Especially isolated tibial fractures may go into varus position within a couple of weeks after the fracture. Check that knee movement is free before turning down the Stockinet and finishing in the usual way. After preliminary treatment by traction, the cast brace is applied when the fracture is “stable and firm. The actual weight is born on the patellar tendon region anteriorly. Fracture instability after 24 weeks is considered a delayed union. Weight bearing Once the plaster is fully hardened hours , a cast shoe may be applied and weight bearing and knee flexion started. The principle of tibial PTB casting is the same as for the femoral cast brace. Plaster Casts and Splints Functional Braces The principle of these is that a well fitting plaster cast is applied and the patient uses the extremity ie walks on a the cast.
Case presentation wedge cast. At weeks post injury, the long leg cast is removed and a Sarmiento cast is applied. There is also high risk of delayed or nonunion. A rubber heel is applied and the patient is encouraged to weight-bear on the plaster. Mold the posterior side of the cast to assume a triangular shape, slightly convex at the anterolateral and -medial border, flat over posterior, anterior compartments and medial surfaces as shown in the illustration. Then the thigh portion is applied.
Note that the posterior trim line is thus more distal then the anterior edge of the cast, since it must be just below the popliteal flexion crease. For days, pahellar swelling subsides, the plaster is checked for slackness and adapted if required. The actual weight is born on the patellar tendon region anteriorly.
Sarmiento or PTB patella tendon bearing cast Principle. Begin isometric exercises for all muscle groups immobilized in the cast. Aftercare Sarmiento cast Aftercare Sarmiento cast. pateplar
Plaster casts -functional braces
After preliminary treatment by traction, the cast brace is applied when the fracture is “stable and firm. The cast is retained until union is sound, and the patient can comfortably bear full weight. After that it is changed to a Sarmiento or PTB patella tendon bearing cast. Change casts at 4-toweek intervals, depending on the stability of the fracture.
This type of cast must be applied with care over minimal padding and is applied in segments. Functional Braces The principle of these is that a well fitting plaster cast is applied and the patient uses the extremity ie walks on a the cast.
AO Surgery Reference
Another name for the femoral brace is a “Box Plaster” A full leg cast is applied and molded in a right angled “box” form to prevent rotation. It is then trimmed from the upper pole of the patella round to the upper part of the calf. The long leg cast is normally applied for 6 weeks. Muscle action and the intermittent axial compression stimulates bony union.
A hinge may be worked into the plaster and the knee left free. Slight slipping of the fracture may be accepted, but if evidence of substantial displacement is found, internal fixation should be considered. Usually, however, the Sarmiento cast follows the application of a long leg cast after weeks post injury.
A Sarmiento cast or brace can be used initially in stable fractures in the distal half of the tibia. Where materials are available, the cast can be made of fiberglass or thermoplastic material.
Patellwr firm, the proximal margin of the cast is trimmed from the proximal pole of the patella, circumferentially to the proximal part of the calf. Displaced fractures that can be reduced, and maintain acceptable alignment, can also be treated conservatively, ie, oblique or transverse fractures, especially if the fibula is intact. When the cast has set, the knee is extended until 5 to 10 degrees short of full extension.
Mold in the transverse and longitudinal arches of the foot, and around the malleoli, and mold a posterior bulge for the Achilles tendon. Additionally a hinged foot support can be used to pyb the cast around the ankle and foot, permitting also mobilization of the ankle.
For undisplaced tibia shaft fractures without significant swelling it patellag even be used as the initial cast. Mold the posterior side of the cast to assume a triangular shape, slightly convex at the anterolateral and -medial border, flat over posterior, anterior compartments and medial surfaces as shown in the illustration.
The effect of the patellar tendon-bearing cast on loading.
The cast is molded anteriorly around the patella, and an indentation is made over the patellar tendon. Tendno setting, the plaster is molded to fit the contours of the proximal tibia tednon fibula, not only around the tibial tubercle and patellar tendon, but also the fibular head, peroneal nerve, and posterior proximal calf. It bears weight on the ischial region. Principles Undisplaced trndon minimally displaced fractures. The patient sits on the edge of a table. In applying the upper portion of the cast, the knee should be flexed to a right angle and the cast molded flat over the upper calf to give a triangular cross section.
Oblique and spiral fractures are potentially unstable. The application of such a cast requires considerable experience, especially the molding in the infrapatellar region.