Term
| airCast, knee immobilizers are examples of what type of splint? |
|
Definition
|
|
Term
| what type of splints include ace wraps, sports taping, neoptrene sleeves, or padding (jones splint) |
|
Definition
|
|
Term
| Short-Arm casts do not limit which motion |
|
Definition
| Pronation & Supination; thus it does not fully immobilize the wrist joint!! |
|
|
Term
| which type of cast causes immobilization applied to *majority* of entire extremity? |
|
Definition
|
|
Term
| shoulder dislocation: study showed better results and decresed recurrence w/what? |
|
Definition
study showed better results and decreased recurrence
if splinted w/ neutral wedge |
|
|
Term
| what jt problem could be caused by gout? |
|
Definition
|
|
Term
| telipes equinovarus, or clubfoot, is an example of what type of problem? |
|
Definition
| congenital deformities, jt problems |
|
|
Term
| what are post-op indications for splint/cast? |
|
Definition
| Post-op application for repairs of vasculature, tendons or nerves |
|
|
Term
| to accomplish the benefits of rest, protection (prophyolactic adn therapeutic), pain reduction, and improved healing, what must characterize the cast or splint? |
|
Definition
To accomplish these benefits, the cast or splint must conform to the anatomy
of the region being immobilized |
|
|
Term
Casting is a potentially dangerous form of treatment!!
what certain Risks are expected? |
|
Definition
| (dermatitis, atrophy, stiffness); stench and scaling, loosening |
|
|
Term
| what are 5 undesirable complications of casting? |
|
Definition
| burns, pressure ischemia & sores, nn palsy/paralysis, compartment syndrome, dvt |
|
|
Term
what s/a of casting is d/t insufficient air circulation and ongoing limb perspiration; accompanied by
pruritus? |
|
Definition
|
|
Term
what s/a of casting involves muscle atrophy and osteopenia from lack of movement and normal
physiologic stress |
|
Definition
|
|
Term
what s/a of casting involves the following sensation: think how you feel in the morning after running/exercising the night before;
becomes an issue once immob period over; worse if injury occurs to the joint? |
|
Definition
|
|
Term
which s/a of casting involves curing and setting of materials are exothermic reactions and produce heat; d/t using
hot water, excessive layers of material, inadequate padding, undue pressure ? |
|
Definition
|
|
Term
which s/a of casting is d/t inadequate padding and/or poor technique (indentations of
deep layers from wrinkles or finger pressure) |
|
Definition
|
|
Term
which s/a of casting is d/t inadequate padding and/or poor technique (too much tension/pressure);
common sites include common peroneal nerve and ulnar nerve |
|
Definition
|
|
Term
which s/a of casting is immobilization and lack of ambulation increased the risk of this abnmality (stasis,
hypercoagulable state & intimal injury) |
|
Definition
|
|
Term
| does compartment syndrome require fx? |
|
Definition
no. (crush injury to thigh, tourniquet application > 2
hours, electrical injury, high-velocity soft-tissue injury (air compressors),
significant contusion w/ post-injury heat application, intoxication (changes in
sensorium), runners, chronic anticoagulation therapy, etc. |
|
|
Term
| what is the critical pt for compartment syndrome |
|
Definition
| high pressures for > 6-8 hours. Muscle ischemia->fibrosis ->contracture |
|
|
Term
| resisted dorsiflexion of great toe is another dx clue for what? |
|
Definition
|
|
Term
| what can heat application post injury cause? |
|
Definition
| compartment syndrome- vasodilation and further swelling |
|
|
Term
| what are insensate causes of compartment syndrome? |
|
Definition
| spinal cord pts adn intoxicated pts |
|
|
Term
| what type of compartment sx is usually on ly in calf and gets better w/rest? |
|
Definition
|
|
Term
| crush injuries, burns, and anticoagluation tx can be associated w/ what? |
|
Definition
|
|
Term
| what can prolonged tourniquet time can cause what? |
|
Definition
| thigh compartment- compartment syndrome |
|
|
Term
| how common is compartment sx due to bites? |
|
Definition
|
|
Term
| what is the "hot dogger"? |
|
Definition
