plaster equipment

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I- INTRODUCTION :

Definition : the plaster is hardened sand tissue system to ensure containment and & rsquo; immobilization & rsquo; a member. It is left in place until & rsquo; in the formation of & rsquo; callus solid for fractures.

It s & rsquo; is d & rsquo; a rigid containment means of holding the bone fragments in their normal reporting.

C & rsquo; is a gesture very common.

There are multiple indications in traumatology. It is part of the treatment of orthopedic injuries.

The realization d & rsquo; a cast immobilization is a delegated medical act to & rsquo; nursing.

Monitoring d & rsquo; a patient in plaster obeys strict rules. Failure to monitor commits the physician's responsibility and nurse.

II- INDICATIONS :

1- trauma :

Restraint and immobilization

A- Immobilization d & rsquo; fracture :

  • During orthopedic treatment to contain an undisplaced fracture or have been reduced.
  • In post-operative after osteosynthesis to ensure the strength of & rsquo; editing.

B- Quiesce ligaments and joint :

After sprain and dislocation.

2- In orthopedics and rheumatology :

To maintain a temporary form of & rsquo; plaster splint.

  • Fixing physiological position & rsquo; a deformed hinge : arthritis – scoliosis.
  • Quiescing d & rsquo; a joint in infectious processes : osteomyelitis – arthritis.

III- CLOTHING D & rsquo; A PLASTER :

A cast is made on :

  • conscious subject : must reassure, l & rsquo; install plastered position and clean the part without aggravating the injury.
  • subject unconscious : must be vigilant beings.

1- General principles :

  • To immobilize a joint, must secure the extra segment and underlying.
  • To immobilize a limb segment, it is necessary to immobilize the above joints and underlying.
  • The ends are always free : they allow monitoring of & rsquo; a plastered member.
  • The plaster has a pain relief.
  • A plaster is comfortable, he mold bone reliefs avoiding compression zones and being careful to areas necking, therefore any plaster poorly supported to be split, spread, bivalve and if that is not enough remove.

2- materials used :

  • Plaster Shears.
  • Circular saw.
  • Water.
  • crepe paper (to absorb water and facilitate removal of the plaster).
  • Skin protection : plaster n & rsquo; is never in direct contact with the skin. jersey used to be placed on clean skin and cotton synthetic foam in compression zones for protection.
  • The plaster : in the form of heavy plaster bandages easy to shape, economic. Slower taken that the resin.
  • Resin : in the form of light strips, fast setting, solid. It is not afraid of splashing water with the resin, expensive.

3- The technical realization of & rsquo; a plaster :

  • Protect skin with jersey.
  • Ask the band plaster without tension.
  • Modeler with care by marrying the reliefs.
  • We must handle with the palm of the hand rather than & rsquo; with fingers.
  • Allow to dry at & rsquo; open. The plaster is still slightly soft up & rsquo; to that & rsquo; it is completely dry. A wet plaster can be deformed and this deformation can cause pressure on the skin. A dry plaster 24 72h according & rsquo; thickness of the plaster.
  • It will be performed later notches and windows if necessary.
  • The window is an opening formed on the plaster with an oscillating saw for monitoring d & rsquo; a particular area or decompression d & rsquo; a painful area. The edges of the window are protected by the & rsquo; élastoblaste.
  • Always make a radio control to see if the fracture s & rsquo; is not moved by the establishment of the plaster.

IV- THE DIFFERENT TYPES OF PLASTER :

1- In the upper limb :

A- Plaster antébrachio-palmar or headline plastered :

  • Begin below the elbow ; the bend is free.
  • Stop palmar crease.
  • Oblique d & rsquo; back and forth.
  • Immobilisation : – wrist – carpe – pasterns (off the metacarpophalangeal joints – phalangienne).
  • Indication : – broken hand (scaphoïde) + wrist fracture
  • Compression :

– Epiphyseal distal of the & rsquo; ulna.
– Forearm
– Column thumb and 5th finger,

  • Striction :

– more Palmaire.
– Top of the & rsquo; forearm.
– Around the thumb.

