70.1 Plaster, and the equipment for it

Plaster of Paris is ideal for treating some fractures. But you must apply it skilfully, and only on the proper indications. If you apply a plaster cast carelessly, it can cripple a patient forever, and you may even have to amputate his limb. Use a plaster cast: (1) to immobilize bony fragments in the right position, (2) to protect his limb while his bones unite, (3) to make him comfortable. But casts have serious disadvantages. They can obstruct his circulation, they can cause pressure sores (70.3), they are heavy and inconvenient, they stiffen joints, and if you leave them on too long, the cones inside them become weak and osteoporotic.

Figure 70.1: PLASTER EQUIPMENT. Use this equipment to make standard casts, such as the long leg and short leg walking casts. The indications for each of them and the details as to how you should apply them are critical.

Use standard casts, such as the long leg and short leg walking casts (81.3). The indications for each of them and the details as to how you should apply them are critical. These critical details include the position of the patient’s limb, how far up and down it the cast should go, where you should put the padding, and the rule that a patient must exercise his muscles inside his cast. So follow the details we give exactly, and see that your assistants do so too. There are other ways of doing things, but you will not know which they are, and we do not have the space to describe them. Vary the methods we describe only if you have good reasons for doing so. For example, never apply any cast at the extreme range of movement of a joint. Pressure on the joint surface will make its cartilage necrose and cause osteoarthritis later.

•PLASTER BANDAGES, normal, slow setting, best quality, 10 cm, 15 cm, and 20 cm wide. Good quality plaster bandages make the strongest casts and poor ones are a mistake. If you use them, you will need twice as many, and the cast will be twice as heavy. If necessary, you can make plaster bandages locally from powdered plaster of Paris and rolls of gauze bandage. Plaster bandages are cheaper if you buy them as a long roll which you can cut off in the lengths you require.

•CREPE BANDAGES Many hospitals do not have these, so we have indicated alternatives when possible. You can use a plaster bandage instead of a crepe one to hold plaster slabs, but this is far from satisfactory.

•STOCKINETTE, woven tubular, orthopaedic, various widths, three rolls of each width. Use this in suitable widths for the finger, the arm, the leg, and in small quantities for the trunk. If you thread it on to the limb before applying plaster, it will stop the plaster sticking to the hairs on the patient’s skin, and will make casts and slabs more comfortable. It is not a substitute for adequate padding. If you don’t have it, use ordinary cotton bandages, or a single layer of expanded cotton wool. Cotton bandages will also make a stronger cast.

•PADDING, cotton wool, orthopaedic, ten rolls only. If you do not have this, cut a roll of ordinary cotton wool into smaller rolls 10 or 15 cm wide. Unroll them, leave in the sun, and let them expand. Then split them into four or five layers of the thicknesses you want, and roll them up again, ready for use. Each of your new rolls of expanded cotton wool will be the same size as the original one, but it will contain more air and collapse down more easily when you roll it on to a limb and cover it with plaster.

•STIRRUPS, locally made. These support a patient’s leg when he wears a walking cast. The cross pieces at the top are thin so that they bend easily to fit the shape of his leg and spread its weight through the cast.

•PLASTER SHEARS, Lorenz, 380 mm, nickel plated, one only. These large shears will open the strongest casts, but are unnecessary if you have an electric cast cutter.

•PLASTER SHEARS, Guy, with shaped bows and flattened probe end, 250 mm, nickel plated, one only. These shears are smaller and easier to use for removing small casts than the Lorenz shears. If you don’t have them, use ordinary pliers.

•PLASTER KNIFE, Esmarch, solid forged, two only. Use this for splitting circular casts after they have hardened; sharpen it on a stone. If necessary, you can use almost any knife.

PLASTER SAW, Bergman’s, hand, one only. If you don’t have electricity, you will need this.

•PLASTER CAST SAW, electric, oscillating, with four extra blades, 44 mm and 64 mm, state voltage, one outfit only. These will be useful if you have electricity; unfortunately most plaster saws have a short life.

•PLASTER CAST SPREADER, one only. When a cast has been split, this will spread it, so that you can remove it from the limb.

•PLASTER CAST BENDING FORCEPS, Boehler, one only. These are large pliers for bending the edges of a cast and opening it.

•PENCILS, INDELIBLE, for writing on a cast, six only. When you apply a cast write on it the date you applied it and the date you expect to remove it, together with a sketch of the fracture inside, as in Fig. 70-6. If the plaster is still wet, you can use a ball pen, but an ordinary pencil is unsatisfactory. An indelible pencil containing a water soluble blue dye is ideal.

Figure 70.2: ALWAYS PAD THESE PARTS OF A LIMB, or a cast will be uncomfortable and pressure sores may form. Protection of the common peroneal nerve as it winds round the neck of the fibula is especially important.