Plaster casts have been widely used in the treatment of fractures for many years, but medicine does not stand still and modern alternative materials to the usual plaster splint are increasingly being used - plastic (polyurethane) casts, which are used in our clinic.
Complaints about plaster from ordinary people are not difficult to understand.
A heavy bandage greatly restricts movement. If it is placed on your leg, it is impossible not only to get to the hospital without outside help, but sometimes even to get to your own kitchen. Plaster chips that break off from the inside of the cast cause itching and discomfort, and in some cases allergic reactions. The plaster also gets wet, so taking a shower after a fracture is a real adventure: you have to wrap the plastered area with polyethylene or literally wash yourself in parts. However, all this is temporary discomfort, which can be easily tolerated. Doctors have much more serious claims. Recently, one can increasingly hear that traditional plaster application can lead to re-displacement of the fracture. It is extremely difficult to monitor whether the bones are healing correctly under the bandage: the plaster does not transmit x-rays well. And with its prolonged use on the damaged area, blood circulation is disrupted, muscles, joints and tendons suffer. Chained and immobilized, they hardly work, so they gradually begin to lose their functions. It is no coincidence that after the cast is removed from the leg, patients still limp for some time. Local osteoporosis is also a frequent complication: without load, the bones near the fracture become less strong.
That is why specialists have recently used techniques in which gypsum is used to a minimum or replaced with other materials.
Plastic generation or alternative to conventional plaster
A good alternative to good old plaster is now considered, for example, plastic gypsum. It can also be called artificial or polymer - the essence does not change. This is a special material that the doctor first dips into water and then applies to the broken segment according to a certain pattern. After some time, the bandage dries, fixing the damaged area.
In general, the principle of operation is not very different from the traditional one. However, there are a number of advantages: plastic bandages are 4-5 times lighter than plaster ones - it is much easier to move when wearing them. In terms of strength, they are in no way inferior to plaster, so you don’t have to worry that broken bones will move or heal incorrectly.
Plastic plaster is not afraid of moisture, you can take a shower with it. This bandage also “breathes.” Unlike standard plaster, it allows oxygen to pass through to the skin and, on the contrary, evaporates to the outside. As a result, itching and irritation occur much less frequently.
In addition, plastic plaster looks neater than regular plaster. If you accidentally get it dirty, you can simply wipe the bandage with an important tissue.
However, with all the advantages, this material has its own nuances. A doctor who knows its characteristics should work with this type of plaster, since the material hardens very quickly and self-application of this plaster by the patient is unacceptable! And in some cases it is even dangerous. In addition, removing an artificial bandage is more difficult than a traditional one. You cannot cut artificial plaster with scissors—special tools are required. Our clinic has quite experienced doctors, so applying a plastic plaster cast, after consulting a doctor, will not take much time.
Transport immobilization for injuries of the head, neck, spine
Creating immobilizing structures for the head and neck is very difficult. Attaching the splint to the head is difficult, and on the neck, rigid fixing grips can lead to compression of the airways and large vessels. In this regard, for injuries to the head and neck, the simplest methods of transport immobilization are most often used.
All immobilization actions are usually performed with an assistant, who must carefully support the victim’s head and thereby prevent additional injury. The transfer of the victim onto a stretcher is carried out by several people, one of whom supports only the head and ensures that sharp jolts, rough movements, and bends in the cervical spine are inadmissible.
Victims with severe injuries to the head, neck, and spine must be provided with maximum rest and prompt evacuation using the most gentle means of transport.
Transport immobilization for head injuries. Head injuries are often accompanied by loss of consciousness, tongue retraction and vomiting. Therefore, placing the head in a stationary position is undesirable, since vomiting may cause vomit to enter the respiratory tract. Immobilization for skull and brain injuries is primarily aimed at eliminating shocks and preventing additional head contusion during transportation.
Indications for immobilization are all penetrating wounds and skull fractures, bruises and concussions accompanied by loss of consciousness.
