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Departement of Orthopaedi and TraumatologiDr. Moewardi Hospital/ Prof. Dr. dr. R. Soeharso
Hospital
UNS Medical acult!
SUR"#"RT"$
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%ower &'tremit! (astDespite the man! ad)antages of operati)e
care* nonoperati)e care remains the
foundation on which treatment ofmusculos+eletal trauma is ,ased.
Nonperati)e treatment for lowere'tremit! - reposition and immo,iliationusing cast.
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%ower &'tremit! (astal+ing Shoes and Heel
Shoe (ast
(!linder (astDel,et (ast
0elow #nee (ast
Sarmiento (ast
%ong %eg (astHip Spica / dou,le hip spica
eight 0earing Spica
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al+ing Shoe and Heelal+ing shoe and heel pro)ide some
protection for the foot portion of the
cast.
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0oot (ast0oot cast can ,e used for support and
immo,iliation
Used for metatarsal and tarsal fracture"plied ,elow gastrocnemius muscle
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0oot cast
Fabricated Boot Cast
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(!linder (astor +nee in1uries 2ligament 3 fracture4
Uncontrolled rotation
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Del,et (astUsuall! for sta,le midshaft ti,ial fr
Tend to slip down
Hinge o)er maleoli
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0elow #nee (astMost common cast use for an+le
fractures* foot fractures* and softtissue in1uries
Occasionall! use to tread undisplacedlower ti,ial diaph!seal fracture or
minor pilon fracture
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"plication StepTwo team person, with an assistant
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Positioning in undisplaced fracture Application of the padding
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First, apply the padding above and bellow the knee, this needs to be thicker
over the maleolar and around the fibular head.
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The principle of !point fi"ation within the cast
needed to be aplied. The two main molding points
are created by gentle pressure over the lateral hind
foot and above over the medial supramaleolar part
of the lower leg.
The third point is created later by mmolding the
upper end of the cast firmly around the lateral
aspect of the leg.
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Completed Below #nee Cast
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Sarmiento 2PT04 (ast
5ndication-
" Sarmiento cast or ,race can ,e used
initiall! in sta,le fractures in the distal halfof the ti,ia.
"lso used to treat ti,ial diaph!sal fracture
after a few wee+s in long leg cast.
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The surgeon is seated on a low chair. The patient’s knee is flexed over
the end of the table; the thigh is supported with padding.
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"plication StepPositioning
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Padding
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(ast application
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Mold
Trimm
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$ %old in the transverse and longitudinal arches of the foot, and around the
malleoli, and mold a posterior bulge for the Achilles tendon.$ &mooth the cast along the entire anteromedial border of the tibia.
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(ompleted Sarmiento cast
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%ong %eg (ast"ppl! short leg
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"pplication Step
The patient should be lying supine, with the ankle over the edge of the table.
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The patient's knee should be fle"ed to appro"imately ()!*+, which will rela"
the gastrocnemius muscle. This will reduce the hypere"tension.
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Apply a stockinette and cut it slightly longer than the final cast will be.
ind the cast padding towards the knee, with an overlap of *)-.
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&tarting with the bottom of the foot, wrap the plaster bandage around the ankle
in a figure!of!eight.
Fold the loose end of the stockinette over the pro"imal edge of the cast.
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hile the plaster is still soft, mold it gently to the curve of the tibia and
around the knee. n addition, a supracondylar mold is important for the
cast to control the length of the limb.
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The application of the long leg circular cast is now complete.
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Hip SpicaSeldom to use in adults
(hildren - fracture* hip d!splasia* post opimmo,iliation
Use fracture ta,le
Reinforce lateral aspect rolls from chestcage > pel)is
Hole for eas! ,reathing 3 comfort
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ndication/ fracture, hip
dysplasia, post op immobili0ation
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ndication/ fracture, hip dysplasia,
post op immobili0ation, withcontralateral hip or pelvic problem
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eight ,earing spica The weight>,earing single>hip spica
cast is useful for adults. Sometimes itis necessar! to immo,ilie the hip andfemur in a hip spica cast that will ,eused for wal+ing.
it much ,etter in weight ,earingposition
Stand ,etween two chairs
Stop a,o)e an+le distal!
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THANK YOU