Splints And Casts: Indications And Methods
Splints and Casts: Indications and MethodsANNE S. BOYD, MD, University of Pittsburgh School of Medicine, Pittsburgh, PennsylvaniaHOLLY J. BENJAMIN, MD, University of Chicago, Chicago, IllinoisCHAD ASPLUND, MD, The Ohio State University College of Medicine, Columbus, OhioManagement of a wide variety of musculoskeletal conditions requires the use of a cast or splint. Splints are noncircumferential immobilizers that accommodate swelling. This quality makes splints ideal for the management of a varietyof acute musculoskeletal conditions in which swelling is anticipated, such as acute fractures or sprains, or for initialstabilization of reduced, displaced, or unstable fractures before orthopedic intervention. Casts are circumferentialimmobilizers. Because of this, casts provide superior immobilization but are less forgiving, have higher complicationrates, and are generally reserved for complex and/or definitive fracture management. To maximize benefits whileminimizing complications, the use of casts and splints is generally limited to the short term. Excessive immobilization from continuous use of a cast or splint can lead to chronic pain, joint stiffness, muscle atrophy, or more severecomplications (e.g., complex regional pain syndrome). All patients who are placed in a splint or cast require carefulmonitoring to ensure proper recovery. Selection of a specific cast or splint varies based on the area of the body beingtreated, and on the acuity and stability of the injury. Indications and accurate application techniques vary for eachtype of splint and cast commonly encountered in a primary care setting. This article highlights the different types ofsplints and casts that are used in various circumstances and how each is applied. (Am Fam Physician. 2009;80(5):491499. Copyright 2009 American Academy of Family Physicians.)The online versionof this articleincludes supplemental content at http://www.aafp.org/afp.Family physicians often make decisions about the use of splints andcasts in the management of musculoskeletal disorders. Because of this,they need to be familiar with indicationsfor application, proper technique, and thepotential pitfalls of casting and splinting tooptimize patient care when treating common orthopedic injuries.Splints and casts immobilize musculoskeletal injuries while diminishing pain andpromoting healing; however, they differ intheir construction, indications, benefits, andrisks. When determining whether to applya splint or a cast, the physician must makean accurate diagnosis, as well as assess thestage, severity, and stability of the injury; thepatient’s functional requirements; and therisk of complications (Table 1).1,2Because splints are noncircumferentialimmobilizers and are, therefore, more forgiving, they allow for swelling in the acutephase. Splinting is useful for a variety ofacute orthopedic conditions such as fractures, reduced joint dislocations, sprains,severe soft tissue injuries, and post-lacerationrepairs. The purpose of splinting acutely is toimmobilize and protect the injured extremity, aid in healing, and lessen pain. Splintingduring the later phases of injury or forchronic conditions will assist with healing,long-term pain control, and progression ofphysical function, and it will slow progression of the pathologic process.3,4Casting involves circumferential application of plaster or fiberglass to an extremity. Casts provide superior immobilization,but are less forgiving and have higher complication rates. Therefore, they are usuallyreserved for complex and/or definitive fracture management.Application of any immobilizer comeswith potential complications, includingischemia, heat injury, pressure sores, skinbreakdown, infection, dermatitis, neurologic injury, and compartment syndrome.These conditions can occur regardless ofhow long the device is used.5 To maximizebenefits while minimizing complications,the use of casts and splints is generally limited to the short term. Excessive immobilization from continuous use of a cast orsplint can lead to chronic pain, joint stiffness, muscle atrophy, or more severe complications, such as complex regional painsyndrome.6 All patients who are placed in asplint or cast require careful monitoring toensure proper recovery.7 Downloaded from the American Family Physician Web site at www.aafp.org/afp. Copyright 2009 American Academy of Family Physicians. For the private, noncommercialuse of one individual user of the Web site. All other rights reserved. Contact copyrights@aafp.org for copyright questions and/or permission requests.
