OR13.1 | Plastering and Splinting Skills — Summary & Reflection

KEY TAKEAWAYS

Plaster-of-Paris (calcium sulphate hemihydrate) immobilisation and splintage are essential orthopaedic skills governed by clear anatomical and biomechanical principles. The joint-above-and-below rule mandates spanning both the proximal and distal joints to the fracture site. Common cast types include above-elbow POP (forearm and elbow fractures), below-knee POP (ankle/distal leg), and above-knee POP (knee-level pathology). The Thomas splint provides pre-operative traction for femoral shaft fractures via an ischial ring and longitudinal traction.

The POP application sequence is: stockinette → orthopaedic wool with extra padding over bony prominences → POP in spiral with 50% overlap → palm moulding → finish and fold stockinette → document distal neurovascular status. Room-temperature water must be used to avoid thermal burns from the exothermic setting reaction.

Compartment syndrome is the most dangerous early complication. The 6 P's (pain out of proportion and on passive stretch, pressure, paraesthesia, paralysis, pallor, pulselessness) define the clinical spectrum; pain on passive stretch is the earliest and most reliable sign. The pulse is often present until late — never rely on its absence to exclude compartment syndrome. A compartment pressure >30 mmHg or ΔP <30 mmHg mandates fasciotomy. Initial management is immediate cast splitting or bivalving.

Shoulder strapping (broad-arm sling or figure-of-eight) and clavicle strapping are first-contact interventions for shoulder-girdle injuries. Every cast application must be followed by a documented distal neurovascular check.

REFLECT

Reflect on a clinical encounter or simulation session where a cast was applied. Consider: Was the joint-above-and-below rule followed? Was a post-application neurovascular check performed and documented before the patient left the department? If you observed a patient returning with cast-related complications, what was the system failure? What steps — at application and at discharge counselling — could have prevented it? Write a brief clinical note (3–5 sentences) describing what you observed and what you would do differently.