Bedside Clinics in Orthopedics Upendra Kumar
INDEX
Page numbers followed by f refer to figure and t refer to table.
A
Abductor lever arm 292
mechanism 293f
Aberrant epiphysis 268
Above elbow cast 9, 9f
Above knee cast 10, 11f
types of 11, 12f
Abrasive wear 157
Absorbable suture materials 167, 167t
Acetabular index 205, 205f
Acetabuli osteophyte 387
Acetabulum
cup size 387
preparation 377
Acetic acid 26
Achilles tendon 397
Acromioclavicular joint 397
Acutrak screw 125, 125f
Adam's test 202
Adduction test 230
Adductor canal 295, 295f
Adhesive surgical tapes 19, 20f
Adhesive wear 157
Adrenaline 419, 423
Adriamycin 189
Adson retractor 115, 116f
Adult bone classification 266
Aesculap circular clamp 161
Agnes-hunt traction 48, 48f
Air conditioning system 414, 414f
Air mattress 57, 57f
Airplane splint 238, 238f
Alcohols 428
Alginates 21, 21f
Alkaptonuria 194
Allen key 100, 100f
Allergy 400
Allis forceps 75, 76f
Amiodarone 419, 423
Amphiarthrosis 270
Amputation saw 86, 86f
Anatomical face mask 417, 418f
Anchor screw 127, 127f
Anconeus triangle 281
Anderson's lesion 194
Anesthesia
care, monitored 438
equipment kit 417, 418f
general 438
machine 416, 417f
functioning of 417
procedure 438f
Angle guide 108, 108f
Angled blade plate 146, 146f
Ankle 194, 196f, 314, 315f, 352, 354f, 397
and wrist, bandaging around 29, 29f
anterior approach 353
arthrodesis 385f
bone 305f
foot orthosis 231, 232f
components 222
conventional type 222, 224f
design 222
floor reaction 223
functions of 222
total contact 222
joint 302, 385
ligaments around 302, 303f
movement around 303
mortise 303
Ankylosing spondylitis 193, 193f, 194, 401
Ankylosis
bony 401
painful 386
Anserine bursae 302
Anterior cruciate ligament 101, 297, 301
Anterior hyperextension orthosis 245f
Anterior spinal
hyperextension orthosis 244
locking plate and screw 149, 150f
Anterior superior iliac spine 341f, 343f
Anteversion
angle of 376f
guidewire 373, 375
Antibiotic
characteristics of 167
dosing of 169
elution of 169
factors affecting elution of 169
impregnated bone cement 167
sensitivity 27
AO external fixator frame, components of 161, 162f
Arches 53, 162
factor affecting stability of 304
Arcuate ligament 298
Arm 328f, 329f
anterior 328
anterolateral approach of 328
chest strapping 28, 29f
compartment of 279f
posterior approach of 328
pouch sling 32, 32f
Arterial arches 315
Artery 295
anterior tibial 306
forceps 75, 75f
Arthritis 191, 388, 394, 397, 401
severe 386
Arthrodesis 384
around joints 384, 385t
implants 160
used for 161
principles of 380
Arthrogram 381, 393
hip joint 395f
Arthroplasty implants 154
Arthroscope 118, 118f
optical
characteristic 118
system 118
trolley 422, 423f
Arthroscopic knife 119, 119f
Arthroscopy, instruments for 118
Articular cartilage 403, 405
Articular disk 285
Ascorbic acid 24
Asepsis 425
Aspirin 437
Atavistic epiphysis 267
Atropine 419, 423
Aufranc retractor 80
Austin-Moore
pin 143f, 143t
prosthesis 154t, 376
Avascular necrosis 408
Axial traction 44
Axillary crutches 259, 259f
B
Babcock's tissue forceps 75
Back pain 409f
Backache, low 403
Bains breathing circuit 418f
Baker's cyst 351
Balkan frame 57, 57f
Balkan war 57
Ball bandaging 31, 31f
Balloon inflation 61
Bamboo spine 193f
appearance 194
Bandages 28, 49
Bard-Parker knife handle 74, 75f
Barlow's disease 196
Barlow's test 230
Barrel plate application 374
Barton's disease 196
Barton's fracture 8
Basket forceps 119, 119f
Baumgartner's tip-apex distance 374
Bearing, types of 158
Bechterew's disease 193
Beheaded Scottish terrier dog sign 204, 204f
Below knee cast 10, 10f
Bent Thomas splint 34f
Biceps
femoris muscle 347
tendon 327
Bicipital groove 279
Biconcave spine 200
Bicondylar entry 369
Biomedical waste, segregation of 66, 67f
Bipolar prosthesis 376
advantages of 155
Birth control pills 437
Bisphosphonate 201
Bladder washing 61
syringe 66f
Blood
and blood products 64, 64f
transfusion set 64f, 65
Blount's disease 208, 209f
Langenskiold classification of 209
Blount's epiphysiodesis staple 152, 153f, 383
Body jacket orthosis 244, 245f
Body powered upper limb prosthesis 253f
Bohler's plaster
bender 104f
shear 103f
Bohler's splint 35
Bohler's stirrup 35, 35f
components of 35
Bohler-Braun splint 33, 33f, 42, 42f
Bone 263, 265
and plate holding instruments 87
awl 90, 90f
cement 165, 167, 169
and liquid 169f
chisel 82, 82f
clinical anatomy of 173
composition of 265
cutter 82, 83, 83f
cyst
aneurysmal 184
simple 183, 184f
deformity 185
developmental classification of 266
disease 178
filler 99, 99f
formation
and growth pattern 268
intramembranous 269f
gouge 82, 83f
graft impactor 99, 99f
holders 87
hook 98, 99f
levers 79
marrow edema syndrome 405
microscopic classification of 266
modeling, process of 270t
nibbler 83, 83f
parts of 173, 265, 265f
periosteum of 266
piercing instruments and screwdrivers 90
plate 129
scintigraphy 408f
tap 91, 91f
transection 137f
tumor, radiographs of 180
turnover, normal 270
Bony sequestrum, specimen of 316, 316f
Boot cast 10, 10f
Boston brace 246, 247, 247f
Boutonniere deformity 192
Box chisel 111, 111f
Boyd's amputation 211
Boyd's approach 332, 333
Boyd's classification 209
Brace
condition of 233
wearing schedule of 247
Bradawl 90, 90f
Breathing circuit 418
Bright articular cartilage 405f
Bristow's retractor 81, 81f
Broad arm sling 32, 32f
Broken nail extractor 107, 107f
Brown tumor 199
Brueet dura elevator 115
Bruner's ten rules 72, 73t
Bryant's traction 39, 39f
Bryk and Rosenkranz, sign of 204
Buck's pulley 35, 36f
Buck's traction 37
Buddy taping 28f
Bupivacaine 419, 420
Burette dura elevator 116f
Burns bone holders 88, 88f
Bursitis 397
Butterfly fragment 175f
Buttress mode 129, 130f
C
Calcaneal traction 43
application, site for 43f
Calcaneum 354t, 355f
Calcium gluconate 423
Canal preparation 363, 365, 368
Cancellous bone 266
Cancellous screw 124, 124f, 125t, 126
Cannula, intravenous 65, 65f
Cannulated bolt 127, 127f
application 368
Cannulated cancellous screw 143, 143f
configuration for 375f
Canvas head Halter, parts of 44
Capener's incision 339
Capener's sign 206
Capner's spring coil splint 234, 235f
Capsule attachment 297
C-arm control, under 365, 367
Carpal tunnel syndrome 397
Cartilage holding forceps 101, 101f
Cast 8
bivalving of 16, 16f
extent of 8, 14
index 3
indication of slitting of 16
slitting of 16, 16f
wedging of 15, 15f
Casting 4, 7
materials 3
Catterall's classification 206, 207
Catterall's sign 206
Celecoxib 437
Cellulitis 404
Cellulosic materials 432
Cement
contraindication of 167
different generations of 169t
generation of 167
phases of mixing of 166
uses of 167
viscosity of 166
Cemented prostheses 158
Cemented stem 156
Cementless stem 157
Centromedullary nail 136
Cephalomedullary nail 136
Cerebrospinal fluid 438
Cervical
collar, components of 240
control 243t
halo 242, 242f
level and weight correlation 46t
orthoses 240, 243
retractor 113
skeletal traction 45
contraindications of 46
spine 337, 337f
typical 308f
synostosis 202
congenital 202
traction 45f
vertebrae, fusion of 202f
Cervicothoracic orthosis 242, 243f
Cervicothoracolumbosacral orthosis 243, 244f
Chairback orthosis 246f
Charcot joints 208
Charley's principle 6, 6f
Charnley's clamp 160, 160f
Charnley's compression system 160
Charnley's pins retractor 110
Charnley's self-retaining initial retractor 109, 110f
Charnley's traction unit 46, 47f
Cheatle forceps 76, 76f
Chemical disinfectants 428t
Chest 201
strapping 29, 29f
tube 63, 63f
application, site of 63
Chlorhexidine
gluconate 441
solution 23, 24f
Chlorine compounds 428
Chondroma 183
Chondrosarcoma 187, 187f
Cidex tray 26f
Claustrophobia 403
Clavicle 273
brace 238f, 239
morphology of 273, 273f
Clear cell chondrosarcoma 188
Clopidogrel 437
Closed wound suction set 61
Cloverleaf nail 139f
Cobb's angle 203, 203f
Cobb's elevator 113, 113f
Cobb's retractor 378
Cobbler's awl 90, 90f
Cobra plate 384f
Cobra retractor 80, 80f
Cock-up splint 237
Cod fish vertebrae 200
Codman's forceps 115, 116f
Cold
abscess 339f
meniscal pathology 318
Collagen
granules 25
sheet 25, 25f
Collar sling 32f
Colles’ cast 8, 8f
Colles’ fracture 8
Color rendering index 414
Common hand orthosis 234
Common knee orthoses 224
Common orthopedic plating and nailing 359
Compression
mode 130
screw 126f
application 374
stockings 58, 58f
Computed tomography 398
arthrography 402
advantages of 399
Condom catheter 62f
Condyle, lateral 293t
Condylocephalic nail 136
Congenital talipes equinovarus
ankle-foot orthosis of 231, 232f
cast 11, 12f
orthoses for 231, 232f
shoe 231
Conventional total shoulder arthroplasty system, components of 158
Cord decompression 378
Cork screw 110, 110f, 123
Corona mortis 342
Coronary ligament 298
Corrugated rubber drain 60f, 61
Cortical bone 266
Cortical screw 124, 124f
Corticomedullary delineation 180, 181, 186
Corticotome 84, 84f
Costotransversectomy 339, 339f
Cotton gauze pieces 18, 19f
Cotton roller bandage 5, 5f
Couch, differential elevation of legs of 41f
Counter sink 91, 91f
Counter traction 36
Coventry staple 152, 153f
Coxa vara 205
Cramer's wire 33, 33f
Crepe bandage 19, 19f
Crescent sign 207
