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A modified technique for the application of a plaster cast to fresh tibial fractures
340
Injury (1991) 22, 000-000
Printed in Gr& Bn’tair~
A modified technique for the application of a plaster cast to fresh tibia1 fractures R. Burnett and L. Freedman Department
of Orthopaedics,
Northwick
Park Hospital and Clinical Research Centre, Harrow, Middlesex,
A moclifiedtechnique for the application of a plaster cast foofreshfracfwes, which improvescontrol of the fracture during application arm’obviates the needfor an assistant is desm’bed.
UK
lation at the fracture site is not a problem because the ankle has already been placed in the cast in neutral prior to manipulation of the fracture. There have been no specific problems or complications using this technique, which we recommend for routine use in fresh tibia1 fractures.
Introduction Numerous techniques exist for the treatment of fresh fractures using a plaster cast, the two most commonly used being vertical traction with the knee at 90” and the leg hanging over the end of the table, and horizontal traction with the knee supported on a block and manual traction on the foot (Watson-Jones, 1982; Rockwood and Green, 1984). As with the other techniques described, the assistance of a second skilled person is needed either to hold the fracture in satisfactory alignment or to apply plaster. Furthermore, it is always difficult to hold the fracture reduced and at the same time apply the plaster-of-Paris. The following technique alleviates the need for an assistant and permits improved and easier control of the fracture during plaster application. Figure 1. Plaster applied I cm above the level of the fracture to the groin.
Method Plaster is the first applied from I cm above the level of the fracture to the groin with the knee in 20” of flexion (Figure I). After this has set, plaster is applied from 1 cm below the level of the fracture to include the ankle in neutral (Figure 2), but no attempt is made at this stage to manipulate the fracture. After both plasters have set the fracture is manipulated and accurate reduction confirmed using image intensification. It is then a simple matter to apply plaster across the gap to maintain the reduction (Figure 3).
Discussion In our experience this method has proved in the management of unstable fractures of the tibia, permitting an excellent reduction In particular, unlike standard techniques, 0 1991 Butterworth-Heinemann 0020-1383/91/04000~00
Ltd
extremely useful the distal third of to be performed. posterior angu-
Figure 2. Plaster applied 1 an below the level of the fracture to include the ankle in neutral.
Ideas and innovations
341
References Rockwood C. A. and Green D. P. (1984) Fractures in Adults. Vo12, 2nd Ed. Philadelphia: Lippincott, 1626. Watson-Jones R. (1982) Frucfures and Joint Irzjuries.Vol 2, 6th Ed. London and Edinburgh: Churchill Livingstone, 1078.
Paper accepted
Figure 3. Accurate fracture reduction the gap.
and plaster applied across
17 September
1990.
Requestsfor reprints should beaaiiressed to: Mr R. Burnett, Department of Orthopaedics, Nothwick Park Hospital and Clinical Research Centre, Watford Road, Harrow, Middlesex HAI 3UJ, UK.
Injury (1991) 22, 000-000
Printed in Gr& Bn’tair~
A modified technique for the application of a plaster cast to fresh tibia1 fractures R. Burnett and L. Freedman Department
of Orthopaedics,
Northwick
Park Hospital and Clinical Research Centre, Harrow, Middlesex,
A moclifiedtechnique for the application of a plaster cast foofreshfracfwes, which improvescontrol of the fracture during application arm’obviates the needfor an assistant is desm’bed.
UK
lation at the fracture site is not a problem because the ankle has already been placed in the cast in neutral prior to manipulation of the fracture. There have been no specific problems or complications using this technique, which we recommend for routine use in fresh tibia1 fractures.
Introduction Numerous techniques exist for the treatment of fresh fractures using a plaster cast, the two most commonly used being vertical traction with the knee at 90” and the leg hanging over the end of the table, and horizontal traction with the knee supported on a block and manual traction on the foot (Watson-Jones, 1982; Rockwood and Green, 1984). As with the other techniques described, the assistance of a second skilled person is needed either to hold the fracture in satisfactory alignment or to apply plaster. Furthermore, it is always difficult to hold the fracture reduced and at the same time apply the plaster-of-Paris. The following technique alleviates the need for an assistant and permits improved and easier control of the fracture during plaster application. Figure 1. Plaster applied I cm above the level of the fracture to the groin.
Method Plaster is the first applied from I cm above the level of the fracture to the groin with the knee in 20” of flexion (Figure I). After this has set, plaster is applied from 1 cm below the level of the fracture to include the ankle in neutral (Figure 2), but no attempt is made at this stage to manipulate the fracture. After both plasters have set the fracture is manipulated and accurate reduction confirmed using image intensification. It is then a simple matter to apply plaster across the gap to maintain the reduction (Figure 3).
Discussion In our experience this method has proved in the management of unstable fractures of the tibia, permitting an excellent reduction In particular, unlike standard techniques, 0 1991 Butterworth-Heinemann 0020-1383/91/04000~00
Ltd
extremely useful the distal third of to be performed. posterior angu-
Figure 2. Plaster applied 1 an below the level of the fracture to include the ankle in neutral.
Ideas and innovations
341
References Rockwood C. A. and Green D. P. (1984) Fractures in Adults. Vo12, 2nd Ed. Philadelphia: Lippincott, 1626. Watson-Jones R. (1982) Frucfures and Joint Irzjuries.Vol 2, 6th Ed. London and Edinburgh: Churchill Livingstone, 1078.
Paper accepted
Figure 3. Accurate fracture reduction the gap.
and plaster applied across
17 September
1990.
Requestsfor reprints should beaaiiressed to: Mr R. Burnett, Department of Orthopaedics, Nothwick Park Hospital and Clinical Research Centre, Watford Road, Harrow, Middlesex HAI 3UJ, UK.