Splints and CastsSORT: KEY RECOMMENDATIONS FOR PRACTICEEvidenceratingReferencesCommentsUse of a short arm radial gutter splint is recommended for initial immobilization of a displaceddistal radial fracture.B11RCTImmobilization of the thumb with a removable splint after a ligamentous injury is stronglypreferred by patients, and the functional results are equal to those of plaster castimmobilization after surgical and nonsurgical treatment.B12RCTRemovable splinting is preferable to casting in the treatment of wrist buckle fractures in children.B13RCTEvidence supports a functional treatment approach to inversion ankle sprains with the use ofa semirigid or soft lace-up brace.B17SystematicreviewClinical recommendationRCT randomized controlled trial.A consistent, good-quality patient-oriented evidence; B inconsistent or limited-quality patient-oriented evidence; C consensus, diseaseoriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.xml.Cast/Splint Choice and ApplicationThis article highlights the different types of splints andcasts that are used in various circumstances and how each isapplied. In a previous article in American Family Physician,we discussed the principles and risks of casting and splinting, as well as proper techniques for safe application.6Casting and splinting both begin by placing the injuredextremity in its position of function. Casting continueswith application of stockinette, then circumferentialapplication of two or three layers of cotton padding, andfinally circumferential application of plaster or fiberglass. In general, 2-inch padding is used for the hands,2- to 4-inch padding for the upper extremities, 3-inchpadding for the feet, and 4- to 6-inch padding for thelower extremities.Splinting may be accomplished in a variety of ways.One option is to begin as if creating a cast and, with theextremity in its position of function, apply stockinette,then a layer of overlapping circumferential cotton padding. The wet splint is then placed over the padding andmolded to the contours of the extremity, and the stockinette and padding are folded back to create a smooth edge(Figure 1). The dried splint is secured in place by wrapping an elastic bandage in a distal to proximal direction.For an average-size adult, upper extremities should besplinted with six to 10 sheets of casting material, whereaslower extremities may require 12 to 15 sheets.An acceptable alternative is to create a splint withoutthe use of stockinette or circumferential padding. Several layers of padding that are slightly wider and longerthan the splint are applied directly to the smoothed, wetsplint. Together they are molded to the extremity andsecured with an elastic bandage (Figure 2). Prepackagedsplints consisting of fiberglass and padding wrapped in aTable 1. Comparison of Splints and isks/disadvantagesSplintNoncircumferentialAcute and definitive treatmentof select fracturesAllows for acute swellingLack of complianceDecreased risk of complicationsSoft tissue injuries (sprains,tendons)Faster and easier applicationIncreased range of motionat injury siteAcute management ofinjuries awaiting e management ofsimple, complex, unstable, orpotentially unstable fracturesCommercial splints available andappropriate for select injuriesMay be static (preventing motion)or dynamic (functional; assistingwith controlled motion)More effective immobilizationNot useful for definitive careof unstable or potentiallyunstable fracturesHigher risk of complicationsMore technically difficultto applySevere, nonacute soft tissueinjuries unable to bemanaged with splintingInformation from references 1 and 2.492 American Family Physicianwww.aafp.org/afpVolume 80, Number 5 September 1, 2009
Splints and CastsFigure 1. Ulnar gutter splint with underlying stockinetteand circumferential padding.mesh layer also exist. These are easily cut and molded tothe injured extremity; however, they are more expensiveand are not always available. Prefabricated and overthe-counter splints are the simplest option, althoughthey are less “custom fit,” and their use may be limitedby cost or availability.The most common types of splints and casts usedin primary care, with information on indications andfollow-up, are discussed in Tables 2 through 4. All splintsare described before elastic bandage application.general fracture management principlesFigure 2. Padded thumb spica splint.Position of Function. The wrist is slightly extended,with the metacarpophalangeal (MCP) joints in 70 to90 degrees of flexion, and the proximal interphalangeal(PIP) and DIP joints in 5 to 10 degrees of flexion.ulnar gutter