Cruciate ligament, posterior 298, 301
Cruciate sacrificing implants 157
Crutch
gait 261
length measurement of 259
parts of 260
Crutchfield tong application 45
site for 45f
Cubital fossa 312, 312f
boundaries of 312
Cuff sling 32f
Cutting cone mechanism 271f
Cylindrical cast 10, 11f
Cystic lesion 185
Czerny's retractor 79, 79f
D
Dagger sign 194
Defibrillator 419, 419f
Deformity
correction 383
severe 386
Degenerative arthritis 192, 192f
Denham pin 120, 120f
Dennis-Browne splint 232, 232f, 233t
Desmopressin 420
Destruction pattern 181f, 182
Detachable blade 75f, 86
Dettol 23f
Dexamethasone 189, 423
Diabetes 194
Diabetic foot 194f
Diarthrosis 271, 272f
Diazepam 419, 423
Direct conventional arthrography 393
Direct measuring device 109, 109f
Discectomy forceps 115, 116f
Disinfection 425
level of 425
Disk herniation 406
Disposable syringe 66f
Dissecting forceps 77, 78f
Dissection, steps of 338
Distal arm 330
Distal cannulated bolt 127
Distal femoral traction 41
application, site for 41f
Distal femur 178f, 182f, 187f, 190f, 347f
lateral approach 347
Distal humerus 178f
osteotomy 383
Distal interphalangeal joint 7
Distal locking 365, 368
Distal radial distractor 100, 101f
Distal radius 362
Distal tibial traction 43
application, site for 43f
Distal ulna 186f
Dobutamine 419, 423
Dopamine 419, 423
Dorr's classification 387
Dorsal spine 338f, 339, 339f
transthoracic approach 338
typical 308f
Dorsolumbar spine 317f, 340, 340f
Dorsum of foot, muscles on 304, 305f
Double angle
blade plate 380f
dynamic hip screw plate 152, 152f
osteotomy blade plate 151, 152f
Double density sign 408
Double hip spica 14
Doxorubicin 189
Doyen's rib raspatory 114, 114f
Drain application
advantage of 61
disadvantages of 61
Draping
functions of 442
layers of 443
methods of 443
Drennan's angle, physiometaphyseal defect of 209f
Drennan's metaphyseal-diaphyseal angle 208
Dressing
absorptive layer 18
compressive layer 18
contact layer 18
layers of 18, 18f
materials 18
objectives of 18
pad 19, 19f
trolley 25, 26f
total number of 25
Drill bit 90, 91f, 128
correlation 128t
Drill guide 91, 92f
Drug
cart 419, 419f
guidelines for 436
Drummond wire 148, 148f
Dry heat sterilization 430
Dunlop's traction 39, 40f
Duoderm 21, 22f
Dura dissector 115, 116f
Dura retractor 115, 116f
Dynamic cock-up splint 236f
Dynamic compression plate 130, 131, 131f
classification of 131t
Dynamic condylar screw 108f, 109f, 145
plate 145f
Dynamic hip screw 108f-110f, 126, 126f, 144f, 372, 372f
plate 144
tap 109f
Dynamic orthosis 217, 218f
Dynamometer 100, 100f
E
Edinburgh University Solution of Lime 24, 24f
Eggers’ plate 129f
Elastic bandage 19, 19f
Elbow 30, 200f, 330f-332f, 395
arthrodesis 385f
arthroplasty 390, 390f
carrying angle of 281
crutches 259, 259f
dissected specimen of 312, 312f
extension orthosis 237f, 238
joint 385
ligaments around 280
review of 280
unit 254, 255f
lateral approach 331
movement around 280
orthosis 237, 237f
posterior approach 330
range of motion 237, 237f
restraints 281
Electrical surgical cautery unit 420, 420f
Enchondroma 183, 183f
Ender's nail 138, 138f
Endochondral bone formation 269f
Endochondral ossification 270
Endoskeletal prosthesis 218, 219f
Endotracheal tube 418, 418f
Energy storing 248
foot 249f
Epidural anesthesia 438
Epiphyseal fracture 175
Epiphyseal injuries 400
Epiphyseal plate 266
Epiphysiodesis
around knee 383, 383f
implants 151
indications for 383
Epiphysis, types of 267
Epsilon aminocaproic acid 420
Esmarch's bandage 71f, 72
Ethylene oxide 430
properties of 430
sterilization 430, 430f
Ewing's sarcoma 188, 188f
histopathology of 322f
specimen of 321, 322f
Exoskeletal prosthesis 218, 219f
Exsanguination, contraindications of 72
Extended cervical orthosis 242
Extensor apparatus around patella 297
Extensor carpi
radialis
brevis 282f
longus 282f
ulnaris 283f
Extensor digitorum longus 282f
Extensor indicis proprius 282f
Extensor pollicis longus 282f, 283f
Extensor retinaculum 315f
External fixator 160
removal of 52
External frame, classification of 50, 51t
External shoe modifications 221f
F
Face mask, simple 417, 418f
Facet joint 191
Fas sterilization, disadvantages of 431
Fatigue wear 157
Feil classification 202
Femoral canal preparation 377
Femoral component selection 388
Femoral distractor 100, 101f
Femoral epiphysis 205
Femoral head, avascular necrosis of 207, 405f
Femoral nail, long proximal 146t
Femoral triangle 296, 296f
Femoroacetabular impingement 405
Femur 188f, 199f, 200f, 293, 294f
head, avascular necrosis of 207
interlocking nailing 365
awling for 366f
morphology of 293, 293f
neck, trabeculae pattern in 198f
nonunion neck of 380
osteomyelitis of 346
shaft osteomyelitis 345f
Fiberglass plaster 4, 4f
Fibrocartilage, histopathology of 318f
Fibrous cortical defect 185, 186f
Fibrous dysplasia 184, 185f
Fibrous joint 270, 271f
Fibula 299, 300
anterior view of 55f
morphology of 299, 300f
plating of 353f
posterior view of 55f
Ficat and Arlet's classification 207, 207t
Fiddle-bow position 74
Figure of 8
bandage 30, 30f
brace 238f, 239f
manner 371
plate 153f
splint 234, 235f
Finger
and toes strapping 28, 28f
cot 234, 235f
First carpometacarpal arthritis 192f
First-generation nail 136
Fisk splint 35
Fixation
mechanism of 155
technique of 158
Fixator
categories of 50
factors affecting stiffness of 50, 51f
Fixed bearing prostheses 158
Fixed blade 86
Fixed flexion deformity 48, 48f
Fixed traction 37, 37f
Flash sterilization 429
Flat nose plier 94f
Flexor retinaculum 315f
Floor reaction ankle-foot orthosis 224f
Fluid compression bag 421f
Fogging machine 434f
Foley's catheter 61, 62f, 67
Foot 314, 315f, 352
arches 306t
classification of 304
bone 305f
of ankle and 303
multiple axis 248
orthosis 220, 221, 223f
sole of 315
Forearm 333, 334f
and wrist 334, 335f
compartment of 281, 284f
section 254, 254f
Formaldehyde 428
Four post collar 241
Four-point gait 262
pattern 261f
Fracture
butterfly 173
classification of 173
comminuted 173, 175f
communication 173
disease 4
causes of 4
etiological classification of 173
fragment, displacement of 173
healing 132, 270
stages of 271f
humerus fixation 359f
level 362
neck femur 374, 375f
oblique 173
olecranon 370
pathological 174
pattern 173, 174, 175f, 176t
radiographs of 173
reduction 363, 365
segmental 173
spiral 173
stability, factors of 173
stress 174
table 439
transverse 173
traumatic 173
X-ray, study of 173
Frankel White line 197
Frejka pillow 229f
Friction wrist unit 254
Frog splint 235f
Fumigation 433t
Functional cast bracing 11, 12f
G
Gait
orthosis 228, 228f
pattern 261f, 262
Galeazzi's fracture dislocation 361
Galeazzi's sign 204
Gallow's traction 39, 39f, 57
Gamgee roll 19, 19f
Gamma nail 147, 147f
Ganglion cysts 397f
Gap index 3
Garden's screw 147f
Garden-well tongs 46
Gas
plasma sterilization 432
sterilization, advantages of 430
Genu valgus deformity 381
Genu varus deformity 381
Gerdy's tubercle 347, 349
Giant cell tumor 186, 186f
histopathology of 320, 320f
specimen of 320, 320f
surgical procedure for 321
Gibson's approach 344
Gigley's saw 85, 85f
Glenohumeral joint 405
Glutaraldehyde 428, 434
Gluteal muscles 289
Gomphosis joint 270
Good orthosis, criteria of 218
Good prosthesis, criteria of 219
Grasp forceps 119, 119f
Green stick fracture 176f
Green's procedure 211
Ground glass appearance 198
Growth plate 226
GS Kulkarni machine for vacuum-assisted dressing 59, 59f
Guidewire 92, 92f, 108, 108f
holder 93, 93f
insertion of 368, 373, 375
Gutter crutch 259, 260f
Guyon's canal 288
H
Hair removal
preoperative 437f
rationale for 436
Hallux valgus 223f
Halo pelvic brace 243, 244f
Halothane 438
Hamilton Russell traction 47
Hammer toe correction 223f
Hand 286, 333
dissected specimen of 313
drill 97
muscles of 286
orthosis 234, 235f
Handwashing 440
technique 440, 441f
Hard cervical collar 240, 240f
Hardinge approach 344
Harrington rod with hook 148, 149f
Hartshill ring wire 148, 148f
Haversian system 266, 267f
Head
halter traction 44, 44f
impactor 112, 112f
measuring gauze 111, 111f
of femur, blood supply of 295, 296f
of humerus, blood supply of 280f
shaft angle 206f
Heel
cushion 221
elevation 220, 221, 221f
flare 220, 221f
Hemangioma 397
Hemarthrosis 404
Hemiarthroplasty hip 376
Hemostatic agents 419
Hemostatic forceps 75, 75f
Henning plaster cast spreader 104f
Henry's approach 333
Herbert screw 125, 125f
Herndon's hump 206
Heuter's line and triangle 281
Heygroves bone holders 87, 88f
Hilgenreiner line 205f
Hip 341, 342, 343f, 344, 344f, 345f, 405
arthrodesis 384f
cobra plate for 160, 160f
arthroplasty 344, 376f
bearing surfaces in 155
femoral stem in 156
avascular necrosis of 207f
developmental dysplasia of 14f, 204, 205, 205f, 395
dysplasia 395
fixed flexion deformity of 48
hemiarthroplasty 108
instruments for 109
joint 193f, 292, 293f, 385
ligaments around 292, 292f
movement at 292
knee-ankle-foot orthosis, conventional type 288f
knee-ankle-orthosis 228
conventional type 228
functions of 228
total contact 228
orthoses for developmental dysplasia of 228, 229f
Perthes disease of 206f
prosthesis, unipolar 154
special implants around 143
