Fracture Care and Casting for Primary Care Physicians Matt Leiszler, MD Stephanie Chu, DO Jack Spittler, MD University of Colorado Sports Medicine Goal Provide an intro to fracture management and casting for family physicians Objectives Identify common fractures in Primary Care Proper use of a splint versus a cast Identify commonly used casting materials and when to use them Demonstrate proper cast application and removal Describe appropriate patient education with regards to casting Introduction Orthopedic problems are over 10% of all primary care visits 1.6% of all visits to any physician are fracture related 16% of all fracture care is handled by family physicians Fractures seen by FPs Fracture Finger Metacarpal Radius Toe Fibula Metatarsal Clavicle Eiff 17% 16 14 9 7 6 5 Hatch 18% 7 10 9 7 5 6 Alcoff 12% 5 16 1 7 4 7 Fractures seen by FPs 4th digit distal phalanx fracture 4th and 5th metacarpal fracture Distal radius fracture Fractures seen by FPs Other Fractures: Radius and ulna Carpal Ulna Humerus Tibia Tarsal Casting and Splinting Overview Mainstay of treatment for most fractures Joint above and a joint below Avoid pressure points – Excessive molding – Cast indentations Appropriate padding – More at bony prominence – Not too much at fracture site Consider skin wounds Splinting Splinting Purpose Reduce pain Reduce bleeding and swelling Prevent further soft tissue damage Prevent vascular constriction What to splint Fracture Dislocation Tendon rupture Specific splints Forearm and wrist – Ulnar gutter Metacarpal – Thumb spica Scaphoid Ankle – Posterior splint – “L and U” or Sugartong Casting Jones Fracture Supplies Stockinette Padding material Cast material – Plaster: cheaper, long shelf life, easier to work with May be fragile, disintegrate in water – Fiberglass: more durable, lighter, dry quicker, multiple colors, water tolerant – Newer synthetic materials Procedure Apply stockinette – Protect skin and provide smooth edge Apply padding – Protect bony prominence – Allows for swelling Wet the casting material – Hot water hardens faster – Squeeze out excess water Apply splint or cast Patient Education Keep injured limb elevated and iced Warning signs – Numb extremity – Inability to move extremity – Discoloration, Cold – Increased pain Avoid getting wet – Completely with plaster – May use hair dryer on cool setting if fiberglass Patient Education Keep cast clean Do not stick objects into cast Do not pull out the padding Watch for skin irritation Do not modify your cast Watch for cracking and breaking of cast Cast Removal Cast saw Vibrates, doesn’t rotate Biggest concern is burn Take Home Points You will see fractures Know your comfort level and when to refer Splint acutely and with active swelling Variety of materials – Know what you have, be comfortable with it Educate your patients Recommended Resources Eiff MP, et al. Fracture management for Primary Care, 2nd edition. Saunders. 2003. Honsik K, et al. Sideline splinting, bracing and casting of extremity injuries. Current sports Medicine Reports. 2003;2:147-154. Meredith RM, et al. Field splinting of suspected fractures: preparation, assessment, and application. The Phys and Sports Med. 1997;25(10).