castCommon Uses. Definitive or alternative treatment ofinjuries commonly treated with ulnar gutter splint.8Application. Ideally, the cast is applied 24 to 48 hours ormore after the initial injury to allow swelling to decrease.Placement of the casting materials is similar to that ofthe ulnar gutter splint, except the plaster or fiberglass iswrapped circumferentially (Figure 3).It is important to maintain good anatomic fracture alignment throughout treatment. Acceptable angular deformity in the hand varies depending on the fracture site. radial gutter splintRotational deformity in the hand is never acceptable.Common Uses. Nondisplaced fractures of the head, neck,Stable fractures are generally reevaluated within one to and shaft of the second or third metacarpal withouttwo weeks following cast application to assess cast fit and angulation or rotation; nondisplaced, nonrotated shaftcondition, and to perform radiography to monitor heal- fractures and serious injuries of the second or third,ing and fracture alignment. Hand and forearm fractures, proximal or middle phalanx; initial immobilization ofhowever, are often reevaluated within the first week.displaced distal radius fractures.11Displaced fractures require closed reduction, followedApplication. The splint runs along the radial aspectby post-reduction radiography to confirm bone align- of the forearm to just beyond the DIP joint of the indexment. Both displaced and unstable fracturesshould be monitored vigilantly to ensureTable 2. Commonly Used Splints and Castsmaintained positioning. If reduction or positioning is not maintained, urgent referral toArea of injuryType of splintType of castan orthopedic subspecialist is warranted.8-10Upper Extremity Splints and Castsulnar gutter splintCommon Uses. Nondisplaced, stable fracturesof the head, neck, and shaft of the fourth orfifth metacarpal with mild angulation and norotational deformities; nondisplaced, nonrotated shaft fractures and serious soft tissueinjuries of the fourth or fifth, proximal ormiddle phalanx; boxer’s fractures (distal fifthmetacarpal fractures, the most common injuryfor which ulnar gutter splint/cast used).Application. The splint begins at the proximal forearm and extends to just beyond thedistal interphalangeal (DIP) joint (Figure 1).Cast padding is placed between the fingers.September 1, 2009 Volume 80, Number 5Hand/fingerUlnar gutter, radial gutter,thumb spica, fingerUlnar gutter, radial gutter,thumb spicaForearm/wristVolar/dorsal forearm, singlesugar-tongShort arm, long armElbow/forearmLong arm posterior, doublesugar-tongLong armKneePosterior knee, off-the-shelfimmobilizerLong legTibia/fibulaPosterior ankle (mid-shaft anddistal fractures), bulky JonesLong leg (proximal fracture),short leg (mid-shaft anddistal)AnklePosterior ankle (“post-mold”),stirrup, bulky Jones, hightop walking bootShort legFootPosterior ankle with orwithout toe box, hard-soledshoe, high-top walking bootShort leg, short leg with toebox for phalanx fracturewww.aafp.org/afp American Family Physician 493
Splints and CastsTable 3. Upper Extremity Splinting and Casting ChartRegionType ofsplint/castUlnar sideof nar guttersplint/castFourth and fifth proximal/middlephalangeal shaft fractures andselect metacarpal fracturesProper positioning of MCPjoints at 70 to 90 degrees offlexion, PIP and DIP joints at5 to 10 degrees of flexionOne to two weeksRadial sideof handRadial guttersplint/castSecond and third proximal/middle phalangeal shaftfractures and select metacarpalfracturesProper positioning of MCPjoints at 70 to 90 degrees offlexion, PIP and DIP joints at5 to 10 degrees of flexionOne to two weeksThumb, firstmetacarpal,and carpalbonesThumb spicasplint/castInjuries to scaphoid/trapeziumFracture of the middle/proximal one third of thescaphoid treated withcastingOne to two weeksNondisplaced, nonangulated,extra-articular first metacarpalfracturesStable thumb fractures withor without closed reductionFinger injuriesBuddy tapingRefer for angulated, displaced,rotated, oblique, or intraarticular fracture or failedclosed reductionRefer for angulated, displaced,rotated, oblique, or intraarticular fracture or failedclosed reductionRefer for angulated, displaced,intra-articular, incompletelyreduced, or unstable fractureRefer displaced fracture of thescaphoidNondisplaced proximal/middlephalangeal shaft fracture andsprainsEncourage active rangeof motion in all jointsAluminumU-shapedsplintDistal phalangeal fractureEncourage active rangeof motion at PIP and MCPjointsDorsalextensionblock splintMiddle phalangeal volar plateavulsions and stable reducedPIP joint