spica 13, 14f, 15
types of 14f
Hitchhiker's thumb 193
Hohmann's retractor 80, 80f
Holding scalpel, methods of 74, 75f
Hollow mill 99, 99f
Honda sign 408
Hook retractors 79, 80f
Hoop stress 137, 137f
Hormone replacement therapy 437
Humby's knife 102, 102f
Humerus 185f, 278
morphology of 278, 278f
plating 359
steps of 359
Hunter's canal 295, 295f
Huntscher's cloverleaf nail 139f
Hybrid
fixator 54f
system 54
Hydrocolloids 21, 22f
Hydrocortisone 423
Hydrogen peroxide 22, 22f, 428
Hyperparathyroidism 198
primary 198, 199f
Hypodermic needle 66f
Hypoechoic synovitis 397f
I
Ibuprofen 437
Ilfeld orthosis 229f
Iliac crest 291f
Iliac spine, posterosuperior 342, 344f, 345f, 377
Iliotibial band 295, 295f
Ilizarov frame, components of 53, 162, 164f
Ilizarov system 53, 53f
Ilizarov wire
application 55f
tensioning limits of 53
Implant
characteristics of 149
types of 387390
Infection 396, 400, 403, 404, 408
Infective disorder 177
radiographs of 190
Injury, mechanism of 173, 174, 176t
Intercondylar humerus fracture
configuration for 360f
plating for 360
Intercostal drainage 63, 63f
Interlocking bolt 126, 127f
Interlocking nail 107f, 140
types of 141t
working mode of 141f
Intermittent pneumatic compression device 58
Internal shoe modifications 222f
Intra-articular fracture, characteristics of 177
Intramedullary nail 52, 136
inserters 106f
introducer 106
Intramedullary reamers 91, 92f
Intravenous drip set 64, 64f
measurements of 65t
parts of 64
Iodine
compounds 428
disadvantages of 23
Iodophors 428
Ischial tuberosity 291f
Italian plates 162
J
Jaffe's histological grading 320
Jaipur foot 249f
Jewett plate 147, 147f
Joint 265, 270
capsule 275, 280, 284, 292, 297, 302
cartilage, harmful for 208
classification of 270
effusion 406
functions of 272
instability 386
interphalangeal 236
involvement 173
space narrowing 195
tuberculosis of 190
types, three major 310
Jone's bandage 30
Jone's strapping 28, 29f
Joshi External Stabilization System 54, 56f, 121
fixator, components of 162
frame, components of 164, 164f
Juxta-articular osteoporosis 195
K
Kahler's disease 207
Kerrison's rongeurs 115, 115f, 378
Kirschner's wire 96, 97, 121, 121f
application 370
bender 95
entries, mode of 369f
handling instruments 94
inserter 95, 96f
strainer 36, 36f
Kissel spline 151, 151f
Klein line 205, 206f
Kleinberg-Lieberman index 205
Kleinert splints 237
Klippel-Feil syndrome 202, 202f
K-nail 97, 139
ankle foot orthosis 210, 227
conventional 227, 227f
functions of 227
ischial weight-bearing type 227f
total contact 227
anterior stabilized 157
anteromedial approach of 348
arthrodesis 384f
cruciate retaining 157
dissected specimen of 313, 314f
flexion attachment 35
gaiter 225f, 226
immobilizers 224, 225f
joint 224, 226, 226f, 297, 385
complex 297
flexion type 226f, 227
ligaments around 297, 298f
movement at 298
loose bodies of 208, 208f
orthosis 224, 225f
posterior stabilized 157
range of motion 224, 225f
screw home mechanism of 298
Knots 165
common types of 165
types of 168f
Knowles pin 143, 143f, 143t
Knuckle-Bender splint 236f, 237
Kocher's approach 331, 332
modified 332
Kocher's artery forceps 75
Kocher's hook 98, 99f
Kocher-Langenbeck approach 342, 342f
Kuntscher's cloverleaf nail 139
Kuntscher's diamond pointed awl 90, 90f
Kuntscher's V-nail 140, 140f
L
Labetalol 423
Ladder splint 33, 33f
Lag screw 124, 125f
drilling for 124
placement 374
Lamellar bone 267f, 267t
Laminar flow system 415f
Laminectomy forceps 83, 83f
Lane's artery forceps 75
Lane's bone
holders 87, 88f
lever 80, 81f
Langenbeck's right angle retractor 79, 79f
Langenskiold classification 209
Langenskiold staging 209f
Laryngeal mask airway 418, 418f
Laryngoscope 417, 418f
Lateral collateral ligament 297
complex 280, 280f
Lateral upper femoral traction 40
application, site for 41f
Lazy S curve 350
Lead-better method 373, 375
Leg 352, 353f
anterolateral approach 352
compartment of 302f
extension prosthesis 252, 252f
posterolateral approach 352
Leontiasis ossea 185
Leprosy 194
Ligaments 397
Ligamentum
flavum 378
patellae 297
teres 295
Lignocaine 419, 420
Limb
abnormal alignment of 386
exsanguination 71f
reconstruction system 52, 52f
Limited contact dynamic compression plate 131
Lipohemarthrosis 404
Lister's tubercle 284, 363
Lofstrand crutch 259, 259f
Long bone 196198
blood supply of 266, 266f
Long finger extension splint 234, 235f
Long interlocking nails 160, 161f, 384f
Loose bodies
etiological classification for 208
histopathology of 319f
pathological variants of 319
specimen of 318, 318f
Looser's zone 197
characteristics of 197
Lower limb 46
bones and joints of 289
orthoses 220, 224, 226, 226f
prosthesis 218, 248
components of 248
skin traction 38
special orthosis for 228
Lowman's clamp 88, 89f
Ludloff's approach 345
Lumbar pedicular screw 378f
entry point for 340, 379
Lumbar spine, typical 308f
Lumbar spondylosis 192f
Lumbosacral brace 245
Lumbosacral corset 245, 246f
Lumbosacral frame 246f
Lumbosacral orthosis 245
Lytic destruction 401
M
Machine screw 124t
Madelung's deformity 212, 213f
Madras foot 248
Maffucci syndrome 183
Magnesium sulfate cream 20, 21f
Malecot's catheter 62f
Malfunctioning equipment 427
Malleolar
fracture fixation 371
screw 126, 126f
Mallet 97, 97f
finger splint 234, 235f
Malunited intertrochanteric fracture 380
Mani's clamp 88, 88f
Marie-Strumpell syndrome 193
Marrow abnormality 403
Martin's holding forceps 101, 101f
Mayo's towel clip 74
Mazabraud's syndrome 185
McCune-Albright syndrome 185
McDonald dissector 115, 116f
McFarland sign 205
McLaughlin plate 147, 147f
McMurray osteotomy 151
Medial arch support 221
Medial collateral ligament 280, 297
complex 280f
Medial condyle 293t
Medial malleolar fracture fixation, screw positioning for 371f
Medial meniscus 318t
Meloxicam 437
Meniscofemoral ligament 298
Meniscus
common pathologies of 318
lateral 318t
medial and lateral 317f
specimen of 317
Mermaid splint 225f, 226
Metabolic disorder 178
radiographs of 196
Metacarpal traction 44
application, site for 44f
Metallic artifacts 403
Metallic foreign bodies 403
Metaphyseal wedges 158
Metastasis 408
Metatarsal bar 220, 221f
Metatarsal pad 221
Metatarsalgia 221
Metatarsals 304f
Metoprolol 419, 423
Mid foot 356f
anterior approach 356
joint 194
Midprone forearm 9f
Milwaukee brace 246, 247, 247f
Minerva jacket 242, 243f
Mirel's criteria 178t
Mobile bearing prostheses 158
Modular bipolar prosthesis 155, 155f
Molded thoracolumbosacral orthosis 244, 245f
Monomer liquid 166
Monteggia fracture dislocation 332
Moore's pin 143
Morris’ retractor 79
Morton's neuroma 397
Müller's classification 177
Müller's compression device 105, 105f, 127
Multipara monitors 418, 419f
Multiple hip screw 374
Multiple myeloma 188, 189f
histopathology of 323, 323f
spine 322f
specimen of 322
Murphy skid 112, 112f
Musculoskeletal neoplasm 407
Musculoskeletal tissue 402
Mycobacterium tuberculosis 425
Myeloma 408
Myelomeningocele 194
Myoelectric prosthesis 253, 255, 256f
Myositis ossificans 199, 200f
N
Nail
anatomy of 139, 140
cross-section of 136, 136f
diameter of 136, 142, 363, 364, 366
dynamization of 137
extractors 106, 107f
generation of 136
hole 142
insertion 363, 365, 368
methods of 139
zigs for 106, 107f
length of 364
parts of 137, 138
second-generation 136
third-generation 136
working length of 136, 137f
Naproxen 437
Narrow pedicles 379
Nasal airways 418, 418f
Nash and Moe grading 203
Neck
and back, muscles of 307, 309f
femur 206
size 388
Needle 65
holder 76, 78f
nose plier 94f
Neer's shoulder prosthesis 158, 158f
Negative suction drain 60f, 61
contraindications of 61
Nephrogenic systemic fibrosis 403
Nerve root retractor 115, 116f
Neuraxial anesthesia 438
Neuropathic arthropathy 194
Neuropathic joint 194f
radiological staging of 195
Neurovascular status 173
Neutral vertebrae 203
Newington orthosis 231f
Newton's third law 223
Ninety-ninety traction 47, 47f
Nitroglycerin 423
Nonabsorbable suture materials 167
Nonarticular orthosis 226
Nonenergy storing foot 248
Nonossifying fibroma 185, 186f
Nonsteroidal anti-inflammatory drugs 437
Noradrenaline 419, 423
Nuclear medicine 407
Nutritional rickets 196, 196f
O
Oblique fracture 175f
Oblique ligament, posterior 298
Oblique-popliteal ligament 298
Obturator artery 342
Occult fractures 404
Ochronosis 194
Olecranon fracture 370f
Olecranon traction 43
application, site for 43f
Ollier’ disease 183
Ollier's approach 356, 356f
Operation table 416
Operation theater 412f, 438
ceiling of 411
complex 412, 413f
corridors 411
doors of 411
drugs 411
equipment 411
floor of 411
laminar flow system in 415
light 413, 414, 414f
location of 411
principles 391
safety hazards in 416
scrub area 411
size of 411
sterilization of 432
structure of 411
trolley 422, 422f
wall of 411
zones of 412f
zoning plan of 411
Operative site preparation, principle of 436
Oppenheimer splint 237
Optimal pressure gradients 58
Oral airways 418f
Oropharyngeal airways 418
Orthogonal plating 361
Orthopedic
bed 57, 57f
casts 3
drill
machine 97, 98f
types of 97
hammer 97
imaging 391
infection rate 434
nailing 136
plating 129
pliers 94, 94f
screws 123
