This chapter defines the materials applied and prescribed by an orthopaedist or assigned to an individual in the direct care of patients with fractures, dislocations, and conditions of the musculoskeletal system. The types of cast immobilization materials are described, as are the traction devices and weights designed for hospital or home care. Some emergency stabilization devices are included at the end of the chapter.
The techniques of cast immobilization, splints, dressings, and traction devices are designed to provide an external means of support or protective covering while healing proceeds under optimal conditions. Casts are generally applied in fracture reduction and immobilization, but they are also helpful in the correction of pediatric deformities, dysplastic hip disease, scoliosis, and foot deformities such as club foot, with the goal being to maintain or obtain a correction of deformity, promote alignment following surgery, and give support to damaged soft tissues in the healing process of fractures, dislocations, and sprains.
Because the care of the orthopaedic patient is a team approach, orthopaedists in private or group practice and in hospital settings are assisted by qualified orthopaedic nurses and other healthcare-related professionals educated in caring for the orthopedic patient. The orthopaedic nurse may choose to work in a doctor’s office or an outpatient clinic of a hospital or become directly involved with inpatient management by assuming diverse responsibilities for a plan of quality care from admission to discharge. This requires specialized knowledge of orthopaedic nursing, to include skills in the use of traction equipment and appliances, and the ability to manage patients with this armamentarium. Depending on educational background, training, and hospital policies, qualified nurses and technologists scrub in on orthopaedic surgical procedures in the operating room, clinic, or physician’s office.
The National Association of Orthopaedic Nurses (NAON), founded in 1980, is the professional organization that offers a certification program to orthopaedic nurses who wish to further develop their skills in the management and care of orthopaedic patients. The NAON provides support and educational opportunities through its sponsored activities to promote continued professional development.
There are numerous organizations that support orthopaedic technician healthcare professionals working in the orthopedic physician practice setting The National Board for Certification in the Orthopaedic Specialties (NBCOS) [ www.nbcos.org ], founded in 2019, provides the certification platform for the Orthopedic Physician Extender Certification examination candidate (OPE-C®). The OPE® certification examination consists of the knowledge and skills genuinely representative and provides the marked designation that supports the value-added practice credential possessed by the OPE® in the orthopedic physician setting. Successful completion of the OPE credentialing exam will indicate the knowledge and skills in the following competency areas within orthopedic practice: (1) Evidenced-based reasoning in the assessment and management for specific musculoskeletal injury/pathology; (2) Appropriate fracture immobilization and identifying the fundamental goals relative to patient care/safety; (3) Understanding of musculoskeletal imaging and intervention strategies/techniques in orthopedic practice; (4) Surgical considerations in clinical practice; (5) Knowledge of orthopedic healthcare management and leadership practices.
The NBCOS and its orthopedic strategic partner, the American Society of Orthopaedic Professionals (ASOP), was formed to include all allied professionals working within orthopaedics, such as the orthopaedic technologists, medical assistants, and other orthopedic-related professionals. In 1999, ASOP, along with the Registered Orthopaedic Technologist (ROT) professional designation, became recognized as the standard of orthopedic knowledge required by allied professionals who are actively upgrading their skills.
Together, the NBCOS and ASOP makes every effort to help improve the quality of health care by setting professional credentialing standards among select orthopedic medical specialties. The NBCOS helps demonstrate to the public that the respective healthcare provider meets nationally recognized standards for knowledge, experience, and skills and maintains their certification through continuous learning and practice improvement.
With appropriate orders the technologist assists in setting up traction appliances, Circ-O-Lectric beds, and similar devices of care, and has the shared responsibility of proper application of traction, weights, and equipment required for patient rehabilitation. Administrative tasks involve ordering supplies and equipment for the plaster rooms, examining rooms, wings, and clinics and conferring with medical suppliers on catalogue items and supplies.
