cast.
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