significance 274
points of 275, 279, 282, 287, 289, 295297, 302, 310
strappings 28
surgeries 357
surgical approaches 325
traction 33
unit 417f
Orthophthaldehyde 428
Orthosis 215, 217, 223f
checking of 230
classification 217
complications 218
components of 221, 230, 234, 239
functions 217
materials for making of 217
parts of 229, 241243, 247
weaning of 230
Ossification center 273, 278, 289, 303, 307
primary 268
secondary 268
Ossification, intramembranous 270
Osteoarthritis
hip 380
knee 192f
Osteoarticular tuberculosis 190, 191f
Osteoblastomas 404
Osteochondritis dissecans 405
Osteochondroma 180, 182f
specimen of 319, 319f
histopathology of 319, 319f
surgical procedure for 320
Osteogenesis imperfecta 199, 200f
Osteoid osteoma 182, 182f, 185, 404, 408
Osteomalacia 197, 197f
Osteomyelitis 396
chronic 178f, 190, 190f
Osteon 266, 267f
Osteophytes 401
Osteoporosis 198, 198f, 387
Osteosarcoma 187, 187f
histopathology of 321, 321f
specimen of 321, 321f
surgical procedure for 321
Osteotome 82, 82f
Osteotomy 205, 213, 381, 383
blade plate 151, 152f
fixation 151
fixed, medial displacement 381f
indications of 380, 381
methods 382, 384
principle of 53, 380
proximal femur, medial displacement 380
Oxoferin solution 24, 24f
P
Palm, muscles of 288f
Pamidronate 201
Paraffin gauze 20, 21f
Parallel plating 361
Parenteral fluids 63, 63f
Pars defect 204
Pascal's law, mechanism of action of 11
Pasteurization 426, 427
Patella 296, 370
anterior surface of 297f
bone holding clamp 88, 89f
development of 296
extensor mechanism of 299, 299f
morphology of 296
muscle attachments on 297f
ossification center of 296
position of 299
posterior surface of 297f
Patellar component loosening 389
Patellar replacement, patella implants for 158
Patellar subluxation 389
Patellar tendon bearing 12f, 228, 250
cast 11
prerequisites for 11
Pathological fracture 177, 178f, 178t, 184
etiological classification of 177
Pavlik harness 229, 229f
Pearson component 34f, 35
Pediatric drip set 64f
Pediatric fracture 174, 176f
characteristics of 174
classification 175
Salter-Harris classifications of 177
Pediatric supracondylar humerus fracture fixation 369
Pedicle awl 115, 116f
Pedicle probe 116, 117f
Pedicle sound 117, 117f
Pedicle wall, lateral 379
Pedicular screw 149, 149f, 378
connecting rod 149f
fixation 378, 379
Pelken spur 197
Pelvic bone 194, 289, 291f
iliac spine of 243
morphology of 289, 290f
Pelvic fractures 399f
Pelvic reduction clamp 89, 89f
Pelvic traction 44, 45f
Pelvis 197, 197f, 201, 341, 341f
anterior approach 341
posterior approach 342
Pen holding position 74
Peracetic acid 428
Periarticular changes 197
Periarticular fracture 177, 178f
Müller's classification 177
Peri-implant fracture 178, 179, 179f, 386
risk factors for 178
Periosteal elevator 85, 85f
Periosteal reaction 180, 181f, 183, 188
types of 182
Peripheral cannulation, site of 65
Periprosthetic fracture
around hip 179
classification of 179
Perkin's line 205f
Perkin's traction 37
Perren strain theory 133
Personnel complications 430
Perthes disease 206, 206f
abduction orthoses for 231f
Catterall's classification of 207
orthoses for 230
Perthes hip 206
Petit's triangle 310
Phalanges 304f
Phalanx 183f, 199f
Phenolic compounds 428
Phenytoin 419, 423
Philadelphia collar 241, 241f
components of 241
Physis
blood supply of 266
layers of 268f
zones of 268t
Pigeon chest 196
Pin 120
direction of entry of 40
tract, care of 40
Pin fixator 50, 51f
AO type fixator 50
Pin plaster technique 13, 13f
disadvantages of 13
Placenta extract 25, 25f
Plain rubber catheter 62f
Plantar fascia 397
Plaster
care of limb in 4
cutting instruments 102
of Paris bandage 3, 3f
saw 103f
Plastic bag 66
Plate 153
application 129, 130
bender 105, 105f
bridging mode of 130f
buttress mode of 130f
compression mode of 130f
functional classification of 129
length 132
neutralization mode of 130f
parts of 160
regional 135f
Pneumatic compression device 58, 58f
Pneumatic drill 97
Pneumatic tourniquet 71f
components of 72
system 421f
Poller screw 127f
Polycentric knee joint 226f, 227
Polyethylene patella 158
Polyfilaments 167t
Polymer powder 165
Polyvinyl chloride 217
Pop bandage 4
uses of 4
Pop slab application 5
Popliteal cyst 397f
Popliteal fossa 313, 314, 314f
boundaries of 313
Positive contrast arthrography 394
Poster brace 241
Potassium chloride 423
Pott's belly 196
Pott's spine 191, 191f, 339
specimen of 316, 317f
surgical procedure for 317
Povidone-iodine 23, 23f
Power drill 97
Power system 253
Preanesthetic checkup 435f
Pressure epiphysis 267
Pressure infusion bag 421, 421f
Pronated forearm 9f
Prophylactic bracing 201
Prosthesis 215, 217, 218
classification 218
complications 219
design 157, 158
fabrication, material for 219
features of 252
functions 218
immediate postoperative 219, 219f
insertion of 377
parts of 155
selection of 377
Prosthetic elbow joint 254
Prosthetic foot 248
classification of 248
Prosthetic knee joint 251, 251f
Prosthetic shank 250, 250f
Prosthetic socket 250, 250f, 251, 251f, 254, 254f, 255, 255f
Proximal femoral nail 107f, 145, 367, 385f
awling for 367f
Proximal femur 182f, 185f, 190f, 206
Proximal forearm 330
Proximal humerus 184f, 186f
Proximal interphalangeal joint 7
Proximal radius 362
Proximal tibia 186f, 187f, 349f, 350f
anterolateral approach 349
osteotomy 381
posteromedial approach 350
Pseudomonas infection 24
Psteoarticular tuberculosis 191f
Puddu plates 152, 153f
Pulleys, uses of 33
Pus culture tube 26, 27f
Push-pull screw 127, 127f
Q
Quadratus femoris muscle, part of 377
Quaternary ammonium compounds 428
R
Radial club hand 211, 212f
Heikel classification of 212
Radial entry 363
Radial groove 279
Radial gutter 7, 7f
Radiation sterilization 432, 432f
Radiopharmaceutical agent 407
Radius 281
complete absence of 212f
morphology of 282f
nail, length of 362
plating 361
square nailing 362
Rampley's sponge holding forceps 76, 76f
Ranawat technique 377
Recon nail 127
Recon plate, simple 133
Reconstruction nail 146
Reconstruction plates 133, 133f
Reconstructive surgery 207
Reduction clamp 87, 87f
Reduction forceps 87, 87f
Regional nerve blocks 438
Renal angle 310
Resuscitation trolley 422, 423f
Retinaculum around ankle 314
Rheumatic disorders, radiographs of 190
Rheumatoid arthritis 192, 193f
juvenile 193
Rheumatoid hand 193f
radiology of 192
Rheumatoid joint 192
radiological features of 195
Rheumatoid knee 193f
Rheumatoid upper cervical spine 193f
Rib
cage 196
retractor 114, 114f
shear 114, 115f
vertebral angle difference 203, 203f
Richard's screw 126
Rickets 196
Ring bandage 30
Ring sign of Wimberger 197
Rissier's sign 203, 203f
Robert Jones bandage 30f
Roentgen X-ray machine 393f
Rollator walking frame 258, 258f
Romanus lesion 194
Romovac drain, features of 61
Ropivacaine 420
Rotator cuff 277
dysfunction of 389
tear 394
Rotator interval 277
Rush nail 97, 137, 138f
Russell traction 48f
S
Sacral hiatus 310
Sacroiliac joint 193, 193f
Salter-Harris classifications 177, 177f
Savlon 22, 22f
Scanogram 381
Scaphoid bone 405
Scaphoid cast 7, 8f
Scapula 274
morphology of 274, 275f
Scarpa's triangle 296, 296f
Schanz screw 50, 121, 121f, 161
application, safest area for 52t
Schatzker classification 400f
Scintigraphy, principle of 407
Scissor 76, 118, 118f
types of 77f
Scoliosis 202
idiopathic 203f
special orthosis for 246
Scoop 84
Scottish rite orthosis 231f
Screw 153
cancellous 128
cannulated bolt 128
cortical 128
description 123, 123f
diameter 128t
eye 120, 121f
functions of 127
garden's 147
head, types of 123f
holder 93
locking 128
bolt 128
malleolar 128
parts of 149
placement 143f
poller 128
Richard 144
sliding 144
tip of 123
types of 128, 160
Scurvy 196, 197f
Sectoral sign 207
Segmental fracture 175f
Semiconstrained tea system, components of 159
Senn Miller retractors 80
Sequestrum
classification of 316
forceps 100, 101f
localization of 316
Sevoflurane 438
Shaver system 119, 119f
Shenton line 205f
Shepherd crook deformity 185
Sherman plate 129f
Shoe
and crutch ferrules, position of 261f
modification 220, 221
wedging 220, 221, 221f
Short barrel plate 108
Short proximal femoral nail 145f, 146t, 367
Short tau inversion recovery 402
Shoulder 194, 327f, 394, 397, 405
and arm 327
anterior approach 327
arthrodesis 385f
arthroplasty, indications for reverse 389
movement, Saha's functional classification of 278
orthosis 238, 238f
restraints 277
Saha's zero position of 277
spica 9, 10f
trauma 394f
Shoulder joint 385
capsule, peculiarities of 275
conventional arthrogram of 394f
ligaments around 275, 277f
review of 275
Siffert-Katz sign 208
Silver ions solution 24, 25f
Singh and Maini index 198
Single axis foot 248
Single axis knee joint 226, 226f
Single hip spica 14, 14f
Single photon emission computed tomography 409
Sister's forceps 76, 76f
Skeletal traction, equipment for 40
Skeleton traction 40
Skin
complication 49
strap 38
traction 37, 38f
kit 38
strappings of 48
Skull 189f, 196, 199
Sliding traction 37, 37f
Sling and Swathe immobilizer 239
Slipped capital femoral epiphysis 205, 206f
Smith fracture 8
Smith-Peterson
approach 342, 343f
nail 147, 147f
Sodium