The orthopaedic technologist, with training and practice, becomes skilled in the art and science of cast application and the many types needed for specific injuries and conditions. The orthopaedic specialty is so diversified that opportunities for continuing medical education for nurses and technologists are offered through the American Academy of Orthopaedic Surgeons instructional courses across the country and within the specialty organizations of orthopaedics. Corporate-sponsored activities have also been instrumental in updating product designs and state-of-the-art equipment. Together, these groups seek to promote the highest standards of quality care in cooperation with orthopaedic surgeons and other members of the health care team.
The basic tools of the trade are as follows.
A cast is a circumferentially wrapped plaster of Paris–impregnated bandage or encasement applied to a portion of the body. Additional materials, such as fiberglass and plastics, are also used instead of plaster of Paris.
A splint is a rigid or semi-rigid, non-circumferential material used to reinforce a soft dressing or to provide additional support for or immobilization of the body part being treated. The splint may be made of plaster of Paris, metal, wood, plastic, or, in an emergency, newspapers or magazines.
A dressing involves those materials used to cover a wound or surgical incision, a fabric with or without accessory medications or self-adhesive properties.
A bandage is a non-rigid, usually cotton material that holds a dressing in place or acts as the dressing by itself. It may be applied to provide padding over a body prominence under a cast. An elastic bandage provides support for a joint or soft tissue to control swelling.
Traction devices are any adjustable external appliances used in early treatment of fractures that suspend or deliver pull to any given part of the body. Traction is also used for temporary treatment of specific spinal conditions.
Cast Materials
Casting materials have improved considerably over the years; however, plaster of Paris casts are still widely used and familiar to all practitioners. These rolled crinoline bandages are impregnated with gypsum powder (calcium salt) that, when exposed to water, crystallizes. The reaction then slows to a maturation process (hardening) that takes approximately 24 hours to dry. The heat felt by the patient is the crystallization process that takes place within the cast material. To fabricate and mold plaster of Paris bandages is considered an art, and the technician soon learns the numerous techniques of application.
Fiberglass and thermoplast casts have become a popular form of treatment. They are lightweight, are radiolucent, are easier to apply, can tolerate moisture, and harden within 5 minutes, allowing for immediate weight-bearing. This rolled type consists of fiberglass and resin, fiberglass and plastic polymer, and polyurethane that also crystallize on exposure to water. Most fiberglass casts are long-wearing.
cast cutter: electrical circular oscillating saw for splitting or removing a cast. Long-handled cast-cutting instruments are also designed to remove small plaster casts from children.
cast padding: soft cotton wrap or synthetic wraparound material used with a plaster or fiberglass cast.
cotton roll: material made from cotton that can be rolled as a bandage and acts as a buffer between the skin and plaster material; also called Webril.
felt padding: thick felt or felt-like material added to the undersurface of a cast to relieve pressure on local areas of bony prominences or pressure areas; also called Reston.
fiberglass cast: lightweight fiberglass wrap material that is impregnated with resin or another substance that polymerizes when exposed to water.
moleskin: adhesive, thin, velvet-like material used to smooth edges of casts or to buffer areas of excessive skin wear.
plaster rolls: gauze roll impregnated with plaster of Paris, which, when dipped in warm water, can be applied, rolled smoothly, and molded, becoming hard within minutes.
sheet wadding: strong, cotton material that clings to part being applied and molded to contour of that part.
stockinette: cloth stocking roll used initially in cast applications; comes in many sizes; can be covered by padding followed by firm cast material. Bias-cut and tubular are two different varieties.
Cast Immobilization
Cast immobilization involves the following anatomic areas: upper and lower extremities, cervical to chest region, and chest to lower spine. The various types are described later.
Body Casts
A body cast is a circumferential cast enclosing the trunk of the body and may extend from the head or upper chest to the groin or thigh. This type of cast immobilization is used in treating disorders of the cervical, thoracic, and lumbar spine such as fractures and scoliosis, or it may be applied following some types of surgery on the spine. There are several types of body casts.
extension body c.: chest-pubis cast in which the patient is positioned so that the trunk is extended backward; applied for specific fractures.
flexion body c.: chest-pubis cast in which the patient is positioned so that the trunk is flexed forward; for treatment of painful lower back conditions.
halo c.: for high-level cervical fractures; a thoracic-to-pelvic level cast incorporating the necessary extensions used to support the posts that are attached to a metal halo skeletally affixed to the head.
