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Casting techniques should not be ignored in treatment of children’s fracture
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MADRID — The “art and science” of casting are poorly understood and poorly practiced by today’s orthopaedic surgeons, according to a physician here.
J. Mark H. Paterson, FRCS, presented his viewpoint at the EFORT Congress 2010.
“These techniques … are not obsolete, they are not irrelevant,” Paterson said. “We should respect the importance of them. We have the responsibility to raise our own game.”
“We have to improve our own practice, and just as importantly we have to teach our trainees how to manage casts, not simply rely on orthopaedic technicians,” he added.
Potentially dangerous price for ignorance
Paterson stressed that while the development of numerous advancements has potentially put proper casting techniques by the wayside in the minds of many, the ability to apply and maintain an effective cast remains as important as ever.
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Poor casting can lead to catastrophic failures in healing – or cause entirely new problems, Paterson said. He mentioned the Ponseti method as one of those that requires casting that “follows the rules.”
“The thing that brings Ponseti down … is not following the rules,” Paterson said. “You have below-knee casting, or using the wrong materials, or not changing regularly. There is a rigid protocol. Adherence to the protocol means success.”
Three-point fixation
Paterson noted that proper healing with a cast is not a matter of making the cast “beautiful” by letting it adhere to the shape of the limb so much as creating a cast that looks “pretty awful” and follows the parameters of three-point fixation.
“The concept of keeping the interosseous membrane under tension by applying your forces in the correct manner is very important,” Paterson said.
“Poor casting leads to bad results and complications, and we need to look at why things go wrong,” he added.
- Reference:
Paterson, JMH. Do not throw the cast away … EPOS Guest Session. Presented at the EFORT Congress 2010. June 2-5, 2010. Madrid.