bicarbonate 423
hypochlorite 428
Soft cervical collar 240, 240f
Soft tissue
complications 390
components 402
extension 180, 181f, 183
lesions 401
masses 397
swelling 192, 195
Sole
layers in 315
of foot, muscles in 304, 306f
Solid ankle
cushion heel foot 249f
flexible-endoskeletal foot 248, 249f
Southwick, head-shaft angle of 206
Spanner, types of 99
Spaulding 425
Specimen section, proceeding for 312
Spica, strengthening of 14
Spin down 402
Spina ventosa 191, 191f
Spinal and epidural needles 418
Spinal anesthesia 438, 438f
Spinal cage 150, 150f
Spinal column, structure of 307, 307f
Spinal implantation 148
Spinal orthosis 240
Spinal retractor
posterior 113, 114f
self-retaining 113, 113f
Spinal tuberculosis 404f
Spine 189f, 191, 191f, 196, 197, 198f, 200, 337, 401
bones 307
and joints of 307
diseases 406
functions of 310
groups of muscle of 307
interlaminar approach of 340
joints in 310, 310f
ligaments in 310, 311f
movements in 310
radiological features of 194
surgery
instruments for 113
posterior 436
typical 308f
Spinoglenoid notch 275
Spiral fracture 175f
Splint
measurement of 35
padding of 48
Spondylolisthesis 203, 204, 204f
Meyerding's grading of 204
Spondylolysis 203
Sprengel's shoulder 211, 211f
Cavendish's grading of 211
Stability test 230
Stainless steel wire 94, 122
over spool 122f
sleeve 95, 95f
tensioner 94, 95f
Stance control knee joint 226f, 227
Standard barrel plate 108
Standard walking frame 258, 258f
Stapler remover equipment 77f
Starch impregnated roller bandages 5
Static cock-up splint 236f
Static compression 130
Static orthosis 217, 218f
Steam autoclaving
advantages of 429
disadvantages of 429
Steam quality 427
Steam sterilization 427, 429f
monitoring of 427
problems with 427
Steel, metaphyseal blanch sign of 205
Steffee spine plate and screw 148, 148f
Steinbeck foot abduction brace 232, 232f, 233t
Steinmann pin 120, 120f
Stem, geometry of 157
Sterilization
advantages of 431t
disadvantages of 431t
duration of 427
frequency of 433
methods of 431
principles of 425
Sterilized drums and boxes 422, 422f
Sterno-occipital-mandibular immobilizer brace 241, 241f
Stille plaster shear 103f
Stitch cutting, method of 77f
Stoppa approach, modified 342
Stress 133
fracture 404, 408
shielding 133
Stubbies 252, 252f
and leg extension prosthesis 252
Subacromial impingement syndromes 397
Subdeltoid bursae complex 394
Subsynovial intracapsular ring 295
Suction machine 421, 421f
Sulfasalazine 194
Superior-radioulnar synostosis 211, 212f
Wilkie classification of 211
Supracondylar fracture fixation 369f
Suprascapular notch 275
Surgeon preparation 440
Surgical drain 60
Surgical draping 442
Surgical needle 165, 168f
different curvatures of 168f
parts of 168f
Surgical retractors 79
Surgical safety checklist 443
Surgical shoe 220
components of 220f
Surgical site preparation, steps of 442f
Surgical spirit 23, 23f
Suture classification 165
Suture joint 270, 271f
Suture materials 165
absorbable 166f
nonabsorbable 166f
Suturing methods 165
types of 168f
Swan neck deformity 192
Swedish knee cage 225f, 226
Syme's amputation 211
Symphysis joint 310
Synarthrosis 270, 271f
Synchondrosis 271
Syndesmophyte formation 194
Synovial joint 271, 272f
types of 272
typical 272
Syringe 65
Syringomyelia 194
T
Tabes dorsalis 194
Talus 354f, 355f
blood supply of 305
body of 306
congenital vertical 121
head and neck of 305
Talwalkar's bipolar prosthesis 154, 155f
Talwalkar's square nail 138, 138f
Tap sleeve 91
Tarsals 304f
Taylor's brace 243, 244f
Taylor's spatial frame 54, 56f
Tears 397
Tendinitis 397
Tendon passing forceps 102, 102f
Tendon stripper 101, 101f
Tendon tunneling 102, 102f
Tenosynovitis 397
Tension band wiring 120122, 127, 361, 370, 370f, 371
dynamic 122
principle 122f
static 122
Terminal device 253, 253f
T-handle 98
Thigh 341, 345f
compartment of 294, 294f
lateral approach 345
Thomas collar 240, 240f
Thomas heel 220, 221f
Thomas splint 34, 34f, 35
padding 34f
Thompson procedure 347
Thompson prosthesis 154t, 376
Thomson approach 333
Thoracic pedicular screw, entry point for 379
Thoracolumbosacral orthosis 243
Three-point gait 262
pattern 261f
Thumb spica 7, 8, 8f, 236, 236f
Tibia 200f, 299, 300
anterior view of 55f
congenital pseudoarthrosis of 209, 210f
interlocking nail 364
morphology of 299, 299f
partial deficiency of 210f
physiometaphyseal defect of 209
posterior view of 55f
Tibial collateral 297
Tibial condyle 300f
Tibial fracture, Felix, Stuart and Hansen classification of 179
Tibial hemimelia 210, 210f
classification of 210f
Jones, Barnes, and Lloyd-Roberts classification for 210
Tibial interlocking nail 364f
Tibial plateau fractures 400f
Tie beam 304
Tincture benzoin 20, 20f
Tissue protector sleeve 93, 93f
Titanium elastic nail 138f, 139
system 106f
Tobruk splint 35
Toe deformities 223t
Tomofix 152, 153f
Tong, tightening of 45
Topical use, antibiotic of 25
Toronto orthosis 231f
Torque limiting screwdrivers 93
Torsional stiffness 137
Total arthroplasty, principles of 387
Total contact ankle-foot orthosis 224f
Total contact knee-ankle-foot orthosis 227f
Total elbow arthroplasty system 159, 159f
Total hip arthroplasty 387, 387f
implant 155, 156f
system, components of 155
Total hip replacement 178, 387
Total knee arthroplasty 80, 388, 388f
system 157, 157f
component of 157
types of 157
Total knee replacement 158, 178, 349, 389
Total shoulder arthroplasty 389, 389f
system 158, 159f
Tourniquet 421
and Esmarch's bandage 71
application
complications of 72
contraindications of 72
Towel clips 74, 74f
uses of 74
T-plates 152
Trabeculae, types of 198
Traction 36
application
steps of 40
ways of 45
benefits of 36
component of 47
cord, direction of 49
epiphysis 267, 268f
types of 46
weight 36, 36f, 49
Tranexamic acid 419
Trans-olecranon-approach 360
Transverse fracture 175f
Transverse ligament 298
Trauma 396, 400, 404
procedures, miscellaneous 369
Traumatic fracture 174f
Trethowan's bone lever 80, 81f
Trethowan's sign 205
Trevor's disease 180
Triangular fibrocartilage 285
complex 285f
Triangular sling 31, 31f
Triflow incentive spirometer 58, 59f
Trilateral orthosis 230, 231f
Triple diaper 229f
Triple joint arthrodesis 356
Triple reamer 108, 109f
selection of 373
Tripod and quadripod walking aid 260, 260f
Tripod crutch gait 262
Tubercle, posterior 306
Tubercular dactylitis 191
Tubercular granuloma
composition of 317
fate of 317
Tuberculous lesion, histopathology of 317, 317f
Tubular plates 131, 132f
classification of 132t
Tumor 178f
benign 403
cortical part of 181
in bone, distribution of 321
lesions 397, 404
location 180, 181f, 182188
malignant 403
margin of 180, 182, 184, 189
medullary cavity of 181
radiographs 180, 181f, 182188
surgery 346
Tumoral calcinosis around hip 200f
Tumorus disorder 177
Tupman plate 151, 151f
Turnbuckle splint 230, 231f, 239
Two-pins retractor 110
Two-point gait 262
pattern 261f
Typical spine, morphology of 307
U
U-cast 9f
Ulna 281, 335f, 362
morphology of 282f
square nailing 362
Ulnar collateral ligament 280
complex 280f
Ulnar defect 213
Ulnar entry 363
Ulnar fracture 361f
Ulnar groove 280
Ulnar gutter 7, 7f
Ulnar nail
first 363
length of 362
Ulnar plating 361
Ulnar tunnel 288
Ultrasonography 395
principle of 396
Uncemented prostheses 158
Uncovertebral joints 310
Underneath flexor retinaculum 314f
Unicameral bone cyst 183
Universal shoulder immobilizer 238f, 239
Upper extremities 436
Upper limb
bones of 273
joints of 273
orthosis 234
prosthesis 218, 253
components of 253
special orthosis in 239
Upper tibial traction 42, 42f
application, site for 42f
U-slab 8
V
Vacuum-assisted closure device 59
components of 59f
Vacuum-assisted closure dressings, components of 59
Valgum-varus brace 225, 225f
Valgus osteotomy 380f
proximal femur 380
Vancouver classification 179
Ventilation 414
Verbrugge's self-centering bone holding forceps 88, 89f
Vertebrae
apical 203
cervical 309t
dorsal 309t
lumbar 309t
Vickers ligament 212
Victorian ward 67
Vincristine 189
V-nail 97
Volar defect 213
Volar splint 7, 7f
Volkmann ischemic contracture splint 236f, 239
Von Rosen splint 229f
W
Wainwright plate 151, 151f
Walker 258f
Walking heel 12, 13f
Walking iron 12, 13f
parts of 12
Walking sticks 260, 260f
Ward round, preparation of 67
Warming device 422, 422f
Waste disposal unit 423, 424f
Water seal, function of 63
Watson-Jones approach 344
Wheelchair 257
manual 257f
motorized 257f
parts of 257
training 257
White glistening tendon of piriformis 377
Whitman method 368, 373, 375
Wide-throated periarticular clamp 89, 89f
Wilkie classification 211
Wire and pin cutter 94, 95f
Wooden blocks 37
Woodward's procedure 211
Woven bone 267f, 267t
Wrench 99, 109f
Wrist 196f, 333, 395, 405
abduction 285
arthrodesis 385f
arthrogram 407f
bones of 286
circumduction 285
dissected specimen of 313
dorsal compartment of 284, 284f
extension 285
flexion 285
movement around 285
Wrist hand
orthosis 234, 236f
stabilizer 234, 236f
Wrist joint 7, 336, 336f, 336t, 385
complex 284
ligaments around 284
Wrist unit 253, 254f
quick change 254
X
Xylocaine 406
Z
Z deformity 193
Zygapophyseal joint 310
×
Chapter Notes