| compartment sx- electrical injuries |
|
|
Term
| what is d/t xs pressue in soft tissues d/t surrounding fascia (b/t 30-60 mmHg) |
|
Definition
|
|
Term
| what is the most serious and feared complication of casting? |
|
Definition
|
|
Term
| when is compartment sx most common? |
|
Definition
| long bone fx, crush injury, or arterial issue (function of soft-tissue injury) |
|
|
Term
| increasing pain out of proportion; increased pain w/prom; arom avoided by pt. less predictive: paresthesias, decresased 2-pt discrimination, decreased cap refil, refil pallor, pulselessness (rare and very late) |
|
Definition
|
|
Term
| how accurate is whiteside's technique? |
|
Definition
| least accurate to dx compartment syndrome via pressure msmt |
|
|
Term
whiteside's technique, arterial line monitor system, and stryker 295 ICPM: Intracompartmental pressure monitor
system are all used for what? |
|
Definition
| dx via pressure management |
|
|
Term
| what is the tx of compartment sx? |
|
Definition
| remove ALL overlying material ASAP, and surgical fasciotomy if needed |
|
|
Term
| at what level must compartment to be msed be |
|
Definition
| Compartment to be measured must be at the level of the heart |
|
|
Term
| at what angle must needle be to compartment |
|
Definition
| Needle must be perpendicular to compartment |
|
|
Term
| how should external pressure be applied for compartment syndrome? |
|
Definition
| No External Pressure applied |
|
|
Term
| which methods for compartment sx can used 18g neele, 18g spinal needle, or spine-port needle? |
|
Definition
|
|
Term
| what are 2 immobilization principles? 1) device MUST . . . 2) sufficient amt of . . . |
|
Definition
| 1) device MUST conform precisely to the anatomy of the region being addressed. 2) sufficient amt of injured area must be included in the device (ideally the jt ABOVE and BELOW) |
|
|
Term
| splint material should cover how much of the circumference of teh extremity? |
|
Definition
|
|
Term
| where does a long-arm post splint begin and end |
|
Definition
Start: proximal palmar crease
End: upper 2/3rdsof humerus |
|
|
Term
| what begins w/short arm and extends up w/second stage? |
|
Definition
|
|
Term
| what are 4 indications for posterior long-arm splint |
|
Definition
| elbow/forearm injury, distal humerus fx, forearm fx, unstable prox rad/ulna fx? |
|
|
Term
| what are wrist and elbow positions for long-arm posterior splint? |
|
Definition
| elbow @ 90 degrees, wrist in neutral |
|
|
Term
| where does sugar tong splint begin and end? |
|
Definition
STARTS: distal palmar crease
ENDS: proximal to dorsal MC heads. |
|
|
Term
| what is the position for sugar tong splint: wrist, elbow |
|
Definition
| elbow @ 90degrees. wrist in extension, fingers free |
|
|
Term
| which is better at preventing supi/pronation: post-long-arm splint or sugar tong? |
|
Definition
| sugar tong, which also immobilizes elbow |
|
|
Term
| what are the indications for double-sugar tong splint? |
|
Definition
| elbow and forearm fx. any radius/ulna fx. complex distal forearm fx. |
|
|
Term
| what motion does double sugar tong splint eliminate? |
|
Definition
|
|
Term
| does a long-arm posterior splint immobilize supination/pronation? |
|
Definition
| no. allows for sup/pronation |
|
|
Term
| what is a "cockup" splint? |
|
Definition
|
|
Term
| where does volar splint begin and end? |
|
Definition
STARTS: distal palmar crease
ENDS: proximal to elbow crease/AC fossa |
|
|
Term
| what are the indications for volar splint? |
|
Definition
| soft tissue hand/wrist inj. wrist fx. mc fx (2-5). NOT distal radius/ulna fx |
|
|
Term
| how can you increase stability w/volar splint? |
|
Definition
|
|
Term
| what's the hand position for volar splint? |
|
Definition
|
|
Term
| start and end of ulnar gutter splint |
|
Definition
STARTS: distal to fracture up to tips of 4thor 5thdigit
ENDS: proximal to elbow crease/AC fossa (1” or so) |
|
|
Term
| what are indications for ulnar gutter splint? |
|
Definition
| phalanx or mc fx. soft tissue injury digits 4-5 |
|
|
Term
| what's the position of ulnar gutter splint? |
|
Definition
|
|
Term
| what should you make sure you cover w/ulnar gutter splint? |
