PLASTER CAST APPLICATION –

TECHNIQUES, PRECAUTIONS,
TYPES AND COMPLICATIONS

BY:- DR. AKASH AGARWAL

Introduction

• Casting properties of POP first observed when

a house in Paris built on gypsum burnt down.
It was found after rain fell, that the footprints
in the mud were caked upon drying.

• First used in fracture care by Antonius

Mathijsen, dutch army surgeon in 1852
MATERIALS Available for CASTING
1) POP (plaster of paris)
2) Synthetic based fiber glass
 PLASTER OF PARIS
The POP is hemi-hydrated calcium sulphate.
When water is added in POP, the calcium sulphate
takes up its water of crystallisation.
2(CaSO4.1/2 H20) + 3 H20  2 (CaSO4.2H20) + ENERGY
Its an exothermic reaction.
Faster settling plasters produce more heat.
ADVANTAGES OF POP
• Less expensive
• More moldable
• More pliable
DISADVANTAGES OF POP
Poor resistance to water
Relatively low strength
Heavier (thicker) casts
SYNTHETIC FIBRE GLASS MATERIAL
Advantages:
– Lightweight,
– May be combined with waterproof liners to allow
bathing and swimming in the cast.
Relatively strong

Disadvantages:
More expensive.
More difficult to mold
More stiff
Indications Of Casting
• Fractures
• Ligament injuries
• Reduced dislocations
•congenital anomaly -DDH
• Deformity correction
• Severe soft tissue injuries across joints
• Post tendon repair
• Post-operatively to augment internal fixation
• Congenital talipes equinovarus (CTEV) or clubfoot
 CAST APPLICATION
Clean skin and apply uniform thickness of cotton padding.
Soak plaster roll in water at room temprature.
Gently pick up the end of the bandage with both hands and
lightly squeeze it, pushing the end together without twisting or
wringing.
Hold relevant body part in correct position.
Apply the plaster by unrolling the bandage as it rests on the
limb, overlap the previous layer of plaster by about half the
width of the roll.
Mould the plaster evenly, rapidly and rub each layer firmly with
the palm so the cast becomes firm.
Joint should be immobilized in the functional position.
Cast should not be too tight or too loose.
• Stockinette is measured, extending 10cm beyond
determined limits of cast

guide to appropriate size

• Arm & forearm – 6”
• Wrist – 4”
• Thumb & fingers – 3”
• Thigh & leg – 8”
• Ankle & foot – 6”
• Apply POP one joint above and below
• Joint should be immobilized in functional position
guiding POP use
• Padding should be adequate esp over bony
prominences e.g. olecranon, ulnar styloid,
patella, fibular head, malleoli, heel
• POP shouldn’t be too tight or too loose

• The plaster should be of uniform thickness

throughout
• Check neurovascular status after cast application
• Do check xray for acceptability of reduction
Padding is applied generally in 2 layers, but may be
increased where there are bony prominences or if
significant swelling is anticipated
• Padding sizes, hand: 2”, upper limb: 3-4”;
foot:3”, lower limb: 4-6”
POP application
• POP to be used is dipped completely with both hands
into slightly warm water and held there till
bubbling stops
• Prior to this, for slabs, the required length is measured
and layered. On average 6-10 layers for upper limb and
12-16 layers for lower limb would suffice
It is then brought out and lightly squeezed to get rid of
excess water.
• If a slab is to be created, the wet plaster is kept on a
flat surface and the hand is run from one end to
another to get rid of air bubbles, which may cause slab
to be brittle and the layers to separate when dry.
Technique
For cast
– POP is applied in distal to proximal with 50% overlap
– POP is applied snugly, compressing padding thickness
by 50%
– The padding is rolled over and the final turns of POP
are rolled over it.
For slabs
– POP slab is applied and moulded onto the limb
contours
– Moulding is only with palms
– Stockinette & padding are rolled over the edge of slab
 TYPES OF CAST
• Above Elbow
• An above elbow plaster cast is applied from
knuckles of hand (distal palmar crease anteriorly] and
covers two thirds of arm
Indication-
Mid to proximal forearm fracture
Elbow fracture & dislocation
AE cast in supination-
-DRUJ
AE cast in Flexion-
-Supracondylar humerus # extension type
AE cast in Extension
-Olecranon #
-Supracondylar humerus # flexion type
Below Elbow
• While distal extent is from knuckles of hand (distal palmar
crease anteriorly , proximally the
plaster ends below elbow crease
Indication
-Distal forearm # like colles fracture
in colles cast-cast should in
a)palmer flexion
b)ulnar deviation
-Wrist sprain & carpal injury
-Some metacarpal fracture
Above Knee
• Distal extent is up to metatarsophalangeal joints and
proximally it covers lower two thirds of thigh.
knee in 5 to 15 degree flexion position
Indication-
Supra condylar # femur
Proximal & mid shaft tibial fracture

.
• Below Knee(short leg cast)
• Distal extent is metatarsophalangeal joints and,
proximal extent ends below knee.
Ankle in neutral position
Indication-
Distal tibia/fibula fracture, sprain
Dislocation of ankle joint
Tendo-achilis rupture(ankle in equinus)
Metatarsal fracture
HIP SPICA

A hip spica cast used to immobilize the hip or thigh.