dislocationsIncrease flexion by 15 degreesweekly, from 45 degrees tofull extensionTwo weeksRefer for angulated, displaced,rotated, oblique, orsignificant intra-articularfracture or failure to regainfull range of motionBuddy taping permitted withsplint useWrist/handMallet fingersplintExtensor tendon avulsion fromthe base of the distal phalanxContinuous extension in thesplint for six to eight weeksis essentialVolar/dorsalforearmsplintSoft tissue injuries to handand wristConsider splinting asdefinitive treatment forbuckle fracturesAcute carpal bone fractures(excluding scaphoid/trapezium)One weekRefer for displaced or unstablefracturesRefer lunate fracturesChildhood buckle fractures ofthe distal radiusShort arm castNondisplaced, minimallydisplaced, or buckle fracturesof the distal radiusCarpal bone fractures other , andskeletallyimmaturewrist injuriesSingle sugartong splintAcute distal radial and ulnarfracturesUsed for increasedimmobilization of forearmand greater stabilityLess than one weekLong armposteriorsplint, longarm castDistal humeral and proximal/midshaft forearm fracturesEnsure adequate paddingat bony prominencesWithin one weekDouble sugartong splintAcute elbow and forearmfractures, and nondisplaced,extra-articular Colles fracturesOffers greater immobilizationagainst pronation/supinationLess than one weekNonbuckle wrist fracturesRefer for displaced or unstablefracturesRefer for displaced or unstablefracturesRefer childhood distal humeralfracturesDIP distal interphalangeal; MCP metacarpophalangeal; PIP proximal interphalangeal.494 American Family Physicianwww.aafp.org/afpVolume 80, Number 5 September 1, 2009
Splints and CastsTable 4. Lower Extremity Splinting and Casting ChartRegionType of erralAnklePosterior anklesplint (“postmold”)Severe sprainsSplint ends 2 inches distal to fibularhead to avoid common peroneal nervecompressionLess than one weekStirrup splintAnkle sprainsMold to site of injury for effectivecompressionLess than one weekCompartment syndrome most commonlyassociated with proximal mid-tibialfractures, so care is taken not toover-compressTwo to four weeksIsolated, nondisplacedmalleolar fracturesRefer for displaced ormultiple fractures orsignificant joint instabilityAcute foot fracturesAnkleIsolated, nondisplacedmalleolar fracturesLower leg,ankle,and footShort leg castIsolated, nondisplacedmalleolar fracturesFoot fractures—tarsalsand metatarsalsRefer for displaced orangulated fracture orproximal first throughfourth metatarsalfracturesWeight-bearing status important; initiallynon–weight bearing with tibial injuriesKnee andlower legPosterior kneesplintAcute soft tissue andbony injuries of thelower extremityIf ankle immobilization is necessary, aswith tibial shaft injuries, the splint shouldextend to include the metatarsalsDaysFootShort leg castwith toe plateextensionDistal metatarsal andphalangeal fracturesUseful technique for toe immobilizationOften used when high-top walking bootsare not availableTwo weeksRefer for displaced orunstable fracturesfinger, leaving the thumb free (Online Figure A). Castpadding is placed between the fingers.Position of Function. The wrist is placed in slightextension, with the MCP joints in 70 to 90 degrees offlexion, and the PIP and DIP joints in 5 to 10 degreesof flexion.radial gutter castor fiberglass is wrapped circumferentially (Figure 4). Thecast is usually placed two to seven days after the initialinjury to allow for resolution of swelling.Pearls and Pitfalls. Minimal angulation or rotation atthe fracture site may cause functional problems, such asdifficulty with grasp, pinch, or opposition. Therefore,meticulous evaluation and follow-up are essential.Common Uses. Definitive or alternative treatment offractures initially managed with a radial gutter splint.Application. Placement of the casting materials is similar to that of the radial gutter splint, except the plasterthumb spica splintFigure 3. Ulnar gutter cast.Figure 4. Radial gutter cast.September 1, 2009 Volume 80, Number 5Common Uses. Suspected injuries to the scaphoid; stableligamentous injuries to the thumb; initial treatment ofnonangulated, nondisplaced, extra-articular fractureswww.aafp.org/afp American Family Physician 495