Mehta casting: for early onset scoliosis, cast application following the method of Cotrel and Morel with cast molded with manual pressure over the rib prominence instead of use of straps for de-rotation.
Minerva c.: cast immobilization extending along the side and in back of the head and neck, chest to hip area, incorporating a plaster-of-Paris headband; for fractures of the neck and in certain scoliosis problems.
scoliosis c.: special modification of the body cast for preoperative and postoperative treatment of scoliosis (curvature of the spine). These casts have in large part been replaced by operative fixation and custom fabricated orthoses. Modifications of this type are as follows:
Cotrel c.: modified scoliosis cast applied following Cotrel traction.
turnbuckle c.: special modification to allow changes in angle by use of turnbuckles on either side of the cast.
Risser localizer: specialized body cast with localizer pressing over convex side of curve.
Spica Casts
A spica cast immobilizes an appendage by incorporating a part of the body proximal to that appendage. The most common spica casts are hip, thumb, and shoulder spicas. They are listed by anatomic region in the following sections.
Limb Casts
Upper Limb Casts
arm cylinder c.: long-arm cast with the elbow set in flexion and free motion at the wrist.
Dehne c.: cast incorporating the thumb with a separate extension incorporating the index and middle fingers; for fractures of the navicular. Also called three-finger spica.
drop out c.: for elbow contracture, a modification of the long-arm cast with posterior portion above elbow, cut out to allow arms extension resulting from gravity on forearm. By allowing elbow extension, the patient is also able to operate a manual wheelchair for independence.
gauntlet c.: short cast extending from slightly above or proximal to the wrist to some point in the palm; usually has an outrigger to control one or more fingers; indicated for metacarpal fractures, phalangeal fractures, or dislocations.
hanging arm c.: long-arm cast that, through suspension from a sling around the neck, brings about traction of fracture fragments of the distal humerus.
long-arm c. (LAC): extends from the palm and wrist to the axilla, with the elbow at 90 degrees and the wrist at neutral, preventing movement at the elbow; for treatment of fractures of the forearm, elbow, and humerus.
cotton-loader position c.: rarely used long-arm cast applied with the wrist in full pronation, flexion, and ulnar deviation; for distal radial fractures.
Muenster c.: cast that comes above the humeral epicondyles to prevent pronation and supination but allows some flexion and extension of the elbow; also called supracondylar c.
short-arm c. (SAC): any of a number of casts extending from about 2–3” from the antecubital crease of the elbow to the distal palmar crease; commonly used for distal forearm and wrist fractures.
shoulder spica c.: cast that incorporates the upper torso and envelops a part or all of the limb in a position of abduction; for proximal humeral fractures. Also called airplane c. and statue of liberty c.
thumb spica c.: short- or long-arm cast that incorporates the thumb; for treatment of navicular fractures. Also called navicula c. and scaphoid c.
Lower Limb Casts
cylinder c.: cast from proximal thigh to just above the ankle with the knee in extension; for injuries of the knee.
Delbert c.: a short-leg cast that is trimmed away from the anterior and posterior portions of the ankle and from the heel. This allows dorsiflexion and plantar flexion while maintaining lateral stability.
gel c.: semi-rigid cast, usually applied to the lower leg and foot for ankle injuries, lymphedema, or venous ulcers; also called Unna boot.
hip spica c.: cast incorporating the lower torso and extending to one or both lower limbs.
Batchelor plaster: hip spica cast that holds the hip in internal rotation but allows motion in other planes; for dysplastic hip in an infant.
bilateral hip spica c.: cast incorporating both the lower torso and lower limbs, usually because of bilateral fractures of the hips, femur, or tibia. If only the thighs are incorporated leaving the knees and leg free, called a panty c. Also called double c.