It is used to facilitate healing of injured hip joints or
fractured femurs. A hip spica includes the trunk of
the body and one or both legs.
Patellar Tendon Bearing Cast

A well fitting below knee cast is applied and molded

between the gastrocnemius heads. The actual weight
is born on the patellar tendon region anteriorly. A
rubber heel is applied and the patient is encouraged to
weight-bear on the plaster after 4-6 wks of injury.
THUMB SPICA-
Extend from DIP jointof thumb
Incorporate the thumb & extend
Up to 2\3 of proximal forearm

Indication-
-thumb phalynx fracture/dislocation
The Hand

Position of Safe Immobilization (POSI)

Wrist: Moderate extension (10-45o)
MCP joints: Flexion (70-90o)
PIP joints: full extension
Thumb: midway between maximal radial and palmar
abduction
& Elbow: 90º of flexion
SCAPHOID CAST-
for scaphoid fracture

Wrist in slight radial deviation & extension

like”GLASS HOLDING Position”

Thumb in functional position & mcp joint free

& extend Up to 2\3 of proximal forearm
Cylindrical cast
Extend 2cm above from medial malleolus to two thirds
of thigh
Early weight bear in full extention
-indication
For Patella fracture-
 intact extensor mechanism (patient able to perform
SLR)
Nondisplaced or Minimally displaced fracture
In some Vertical fracture pattern
MINERVA CAST
Rarely used.
A pop cast incorporating the head & trunk
usually for fracture of cervical/ thoracic spine
CTEV CAST
Used for CLUB FOOT by ponseti
method.it is high above knee cast.which prevent slipage of
cast.after cast all toe should exposed & pink in colour

First cast is CAVUS correction cast applied by extend first

metacarpal & supinate forefoot
Then Abduction cast applied-whole foot abducted under
the talus. Thumb should on head of TALUS.
Do not dorsiflex until reached to 70 degree abduction than
equinus correction cast applied after tenotomy.
SOME OTHER CAST
Hanging U CAST-use for Humerus shaft #

LORENTZ CAST-use for DDH

Cast Wedging
Cast wedging is a technique traditionally used to
correct fracture malalignment
When a fresh fracture is found to have an
unacceptable loss of reduction within the plaster cast
& cast appears to be well fitting,than cast wedging may
be attemped to regain correction
A radiograph of injured area is used to trace long axis
of malaligned bone onto a sheet of paper.
The piece of paper is cut along this line & cut is traced
on to yhe cast.
than position of apex of deformity is determined from
the xray.
Next the plaster is cut nearly circumferentially at this
level,leaving a bridge of intact plaster only at apex.
Corks or cast wedges are applied opposite the
bridge,Untill the line transferred onto the cast is
straight.than check xray be done.
If it fails.reapply new cast.
Window in Cast
A plaster window is usually created over a pressure
area, or wound or suture line. This can relieve pressure
at the site, and provide an opportunity to change
dressings, check on drainage, and inspect a wound or
ulcer.
• POP precautions
•inform patient about thermal changes after application of
cast.
Where swelling is anticipated use a slab instead of cast, if a
cast must be used then it should be well-padded
Observe for changes in skin colour.which can indicate
impairment of circulation.
Whenever possible injured limb should be elevated
1)In case of arm & forearm a sling may be used
2)In lower limb leg may be elevated on pillows.
Aftercare of POP
INSTRUCTION to be given after applying pop
1)come immediately if any of following symptoms
develops
_exessive crying/fever
-exessive pain
-exessive swelling
-bluish or blackish discolouration of fingers &toes
2)keep the plaster dry
3)mobilize all near joints which are not incorporated in
the plaster to their full range of motion.
4)notice any crack or breakage in cast.if there
reinforce the cast
5)non weight bearing in lower limb fracture cast
6)elevation of cast to prevent swelling.
7)the patient should be reviewed in 1-2 wks & xray done
to reaffirm maintenance of reduction.
POP removal
• Slabs are removed by cutting the bandage, carefully
avoiding nicking the skin
• For casts
1) Using shears
» shears must lie between plaster and skin, avoiding bony
prominences
» Avoid cutting over concavities
2)– Using electric saw
» Do not use unless there’s wool padding
» Do not use over bony prominences
» Do not use blade if bent, broken or blunt
COMMONLY MADE MISTAKES DURING
CASTING
1. Well moulded cast does not mean tight cast.
2. To avoid pressure sore in casting by increasing the
amount of padding is a misconception, as excessive
padding leads to making the cast too loose.
The loose-fitting cast can also cause malunion due to
loss of fracture reduction.
COMPLICATIONS
1) DUE TO TIGHT CAST:-
- pain
- pressure sore
- compartment syndrome
- peripheral nerve injury

2) DUE TO IMPROPER APPLICATION

- joint stiffness
- blisters and sores
- cast breakage

3) DUE TO PLASTER ALLERGY

- allergic dermatitis

4) OTHERS
- deep vein thrombosis
THANK YOU