To immobilize the head, as a rule, improvised means are used. The stretcher for transporting the victim is covered with a soft bedding in the head area or a pillow with a recess. A thick cotton-gauze donut ring can be an effective means of softening shocks and preventing additional head injury (Fig. 36). It is made from a dense strand of gray wool 5 cm thick, closed with a ring and wrapped in a gauze bandage. The victim's head is placed on the ring with the back of the head in the hole. In the absence of a cotton-gauze “donut”, you can use a roller made from clothing or other improvised means and also closed in a ring. Victims with head injuries are often unconscious and require constant attention and care during transportation. You should definitely check whether the victim can breathe freely and whether there is nosebleed, in which blood and clots can enter the respiratory tract. When vomiting, the victim's head should be carefully turned to the side, with a finger wrapped in a handkerchief or gauze, it is necessary to remove the remaining vomit from the mouth and pharynx so that it does not interfere with free breathing. If breathing is impaired due to the retraction of the tongue, you should immediately push the lower jaw forward with your hands, open your mouth and grab your tongue with a tongue holder or napkin. To prevent repeated retraction of the tongue into the oral cavity, you should insert an air tube or pierce the tongue with a safety pin along the midline, pass a piece of bandage through the pin and fix it taut to a button on the clothing.
Rice. 36. An improvised head splint in the form of a roller closed in a ring: a - general view of the splint; b - position of the victim’s head on it
Transport immobilization for injuries of the lower jaw is carried out with a standard plastic sling splint. The technique of using the splint is described in the section “Means of transport immobilization”. Immobilization of the lower jaw is indicated for closed and open fractures, extensive wounds and gunshot wounds.
In case of prolonged immobilization with a plastic chin splint, it becomes necessary to water and feed the patient. You should feed only liquid food through a thin rubber or polyvinyl chloride tube 10-15 cm long, inserted into the oral cavity between the teeth and cheek to the molars. The end of the polyvinyl chloride tube should be pre-melted so as not to damage the oral mucosa.
When a standard sling splint is not available, the lower jaw is immobilized with a wide sling bandage or a soft frenulum bandage. Before applying a bandage, you need to place a piece of thick cardboard, plywood or a thin board measuring 10x5 cm, wrapped in gray wool and a bandage, under the lower jaw. A sling-shaped bandage can be made from a wide bandage or a strip of light fabric.
Transportation of victims with injuries to the lower jaw and face, if the condition allows, is carried out in a sitting position.
Transport immobilization for injuries of the neck and cervical spine. The severity of the damage is determined by the large vessels, nerves, esophagus, and trachea located in the neck area. Injuries to the spine and spinal cord in the cervical region are among the most severe injuries and often lead to the death of the victim.
Immobilization is indicated for fractures of the cervical spine, severe injuries to the soft tissues of the neck, and acute inflammatory processes.
Signs of severe neck injuries: inability to turn your head due to pain or keep it upright; curvature of the neck; complete or incomplete paralysis of the arms and legs due to spinal cord injury; bleeding; a whistling sound in the wound when inhaling and exhaling, or accumulation of air under the skin when the trachea is damaged.
Immobilization with stair splints in the form of a Bashmakov splint. The splint is formed from two ladder splints of 120 cm each. First, one ladder splint is bent along the lateral contours of the head, neck and shoulder girdles. The second splint is curved according to the contours of the head, back of the neck and thoracic spine. Then both tires are wrapped with cotton wool and bandages and tied together, as shown in Fig. 37. The splint is applied to the victim and reinforced with bandages 14-16 cm wide. Immobilization must be performed by at least two people: one holds the victim’s head and lifts him, and the second applies and bandages the splint.
Rice. 37. Transport immobilization with a Bashmakov splint: a - modeling of the splint; b - wrapping the tires with cotton wool and bandages; c — bandaging a splint to the victim’s torso and head; d - general view of the applied splint
Immobilization with a cardboard-gauze collar (type of Shants collar). The collar can be prepared in advance. It is successfully used for fractures of the cervical spine. A shaped blank measuring 430×140 mm is made from cardboard, then the cardboard is wrapped in a layer of cotton wool and covered with a double layer of gauze, the edges of the gauze are sewn together. Two ties are sewn at the ends (Fig. 38). The victim's head is carefully lifted and a cardboard-gauze collar is placed under the neck, the ties are tied in front.