1½ hip spica: cast that incorporates the lower torso, the entire affected limb, and the opposite limb to just above the knee; for proximal femoral fractures and some pelvic fractures.
Petrie spica c.: specially applied cast for abduction to assist in ambulation for Legg-Calvé-Perthes disease; also called broom-stick c.
unilateral hip spica c.: cast incorporating the lower torso and entire position of only one leg; for femoral fractures. Also called single-hip spica c.
long-leg c. (LLC): non–weight-bearing cast extending from the upper thigh to the toes; for fractures of the tibia and fibula or ligament injuries of the knee.
long-leg walking c. (LLWC): a cast from the upper thigh to the toes, with a cast shoe or with an attached rubber sole device called a walker.
Quengle c.: for flexion contracture of the knee, a two-part cast hinged at the knee level, with the distal portion of the cast terminating at the ankle or foot, and the proximal portion terminating at the upper thigh.
short-leg c. (SLC): non–weight-bearing cast extending from just below the knee to the toes; for injuries of the lower limb, ankle, and foot.
short-leg walking c. (SLWC): reinforced to accept a cast shoe or with an attached rubber walker; for ankle and foot injuries.
patellar tendon bearing (PTB) c.: indicated for fractures in the distal third of the tibia. A short-leg walking cast with special molding at the patellar tendon, condyles, and calf to reduce rotation and reduce the axial force on the tibia during ambulation. Also called a Sarmiento cast.
slipper c.: incorporating the foot up to the ankle; a rigid postoperative dressing following forefoot procedures.
toe spica c.: cast specifically designed to incorporate all of the great toe and a portion or all of the foot; usually after bunion surgery.
well-leg c.: casts applied to both lower limbs and then attached together; used in some rare instances for treatment of femoral fractures.
Other Cast-Related Terms
air cast c.: term use for a wide variety of items. Most commonly used for ankle stirrups, which have air bags on both sides. However, the term is often used for larger devices such as a walking boot with air bladders.
ankle stirrup: for ankle sprains and some fractures; a hard plastic that covers the lateral and medial ankle and lower part of the leg, held in place with Velcro straps. May contain air bladder for increased stabilization.
bivalve c.: cast that is split in half (shelled) by cuts made on opposite sides of the cast to release pressure or allow removal and reapplication of the cast such as would be needed for wound care and physical therapy treatments.
Boston bivalve c.: cast split in half with a step cut rather than a straight line; most often done when the cast is going to be removed, often for physical therapy, and then reapplied.
univalve c.: cast split on one side to relieve pressure.
cast boot: any of a variety of commercially available walking boots that can often serve the function of a short-leg cast. These devices can have adjustable ankle motion and are called controlled ankle motion (CAM) walkers. Some of these commercially available boots have adjustable air-filled bags and are referred to as an air cast walker. Also called high-tide walker, low-tide walker, short CAM walker or boot, and tibial gaiter.
collar and cuff: sling with a soft portion wrapped around the neck and a cufflike device wrapped around to support the distal forearm, sometimes with the additional support of a waist band; for humeral fractures.
corrective c.: made to correct a deformity by nonsurgical technique; commonly applied to clubfeet.
fenestrate: to cut an opening (window) in a dressing or cast to allow inspection of a part.
petaling edges: to eliminate abrasion from the edge of a cast, small vertical slits are made at the edges of the cast, and then the edges (petals) are folded out and held in place by adhesive tape, moleskin, or other material.
serial c.: any sequence of casts applied in the progressive correction of deformity.
wedge c.: circumferential cutting of the cast and reapplication of plaster over the same cast after a manipulation has been performed to change bone position.
closing wedge c.: removal of a segment of plaster, with closing of that wedge by manipulation and reapplication of plaster.
opening wedge c.: circular cut cast that is opened by manipulation and then covered with a new layer of plaster.
window: removal of a piece of cast, usually square or rectangular, to allow inspection of a wound or relieve pressure at a specific point. Also said to fenestrate.
