Dr.S.Senthil Sailesh-functional cast bracing,PTBcast,sarmiento principle

FUNCTIONAL CAST BRACING & SPICA

DR.S.SENTHIL SAILESH

SENIOR ASSISTANT PROFESSOR

IOT MMC RGGGH

FUNCTIONAL CAST

• The concept of Functional cast bracing

was described in the early 18th century

• Sarmiento re-established the ideology

in late 60s

• It is a type of bracing where the limb is

allowed to do restricted function with

the brace in

PRINCIPLES

Continuing function while a fracture is uniting encourages

osteogenesis promotes the healing of tissues and prevents the

development of joint stiffness thus accelerating rehabilitation

PRINCIPLES

• Not merely a method of fracture reduction but an attitude

towards fracture healing.

• Requirements for fracture healing

• Stability

• Maintenance of reduction

• Blood supply

STABILITY

• Fluid is not

compressible

• Fascia cannot be

stretched beyond

the confines of the

cast

• “Hydraulic container

theory”; Sarmiento

et al 1974

LOADING

• Stability is maintained

by loading in a

functional cast

• Pressure & Load is

transmitted without

further deformation

• Rotation is restricted

by components of the

brace

MUSCLE CONTRACTION

Intermittent loading of the fracture area by muscle activity & weight bearing, promote local blood flow & development of electrical fields which are beneficial for healing

Muscle only

Muscle with Fascia

POP

BLOOD SUPPLY

Loading Contraction

of muscle

Micromotion

at # site

Increases

Blood supply

Bridging

callus

BRIDGING CALLUS & BLOOD SUPPLY

INDICATION

• All middle third shaft fractures and lower 3rd

junction fractures in long bones

in co-operative patients.

TIMING

• For # tibia following low energy injury, bracing can be done with in first 2 wks.

• High energy injuries with more pain & swelling needs an additional period of 1 or 2 more wks.

• For humerus fractures , most conditions bracing can be done by 7-10 days time.

• Median time of brace removal

• Tibia - 18.7 wks,

• Humerus - 10 wks.

TIME TO APPLY

• Fracture ends sticky

• Assess the # , when pain and swelling subsided

1. Minor movts at # site should be pain free

2. Any deformity should disappear once D.F removed

3. Reasonable resistance to telescoping.

4. Shortening should not exceed 6.0 mm for tibia, 1.25 cm for femur

CONTRAINDICATION

• Intraarticular fractures.

• Compound fractures

• Lack of co-operation by the pt.

• Patient with spastic disorders

• Bed-ridden & mentally incompetent pts.

• Deficient sensibility of the limb [D.M with P.N]

• Fractures of both bones forearm when reduction is difficult.

NOT USED IN

• Galeazzi fractures

• Monteggia fractures

• Proximal half of shaft of femur [tends to angulate in to varus

only used by expert]

• Isolated # of tibia, fibula

• Tends to cause varus angulation and to delay in consolidation

of #.

ACCEPTABLE REDUCTION

• 50% cortical contact

• <5-10* of varus / valgus angulation

• <10-15* of anterior / posterior bowing

• <5-7* of internal / external rotation

• Not more than 10-15mm of shortening

SARMIENTO CAST / PTB CAST - PRINCIPLE

• Described by Sarmiento

• Below knee cast extending to the upper pole of

the patella and with a firm moulding over the

medial flare of the tibia, the patellar tendon and

the popliteal space and shaped in a triangular

manner at the upper end of the tibia

• Knee free to move allowed early ambulation as

weight bearing forces should be transmitted

from the ground to the proximal end of tibia

bypassing fracture site

SARMIENTO CAST

Ending point

Starting point

Moulding area

Proximal patellar tendon

Tibial flares Patellar tendon Poplitela space

Metatarsal head

PTB

HUMERAL FCB

SPICA - DEFINITION

• A bandage folded into a spiral

arrangement resembling an ear

of wheat or barley.

• It is applied where

immobilisation is required at

areas where there is difference in

size

HIP SPICA

• Hip spicas are most commonly used to

• correct developmental hip dysplasia (DDH)

• children with hip, femur and pelvic fractures

• Other orthopaedic conditions which require

stabilization of the hip and leg.

Eg: Abduction Cast in Post THR dislocation

• Hips spicas are generally used for children

from 6 months to 6 years of age

Abdomial padding and space for breathing

Diaper Care

TYPES

POSITIONING

Proximal 1/3 frx:

- hip flexion 45 deg

- hip abduction 30 deg

- ext rotation 20 deg

Mid shaft fractures:- hip flexion 30

deg

- hip abduction 20

deg

- ext rotation 15

deg

Distal 1/3 frx:- hip

flexion 20 deg- hip

abduction 20 deg- ext

rotation 15 deg

COMPLICATIONS

COMPARTMENT SYNDROME

•decreased with

•applying smooth contours around popliteal fossa

•limiting knee flexion to < 90°

•avoiding excessive traction

•monitored for by observing the child's neurovascular exam

and level of comfort

MINERVA CAST

t

Diaphyseal

fractures

Initial POP for

2-4 weeks

Functional

casting done

Maintenance of

reduction

External

bridging callus

Loading &

Muscle

contration

Restoration of

vascularityFracture union

THANK YOU