Plaster of Paris
Contents
• Introduction
• What is POP?
• Indications
• Contraindications
• Forms of POP
• Instruments for POP
• Steps to apply POP Cast
• Complications
Introduction
• Each fracture is unique
• Some fractures do well if they are fixed
• There are others which do pretty well if they
are not fixed
• A good surgeon knows when not to operate
• POP is one of the commonest material used in
non operative mx
What Is POP?
• A role of muslin stiffened by dextrose or starch
and impregnated with hemi-hydrate of
calcium sulphate
• When added with water , calcium sulphate
takes up its water of crystallization
• Exothermic reaction
• Few minutes it become a rock like mass
Indications
• Fractures
• Severe sprains
• Dislocations
• Protection
– Post-operative tendon /muscle repairs or reconstruction
• Deformity correction
– Gradual correction of a deformity with serial casting –
ponseti technique
• Off load pressure
– DFU
Contraindications
Absolute contrainfications
• Severe swelling
• Compartment syndrome
Relative contrainfications
• Open fractures
• Insensate limbs
• Ulcers or draining wounds
Forms of POP
• Slab
– Only a part of circumference of limb is
incorporated.
• Cast
– Encircle whole circumference of the limb
• Spica
• Brace
Upper Limb Casts
• Below elbow cast
– Below elbow to knuckles
• Above elbow cast
– Upper arm to knuckles
• U-slab
• Hanging cast
• Scaphoid
Lower Extremity Casts
• Long leg casts
• Below knee cast
• Patellar tendon bearing cast (PTB)
• Hip spica
Rules of application of POP casts
Padding Plaster
– This is placed from – Cold water will
distal to proximal maximize the
– 50% overlap molding time
– A minimum two layers – 8 inch width for thigh
– Extra padding at the – 6 inch width for leg
bony prominence – 4 inch width for arm
and forearm
Application of Cast
• Instruments needed
1. Stockinette
• Usually the first layer
• May be omitted in acute fracture treatment
Instrument
2. Orthoban:
• Widths 2-6 inches
• 2-4 inches for upper extremity
• 4-6 inches for lower extremity
Instrument
3. Plaster of Paris
• 4-inch for arm
• 6-inch for leg
• 8-inch for thigh
• Immersion in water initiates an exothermic reaction
• Hardens within 4 minutes, but dries completely in 2-3
days
Instrument
4. A bucket of water
• Water at or below room temperature
• Cooler water decreases the risk of skin burning and
allows for more working time
Steps 1
• Evaluation of patient and X ray
Step 2- Prepare Equipments and Patient
• Prepare the instruments needed
• Explain to patient and consent
• Comfortable position for patient and person
applying cast
Step 3- Apply the Stockinette and Orthoban
Stockinette Orthoban
• Measure the length of • Apply over stockinette
stockinette needed from distal to proximal
• Overlap the layers by
50%
• Extra padding over bony
prominence eg fibular
haed, maleolus
Step 4- POP Preparation
• Hold the plaster roll in one hand and the free
end of the plaster in the other
• Immerse in water until air bubbles stop rising
• Squeeze gently
Step 5 – POP Application
• Roll plaster in the same direction as padding
• Overlap each turn by 50%
• Mould and smoothed by thenar eminence and
palm
• Hold the cast steadily till cast sets
Step 6 – Check X ray
Wedging
• Correct fracture
angulation
• Open vs closed wedge
• Done when POP set
only
Step 7- Patient Instruction
• Keep the cast dry
• Plaster casts take 2-3 days to dry completely
• The limb should be elevated above the heart
• Fingers and toes should be wiggled often
• DO NOT put anything down the cast, trim or cut
the cast, remove any padding from the cast, drive
while in a cast
• To relieve itch, use a blow dryer on a cool air
setting
Step 7- Patient Instruction
• Seek immediate attention if
– Pain or swelling increases
– Any numbness or tingling
– Any drainage or an unusual smell
– The digits distal to the cast are purple
– Any swelling not relieved by elevation
– The cast breaks
Ultimate Strength of Cast
• Thickness
• Degree to which layers fused together
• Smoothness of finish
Complications
1. Tight cast
2. Loose cast
3. Pressure sores
4. Skin abrasion or laceration
5. Burn to skin
6. Skin allergic reaction to POP
7. Thrombophlebitis and DVT
8. Stiffness and deformity
9. Cast syndrome
Tight Cast
• Presentation • Management
– Pain
– Limb should be elevated
– If pain persist split the
• Causes cast
– Cast too tightly applied
– Limb swelling increase
• Risk
– Pressure sores
– Compartment
syndromes
– Peripheral nerve injuries
Pressure Sore
• Even a well-fitting cast may press upon the
skin over a bony prominence
• Eg : the patella, heel, elbow or head of the
ulna
Loose cast
• Swelling has subsided
• The cast may no longer hold the fracture
securely
• Fracture displacement
Burn And Allergic Reaction
• Thermal effect can cause mild burn
• Depends on water temperature and amount,
total surface area of cast, external
environment
Deep Vein Thrombosis
• Virchow’s triad
– Venous stasis, abnormal coagulability and vessel
wall injury
• Due to
– Immobilization
– Loss of pumping action of the calf muscles
Stiffness and Deformity
• Most common complication
• Pathophysiology
– Swelling and haematoma resolve
– Adhesions may form that bind muscle fibres to
each other and to the bone
Cast syndrome
• Casting of the spine, hyperextension can occur
• Obstruction of 3rd portion of the duodenum by
superior mesenteric artery
• Lead to high intestinal obstruction
Thank You