Rice. 38. Cardboard collar like a Shants collar: a - pattern from cardboard; b - the cut collar is wrapped in cotton wool and gauze, ties are sewn on; c — general view of immobilization with a collar
Immobilization with a cotton-gauze collar. A thick layer of gray cotton wool is wrapped around the neck and tightly bandaged with a bandage 14-16 cm wide (Fig. 39). The bandage should not put pressure on the neck organs or interfere with breathing. The width of the layer of cotton wool should be such that the edges of the collar tightly support the head.
Errors in transport immobilization for head and neck injuries.
• Careless transfer of the patient onto a stretcher. It is best if one person supports your head when moving it.
• Immobilization is performed by one person, which leads to additional injury to the brain and spinal cord.
• The fixing bandage compresses the organs of the neck and makes it difficult to breathe freely.
• Lack of constant monitoring of the unconscious victim.
Rice. 39. Immobilization of the cervical spine with a cotton-gauze collar
Transportation of victims with injuries to the neck and cervical spine is carried out on a stretcher in a supine position with the upper half of the body slightly elevated.
Types of plastic dressings.
In addition to rigid artificial plaster, modern medicine also offers semi-rigid bandages. They can be made from special fiber or thermoplastic.
After application, the bandage becomes elastic rather than hard. Therefore, it supports the broken bone in the desired position, but at the same time it is less restrictive to the muscles than a regular or plastic cast.
Such fixatives transmit X-rays well. You can understand where the broken bones are located without removing the bandage again. However, it is not difficult to free yourself from it. In some cases, the “soft” plaster can simply be unwound like a bandage; other types of such fasteners have a zipper built into them. Removing the bandage on your own to give a broken arm or leg a “rest” is, of course, strictly prohibited! But for a doctor this opportunity is very important. Often, with fractures, a person needs physical procedures - to speed up the healing of bones or improve microcirculation in soft tissues. The ability to remove the retainer without incisions and then put it back on without modeling a new bandage significantly saves time and effort.
If you have been given an “elastic” cast, be sure to ask your doctor whether it can be wetted. Some types repel water and do not interfere with showering. Others are also allowed to be wetted, but then they must be dried with a hairdryer, otherwise they will lose their healing effect. The drying process can be quite tedious: depending on the material, it can take from 20 minutes to 3 hours. So when choosing a retainer, this needs to be taken into account.
“Soft” bandages have one more disadvantage - they cannot be used for all types of fractures. In some cases, rigid fixation is necessary; this must be decided by the attending physician.
Pneumatic splints for immobilization - a fixing agent in emergency cases.
The scope of application of pneumatic tires for immobilization is quite wide. They are used by rescue services, ambulances, and paramilitary units. They should also be in sports complexes, large industries, and mining enterprises. Pneumatic immobilization splints should be included in the driver's first aid kit. Pneumatic splints for immobilization are classified into the following groups: - “short boot” fixes part of the lower limb (foot, lower leg); — “long boot” fixes parts of the lower limb (thigh, knee); — “sleeve” is applicable for immobilization of the upper limb (forearm, hand). There are both adults and pneumatic immobilization splints for children. Their appearance, characteristics (technical, physical, chemical) and scope of application are identical. They differ from each other only in size. Pneumatic immobilization splints. Their characteristics. Medical pneumatic splints for immobilization are a repetition of the topography of the upper and lower limbs, which should be immobilized. These devices are sometimes called temporary casting. They are used for damage to parts of the extremities (forearm, foot, lower leg, thigh) as a means of mutual aid, as well as self-help. The air permeability of immobilization splints helps prevent wound infection and stop hemorrhage. An important characteristic is radiolucency. The pressure in the inner tube of pneumatic tires should not exceed 50 mmHg. The temperature range of their use is from -25 to +40 degrees.