Devices Applied to Casts
abduction bar: to help maintain hip abduction; any bar placed between two long-leg casts.
cast orthosis: modifications of standard casts often applied to facilitate early motion. The cast orthosis (brace) is designed with normal physiologic characteristics in mind while still protecting the fracture site; it is molded in the manner of orthotic-type devices. In addition, it is usually hinged at the joints to allow some free motion of joints and to improve muscle recovery. Also called cast brace.
cast protectors: waterproof covers for a limb cast, allowing patient to shower or bathe.
cast shoe: for the most part replaces walking heels, a hook-and-loop strap-on shoe to protect the bottom of the cast from weight bearing.
walker (walking heel): hard rubber wedge directly incorporated into the sole of a cast to allow walking or resting the leg.
Cast Complications
Generally, a neurovascular and neuromuscular examination is made before, during, and after cast immobilization. However, even with close attention to treatment, the following complications can occur.
cast burns: applying cast material with water temperature too warm, which, when added to the crystallization process that produces heat, can produce skin burns.
constrictive edema: disruption of normal venous drainage with resulting fluid accumulation in soft tissue and swelling distal to the point of constriction caused by circulatory impairment. Severe swelling may lead to neurovascular involvement to include compartment syndrome.
decubitus ulcer: an area of breakdown of skin or subcutaneous tissue as a result of unrelieved pressure on a bony prominence or portion of the body resting on a firm surface for a long time. The lesions are staged as follows:
Stage I: only the dermis is involved.
Stage II: dermis and subcutaneous fat are involved.
Stage III: ulcer involves some deep fascia or muscle; bone not uncovered.
Stage IV: bone is exposed.
dropfoot: when referring to a complication of cast treatment, applies to paralysis of the peroneal nerve resulting from pressure over the fibular head leading to inability to dorsiflex the ankle.
muscle atrophy: loss of muscle tissue resulting from protracted disuse secondary to joint immobilization.
pin tract infection: direct bacterial contamination of area where pins have been used for external traction or skeletal fixation; could potentially lead to osteomyelitis.
pressure sore: breakdown of skin or subcutaneous tissue because of direct pressure of displaced or bunched cotton padding under cast, creating pressure lasting usually in excess of 4 hours; often caused by patient inserting object in cast to reach an area that is itching from plaster dust in cast; also called decubitus ulcer.
superior mesenteric artery syndrome: disruption of circulation to the bowel; occurs after application of body cast and results in abdominal pain, diarrhea, and, if unrecognized, severe problems; also called cast syndrome.
Splints and Accessories
This section is restricted to descriptions of those splints applied in the early treatment of injury or management of postoperative conditions and their accessories.
Splints
airplane s.: removable cast or prefabricated device used to hold the arm in abduction and limit shoulder flexion.
aluminum foam s.: straight, metallic foam, padded splint of various widths from ½ to 2 inches; can be used separately or in association with casts for hand and finger injuries.
baseball s.: prefabricated metallic splint applied to the volar forearm and hand; the palm portion of the splint positions the hand as if it were holding a baseball.
Bohler s.: for spiral phalangeal fractures of the fingers; a device designed to maintain proper position and continuous traction.
co-aptation s.: for limb injuries; two slabs of plaster are placed on either side of the limb and held together by some outer dressing.
dynamic s.: any splint device that incorporates springs, elastic bands, and other materials that produce a constant active force to help reduce a deformity or counteract deforming forces.
frog s.: aluminum foam splint for finger injuries; before application the splint has a frog-shaped appearance.
gutter s.: semicircular or U-shaped splint fashioned around the injured part, usually in metacarpal and phalangeal fractures of the ulnar side of the hand.
hairpin s.: spring-assisted splint to help gain extension in a finger injury affecting the joint.
half shell: usually refers to spica casts; the section of cast that remains after it has been bivalved and a portion removed.
laced splint: for ankle sprains, a laced canvas ankle and proximal foot wrap that is held in place by laces; some have side pockets for insertion of more rigid plastic inserts. Also called Swede-o.
long-arm s.: splint applied from the axilla to wrist or distal palm posteriorly; holds the elbow and wrist in any given position.
