Bowl of water: Water should be warm enough to be tolerated by surgeon’s hands. Cold water delays setting of plaster while very hot water produces unbearable temperature for the patient and may produce blisters.
Dipping of plaster in water: Plaster is put in the water till the air bubbles stop coming out of the plaster bandage.
Squeeze the water: The plaster is then squeezed by applying pressure with both hands. Pressure is applied at both ends towards the center and most of the water should come out during this process. The squeezing pressure should be such that the minimum amount of the plaster material is squeezed out.
Remove the plaster material: Plaster sediments collected at the bottom at the bottom of the bowl should be removed. The sediments impair proper soaking of the fresh plaster bandage.
Plaster Slab: Plaster slab can be applied to strengthen the plaster cast. In cases where swelling is expected, only plaster slab is applied secured by cotton bandage. When the swelling disappears, or the chances of complications are nil, the plaster is completed. This is usually done after 48 hours.
Making of plaster slabs: This can be made by dry or wet method.
- Dry method: The required length of the plaster slab is made with the aid of hand span on the patient’s body. From the dry plaster bandage, 4-5 layers of adequate length of plaster folds are made. These folds are immersed in the bowl of water with both ends held. Once it is properly soaked, it is squeezed by pressing the plaster in between the hands. The plaster slab is smoothened by to and fro rubbing movements of the hand. It is now ready for application.
- Wet method of making plaster slab: This is done by unrolling an ordinary cotton bandage, the plaster powder is sprinkled and the bandage is rerolled. The powder- covered bandage is immersed in water and squeezed. It is again unrolled on the plain surface in 4-5 layers and the desired length is made. The slab must be made even and must be devoid of creases by rubbing with the palm of the hand. This locally made plaster is no doubt more economical but is not so satisfactory when compared to the ready- made plaster.
APPLICATION OF PLASTER
- Application of slab: This slab is applied on the padded area of the body which must be immobilized.
- Application of gauze bandage: Dry gauze bandage, after being soaked in water, is squeezed and rolled round the plaster slab. When the situation permits, the plaster can be completed by applying wet plaster bandage over the slab. Completion of plaster can be done immediately. This is an indication in cases where swelling and oedema are not expected.
- The technique of application of plaster bandage:
- Bony Prominences: Protect the bony prominences with extra amounts of cotton wool. These places are malleoli, head of fibula, occiput, olecranon process, epicondyles of humerus and styloid process of radius and ulna.Some Orthopedic Products Manufacturers whoproduce olecranon plates and humerus plates to heal the fractures of olecranon and humerus parts of the body.
- Padding: This is done with a layer of the cotton
- Application of plaster bandage: Excess water is squeezed out of soaked plaster bandage roll. Gentleness must be exerted during the application of plaster. While wrapping the plaster, the manipulator must never lift the bandage up from the surface of the body where it is applied. It should be pushed by thenar eminence and thumb instead of being pulled.
- Smoothening of plaster surface: During the procedure of unrolling the bandage the hand which holds the plaster also serves the purpose of smoothening the surface. The palm and fingers of the other hand also help in a co-ordinating fashion to make the surface even. This manoeuvre squeezes out the trapped air and removes the dead space between the plaster layers. There must not be any crease or folds.
- Care over the joint: The edge of the plaster during the time of wrapping should not lie over the joint. This produces constriction effect.
- Do not produce indentation with fingers: While holding the limb, the assistant can produce indentation on the plaster. The affected parts should be supported by the palms of the hands while the fingers should be free from taking up any weight of the plaster.
- Thickness of plaster: In most cases, to obtain proper thickness of the cast, it is usually necessary to apply 4-5 layers of plaster over the affected limb.
- Moulding:Moulding must be perfect. This is done during application of plaster bandage and after its completion. With the palm of the hand the plaster is brought to the perfect shape of the area to be immobilized. This is carried on till the cast is hardened, otherwise the plaster is likely to crack.
RESTING OF THE IMMOBILIZED PART
Once the plaster becomes rigid the limb should be rested on sand bags. This prevents indentation and flattening of the newly constructed plaster. Irregular margins of the plaster are trimmed with plaster saw and smoothened.
COMPLICATIONS OF PLASTER
- Plaster sore: Prolonged immobilization by plaster may lead to plaster sores, especially over the areas of bony prominences, e.g., back of scapula, spinal processes, occiput, sacral region, over greater trochanter, malleoli and over the heels.
- Vascular complication: Impairment of blood supply can produce gangrene of the limb. This may develop due to constriction effect of the plaster bandage.
- Neurological complication: Common peroneal nerve lesion due pressure from the plaster can develop foot drop.
ADVISE TO PATIENTS TREATED BY PLASTER
- Elevation: The immobilized limb should be kept elevated for a period between 24-28 hours. This minimizes the chance of developing oedema of the limb.
- Movement: Movements of fingers and toes should be performed to prevent stiffness of the small joints.
- To notify the doctor: Any discolouration of the fingers and toes, swelling, feeling of pain, numbness and coldness of the immobilized part must immediately be brought to the notice of the doctor.
- Check up: The patient must attend the clinics on the following day of immobilization for the check up.
CARE OF PLASTER
The patient must observe the following rules:
- Not to get the plaster wet.
- Not to cut the plaster by himself without the consent of the doctor.
- Not to remove the cotton or stockinet padding from under the plaster.
- Not to scratch the inside with a stick, and not to put any foreign body inside the plaster.
- Dermatitis is likely to develop under the plaster, especially in tropical countries.
Talcum powder can be sprayed inside to prevent irritation.
This information was edited and provided Siora Surgicals Team. Siora Surgicals Pvt. Ltd. well known name in the market for manufacturing and exporting orthopedic implants Indonesia and other country.