Pneumatic tires for immobilization. Their advantage. First, pneumatic splints have a simple design and can be quickly applied to an injured area. Secondly, based on the physical properties of the material, it is possible to monitor the limb being fixed. Thirdly, without removing the pneumatic splint from the injured limb, an x-ray can be taken. Fourthly, thanks to the elastic material, the splint does not injure the injured limb. Fifthly, its size allows it to be placed over clothes and shoes. And, lastly, due to the compactness of the pneumatic immobilization splint, as well as its low weight, it is characterized by high mobility.
Disadvantages of pneumatic tires for immobilization.
These tires also have disadvantages: - the possibility of a tire puncture, therefore, there will be unreliable immobilization; — an increase in the rigidity of immobilization as a result of an increase in pressure in the tire chamber during prolonged use can lead to damage to soft tissues, which leads to necrosis of the limb; — the use of a pneumatic splint will not be effective for fractures of the shoulder and hip, since the fixation rigidity is insufficient; — pneumatic immobilization splints can act as a tourniquet for open fractures, and thereby increase bleeding.
Pneumatic splints for immobilization. Rules for their application.
Initially, it is worth assessing the patient's condition, examining the limb injury, administering pain medications and deciding whether it is necessary to apply a pneumatic splint for immobilization. When the use of one is required, it must be removed from the packaging bag and placed under the limb that requires immobilization. Then open the blower valve. The injured limb is placed comfortably on top of a pneumatic splint. If soft tissues are injured (open fracture), then apply an aseptic bandage. The zipper on the pneumatic immobilization splint is then closed. The next step is to pump air into it using a hand pump or simply by mouth using a napkin. After this, close the valve and check the tightness of the pneumatic tire. It is necessary to constantly monitor the skin (color, temperature) to prevent irreversible ischemia. The patient should be transported in a comfortable position, depending on his condition. Arriving at the hospital, you need to open the valve, then the zipper and release the injured limb. Pneumatic immobilization splints are a unique device that has saved many lives.
Functionality and versatility
Functional treatment of fractures with a shortened plaster cast is an original method that has been used for a long time. But it requires a certain qualification from the doctor; in our clinic we quite widely use this method of casting on different parts of the body for fractures. Most often it is used for fractures of the ankle, radius, metacarpal, and metatarsal bones. The bandage in this case can be made from either ordinary plaster or plastic, or modeling hard and soft plastic plaster at the same time. But they apply it in a special way.
Traditionally, traumatologists try to fix the damaged area as firmly as possible. For example, when a tibia is fractured, a bandage is often applied from the knee to the toes. In functional treatment, the doctor acts differently: a very small area directly above the fracture is placed in the cast. The nearby joints remain free.
TYPES OF IMMOBILIZATION
TRANSPORT IMMOBILIZATION
Students should know:
— types of transport immobilization;
— types of transport tires;
— rules for applying transport splints in case of damage to the bones of the forearm, humerus, and lower leg bones;
— rules for transporting patients with injuries to the bones of the forearm, shoulder, and lower leg.
Students should be able to:
— carry out transport immobilization for fractures of the forearm bones;
— carry out transport immobilization for a fracture of the humerus;
— carry out transport immobilization for fractures of the leg bones;
— carry out transport immobilization for fractures of the upper and lower limbs using improvised means.
In case of fractures and significant damage to soft tissues, immobilization must be used before transportation in order to create rest for the damaged part of the body, reduce pain, prevent further tissue damage (bone fragments), and also to prevent traumatic shock.
There are transport and therapeutic immobilization.
Transport immobilization is the temporary creation of maximum rest for a damaged part of the body or organ during transportation.
Therapeutic immobilization is the creation of immobility in case of injury for therapeutic purposes.
Types of transport immobilization:
• Autoimmobilization - healthy areas of the patient’s body are used for immobilization:
- if the upper limb is damaged, it must be bandaged to the body or secured with a scarf;
- if the lower limb is damaged, it is fixed to the healthy one.
• Immobilization using improvised means (for the purpose of immobilization, plywood, boards, pieces of cardboard, sticks, skis, etc. are used).
• Immobilization using standard splints.
