Fracture Care and Casting for Primary Care Physicians Matt Leiszler, MD Stephanie Chu, DO Jack Spittler, MD University of Colorado Sports Medicine.

Fracture Care and Fracture Care and Casting for Primary Care Casting for Primary Care PhysiciansPhysicians

Matt Leiszler, MDMatt Leiszler, MDStephanie Chu, DOStephanie Chu, DOJack Spittler, MDJack Spittler, MD

University of Colorado Sports MedicineUniversity of Colorado Sports Medicine

GoalGoal

Provide an intro to fracture management Provide an intro to fracture management and casting for family physiciansand casting for family physicians

ObjectivesObjectives

Identify common fractures in Primary Identify common fractures in Primary CareCare

Proper use of a splint versus a castProper use of a splint versus a cast Identify commonly used casting Identify commonly used casting

materials and when to use themmaterials and when to use them Demonstrate proper cast application Demonstrate proper cast application

and removaland removal Describe appropriate patient education Describe appropriate patient education

with regards to castingwith regards to casting

IntroductionIntroduction

Orthopedic Orthopedic problems are over problems are over 10% of all primary 10% of all primary care visitscare visits

1.6% of all visits 1.6% of all visits to any physician to any physician are fracture are fracture relatedrelated

16% of all fracture 16% of all fracture care is handled by care is handled by family physiciansfamily physicians

Fractures seen by FPsFractures seen by FPs

Fracture Eiff Hatch AlcoffFinger 17% 18% 12%Metacarpal 16 7 5Radius 14 10 16Toe 9 9 1Fibula 7 7 7Metatarsal 6 5 4Clavicle 5 6 7

Fractures seen by FPsFractures seen by FPs

4th digit distal phalanx fracture

4th and 5th metacarpal

fracture

Distal radius fracture

Fractures seen by FPsFractures seen by FPs

Other Fractures:Other Fractures: Radius and ulnaRadius and ulna CarpalCarpal UlnaUlna HumerusHumerus TibiaTibia TarsalTarsal

Casting and Casting and SplintingSplinting

OverviewOverview Mainstay of treatment for most Mainstay of treatment for most

fracturesfractures Joint above and a joint belowJoint above and a joint below Avoid pressure pointsAvoid pressure points

– Excessive moldingExcessive molding– Cast indentationsCast indentations

Appropriate paddingAppropriate padding– More at bony prominenceMore at bony prominence– Not too much at fracture siteNot too much at fracture site

Consider skin woundsConsider skin wounds

SplintingSplinting

SplintingSplinting

PurposePurpose Reduce painReduce pain Reduce bleeding and swellingReduce bleeding and swelling Prevent further soft tissue damagePrevent further soft tissue damage Prevent vascular constrictionPrevent vascular constriction

What to splintWhat to splint FractureFracture DislocationDislocation Tendon ruptureTendon rupture

Specific splintsSpecific splints

Forearm and wrist– Ulnar gutter

Metacarpal

– Thumb spica Scaphoid

Ankle – Posterior splint– “L and U” or

Sugartong

CastingCasting

Jones Fracture

SuppliesSupplies

StockinetteStockinette Padding materialPadding material Cast materialCast material

– Plaster: cheaper, long shelf life, easier Plaster: cheaper, long shelf life, easier to work withto work with May be fragile, disintegrate in waterMay be fragile, disintegrate in water

– Fiberglass: more durable, lighter, dry Fiberglass: more durable, lighter, dry quicker, multiple colors, water tolerantquicker, multiple colors, water tolerant

– Newer synthetic materialsNewer synthetic materials

ProcedureProcedure

Apply stockinetteApply stockinette– Protect skin and provide smooth edgeProtect skin and provide smooth edge

Apply paddingApply padding– Protect bony prominenceProtect bony prominence– Allows for swellingAllows for swelling

Wet the casting materialWet the casting material– Hot water hardens fasterHot water hardens faster– Squeeze out excess waterSqueeze out excess water

Apply splint or castApply splint or cast

Patient EducationPatient Education

Keep injured limb elevated and icedKeep injured limb elevated and iced Warning signsWarning signs

– Numb extremityNumb extremity– Inability to move extremityInability to move extremity– Discoloration, ColdDiscoloration, Cold– Increased painIncreased pain

Avoid getting wetAvoid getting wet– Completely with plasterCompletely with plaster– May use hair dryer on cool setting if May use hair dryer on cool setting if

fiberglassfiberglass

Patient EducationPatient Education

Keep cast cleanKeep cast clean Do not stick objects into castDo not stick objects into cast Do not pull out the paddingDo not pull out the padding Watch for skin irritationWatch for skin irritation Do not modify your castDo not modify your cast Watch for cracking and breaking Watch for cracking and breaking

of castof cast

Cast RemovalCast Removal

Cast saw Vibrates, doesn’t rotate Biggest concern is burn

Take Home PointsTake Home Points

You will see fracturesYou will see fractures Know your comfort level and when to Know your comfort level and when to

referrefer Splint acutely and with active swellingSplint acutely and with active swelling Variety of materialsVariety of materials

– Know what you have, be comfortable with Know what you have, be comfortable with itit

Educate your patientsEducate your patients

Recommended Recommended ResourcesResources Eiff MP, et al. Eiff MP, et al. Fracture management for Primary CareFracture management for Primary Care, ,

22ndnd edition. Saunders. 2003. edition. Saunders. 2003. Honsik K, et al. Sideline splinting, bracing and casting Honsik K, et al. Sideline splinting, bracing and casting

of extremity injuries. of extremity injuries. Current sports Medicine Reports.Current sports Medicine Reports. 2003;2:147-154. 2003;2:147-154.

Meredith RM, et al. Field splinting of suspected Meredith RM, et al. Field splinting of suspected fractures: preparation, assessment, and application. fractures: preparation, assessment, and application. The Phys and Sports Med.The Phys and Sports Med. 1997;25(10). 1997;25(10).