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Departement of Orthopaedi and Traumatologi

Dr. Moewardi Hospital/ Prof. Dr. dr. R. Soeharso


Hospital
UNS Medical Faculty
SURAKARTA
1

Lower Extremity Cast


Despite the many advantages of operative

care, nonoperative care remains the


foundation
on
which
treatment
of
musculoskeletal trauma is based.
Nonperative

treatment
for
lower
extremity : reposition and immobilization
using cast.

Lower Extremity Cast


Walking Shoes and Heel
Shoe Cast
Cylinder Cast
Delbet Cast
Below Knee Cast
Sarmiento Cast
Long Leg Cast
Hip Spica / double hip spica
Weight Bearing Spica

Walking Shoe and Heel


Walking shoe and heel provide some

protection for the foot portion of the


cast.

Boot Cast
Boot cast can be used for support and

immobilization
Used for metatarsal and tarsal fracture
Aplied below gastrocnemius muscle

Boot cast

Fabricated Boot Cast

Cylinder Cast
For knee injuries (ligament & fracture)
Uncontrolled rotation

Delbet Cast
Usually for stable midshaft tibial fr
Tend to slip down
Hinge over maleoli

Below Knee Cast


Most common cast use for ankle

fractures, foot fractures, and soft


tissue injuries
Occasionally use to tread undisplaced
lower tibial diaphyseal fracture or
minor pilon fracture

Aplication Step
Two team person, with an assistant

Positioning in undisplaced fracture

Application of the padding

First, apply the padding above and bellow the knee, this needs to be thicker
over the maleolar and around the fibular head.

The principle of 3-point fixation 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.

Completed Below Knee Cast

Sarmiento (PTB) Cast


Indication:
A Sarmiento cast or brace can be used
initially in stable fractures in the distal half
of the tibia.
Also used to treat tibial diaphysal fracture
after a few weeks in long leg cast.

Sarmiento (PTB) Cast


Support metatarsal head, 5 cm proximal to

the patella. Mold the leg portion of the cast


and extend the knee to 45 of flexion
(more Stable)
the lower pole in the patella and moulded
around the patellar tendon
Foot plantigrade, ankle 90 degree

The surgeon is seated on a low chair. The patients knee is flexed over
the end of the table; the thigh is supported with padding.

Aplication Step
Positioning

Padding

Cast application

Mold

Trimm

Mold in the transverse and longitudinal arches of the foot, and around the
malleoli, and mold a posterior bulge for the Achilles tendon.
Smooth the cast along the entire anteromedial border of the tibia.

Completed Sarmiento cast

Long Leg Cast


Indication :
Used to treat unstable tibial diaphyseal
fracture in acute phase, fractures around
the knee.

Long Leg Cast


Apply short leg first up to mid patella
Mold in the transverse and longitudinal

arches of the foot and about the malleoli


Make thigh portion
Keep the knee flexed 20-35
Mold the cast above the medial and lateral
epicondyles
Mold the cast over the anterior and lateral
surfaces to produce a quadrilateral socket

Application Step

The patient should be lying supine, with the ankle over the edge of the table.

The patients knee should be flexed to approximately 20-35, which will relax
the gastrocnemius muscle. This will reduce the hyperextension.

Apply a stockinette and cut it slightly longer than the final cast will be.
Wind the cast padding towards the knee, with an overlap of 50%.

Starting 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 proximal edge of the cast.

While the plaster is still soft, mold it gently to the curve of the tibia and
around the knee. In addition, a supracondylar mold is important for the
cast to control the length of the limb.

The application of the long leg circular cast is now complete.

Hip Spica
Seldom to use in adults
Children : fracture, hip dysplasia, post op

immobilization
Use fracture table
Reinforce lateral aspect rolls from chest
cage - pelvis
Hole for easy breathing & comfort

Indication: fracture, hip


dysplasia, post op immobilization

Indication: fracture, hip dysplasia,


post op immobilization, with
contralateral hip or pelvic problem

Indication: bilateral DDH

Weight bearing spica


The

weight-bearing single-hip spica


cast is useful for adults. Sometimes it
is necessary to immobilize the hip and
femur in a hip spica cast that will be
used for walking.
Fit much better in weight bearing
position
Stand between two chairs
Stop above ankle distaly

THANK YOU