B- Plaster brachiocephalic brachiopods or forearm-palmar :

  • beginning at 1/3 upper arm before the axilla.
  • Stop palmar crease.
  • Immobilisation : – -before elbow arm -poignet
  • Indications :

– Wrist fracture.
– Fractured bones of the forearm ;
– Elbow fracture.

  • Compression : ditto the headline plastered + olecranon + epicondyle of the humerus.
  • Striction : ditto the headline plastered + the upper part of the plaster.

C- Plaster thoracotomy-brachial :

  • Indication : fracture 1 /3 top of the humerus.

2- In the lower limb :

A- Boot plastered or pedal boot :

  • Begin below the knee.
  • Stop : leaves the upper side of the free toe overhang with a sole 02 at 03 cm on the underside.
  • If authorized support : establishment of a heel in the extension of the tibia.
  • Immobilisation : – ankle – Tarse – metatarsus (excluding the MP joint).
  • Indication :

– Fracture and severe ankle sprain.
– ankle fracture.
– Calcaneal fracture.

  • Compression : – tubérosité tibial + neck of the fibula + Mollet + talon.
  • Striction : base of the toes + High plaster.

B- Plaster Cruor-pedal :

  • Start at the root of the thigh.
  • Stop : leaves the upper side of the free toe overhang with a sole 02 at 03 cm on the underside.
  • Knee flexion of 30 °.
  • Immobilisation : – knee – ankle – Tarse – metatarsus.
  • Indications :

– Knee injury (sprain – luxation – fracture ….)
– Fracture of tibia and fibula (Fibula)

  • Compression : Ditto the cast boot + posterior knee.
  • Striction : Ditto the cast boot + High plaster.

C- Plaster pelvic-pedal :

Indicated in cases of pelvic fracture.

D- Grenoullière plastered (plaster cruro tibialis) :

May be indicated in cases of knee sprain, replaced by brace Zimmer.

3- Other orthopedic splinting materials :

  • plate heat – formable (exp : fracture of the fingers).
  • Polyurethane or fiberglass (exp : Minerve and corset).
  • Strapping or flexible contention : elastic adhesive tapes.
  • removable orthosis.

V- COMPLICATIONS :

1- neurovascular complications :

A- Compartment syndrome :

  • Definition : increased tissue pressure at & rsquo; within the fascial extensible lodges responsible for arterial compression, vein and nerve.
  • Etiology : or edema, hematoma, a tight plaster or the conjunction of three factors may be the source of increased pressures.
  • Result
  • Interruption of circulation artériolairc.
  • Ischemic necrosis of muscle and nerve parts.
  • Clinique :

– significant pain Tension type, cramp increased on palpation.
– Pallor and coldness.
– Paresis and paresthesia for d & rsquo; a sensory deficit – see motor paralysis of the extremities.
– Voltage of the concerned box.
– Burning sensation.
– Pain in the voluntary contraction of the muscles with inability to mobilize the fingers and toes.
– Pain passive tensioning of the affected muscle groups.

  • Treatment : c & rsquo; is a surgical emergency.

– The plaster must be removed which highlights the tension increased exertional compartment volume.
– If the regression of symptoms n & rsquo; not quickly obtained the diagnosis is very likely.
– The surgical gesture is a discharge fasciotomy which must be done within less than 06h.

B- Syndrome de Volkmann :

  • Definition : c & rsquo; is ischemic retraction of the flexor muscles of the fingers and wrist, leading to a hand characteristic claw.

– C & rsquo; is the consequence of the syndrome lodges in the upper limb in case of retardation surgical management.
– C & rsquo; is the most feared complication in case in case of injury of the elbow and the & rsquo; forearm.
– When this syndrome appears it is irreversible.