Splints and Castsof the base of the first metacarpal; de Quervain tenosynovitis; first carpometacarpal joint arthritis.Application. The splint covers the radial aspect of theforearm, from the proximal one third of the forearmto just distal to the interphalangeal joint of the thumb,encircling the thumb (Figure 2).Position of Function. The forearm is in the neutral position with the wrist extended to 25 degrees and the thumbin a position of function (i.e., “holding a soda can”).Pearls and Pitfalls. Immobilization of the thumb witha removable splint after a ligamentous injury is stronglypreferred by patients, and the functional results are equalto those of plaster cast immobilization after surgical andnonsurgical treatment.12thumb spica castCommon Uses. Suspected or nondisplaced, distal fractures of the scaphoid; nonangulated, nondisplaced, extraarticular fractures of the base of the first metacarpal.Application. The cast uses the same position of functionas described for a thumb spica splint, but requires circumferential application of casting materials (Figure 5).Pearls and Pitfalls. Because these types of fractures areoften serious and have a high rate of complications, longterm splinting is not an appropriate definitive treatment.Angulated, displaced, incompletely reduced, or intraarticular fractures of the first metacarpal base should bereferred for orthopedic subspecialist evaluation.8 Nondisplaced distal fractures of the scaphoid have a greaterpotential to heal and may be placed in a short arm thumbspica cast and reevaluated out of the cast by radiographyin two weeks.2,9 Nondisplaced fractures of the middleor proximal one third of the scaphoid are treated with along arm thumb spica cast initially and require vigilantmonitoring for nonunion.2buddy taping (dynamic splinting)Common Uses. Minor finger sprains; stable, nondisplaced, nonangulated shaft fractures of the proximal ormiddle phalanx.7,8Application. The injured finger is taped to the adjacentfinger for protection and to allow movement (OnlineFigure B).dorsal extension-block splintCommon Uses. Larger, middle phalangeal volar avulsionswith potential for dorsal subluxation; reduced, stable PIPjoint dorsal dislocations.Application. In reduced, volar avulsion fractures, thesplint is applied with the PIP joint at 45 degrees of flexionand secured at the proximal finger, allowing flexion at496 American Family PhysicianFigure 5. Thumb spica cast.Figure 6. Dorsal extension-block splint.the PIP joint (Figure 6). With weekly lateral radiography,the flexion is decreased 15 degrees until reaching fullextension over four weeks. Buddy taping should follow.Treatment of reduced PIP joint dislocations is similar,but requires a starting angle of 20 degrees.aluminum u-shaped splintCommon Uses. Distal phalangeal fractures.Application. The aluminum splint wraps from the dorsal fingertip around to the volar fingertip and immobilizesonly the DIP joint in extension (Online Figure C).mallet finger splintsCommon Uses. Avulsion of the extensor tendon from thebase of the distal phalanx (with or without an avulsionfracture).www.aafp.org/afpVolume 80, Number 5 September 1, 2009
Splints and Castsing for definitive treatment of wrist buckle fractures inchildren, a removable plaster splint improves physicalfunctioning and satisfaction, with no difference in painor healing rates.13Figure 7. Volar wrist splint.short arm castCommon Uses. Nondisplaced or minimally displacedfractures of the distal wrist, such as Colles and Smithfractures or greenstick, buckle, and physeal fractures inchildren; carpal bone fractures other than scaphoid ortrapezium.Application. The cast extends from the proximal onethird of the forearm to the distal palmar crease volarlyand just proximal to the MCP joints dorsally (OnlineFigure D).Position of Function. The wrist is in a neutral positionand slightly extended; the MCP joints are free.Pearls and Pitfalls. These are the same as for a forearmsplint.single sugar-tong splintCommon Uses. Acute management of distal radial andulnar fractures.Application. The splint extends from the proximal palmar crease, along the volar forearm, around the elbow tothe dorsum of the MCP joints (Figure 8).Position of Function. The forearm is neutral and thewrist is slightly extended.Pearls and Pitfalls. The splint stabilizes the wrist elbowand limits, but does not eliminate, forearm supinationand pronation.Figure 8. Single sugar-tong splint.Application. The DIP joint is placed in slight hyperextension with a padded dorsal splint, an unpadded volarsplint, or a prefabricated mallet finger splint. Continuousextension in the splint for six to eight weeks is essential,even when changing the splint. Compliance is assessedevery two weeks. Night splinting for an additional two tothree weeks is recommended.volar/dorsal forearm splintCommon Uses. Soft tissue injuries of the hand and wrist;temporary immobilization of carpal bone dislocationsor fractures (excluding scaphoid and trapezium).Application. The