Translated from French to English - www.onlinedoctranslator.

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PLASTERING AND
TRACTION DEVICES
Ferrag Taki Eddine
plan
1-Cast retention:
DEFINITION

MAIN INDICATIONS

GENERAL PRINCIPLES OF PLASTERING

IMMOBILIZATION
THE DIFFERENT MATERIALS

THE DIFFERENT PLASTERING DEVICES

COMPLICATIONS AND MONITORING

plan
2-Traction equipment:
I. DEFINITIONS
II. MODES OF ACTION

III. INDICATIONS

IV. DIFFERENT TYPES OF PULL-UPS

V. MONITORING
VI. CONCLUSION
 Plastered apparatus

 DEFINITION:
Therapeutic method used in isolation or in addition to an
surgical procedure,both in the context of traumatology and in
that of orthopedics.

Maintain a traumatized area in a stable and non-dangerous

position until bone, ligament and tendon injuries have healed.
 INDICATIONS:
 Compression and immobilization casts are used during
the consolidation of a fracture or the resting of a joint
(sprain, dislocation).

 corrective casts aim to maintain the correction of a

fracture or dislocation after an orthopedic reduction or
a defective joint attitude.
GENERAL PRINCIPLES

 To immobilize a joint, the above and underlying segments must be

immobilized.
 To immobilize a limb segment, the above and underlying joints must be
immobilized.
 immobilize the joints in the functional position to avoid stiffness.
 The device must be solid and as light as possible.
 the skin must be protected by a tubular jersey.
 the device must be modeled on the limb and well smoothed.
 must be split.
 Regular and careful monitoring.
 Confection:
 Facility.
 Jersey.
 Cotton (except cast plaster)
 Soaking, wringing.
 Application, Modeling.
 Smoothing, finishing.
 Drying.
THE DIFFERENT MATERIALS
 Plaster:
 gypsum: natural product; hydrated calcium sulfate placed
on gauze strips.
 drying: between 30 and 48 hours.
 The skin is protected by tubular jersey and strips of carded
cotton.
 Synthetic resin:

 synthetic support of woven fibers (especially glass fibers,

or polyester and/or Nylon®), impregnated with a
polyurethane resin which polymerizes in water.
 often used as a replacement for cast immobilization.
THE DIFFERENT PLASTERING DEVICES

 Circular plaster appliances

 A. Upper limb casts

 B. Plaster appliances of the lower limb

 Cast splints
A. Upper limb casts

 The position of function:

 Shoulder elbow to body

 elbow at 90° flexion.
 forearm in half-pronation or neutral pronation.
 wrist at 20° of dorsiflexion.
 fingers in intrinsic position (metacarpophalangeal joints in
flexion and interphalangeal joints in slight flexion).
A. Upper limb casts

 Thoracobrachial plaster:
 Definition:
Device immobilizing the shoulder joint, arm, elbow, forearm,
wrist and hand.
Abduction (45-50°) - antepulsion (45°) - Neutral rotation.

Indications:


Fractures:ESH, Trochiter, Shoulder without displacement.

Rotator cuff repairs.

Shoulder surgery.
A. Upper limb casts

 Plaster BrachioAnteBrachioPalmar:
Plaster BrachioAnteBrachioPalmar:

 Definition:Circular device immobilizing the joints of the

carpus, the elbow, and the two bones of the forearm. The
1st phalanx of the thumb can be taken in the event of a
scaphoid fracture.
 Indication:fractures of the wrist, both bones of the
forearm and the elbow region. Orthopedic treatment or
postoperative period.
 Boundaries:begins three finger widths under the armpit;
at the distal level, it stops on the heads of the metacarpals
dorsally and on the second transverse fold palmarly.
A. Upper limb casts

 Antebrachiopalmar plaster:

Cast cuff Scaphoid cuff

Antebrachiopalmar plaster:

 Definition:device immobilizing the wrist and

carpal bones, and limiting pronosupination.
 Indications:fracture of the metacarpals,
postoperative compression cast, contusion of the
soft tissues, after 3 or 4 weeks of a
brachioantebrachial cast.
 Boundaries:the cast begins two fingerbreadths
below the elbow and must be oblique from front to
back.
Scaphoid cuff:
 Definition:device immobilizing the bones and
joints of the carpus and the spine of the thumb.
 Indications: scaphoid fractures, first column
fractures.
 Metacarpophalangeal joint included, in position of
maximum opposition and abduction.
B. Plaster appliances of the lower limb

 The functional position of the lower limb:

 knee at 10° flexion.

 ankle at right angle without rearfoot misalignment.