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1Ward Round2
Upendra Kumar
  • Casting Materials and Orthopedic Casts
  • Dressing Materials
  • Orthopedic Strappings, Bandages, and Slings
  • Orthopedic Tractions and their Equipment
  • Patients on External Fixators
  • Miscellaneous Equipment

Casting Materials and Orthopedic CastsCHAPTER 1

Although casting persisted as an integral part of conservative treatment in orthopedics from 18th century hence, the basic knowledge of materials used in casting is of utmost importance. Side by side principle of reduction and their maintenance are also important.
 
PLASTER OF PARIS BANDAGE (FIG. 1)
  • First used by Mathijsen, a Dutch military surgeon, in the year 1852.
  • Characteristics:
    • Plaster of Paris (POP) impregnated bandage
    • Setting time: 4–5 minutes
    • Full strength of cast is achieved in 24–48 hours
      zoom view
      Fig. 1: Plaster of Paris bandage.
    • Chemical reaction—POP (calcium sulfate hemihydrate) is obtained by heating gypsum (calcium sulfate dihydrate). And again when POP comes in contact of water, gypsum reappears with release of some heat (exothermic).
      2(CaSO4.2H2O) + heat → 2(CaSO4.1/2 H2O) + 3H2O
      2(CaSO4.1/2H2O) + 3H2O → 2(CaSO4.2H2O) + heat
    • Water-resistant cast is prepared when melamine resin is mixed with POP.
  • Commonly available sizes—4 inch, 6 inch × 2.7 meters.
  • Factors affecting setting time:
    • Temperature of water
    • Manufacturer's setting time
    • Impurities in plaster
    • Water condition (hard and soft)
    • Humidity
    • Room temperature.
  • Cast index and gap index:
    • Cast index: It is defined as inner ratio of a plaster cast in anteroposterior (AP) view and lateral view of limb kept in cast.
    • Gap index: It measures the thickness of padding, i.e., gap between inner layer of cast and skin.
    • Significance: Higher the cast index and gap index, more the chance of plaster failure.4
  • Uses of POP bandage:
    • As a slab for immobilization:
      • Extent of slab coverage—50–70% circumference (two-thirds) of limb
      • For upper limb—6–8 layers and for lower limb—10–12 layers
      • Volar surface in upper limb and dorsal surface in lower limb are preferred. Why? Molding is easier against splint and also helps in reduction maintenance.
    • As definitive casting:
      • Wrapped around whole circumference of limb or part is involved
      • The overlapping of bandage is one-third to one-half of previous turn
      • Thickness of cast varies according to nature of fracture, limb type (upper or lower), and age of patient
      • Functional cast bracing
      • Deformity correction serial casting
      • Partial weight relieving orthosis
      • Spica
      • Charley's traction unit
      • Pin plaster technique.
  • Complications with POP bandage:
    • Neurovascular compromise
    • Compartment syndrome
    • Pressure sore
    • Purulent dermatitis
    • Reactionary edema
    • Fracture disease
    • Wasting of limb
    • Joint stiffness
    • Loss of reduction.
  • Care of a limb in plaster:
    • Constant movements of finger or toes
    • Keep limb elevated
    • Do not bring the plaster in contact with water
    • Report immediately if any swelling, color changes, numbness, or excess pain.
zoom view
Fig. 2: Fiberglass plaster.
 
FIBERGLASS PLASTER (FIG. 2)
  • Characteristics:
    • Composition: Fiberglass impregnated with polyurethane polymer
    • Colorful and sticky
    • Setting time: 1–2 minutes
    • Full strength of cast is achieved in 2–4 hours
    • Activated by water or other agents.
  • Caution: Surgical gloves must be worn before using this cast.
  • Commonly available sizes 3” and 5” × 3.6 meters.
  • Advantages: Lightweight, waterproof, and lesser setting time.
  • Disadvantage: Costlier.
 
STOCKINETTE (FIG. 3)
  • Characteristics:
    • Continuous tubular cotton fabrics
    • Water repellent property
    • Stretchable that can accommodate various girth of limb.5
      zoom view
      Fig. 3: Stockinette.
  • Extend it about 10 cm beyond each end of intended splint site.
  • Commonly available in size 3” (upper limb) and 5” (lower limb) × 20 meters.
  • Uses: Before application of slab and cast over limbs.
  • Advantages: Prevention from skin complications like allergy, dermatitis, etc.
 