splint extends from the dorsal or volarmid-forearm to the distal palmar crease (Figure 7).Position of Function. The wrist is slightly extended.Pearls and Pitfalls. The splint does not limit forearmpronation and supination, and is generally not recommended for distal radial or ulnar fractures. A recentstudy, however, demonstrated that compared with castSeptember 1, 2009 Volume 80, Number 5long arm posterior splintCommon Uses. Acute and definitive management ofelbow, proximal and mid-shaft forearm, and wrist injuries; acute management of distal radial (nonbuckle) and/or ulnar fractures in children.Application. The splint extends from the axilla overthe posterior surface of the 90-degree flexed elbow, andalong the ulna to the proximal palmar crease (OnlineFigure E).Pearls and Pitfalls. The posterior splint is not recommended for complex or unstable distal forearm fractures.long arm castCommon Uses. Definitive treatment of injuries initiallytreated with a posterior splint.Application. The cast extends from the mid-humerusto the distal palmar crease volarly and just proximal tothe MCP joints dorsally.Position of Function. The elbow is flexed to 90 degreeswww.aafp.org/afp American Family Physician 497
Splints and Castswith the wrist in a neutral, slightly extended position(Online Figure F).Pearls and Pitfalls. Adequate padding at the olecranon, ulnar styloid, and antecubital fossa prevents skinbreakdown. Physicians should avoid applying the edgeof the casting tape over the antecubital fossa, particularlywith the initial layer. Long arm casts are used most oftenin childhood because of the frequency of distal radial,ulnar, and distal humeral fractures.2,10,14double sugar-tong splintCommon Uses. Acute management of elbow and forearminjuries, including Colles fractures.Application. Physicians should start by placing a singlesugar-tong splint, as described above (Figure 8). A secondsugar-tong splint is then applied, extending from the deltoid insertion distally around the 90-degree flexed elbow,and proximally to 3 inches short of the axilla (Figure 9).Pearls and Pitfalls. The splint provides superior pronation and supination control, and is preferable withcomplex or unstable fractures of the distal forearm andelbow.Lower Extremity Splints and Castsposterior ankle splint (“post-mold”)Common Uses. Acute, severe ankle sprain; nondisplaced,isolated malleolar fractures; acute foot fractures and softtissue injuries.Application. The splint extends from the plantar surface of the great toe or metatarsal heads along the posterior lower leg and ends 2 inches distal to the fibular headto avoid compression of the common peroneal nerve(Online Figure G).Pearls and Pitfalls. For efficient application, the patientshould be placed in a prone position with the knee andankle flexed to 90 degrees.15,16stirrup splintCommon Uses. Acute ankle injuries; nondisplaced, isolated malleolar fractures.Application. The splint extends from the lateral midcalf around the heel, and ends at the medial mid-calf(Online Figure H).16 The position of function is withthe ankle flexed to 90 degrees (neutral).Pearls and Pitfalls. Stirrup and posterior ankle splintsprovide comparable ankle immobilization. Althoughthe stirrup splint is adequate for short-term treatmentof acute ankle sprains, the evidence favors a functionalapproach to inversion ankle sprain treatment with theuse of a semirigid or soft lace-up brace.17A bulky Jones splint is a variation on the stirrup splint498 American Family PhysicianFigure 9. Double sugar-tong splint.used acutely for more severe ankle injuries. The lowerextremity is wrapped with cotton batting and reinforcedwith a stirrup splint, providing compression and immobilization while allowing for considerable swelling.16short leg castCommon Uses. Definitive treatment of injuries to theankle and foot.Application. The cast begins at the metatarsal headsand ends 2 inches distal to the fibular head. Additionalpadding is placed over bony prominences, includingthe fibular head and both malleoli (Online Figure I).Position of Function. The ankle is flexed to 90 degrees(neutral).Pearls and Pitfalls. Weight-bearing recommendationsare determined by the type and stability of the injury andthe patient’s capacity and discomfort. Short leg walkingcasts are adequate for nondisplaced fibular and metatarsal fractures.2,18 Commercially produced high-top walking boots are acceptable alternatives for injuries at lowrisk of complications.2,19toe plate extensionsCommon Uses. Toe immobilization (comparable to ahigh-top walking boot or cast shoe); distal metatarsaland phalangeal