临床医学教学Traction_Casts JTG.ppt

* Figure from: Rockwood and Green: Fractures in Adults, 4th ed, Lippincott, 1996. * Figure from: Rockwood and Green: Fractures in Adults, 4th ed, Lippincott, 1996. * Figures from Rockwood and Green, 5th ed * Figures from Rockwood and Green, 5th ed.. * Figures from Rockwood and Green, 5th ed. * Figure from Rockwood and Green, 4th ed. * Figure from Rockwood and Green, 4th ed. * Figure from:Figure from: Browner and Jupiter: Skeletal Trauma, 2nd ed, Saunders, p 2221 1998. * Figure from:Figure from: Browner and Jupiter: Skeletal Trauma, 2nd ed, Saunders, p 2221, 1998. * Figure from Rockwood and Green, 5th ed. * Loss of reduction is the most common complication of cast treatment as the swelling decreases and the padding compresses while the patient regains mobility. Careful casting technique can avoid this (careful molding, attention to detail—deforming forces:gravity and muscle). Appropriately time radiographic reevaluation and correction of problems will lead to a satisfactory outcome. * Figure from: Rockwood and Green: Fractures in Adults, 4th ed, Lippincott, 1996. * Figure from: Rockwood and Green: Fractures in Adults, 4th ed, Lippincott, 1996. Short Leg Cast When working alone, the patient can help maintain proper ankle position by holding onto a muslin bandage placed beneath the toes Figure from Chapman’s Orthopaedic Surgery 3rd Ed. Above Knee Cast Apply below knee first (thin layer proximally) Flex knee 5 - 20 degrees Mold supracondylar femur for improved rotational stability Apply extra padding anterior to patella Anterior padding Support lower leg / cast Extend to gluteal crease Figure from: Browner and Jupiter: Skeletal Trauma, 2nd ed, Saunders, 1998. Forearm Casts Splints MCP joints should be free Do not go past proximal palmar crease Thumb should be free to base of MC Opposition of thumb to little finger should be unobstructed x x Examples - Position of Function Ankle - Neutral dorsiflexion – No Equinus Hand - MCPs flexed 70 – 90o, IPs in ext