COTTON ROLL (FIG. 4)
  • Properties:
    • 100% cotton and bleached to white
    • High absorbent property
    • Single and uniform lap without joints as thin long continuous layer.
  • Available in standard 500 g but 100 g, 200 g, 300 g, and 400 g are also found.
  • Various uses like:
    • For cleaning and swabbing of wounds
    • For padding before applying slab and cast
    • For wrapping around splints, etc.
 
COTTON ROLLER BANDAGE (FIG. 5)
  • Properties:
    • 100% cotton fabrics with a loose open weave and bleached to white
    • Quick absorbent property
    • Number of holes per square centimeter of cotton gauze—4 × 4 = 16.
  • Cotton roller bandages are commonly available in 4” and 6” × 4 meters.
    zoom view
    Fig. 4: Cotton roll.
    zoom view
    Fig. 5: Cotton roller bandage.
  • Used for:
    • For POP slab application
    • For wrapping around various splints
    • During wound dressing
    • The most common fastening article in ward.
  • Starch impregnated roller bandages become slimy when soaked in water and it becomes harder when dried. This property is utilized to provide extra strength to POP slabs.
  • Why wet roller bandaging is used during POP slab application?
    • Wet bandages increase POP setting time and provide enough time for plaster molding and limb manipulation. Wet bandages are well 6incorporated with slab and provide extra strength.
    • Dry bandages absorb water from POP and decrease the setting time and side-by-side it does not incorporate well with slab.
 
PRINCIPLE OF REDUCTION AND CASTING
  • For fracture reduction, appropriate amount of traction and countertraction is applied in proper direction.
  • Reduction is achieved by manipulation of distal fragment.
  • A perfect reduction is said when all cortices are in contact at fracture site or reduction is said to be acceptable when both fragments have at least 50% contact both in AP and lateral views.
  • Even minimal rotation at fracture site is hardly accepted.
  • Appropriate padding should be done around fractured limb, especially over bony prominence.
  • Reduced position of limb should maintain before, during, and after casting.
  • Any indentation during molding and wrinkles should be avoided during cast application.
  • A reduced fracture is maintained in such a way that one joint above and one joint below is fully immobilized. But exceptions are Colles’ fracture, fracture around ankle, etc.
  • The position of limb should be maintained in functional position or position of immobilization. For most of the joint, these two are the same but for wrist and hand, these stand differently.
    • Functional position: The position in which limb can be maximally utilized even after its stiffness, e.g., glass-holding position of wrist. This position is used for arthrodesis of a joint.
    • Position of immobilization: The position in which the ligaments and tendons around joints remains maximally stretched, so that the contracture of joint could be prevented, e.g., James position of hand (lumbrical plus hand posture).
  • The fracture reduction and maintenance under cast also follows the “three-point molding principle of Charley's”. Out of these three points, two points lie proximal and distal to fracture site. The third point lies at the site of fracture site but the direction of molding force working here is opposite to the above two points (Fig. 6).
  • Ask the patient to follow the instructions like:
    • Keep the limb elevated. Why we ask the patient lying on bed with a cast in his either of the limb to keep over pillow or hang it with some cord or bandage? Just to maintain the limb above the patient heart level to ensure easy venous drainage and this act minimizes the swelling.
    • Ask the patient to do finger or toe movement—this improves the circulation in the respective limb and side-by-side keep the muscle active and finally minimize postcast stiffness.
    • Removal of cast is done immediately if any sign of cast tightness develops in the limb—like continuous pain, discoloration of finger, etc.
zoom view
Fig. 6: Three-point molding principle of Charley's.
7
 
CASTING IN JAMES POSITION (RADIAL GUTTER, ULNAR GUTTER, AND VOLAR SPLINTAGE WITH POP) (FIGS. 7A TO C)
  • Position:
    • Wrist joint: 30–40° extension
    • Metacarpophalangeal joint: 70° flexion
    • Proximal interphalangeal joint: 20° flexion
    • Distal interphalangeal joint: 10° flexion.
  • Extent:
    • Proximally: Cover lower two-thirds of forearm
    • Distally: Proximal to distal interphalangeal joint.
  • Uses:
    • Metacarpal fractures
    • Proximal phalanx fracture of fingers
    • Metacarpophalangeal joint injury
    • For preventing clawing
    • After tendon repair and tendon transfer.
 
SCAPHOID CAST AND THUMB SPICA (FIG. 8A)
  • Position: Glass holding.
    • Wrist attitude: Radially deviated and moderately dorsiflexed
    • Thumb attitude: Mild abduction.
      zoom view
      Figs. 7A to C: (A) Radial gutter in James position; (B) Ulnar gutter in James position; and (C) Volar splint in James position.
      8
      zoom view
      Figs. 8A and B: (A) Scaphoid cast; and (B) Thumb spica.
  • Extent of cast:
    • Proximally: Cover lower two-thirds of forearm
    • Distally: Up to proximal palmar crease and proximal to interphalangeal joint of thumb.
  • Uses: Fracture of scaphoid.
  • Thumb spica (Fig. 8B):
    • It maintains the wrist in 10–20° of extension and thumb in slight flexion and palmar abduction.
    • It is used for immobilization of thumb in injuries around first carpometacarpal joint, metacarpophalangeal joint, and interphalangeal joint.
 
COLLES’ CAST (FIG. 9)
  • Position:
    • Wrist attitude: Approximately 25° ulnar deviation with slight palmar flexion
    • Forearm attitude: Full pronation.
  • Extent of cast:
    • Proximally: Cover lower two-thirds of forearm
    • Distally: Proximal to palmar crease in volar aspect and just short of knuckle in dorsal aspect.
  • Used:
    • For Colles’ fracture
      zoom view
      Fig. 9: Colles’ cast.
    • For unstable fractures like fracture of distal radius with ulna, intra-articular fracture, or fracture dislocation; Colles’ cast must extended above elbow.
  • For smith fracture:
    • Full supinated forearm
    • Ulnar deviation and dorsiflexion at wrist
    • Extent of cast is above elbow.
  • For Barton fracture—volar Barton: Wrist-flexion attitude and in dorsal Barton—wrist-extension attitude.
 
U-SLAB OR CAST (FIG. 10)
  • Position of limb:
    • Arm by the side of trunk
    • Elbow 90° flexion and pronated.9
  • Extent of cast:
    • Stretch from inside of arm
    • Run around the elbow
    • End over the junction of shoulder and neck.
  • Uses: For fracture of shaft of humerus.
Note: Secure the upper most part of cast with some strapping or sling extending up to apposite shoulder or chest.
 
ABOVE ELBOW CAST (FIGS. 11A TO C)
  • Position of limb:
    • Elbow: 90° flexion
    • Forearm:
      • Fully supinated—for proximal one-third fracture
        zoom view
        Fig. 10: U-cast.
      • Mid-pronated—for middle one-third fracture
      • Full pronated—for distal one-third fracture.
  • Extent of cast:
    • Proximally: Up to mid-arm
    • Distally: Just proximal to metacarpophalangeal joint of hand.
  • Uses: For fracture of both bones of the forearms.
 
SHOULDER SPICA (FIG. 12)
  • It incorporates trunk with upper limb.
  • Position of limb:
    • Shoulder abducted: In proximal humeral fractures, shoulder is abducted to such extent that maintain the alignment of distal fragment with proximal fragment.
    • Elbow 90° flexed and forearm in mid-prone position.
  • Extent of cast:
    • Above the waist
    • Involve ipsilateral shoulder
    • Distal to metacarpophalangeal joint if needed otherwise restrict just proximal to wrist joint.
  • There is supporting bar between forearm and trunk.
    zoom view
    Figs. 11A to C: Above elbow cast. (A) Supinated forearm; (B) Midprone forearm; and (C) Pronated forearm.
    10
  • Used for:
    • Brachial palsy
    • Selected cases of proximal humeral fracture dislocation.
 
BELOW KNEE CAST AND BOOT CAST (FIGS. 13A AND B)
  • Position of limb: Ankle slightly plantarflexed.
  • Extent of cast:
    • Proximally: Just above calf bulk. Why?
      • To prevent sore around calf and cast edge interface
      • To prevent hooping effect of calf muscle.
    • Distally: Pulp of toes must be covered.
      zoom view
      Fig. 12: Shoulder spica.
      zoom view
      Figs. 13A and B: (A) Below knee cast; and (B) Boot cast.
  • Used for:
    • Fracture of calcaneum and talus
    • Fracture of tarsals and metatarsals
    • Sometimes for injury around ankle.
Note: When cast extends below the bulk of calf, it is called boot cast as it looks like the military boot.
 
CYLINDRICAL CAST (FIG. 14)
  • Position of limb: Knee extension
  • Extent of cast: High groin to above ankle.
  • Uses:
    • Acute knee injuries
    • Fracture of patella.
 
ABOVE KNEE CAST (FIG. 15)
  • Position of limb:
    • Knee: 15° flexion (why?)
      • To maintain functional position
      • Flexed knee prevent rotation at fracture site.
    • Ankle: 10° plantarflexion in upper one-third fracture and 20° plantarflexion in lower two-thirds fracture. Why? It prevents posterior angulation at fracture site.
  • Extent: Mid-thigh to short of metatarsophalangeal joint.11
    zoom view
    Fig. 14: Cylindrical cast.
    zoom view
    Fig. 15: Above knee cast.
  • Uses:
    • For fracture and fracture-dislocation around knee
    • For fracture of tibia and fibulae
    • For tibial plafond fracture.
 