  • Clinique :

– At first the same as for compartment syndrome ;cold and stubby fingers with fingers bending blank.
– In a second time ; there will be a characteristic of bending fingers, of the hand and wrist carrying hand characteristic claw Volkmann's syndrome. At this stage the functional loss of the fingers is final.

2- skin complications :

  • Types of lesion : erythema – phlyctènc – escarre – necrosis – ostéite.
  • Etiology : different factors are at & rsquo; origin of these lesions whose website : compression on bony prominences, increase d & rsquo; edema, undernutrition, injury intrusion & rsquo; object, skin infection and insufficiently cleaned wound.
  • Clinique : pain – significant itching – skin lesions visible on a necking or friction zone – unpleasant odor even nauseous – stained plaster.

3- Complications thrombo-emboliques :

Deep vein thrombosis and its lethal complication pulmonary embolism.

  • Etiology : prolonged immobilization – orthopedic surgery.
  • Clinique : difficult to spot as impossible to palpate the calf and mobilize Member ; we can have moderate pain in the calf with local signs like redness, heat, edema of the visible parts. If pulmonary embolism is the clinical signs are type: chest pain d & rsquo; sudden onset, dyspnea, anguish, malaise.
  • Prevention :

– Early lifting up with the chair.
– Articulation soon as possible.
– minimal muscle contraction and mobilization under plaster.
– Member Raising.
– Monitoring the & rsquo; clinical signs.
– Prescription d & rsquo; a preventive dose anticoagulation (HBPM).

4- orthopedic complications :

A- malunion :

  • Definition : c & rsquo; is a secondary displacement of the fracture after immobilization and consolidation in an abnormal position.
  • Etiology :

– d & rsquo Confection; unsuitable in bad conditions plaster.
– d & rsquo decrease; an important edema making too wide plaster.

  • Clinique : pain.
  • Radio : displacement – malunion.
  • Treatment :

– Radio control after plaster.
– Redo the plaster if too.
– Do not stay with a broken plaster. .
– surgical treatment (correction osteotomy).

B- Stiffness and ankylosis :

  • Etiology : immobilization in physiological position.
  • Prevention :

– Plaster according to position.
– Release as soon as possible the & rsquo; link.
– Physiotherapy non-immobilized joints.
– curative in rehabilitation.

C- Muscle wasting :

  • Etiology : Total rest up muscles.
  • Prevention : voluntary contractions of muscle groups several times a day.

WE- PATIENT EDUCATION :

A number of instructions to follow should be clearly explained to the patient :

  • Observe the drying time (24 72h according & rsquo; thickness of the plaster), before & rsquo; exert mechanical stress.
  • Do not varnish the cast would prevent the & rsquo; natural evaporation and lead to maceration.
  • Do not wet or immerse the plaster, which weaken the
  • Do not insert foreign objects under the cast.
  • Elevate the member plastered the first few days to reduce the & rsquo; edema.
  • Conduct regular isometric contractions and mobilize left free joints to prevent the & rsquo; atrophy and thromboembolic complications – emboliques.
  • Teach him to detect compression signs : paresthésie – edema – cutaneous pallor or cyanosis – localized or widespread pain in all the plaster.
  • In case of fever, thrill, nausea, chest pain or shortness of breath you should see a doctor.
  • Avoid prolonged standing.
  • Maintain adequate physical activity and Jack up regularly
  • Eat properly limiting fats and carbohydrates but by focusing on proteins, calcium and fibers.

VII- REMOVAL OF PLASTER :

Is on prescription, after radiological control.

  • Necessary material : Saw plaster – retractor clamp – mattress protection – mild soap – antiseptic.
  • Technique :

– Install the member protection and hard surface.
– Sawing plaster over its entire length with a power saw.
– At & rsquo; using the & rsquo; open the plaster spreader.
– Remove the plaster.
– Cut jersey.
– I wash with soap and drying member.
– O & rsquo; there are micro-lesions must disinfect.
– Check motor, the heat, coloring and member of sensitivity.
– Radiation monitoring.

Courses of Dr. Hamlaoui – Faculty of Constantine