long-leg s.: splint extending from the thigh to the lower calf or distally to the toes.
night s.: any splint or similar device used only at night. Commonly refers to a volar splint for treatment of carpal tunnel syndrome and leg splints in ankle dorsiflexion for treatment of plantar fasciitis.
pneumatic compression boot or sleeve: provides periodic compression to a limb to help prevent venous thrombosis and is often used on an uninjured limb. This is in contrast to the sequential type of pump used in lymphedema. The pneumatic sequential compression boot is another type used after knee replacement and is effective against deep vein thrombosis after lower limb surgery.
short-arm s.: splint extending from distal elbow to palm; used for nondisplaced fractures or after advanced fracture healing.
short-leg s.: splint extending from the upper calf to toes for initial immobilization.
sugar tong s.: long slab of plaster applied to the affected limb in the fashion of a sugar tong and held together with outer dressing; for wrist fractures and injuries to the shoulder, arm, and forearm; sugar tong cast.
universal gutter s.: wire mesh splint for lower extremity fractures.
Velcro s.: commercial name becoming generic referring to splints that have straps or surfaces that adhere to each other; these surfaces may be approximated and separated as many times as needed, and there is no loss of the original strength of the adhesion of the two surfaces; can be used for any part of the body.
Velpeau s.: for shoulder dislocation, humeral fracture, and other condition of the upper limb; soft dressing that surrounds the shoulder and arm with arm held close to chest and typically elbow flexed more that 90 degrees. Commercially available devices have an adjustable waist belt and shoulder immobilizer. Also called sling and swathe, and Velpeau dressing.
volar s.: specifies a splint applied to the anterior forearm.
wraparound s.: various commercially available splints that can be wrapped around a limb but are easily removable for physical therapy or wound care.
Accessories
In the area of casts, splints, and dressings, the following important aids to patient management are provided.
canes: for a painful hip; the patient is instructed to hold cane in the hand opposite the affected hip to transmit load through cane at the same moment that weight-bearing takes place on affected extremity.
crutches: when a three-point gait is needed to relieve weight-bearing on affected side; used in fractures, sprains, and after surgery. A three-point gait is when both crutches are placed on the ground simultaneously with the affected limb, decreasing body weight from three to one.
spring-loaded crutches: crutch design that absorbs peak stress, reduces shock, and reduces fatigue in upper limbs. The down-directed weight is borne by the crutches that have energy-storing ability on weight bearing.
walkers: assistive lightweight metallic devices (usually with four legs) that allow patient to apply weight-bearing bilaterally when there is instability in walking. New variations in these devices include the option for a pair or quartet of wheels, hand brakes, and baskets for carrying items.
Dressings
The term dressing may apply to any material used to cover a wound; however, when there is considerable swelling without a wound, a dressing is used to apply pressure.
General Types of Dressings
Adaptic d.: non-adhesive mesh dressing for the direct covering of wounds.
Betadine d.: any dressing that has been impregnated with povidone-iodine (Betadine) and then applied directly to the wound.
compression d.: any dressing intended to apply pressure to reduce or prevent swelling or bleeding.
dry d.: dressing that has not been impregnated with any solution.
figure 8 d.: dressing applied in the shape of an 8, as is often done for clavicular fractures; commercially prefabricated dressings, referred to as clavicle straps, are available.
gauze d.: any dressing made of cheesecloth-type material, for example, Kling, Kerlix, 4 × 4.
iodoform d.: narrow gauze strip impregnated with an iodine compound; for the treatment of open wounds.
Kerlix d.: broad elastic gauze dressing often a part of a compression dressing.
Kling d.: narrow gauze elastic bandage for compression.
Koch-Mason d.: warm occlusive saline dressing placed over a limb with cellulitis.
occlusive d.: any dressing that protects a wound from outside contamination.
packing: describes that portion of a dressing that is placed inside an open wound.
pressure d.: dressing designed to apply pressure to a specific location.
protective d.: any dressing that protects a wound from trauma.
saline d.: any dressing impregnated with normal saline; for treatment of open wounds.