CONGENITAL TALIPES EQUINOVARUS CAST: A SPECIAL TYPE OF ABOVE KNEE CAST (FIG. 16)
  • Ponseti technique of serial casting for congenital talipes equinovarus (CTEV) correction.
  • Position of limb:
    • Knee: 90° flexion (why?)
      • Prevents slippage of cast
      • Relaxes gastrocnemius muscle
      • Prevents tibial rotation.
    • Ankle and foot: As per sequence of deformity correction in serial casting.
      • First midfoot cavus and forefoot pronation
      • Then, forefoot adduction and heel varus and equinus
      • Finally residual equinus, if any.
  • Extent of cast:
    • Proximally: Just short of groin
    • Distally: Cast is applied in such a way that pulp of toes is covered and dorsum of toes is visible.
 
PATELLAR TENDON BEARING CAST—A FUNCTIONAL CAST BRACING (SARMIENTO A, 1963) (FIG. 17)
  • It is a closed method of fracture treatment, which is complimentary to other methods of fracture management.
  • Principle: It is based on the belief that continuing function while a fracture is uniting it does three things:
    1. Enhances osteosynthesis
    2. Promotes healing of fracture
    3. Prevents complication like joint stiffness.
  • Mechanism of action of Pascal's law:
    • When the limb is loaded, there is generation of intracompartmental pressure around fracture site that exerts pressure on the wall of facial compartment.
    • As there is a rigid cast around limb, the similar amount of pressure starts working in opposite direction that maintains the reduction of fracture.
  • Prerequisites for patellar tendon bearing (PTB) casting:
    • Fracture should be treated first by some conventional methods
    • Angular and rotational deformity must be corrected12
      zoom view
      Fig. 16: Congenital talipes equinovarus (CTEV) cast: a special type of AK cast.
      zoom view
      Fig. 17: Patellar tendon bearing (PTB) cast—a functional cast bracing.
    • There is no pain at fracture site on minimal movements
    • There is no deformity at fracture site
    • There should be a reasonable resistance to telescopy
    • Shortening should not exceed 0.25” for tibia and 0.5” for femur.
  • Used for:
    • Fracture of distal femur
    • Fracture of proximal tibia
    • Fracture of distal tibia
    • Fracture of shaft of humerus.
  • Contraindications:
    • Noncompliant patient
    • Neuromuscular disorder
    • Altered sensitivity of limb
    • Isolated tibia fracture (fibula intact)
    • Proximal femur fracture
    • Both bones of the forearms fracture
    • Monteggia fracture-dislocation
    • Galeazzi fracture-dislocation.
 
WALKING HEEL (RUBBER) (FIG. 18)
  • Parts of walking heel:
    • Thin peripheral extension
    • Two ribbed thickened broad base
    • Transverse slot in heel
    • Elevated rounded medial ridge for medial arch
    • Hole on lateral side to make it lighter.
  • Use: In PTB cast. Why? It prevents breakage of plaster cast during weight bearing.
 
WALKING IRON (FIG. 19)
  • Parts of walking iron:
    • Metal cross bar
    • Metal upright
    • Flare (rounded) of side bar
    • Terminal part of side bar
    • Rubber heel.
  • How to apply?
    • 2.5 cm below neck of fibulae
    • Rubber heel corresponds to center of sole13
      zoom view
      Fig. 18: Walking heel (rubber).(Courtesy: Dr Kumar Kaushik, Muzaffarpur)
      zoom view
      Fig. 19: Walking iron.(Courtesy: Dr Kumar Kaushik, Muzaffarpur)
    • Below knee padding of limb and apply one or two POP bandages over it
    • Set the walking iron
    • Further wrapping of walking iron with POP bandages.
  • Uses: As weight-relieving orthosis.
    • Fracture of tarsals and metatarsals
    • Fracture of calcaneum and talus.
 
PIN PLASTER TECHNIQUE (FIG. 20)
  • Principle: Stabilization of fracture with cast and Steinmann pin assembly.
  • How to apply:
    • First pin above fracture and second below fracture, as far as possible
    • Achieve reduction
    • Cast applied in reduced position
    • Minimal joint involvement.
  • Advantages of pin plaster technique:
    • Prevents joint stiffness
    • Early mobilization
    • Check rotation.
  • Disadvantages of pin plaster technique:
    • Loss of reduction
    • Pin track infection.
zoom view
Fig. 20: Pin plaster technique.
 
HIP SPICA (FIGS. 21A TO D)
  • It encompasses trunk with the lower limb.
  • Position of limb:
    • Hip: 45° flexion and slight abduction. Why abduction? To clear the perineum and maintain hygiene14
      zoom view
      Figs. 21A to D: Hip spica. (A) Single hip spica; (B) Types of hip spica; (C) One and half spica; and (D) Hip spica in human position for developmental dysplasia of the hip (DDH).
    • Knee: 45° flexion. Why so? Flexion less than 45° may lead to loss of fracture reduction
    • Ankle: Neutral position.
  • Extent of cast:
    • Proximally—extend up to nipple and rest on rib cage. Why? It provides a bony support to the cast and prevents its breakage.
    • Distally: On the basis of distal extension of cast, spica can be classified as follows:
      • Single hip spica: Involving only one leg and extend up to foot
      • One and half spica: Involves one leg up to foot and other leg up to knee
      • Double hip spica: Involving both leg up to foot.
  • Uses:
    • Fracture of femur (shaft and neck) in children
    • After closed reduction in developmental dysplasia of the hip
    • After pediatric hip surgeries.
  • Strengthening of spica:
    • By applying POP slabs around hip and thigh
    • By wrapping wooden stick with POP bandages between both legs.
  • Why we apply soft material between abdomen and cotton padding during spica application?
    • To create a space between abdomen and spica cast that can adjust the belly of the patient during respiratory movement.
    • To prevent complications mentioned here.15
  • Complications:
    • Urinary retention
    • Plaster cast syndrome (PCS)—a constellation of symptoms—like pernicious vomiting, pain in abdomen, and abdominal distension; developed soon or later after application of spica is called plaster cast syndrome.
The underlying pathology is obstruction of third part of duodenum in between aorta and superior mesenteric artery. Treatments given are:
  • Immediate removal of spica
  • Stop oral intake
  • Intravenous fluid infusion
  • Antiemetics
  • Antacids
  • Gastric decompression by nasogastric tube
  • Serum electrolyte monitoring
  • Severe cases of laparotomy. PCS was common in the past when scoliosis was corrected with Harrington rod.
  • Immediate hip spica application:
    • Indication: Fracture of shaft of femur in children <5–6 years of age with shortening less than 2 cm.
    • Complications:
      • Compartment syndrome
      • Loss of reduction
      • Angulation
      • Shortening.
    • To reduce the rate of complication, the 90–90° position of hip and knee is used but it can be applied only for age less than 2–3 years due to fear of neurologic complication.
Note: Normally, hip spica is applied after keeping the pediatric fracture of shaft of femur under 3 weeks of skin traction (<5 years) or skeletal traction (>5 years) because during these period, acceptable reduction is achieved and fracture becomes sticky also. By this way, above complications can also be minimized.
  • Hip spica in human position for developmental dysplasia of the hip (DDH):
    • Position: 95° flexion at hip joint and 40–45° abduction at hip joint.
    • Advantages of human position:
      • Stability at hip
      • Decreased risk of osteonecrosis of head of femur.
 
WEDGING OF CAST (FIG. 22)
  • How much correction by wedging: Only 10–15° angulation should be corrected by wedging.
  • Timing of wedging: Wedging should be done as soon as possible (2–3 days). Once the fracture becomes sticky, it prevents the lateral motion at fracture site.
  • How wedging is done: Five steps—
Identification of the site of wedging
Do circumferential slitting of cast just opposite to the site of angulation
At least one-fourth of circumference of cast should be left
Hold the wedging of cast with a block and repair the cast with POP bandage
Final reduction is checked under X-ray
zoom view
Fig. 22: Wedging of cast.
16
 
MAKING A WINDOW IN CAST (FIG. 23)
  • Timing of making window: When plaster becomes fully dried.
  • Indications:
    • For frequent inspection of wound
    • For stich removal.
  • Identification of window making site:
    • By overpadding to produce bulging at window site
    • By measuring the wound site from fixed bony point.
  • How window is made:
Apply plaster cutting saw on marked area
Elevate the window out of the cast
Remove the underlying padding
Inspect the wound
Replace the padding and keep the window in place
Apply cotton bandage over window or repair with POP bandage
 
BIVALVING OF CAST (FIG. 24)
  • A method of cast removal when whole cast is removed in two parts.
    zoom view
    Fig. 23: Making a window in cast.
  • When to do bivalving:
    • If there is need of frequent observation of fracture site, e.g., in case of compound fractures
    • Where there is risk of compartment syndrome
    • For removal of fiberglass cast.
  • For example, in case of below knee cast, cut the cast posterior to medial malleoli in medial side and anterior to lateral malleoli in lateral side in vertical plane.
 
SLITTING OF CAST (FIG. 25)
  • Indication of slitting of cast: When a POP cast is applied over a limb, it shows any one of the following features as:
    • Appearance of swelling in distal part of limb, e.g., toes
      zoom view
      Fig. 24: Bivalving of cast.
      zoom view
      Fig. 25: Slitting of cast.
      17
    • Pain in limb
    • Diminished distal pulsation
    • Compromised capillary refilling
    • Paleness in distal part of limb
    • Paresthesia of limb.
  • How to slit a cast:
Make a marking of slitting overt cast
With the help of electric or manual, saw a straight cut is made in long axis of limb
Slit directly up to underlying padding of cast and remove the cotton paddings, so that limb could be directly visible
Now apply a bandage around slitted cast to just keep it in place, i.e., here POP cast is acting as splint only
 
CHECKLIST FOR CASTING
  • Extent of cast
  • Position of limb
  • Alignment of limb
  • Smoothness/irregularity of cast
  • Cracks over cast
  • Any sign of tight plaster.