fractures, particularly of the great toe.Application. A plate is made by extending the castingmaterial beyond the distal toes, prohibiting plantar flexion and limiting dorsiflexion (Figure 10).2,19Pearls and Pitfalls. The cast must be molded to themedial longitudinal arch with the ankle at 90 degrees toallow for successful ambulation.posterior knee splintCommon Uses. Stabilization of acute soft tissue injuries(e.g., quadriceps or patellar tendon rupture, anteriorcruciate ligament rupture), patellar fracture or dislocation, and other traumatic lower extremity injuries,particularly when a knee immobilizer is unavailable orunusable because of swelling or the patient’s size.Application. The splint should start just below thewww.aafp.org/afpVolume 80, Number 5 September 1, 2009
Splints and CastsAddress correspondence to Anne S. Boyd, MD, FAAFP, LawrencevilleFamily Health Center, 3937 Butler St., Pittsburgh, PA 15201. Reprints arenot available from the authors.Author disclosure: Nothing to disclose.REFERENCES1. Chudnofsky CR, Byers S. Splinting techniques. In: Roberts JR, HedgesJR, Chanmugam AS, eds. Clinical Procedures in Emergency Medicine.4th ed. Philadelphia, Pa.: Saunders; 2004:989.2. Eiff MP, Hatch R, Calmbach WL, eds. Fracture Management for PrimaryCare. 2nd ed. Philadelphia, Pa.: Saunders; 2003:1-70.3. Parmelee-Peters K, Eathorne S. The wrist: common injuries and management. Prim Care. 2005;32(1):35-70.4. Hong E. Hand injuries in sports medicine. Prim Care. 2005;32(1):91-103.5. General principles. In: Simon RR, Sherman SC, Koenigsknecht SJ,eds. Emergency Orthopedics: The Extremities. 5th ed. New York, NY:McGraw-Hill; 2007:1-29.6. Boyd AS, Benjamin HJ, Asplund C. Principles of casting and splinting.Am Fam Physician. 2009;79(1):16-22.7. Benjamin HJ, Mjannes JM, Hang BT. Getting a grasp on hand injuries inyoung athletes. Contemp Pediatr. 2008;25(3):49-63.8. Lee SG, Jupiter JB. Phalangeal and metacarpal fractures of the hand.Han
Sep 01, 2009 · Casts provide superior immobilization, but are less forgiving and have higher com-plication rates. Therefore, they are usually
Orthopedic Casts, Braces and Splints - Medical Clinical Policy Bulletins Aetna Casts, Splints Back Braces Orthosis, on deformed Page 1 of 69 Orthopedic Braces and POLICY HISTORY Last Review: 03/08/2022 Effective: 07/21/1995 Next Review: 01/12/2023 Number: 0009 POLICY *Please see amendment for Pennsylvania Medicaid at the end of this CPB.
the type of cast they receive, their size and whether they will be able to put weight on the cast. This guide covers information on caring for children and youth with three types of casts: A-frame casts, double below the knee casts and hip spica casts. Your pre-surgery checklist Carefully read and follow the instructions
Spellbound Project - Ahmed Zewail 2 What procedure must I follow? Part I: Heating wood 1) Wear chemical splash goggles and a chemical resistant apron. 2) Place enough wood splints into the test tube to fill it. 3) Break the splints in half so that they fit, and leave room for a stopper to fit securely on the test tube. 4) Connect the test tube containing the splints to the stopper assembly and .
139 Français 1 Indications, contre-indications et précautions d’ordre général Indications, contre-indications et précautions d’ordre général Chapitre 1 Indications Le concentrateur d’oxygène Inogen On
and/or background materials (e.g., a bag of water), molds created from casts of live fingers, and molds from casts made from latent fingerprints lifted from a surface and reproduced with photographing etching techniques [2] - [7]. Casts have been made from wax, silicon and plastic, and molds
Molds and casts of a series of these are reposited at the National Museum of Natural History, Smithsonian Institution, while ten original casts are among the Titmus Collection at the Willow Creek – China Flats Museum, Humboldt County, California. These casts have been 3D-scanned and archiv
Molds & Casts Casts & Molds of Trilobites Ellipsocephalus hoffi Organisms buried in sediment may decay or dissolve away leaving a cavity or mold. If the space is subsequently filled with sediment, an external cast can be made. Molds and casts are three dimensional an
Asset Management. Authors: Dr James Hawley Jon Lukomnik. March 2018. 2 3. Authors. Dr. James Hawley, also known as Jim, is currently Head of Applied Research at TruValue Labs. He has been with TrueValue Labs since its . inception in May 2013. Dr. Hawley was appointed Professor Emeritus Saint Mary’s College in June 2017. He is an expert on corporate governance, institutional investors and .
