Items in AFP with MESH term: Arm Injuries
Principles of Casting and Splinting - Article
ABSTRACT: The ability to properly apply casts and splints is a technical skill easily mastered with practice and an understanding of basic principles. The initial approach to casting and splinting requires a thorough assessment of the injured extremity for proper diagnosis. Once the need for immobilization is ascertained, casting and splinting start with application of stockinette, followed by padding. Splinting involves subsequent application of a noncircumferential support held in place by an elastic bandage. Splints are faster and easier to apply; allow for the natural swelling that occurs during the acute inflammatory phase of an injury; are easily removed for inspection of the injury site; and are often the preferred tool for immobilization in the acute care setting. Disadvantages of splinting include lack of patient compliance and increased motion at the injury site. Casting involves circumferential application of plaster or fiberglass. As such, casts provide superior immobilization, but they are more technically difficult to apply and less forgiving during the acute inflammatory stage; they also carry a higher risk of complications. Compartment syndrome, thermal injuries, pressure sores, skin infection and dermatitis, and joint stiffness are possible complications of splinting and casting. Patient education regarding swelling, signs of vascular compromise, and recommendations for follow-up is crucial after cast or splint application.
ABSTRACT: Family physicians often are required to evaluate patients who present with acute skeletal trauma. The first of this two-part series discusses the features and evaluation of some commonly missed fractures and dislocations of the upper limb, excluding the hand. Dislocations of the sternoclavicular joint are infrequent and often missed. Clavicular fractures in adults usually are not hard to diagnose. Acromioclavicular joint dislocations represent about 10 percent of all dislocation injuries to the shoulder girdle. Forty percent of all dislocations occur at the glenohumeral joint. Scapular fractures are often a result of significant force. Multiple views should be obtained in adults with a suspected fracture of the elbow. Complications in fractures of the wrist are strongly related to the location of the fracture.