B. Plaster appliances of the lower limb

 Pelvic-pedal plaster:
 Pelvic-pedal plaster:

 DEFINITION :
Device immobilizing the lower limb in relation to the
pelvis
 Note:

young children, exceptionally in adults, after hip

surgery, fracture of the acetabulum, in infectious
diseases of the hip and also the femur.
 Boundaries:going from the last ribs to the foot.
B. Plaster appliances of the lower limb

 cruropedial plaster
 cruropedial plaster

 DEFINITION:
Device immobilizing the knee, ankle and foot joints.
 BOUNDARIES:

Distal: beyond the toes in the plantar part the root of

the toes dorsally.
Proximal: oblique line passing: under the gluteal fold
behind, 2 fingers under the inguinal fold, under the
greater trochanter laterally
 Indications:ankle, leg or knee fractures.
Cruromalleolar plaster
 Definition:
Device immobilizing the joint
of the knee.
stops on the flat of the malleolus.
 Indications:

fractures or dislocations of the patella,

ruptures of the patellar ligaments or
quadriceps
PEDIOUS BOOT
 Definition:device immobilizing the joints and
bones of the foot and leg below the knee.
 Indications: severe ankle fractures and sprains,
midtarsal and metatarsal fractures.
 Application :begins on the TTA and 2 finger
widths from the posterior knee flexion crease and
ends on the metatarsophalangeal joints.
COMPLICATIONS
 Dermal
 Nervous
 Vascular
 Bone
 Joints
 Muscular
 General
Dermal
• Pruritus and macerations are common

• Direct skin compressionBedsores

• Inadequate rubbing under plasterwounds

Nervous
 By localized compression:

 Ulnar nerve: gutterepitrochleo-olcranienee

 Radial nerve: middle third of the humerus
 SPE nerve: neck of the fibula

 Pain, sensory-motor deficit

Vascular
 1-Direct vascular compression:

 Venous:discomfort of venous return with edema and cyanosis

 Arterial:ischemia either positional or permanent

Pain, pallor, cooling, absent distal pulses

 Concerns all flexion zones:

 axillary hollow, popliteal
 Scarpa triangle
Vascular
 2-Compartment syndrome : Linked to the initial
condition (hematoma and crushing of tissues) +
aggravation by the cast (decrease in venous and
arterial return)
 Increased pressure in muscle compartments
 ISCHEMIA THEN MUSCLE AND NERVE NECROSIS
 SEVERE IRREVERSIBLE TENDIN RETRACTIONS AND
MUSCLE WASTING
Vascular
 3-Thromboembolic complication

Phlebitisdue to prolonged immobilization, risk of

embolism: elevation of the cast, preventive
anticoagulant treatment on medical prescription.
Secondary movement

 caused by the melting of theedema, amyotrophy

due to the absence of muscle contraction and
weakening of the cast.
General complications
 Difficulty breathing: plasterthoraco-brachial
or BABP with elbow to the body

 Decubitus complication: elderly people with

loss of autonomy

 Gastric intolerance(vomiting, nausea):

pelvic-pedal casts
MONITORING
I – CLINICAL:

 SYSTEMATIC, REPEATED AND

APPROACHED initially
has) local state
– Pain, smell, appearance of the cast.
b)Locoregional state
– Mobility, sensitivity, warmth, coloring of visible
limb segments (fingers, toes).
MONITORING
vs)Condition
– Temperature, heart and respiratory rate.
 Involves the responsibility of the doctor

 Systematic patient information:

 elevation of the limb

 skin coloring

 pain

 +/- support

 do not wet the plaster

SYSTEMATIC CONSULTATION IN THE LEAST OF DOUBT +++

MONITORING
II – Radiological:

Detect complicationsosteo-articular:
Secondary movement

Regular x-rays until bone union is achieved: at

least on D1, D7, D14, D21.
 Frequency depends on the initial pathology
MONITORING
III – Organic:

 Monitoring of preventive anticoagulant

treatment (platelet count, prothrombin level).
 Monitoring of an infection (blood count,

sedimentation rate,
VS-reactive protein).
Traction equipment
DEFINITION
 Traction:means that a pulling force is applied to
one body part or extremity while counterextension
pulls in the opposite direction. This counter-
extension is constituted by the weight of the body.
MODES OF ACTION

 Principle
pulling along the axis of the limb or part of the
body with precise force and direction
 Aim
 align the bones on either side of the fracture
(anatomical position)
 Immobilize and hold the body part in the required
position
 wait for the fracture to consolidate
MODES OF ACTION

 This force opposes muscle contraction and

therefore:

 forces the bones to move back into place on their own

 relieves pain by muscle relaxation
 maintains the reduction (because traction continues)
 force exerted calculated according to the patient's
weight: + / - 1/10 of the body weight
INDICATIONS

 Temporary treatment:

 Traction-suspension is sometimes necessary

as“waiting treatment”of an osteosynthesis
 (improvement of the skin condition, of the general
condition of the P.,pbcoagulation…)
 opposing algic muscle contracture.
INDICATIONS

 “Comprehensive” treatment of a traction

fracture:

 reduce and maintain the fracture. (acetabulum,

fractures of the tibial plateaus, or even
fracturessupracondylar)
 Dislocation (hip):gradually reposition the femoral head in
the acetabulum
INDICATIONS
 Postoperative treatments

 Sometimes, traction is useful: comminuted fracture of

the acetabulum (where the osteosynthesis remains
fragile).

 Elsewhere, it is the mobilization-elevation which is the

essential (fracture of the tibial plateaus operated)
 DIFFERENTTYPES OF PULL-UPS

 Glued traction:
Sheis carried out using a splintfixedby a bandhave you
adhesivethe tensile force isexerciseddirectly on the skin

-child(femur
fractures, hip
dislocation)
- elderly person
awaiting intervention