Hi You'll
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I was after some confirmation/advice regarding serial casting.
I have an 8 month old patient who is just starting to weight bear and is self-removing current splints during the day.
I am considering a unilateral serial cast as the deformity has improved but needs further correction.
I have done casts on patients before, but the last was 5 years ago.
Normally, the casting procedure I would do would be:
1. Few minutes of stretching/holding in corrected position.
2. Apply TBCo. or occlusive agent
3. Apply stockinet and 2 layers of softban(undercast padding) with extra over pretibial and mall. areas
4. Cut plaster bandages into 5cm wide rolls
5 Apply plaster and hold in corrected position, sl inverted and with foot/leg at right angles
6. I then would normally apply a roll of fibreglass around the foot/ankle to avoid cast breakdown.
7. Review for cast change in 2/52
Could I get advice on:
1. I am allergic to TB Co. - any substitutes
2. Some pods apply bandages to leg up to base of the 5th met initially then apply the foot section 2nd once the leg part has dried. Some pods will do the foot section 1st - any advice/tips appreciated.
3. In past cases the cast removal is never fun, especially is fibreglass is removed. I haven't used a cast saw since uni, but I should be able to borrow an Orthopod's who works from the same centre. I have used plaster shears before but they re tricky on a small leg. - any advice appreciated.
4. Use of normal or fast setting plaster?
5. Any modern substitutes instead of adding fibreglass for easier removal? And if not using fibreglass, do you have success with parent's plaster removal the night before the cast change?
6. Also is 2/52 between cast changes reasonable or would you go less on the 1st cast.
Thanks for any input
Guito
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