|
Definition
|
|
Term
| how frequently is radial gutter splint used? |
|
Definition
|
|
Term
| indications for radial gutter splint |
|
Definition
| phalanx or mc fx. soft tissue injury digits (2-3) |
|
|
Term
| position of radial gutter splint |
|
Definition
|
|
Term
| what should you be careful w/ w/radial gutter splints? |
|
Definition
| make sure to keep thumb functional |
|
|
Term
| where does thumb spica begin and end? |
|
Definition
STARTS: distal tip of thumb
ENDS: proximal 2/3rdsof forearm |
|
|
Term
| what are the indications for thumb spica splint? |
|
Definition
| scaphoid fx. de quervain's tenosynovitis ("an inflammation or a tendinosis of the sheath or tunnel that surrounds two tendons that control movement of the thumb"). |
|
|
Term
| position of thumb spica splint? |
|
Definition
| wine glass. follow thumb direction |
|
|
Term
| what is "buddy tape" and when is it indicated? |
|
Definition
| finger splint. finger sprains |
|
|
Term
| what are the indications for volar/dorsal splint? |
|
Definition
| distal phalange fx, laceration over jt |
|
|
Term
| where does post leg splint start and end? |
|
Definition
STARTS: distal tibia (above malleoli)
ENDS: proximal third of thigh (allow for toileting and ambulation) |
|
|
Term
| what are the positions for post leg splints for tendon rupture and internal damage? |
|
Definition
|
|
Term
| what are the indications for post leg splint? |
|
Definition
| soft tissue injury, proximal fib fx, does not limit ankle motion! |
|
|
Term
| does post leg splint limit ankle motion? |
|
Definition
|
|
Term
| where does post ankle splint start and end? |
|
Definition
STARTS: MT heads or beyond toes
ENDS: distal to popliteal fossa (~1”) |
|
|
Term
| what is used to hold position of post ankle? |
|
Definition
|
|
Term
| what are indications for post ankle splint? |
|
Definition
| distal tib/fib fx. reduced ankle dislocations. severe sprains. tarsal/mt fx |
|
|
Term
| what is the ankle position for post ankle splint? |
|
Definition
|
|
Term
| where does sugartong leg splint begin and end? |
|
Definition
START: below level of fibular head to avoid peroneal n. entrapment
END: similar place on medial side |
|
|
Term
| what are indications for sugartong leg splint? |
|
Definition
| similar to post ankle, great for ankle sprains |
|
|
Term
| what is the position for ankle sugartong splint |
|
Definition
|
|
Term
| advantages of sugartong leg splint? |
|
Definition
| limits eversion/inversion. reduces pflxn more than post ankle splint |
|
|
Term
| general considerations: 6 |
|
Definition
| be prepared: have everything ready. be generous: w/padding. be smooth w/no wrinkles (palms vs fingers). be relaxed: wrap w/little tension. be pt: hold in pof until sets (5-8 min). be astute (n/v checks pre- and post- application) |
|
|
Term
| what are 2 types of prefabs? |
|
Definition
combo of splinting material encased in padding
•OCL = plaster
•OrthoGlass = Fiberglass |
|
|
Term
| what type of padding is typically used? |
|
Definition
Usually Webril but synthetic material is available (adv: no stockinette, water
resistant; disadv: expensive, increases chance of burns w/ cast saw (use
protective strip)) |
|
|
Term
| what are adv and disadv of synthetic material padding? |
|
Definition
(adv: no stockinette, water
resistant; disadv: expensive, increases chance of burns w/ cast saw (use protective strip) |
|
|
Term
| what is the determinant of what type of casting to use? |
|
Definition
Provider Preference is the determinant as to which to use, although plaster
has an advantage in areas where conformity is an issue (ankles and in chubby
extremities in peds). |
|
|
Term
| advantages of plaster/gypsum |
|
Definition
| low cost, moldability, longer shelf life, lower allergenicity |
|
|
Term
| disadvantages of plaster/gypsum |
|
Definition
| heavy, longer curing time, generates more heat, messy |
|
|
Term
|
Definition
| water-resistant, stronger, more durable, lighter, fast curing time (<24 h) |
|
|
Term
| disadvantages of fiberglass |
|
Definition
| expensive, short shelf-life, harder to apply and mold, sticky |
|
|
Term
| what is the advantage of sitting upright when cast is applied? |