Telfa d.: sterile non-adherent dressing, often applied on fresh wounds or incisions.
transparent d.: a class of transparent, occlusive dressings that are weatherproof and allow direct observation of the wound. Brand name terms include Op Site and Tegaderm.
vacuum assisted closure (VAC) dressing: commercially available dressing that is applied directly to an open wound. Vacuum pressure is believed to help speed wound healing.
wet-to-dry d.: dressing that is impregnated with normal saline and allowed to dry; used as a part of open-wound treatment.
Xeroform d.: non-adherent mesh dressing applied to fresh wounds or incisions.
Other Dressing Materials
Ace bandage: non-adhesive, elastic material that is a direct compressive wrap or holds other dressings or splints in place. The trade name is now used generically.
adhesive tape: sticky non-permeable tape used to secure local dressing.
bandage adhesive: sticky material applied to the skin to help in the application of various forms of tape; commonly used adhesive is tincture of benzoin.
pads: variety of bulky materials (rectangular or square) that cover large wounds; often referred to as abdominal pads.
Specialized Dressings
Esmarch bandage: special rubber, rolled bandages used to expel blood from a limb before surgery; also called Martin bandage.
Gibney bandage: strips of adhesive tape applied in alternate directions about the ankle; for ligament and other injuries.
High Dye dressing: method of non-circumferential ankle taping designed to support the ankle after an inversion injury.
Kenny-Howard splint (A/C harness): for acromioclavicular separations, a sling that supports wrist and elbow with a counterforce strap to push the clavicle down and a chest strap to hold the device in place.
Low Dye dressing: taping technique for plantar fasciitis.
Robert Jones bandage: layered bulk dressing applied to the lower limbs for a variety of injuries but specifically following knee surgery or injury; also called Shands dressing.
Shands d.: composed of two layers of cast padding and two layers of elastic bandage applied to the leg and foot; for ankle sprains and nondisplaced fractures of the metatarsals.
universal hand d.: for compression or extensive injuries involving the hand and fingers; a bulky, even-pressured hand dressing composed of cotton or gauze fluffs and wrapped with gauze or other circular dressing material, leaving the fingertips exposed. Over this dressing, a cock-up splint is applied to hold the wrist in 15-degree extension. Some of these dressings are incorporated into a stockinet sling for elevation.
Velpeau d.: bandage applied to the arm and torso such that the elbow is at the side in flexion and the hand is pressed against the upper chest.
Suspensions, Tractions, and Frames
Suspension, traction, and frames are adjustable appliances used with pulleys, bars, weights, and other supports in the treatment of fractures with casts or splints, for scoliosis, and in the care of patients before and after surgery. This method of treatment is offered to ensure proper alignment in healing and to provide suspension or deliver pull, directly or indirectly, to bone, muscle, skin, and fascia.
Many of the parts of various suspensions and traction devices are known by the originator’s name. Devices are listed by placement, each with its component. New techniques and methods of traction can be found in suppliers’ catalogs, but the user should find this section helpful in deciphering why such devices are used in the care of patients. The various types of traction equipment are defined, followed by some emergency stabilization equipment.
Suspension
Suspension is the means by which a limb or part is held suspended by some external device. Traction often accompanies the suspension.
balanced suspension ( Fig. 6-1 ): suspension device that allows the patient to move the affected limb without changing the fracture position of that limb; preferred for treatment of long-bone injuries. There are two components:
Arizona universal leg support: for lower limb fracture; a balanced suspension device with adjustable anterior thigh pad and suspension support by two parallel lines from the knee and foot.
Thomas splint: originally designed to help splint fresh fractures; composed of a full ring around the thigh and two metal rods that extend down either side of the limb and are joined distally to the foot. The half-ring Thomas splint is the most commonly used. Most are adjustable for length and are thus called adjustable Thomas splints.
Pearson attachment: attached to a Thomas splint; consists of two metal rods joined distally, allowing flexion of the knee.
