61. Fracture Management: POP/ Dynacast

Question 1

POP Overview

Answer 1

Principles:
* 8-10 layers of plaster
* Never circumferential plaster in the acute phase

Immobilisation complications:
* Loss of reduction
* Pressure necrosis (onset +2 hours)
* Thermal injury
* Thrombophlebitis/embolus
* Joint stiffness/ atrophy
* Circumferential tamponade effect
o Too tight
o Compartment syndrome
o Inappropriate cast application

Question 2

POSI Splint

Answer 2

Indications:
* Fractures
* Post finger dislocation reduction
* Wounds to hands/ fingers with potential deep structure involvement

Description:
* Position of safe immobilisation
* Extend to mid forearm
* Wrist extension to 10-45*
* MCP flexion 60-90*
* PIP and DIP in full extension
* Judgement – dorsal or volar
* Wound management

Steps:
1. Collect equipment (15cm POP, Velband (underwrap), 10cm crepe bandage, tape)
2. Measure on the unaffected arm from mid forearm right to tips of fingers
3. Cut out thenar eminence (pictured)
4. Cover any wounds if applicable with atrauman, combine.
5. Wrap forearm with Velband from fingers to mid forearm
6. Soak POP in water to wet, remove excess water.
7. Place either Volar or Dorsal aspect moulding to arm
8. Wrap with crepe bandage starting at mid forearm up to fingers and back down wrist
9. Apply Wrist extension and MCP flexion until POP is hard.

Question 3

Thumb Spica

Answer 3

Indications:
* Scaphoid injuries
* 1st MC fracture
* Injury to UCL

Description:
* PIPJ of thumb to mid-forearm
* Non-circumferential
* ‘Can’ hold (position of function)
* Wrist 25* extension
* Classic scaphoid cast

Steps:
1. Collect equipment (10cm POP, Velband (underwrap), 10cm crepe bandage, tape)
2. Measure on the unaffected arm from mid forearm right to thumb
3. Cut bilateral slits (pictured)
4. Either wrap forearm with Velband from forearm to mid forearm or cut velband to slightly bigger shape than POP.
5. Soak POP in water to wet, remove excess water.
6. Place as radial gutter with slits at base of thumb and wrap upper around thumb with fingers and thumb held in “can” position.
7. Wrap with crepe bandage starting at mid forearm up to fingers and back down wrist

Question 4

Short Arm

Answer 4

Indications:
* Radius and/ or ulna fracture to distal third of bone

Description:
* Forearm long bone fractures to the distal third of the bone
* Extends to first palmar crease
* Extends from 3 fingers below elbow crease
* Thenar eminence cut out
* SLAB only
* Variant – the dorsal volar slab – the “sandwich cast”

Steps:
1. Collect equipment (10cm POP, Tubifast, Velband (underwrap), 10cm crepe bandage, tape)
1. Measure on the unaffected arm from palmar crease to 3 fingers below the elbow crease
2. Cut out thenar eminence and angled across palmar crease
3. Place Tubifast from fingers to above elbows
4. Wrap forearm with Velband base of fingers to just distal of elbow crease
5. Soak POP in water to wet, remove excess water
6. Place volar slab (consider dorsal if required) and mould to hand
7. Wrap with crepe bandage starting at mid forearm up to fingers and back down wrist

Question 5

Radial Gutter

Answer 5

Indications:
* Aid to spica splint
* Non-displaced 2nd/ 3rd MC fracture
* Non-displaced 2nd/ 3rd phalange fracture
* Soft tissue injury to 2nd/ 3rd fingers

Description:
* Aids the spica splint
* Extends up and around the thumb
* Extend to mid forearm
* Creating a gutter for the radius to sit in

Steps:
1. Collect equipment (10cm POP, Velband (underwrap), 10cm crepe bandage, tape)
1. Measure on the unaffected arm from mid forearm to mid thumb
2. Either wrap forearm with Velband from forearm to mid forearm or cut velband to slightly bigger shape than POP
3. Soak POP in water to wet, remove excess water
4. Place as radial gutter
5. Wrap with crepe bandage starting at mid forearm up to fingers and back down wrist

Question 6

Ulna Gutter

Answer 6

Indications:
* Non-displaced 4th/ 5th MC fracture
* Non-displaced 4th/ 5th phalange fracture
* Soft tissue injury to 4th/ 5th fingers

Description:
* Maintains dexterity (ADL function)
* Extends up to 4th and 5th MC or phalanges
* Extend to mid forearm
* Extends across to the thenar eminence

Steps:
1. Collect equipment (10cm POP, Velband (underwrap), 10cm crepe bandage, tape)
1. Measure on the unaffected arm from mid forearm to 4th/ 5th phalanges
2. Either wrap forearm with Velband from forearm to mid forearm or cut velband to slightly bigger shape than POP
3. Soak POP in water to wet, remove excess water
4. Place as ulna gutter
5. Wrap with crepe bandage starting at mid forearm up to fingers and back down wrist