|
Definition
Sitting upright allows for gravity to keep swelling in the LE. This gives you a bit
of cushion when you apply your cast |
|
|
Term
| what should pt position be for ue? |
|
Definition
| rest elbow on table or finger trap |
|
|
Term
| what should pt position be for le? |
|
Definition
| sitting or prone w/knee/ankle @90deg *use gravity to your advantage |
|
|
Term
| 3 things used to tx/cover skin issues |
|
Definition
|
|
Term
| how large should cast padding be for mto splints? |
|
Definition
| MTO splints: cast padding should be 1” larger than casting material |
|
|
Term
| no of layers for padding splint |
|
Definition
|
|
Term
| no of layers for material splinting |
|
Definition
|
|
Term
|
Definition
| ace wrap or coban. tight enough to hold but not w/undue pressure |
|
|
Term
| how long should stockinette be cut for cast? |
|
Definition
|
|
Term
| how can undue tension be avoided w/padding |
|
Definition
| Unroll the padding always in contact with the patient to avoid undue tension |
|
|
Term
| how many layers of padding for cast? |
|
Definition
|
|
Term
| start proximally or distally for rolling material |
|
Definition
| start distally and move proximally |
|
|
Term
| where should padding occur for casting? |
|
Definition
| wrap beyond where cast/splint will stop. extra padding over bony prominences & btwn digits |
|
|
Term
| when is hotter water desirable for cast application |
|
Definition
Hotter water will speed up the setting time, making the application more
difficult, but may be desirable if immobilizing a reduced fx or joint. |
|
|
Term
| how many layers of plaster/fiberglass for cast application |
|
Definition
|
|
Term
| make sure each roll of casting material goes how far? |
|
Definition
Make sure that each roll goes the whole length of the extremity area to be
casted |
|
|
Term
| how do you "make it proper"? |
|
Definition
| ensure position of function. hold until setting occurs. (use of tape for le) |
|
|
Term
|
Definition
| foot plate, walking heel, therapeutic window |
|
|
Term
Extra layers applied to sole that extend beyond the toes for
protection |
|
Definition
|
|
Term
6-8 layers of material from MT heads to mid-calf; occ include
rubber heel; only needed on plaster casts that are allowed to WB |
|
Definition
|
|
Term
| what can be used for u/s or rf probes |
|
Definition
| Window for U/S or RF probes |
|
|
Term
|
Definition
Warning Signs: Worsening N/V status; increasing/worsening pain or swelling
. rest and elevate for increased pressure. loosen splint if too type |
|
|
Term
|
Definition
•Increased chance of burns during cast removal (must use DE-FLEX strips)
•Not always covered by insurance |
|
|
Term
| elevate casted limbs for how long? |
|
Definition
|
|
Term
| for how long should sharp pressure be avoided w/plaster and fiberglass? |
|
Definition
|
|
Term
|
Definition
| benadryl. hair dryer on "cool". powder. do not insert anything. |
|
|
Term
| education: emphasize wb status |
|
Definition
cruch/walker training: •Do NOT support weight on axilla; support weight through hands
•Tripod stance: keep crutches in front and lateral when standing
•Small Steps: put crutches out and then move body to where crutches are
•STAIRS: up w/ the good, down w/ the bad |
|
|
Term
|
Definition
Give exercises that the pt can do in the device at home to maintain
generalized strength and tone. |
|
|
Term
|
Definition
•Top: 1-1.5” (two fingerbreadths) below axilla
•Handgrip: Level of Gtr Trochanter (keep elbow ~ 30 degrees of FLXN) |
|
|
Term
| when do you follow up w/splint if converting to cast |
|
Definition
|
|
Term
| how frequently do you follow up for cast? |
|
Definition
| depends on how stable and amt of healing. usually every 2 weeks. typically remove @ 6 weeks for x-rays. NEVER dismiss PT concerns |
|
|
Term
|
Definition
|
|
Term
|
Definition
| cut the cast down ea side |
|
|
Term
| orient blade to cast at what angle |
|
Definition
|
|
Term
| splint prn- for cast removal |
|
Definition
| leave bottom/post half of casat in place for x-ray or additional splinting w/ace |
|
|
Term
|
Definition
| cleanser to remove skin and stench. moisturizer prn |
|
|