Standard transport splints are divided into fixation and distraction. With the help of fixation splints, immobility of the damaged area is created, with the help of distraction splints - fixation and traction.
Fixation ones include : Kramer ladder splint, plywood splints (splint splints), mesh splints, pneumatic splints. With the help of these splints, fixation (immobility) of the damaged part of the body is created.
The Kramer splint, or ladder splint, is made of soft wire.
The splint can be given any shape necessary to immobilize a particular area of the body.
A mesh splint, or Filberg splint, is a mesh made of soft wire. Easily rolls up. It is mainly used to immobilize the forearm, hand and foot.
Plywood tires are most often made in the form of a splint (gutter). Convenient for immobilizing the forearm and lower leg.
RULES FOR APPLYING TRANSPORT TIRES
TRANSPORT IMMOBILIZATION
TYPES OF IMMOBILIZATION
In case of fractures and significant damage to soft tissues, immobilization must be used before transportation in order to create rest for the damaged part of the body, reduce pain, prevent further tissue damage (bone fragments), and also to prevent traumatic shock.
There are transport and therapeutic immobilization.
Transport immobilization is the temporary creation of maximum rest for a damaged part of the body or organ during transportation.
Therapeutic immobilization is the creation of immobility in case of injury for therapeutic purposes.
Types of transport immobilization:
Autoimmobilization - healthy areas of the patient’s body are used for immobilization:
- if the upper limb is damaged, it must be bandaged to the body or secured with a scarf;
- if the lower limb is damaged, it is fixed to the healthy one.
— Immobilization using improvised means (for the purpose of immobilization, plywood, boards, pieces of cardboard, sticks, skis, etc. are used).
Immobilization using standard splints.
Standard transport splints are divided into fixation and distraction. With the help of fixation splints, immobility of the damaged area is created, with the help of distraction splints - fixation and traction.
Fixation ones include : Kramer ladder splint, plywood splints (splint splints), mesh splints, pneumatic splints. With the help of these splints, fixation (immobility) of the damaged part of the body is created.
The Kramer splint, or ladder splint, is made of soft wire.
The splint can be given any shape necessary to immobilize a particular area of the body.
A mesh splint, or Filberg splint, is a mesh made of soft wire. Easily rolls up. It is mainly used to immobilize the forearm, hand and foot.
Plywood tires are most often made in the form of a splint (gutter). Convenient for immobilizing the forearm and lower leg.
RULES FOR APPLYING TRANSPORT TIRES
To correctly apply a transport splint and prevent complications, the following rules must be observed:
— apply tires directly at the scene of the incident;
- it is unacceptable to move the patient without immobilization;
- removing shoes and clothes from the patient is not recommended, as this not only causes pain, but can cause additional injury;
- before applying a splint, cut the patient’s clothing along the seam (if it cannot be removed) at the site of injury and carefully examine it;
- if there is bleeding, stop it, apply an aseptic bandage to the wound and inject an analgesic;
- give the injured limb as comfortable a physiological position as possible before applying the splint;
- when applying a splint, in case of closed fractures (especially of the lower extremities), lightly and carefully stretch the injured limb along the axis, which should be continued until the bandage is completely applied;
- immobilize with a splint two joints adjacent to the site of injury (above and below the site of injury), and in case of fractures of the shoulder and hip - three joints;
- when transferring a patient with a splint onto a stretcher, the injured limb or part of the body must be carefully supported by an assistant;
- follow the rules conventionally called “three times carefully”: carefully apply the bandage; carefully apply the transport splint; carefully move, place on a stretcher and transport the victim.
— fixing the tire must begin from the site of damage.
Possible errors when applying transport splints:
- the use of unreasonably short splints, which violates the rule of immobilization - creating immobility;
— applying hard standard splints without first wrapping them with cotton wool and gauze;
— incorrect modeling of the splint in accordance with the anatomical localization of the damage area;
- insufficient fixation of the splint to the injured limb with a bandage;
- when applying a hemostatic tourniquet, covering it with a bandage, which is a gross mistake;
- insufficient insulation of the immobilized limb in winter, leading to frostbite, especially with bleeding.