Incīsiō : The surgical club
SNAP &
STRAP
WORKSHOP
STUDY
MATERIAL
TABLE OF CONTENTS
1.Introduction & Forms of POP
2.Setting, Drying & Application Rules
3.Padding, Stockinet & Technique
4.Slabs & Casts
5.Spica & Functional Casts
6.Aftercare & Complications
7.Special Casts: Fiberglass & Cast Syndrome
8.Ideal Cast Properties
9. Introduction to splints
10.Pre Splinting Requirnments
11.Orthopedic Materials
12.Application considerations
13.Post Application Care
14. References
Introduction to POP
Plaster of Paris (CaSO₄·½H₂O) is a quick-setting material
made by heating gypsum. When mixed with water, it sets
fast and forms a hard cast, making it ideal for immobilizing
fractures. It’s simple, reliable, and used in ancient
architecture and modern medicine.
Why is Plaster of Paris called that?
It's because the material, which is made from heating
gypsum, was originally sourced from large deposits of
gypsum near Paris, specifically in the Montmartre hill
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Used in 4 Forms Mainly
Slab
Cast
Spica
Functional Cast Brace
Definitions
Setting time: Time taken to change from powder
form to crystalline form. Drying time: Time taken
to change from crystalline form to anhydrous form.
Average setting time: 3–9 minutes Average drying
time: 24–72 hours
Rules of Application of POP
Choose the correct size of the roll.
A joint above and a joint below the fracture/injury should be
included.
Plaster should not be too tight or too loose.
Moulding should be done with the palm, not fingers, to avoid
indentations.
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Padding
Padding should be from distal to proximal with
50% overlap.
Extra padding over elbows and heels.
Be generous over bony prominences.
Always pad between digits when splinting or
buddy strapping.
Should not be applied tightly — danger of
ischemia!
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Stockinet
Protects skin and makes the bandage application neat.
Applied on skin before padding.
Should be cut longer than the splint to be applied.
Available in various widths.
Not to be used in fresh trauma.
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Basic Plastering Technique
Plastering is a skill, not just a textbook topic.
Poor plaster technique can ruin a good reduction.
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1.SLAB
Temporary splint made of POP + bandage roll. Used initially post-
fracture, first aid, or postoperative immobilization.
Steps:
1.Measure slab to required length.
2.Use 8–10 layers (upper limb), 12–15 (lower limb) or up to 20 layers
depending on size.
3.Trim to fit.
4.Dip slab in tepid water, remove excess water.
5.Smooth out and mold along limb contour.
6.Apply wet bandage over to avoid shrinkage issues
Types of Slab and Indications:
Above Elbow Slab (elbow flexion)
Below Elbow Slab
Both bone forearm fractures
Wrist fractures
Supracondylar humerus
Metacarpal fractures
(#extension type)
Colles' fracture
Unstable proximal radius/ulna
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Above Elbow Slab (elbow extension)
Olecranon fracture
Supracondylar humerus
(#flexion type)
Below Knee Slab
Ankle fractures/dislocations
(post- reduction)
Tarsal and metatarsal
fractures Position: Tibial
tuberosity to MTP joints, foot
in neutral position
Above Knee Slab
Proximal/midshaft tibial fracture
Supracondylar femur fractures
Position: High in groin to MTP
joints Knee in 15° flexion, foot in
neutral position
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2. CAST
POP roll completely encircles the limb Used for
definitive fracture management and deformity
correction.
Steps:
1.Apply stockinet and uniform padding
2.Select appropriate POP roll (4 or 6 inch)
3.Dip at 45°, wait for bubbles
4.Squeeze excess water axially
5.Secure and apply
Used for definitive fracture management and
deformity correction
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Triple Sequence in Plaster
Application:
Phase 1: Examination and Rehearsal
Assess displacement
Understand gravity effects
Rehearse reduction
Phase 2: Plastering
Assistant holds limb
Quick application by surgeon
Leave soft for molding
Phase 3: Reduction and Holding
Apply reduction
Hold reduction until set
Avoid pressure points
Check X-ray is mandatory
V-shaped overlapping cast covering two body parts (e.g., hip and
waist)
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Advantages of POP:
Cost-effective
Non-allergic
Easily moldable
Disadvantages of POP:
Radio-opaque
Heavy
Weakens with water exposure
After Care of POP:
Keep dry
Mobilize free joints
Seek care if:
Excessive pain or swelling
Discoloration of fingers/toes
Cracks in the plaster
Gradual weight-bearing
Physiotherapy essential
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Complications of POP:
Due to Tight Cast:
Pain
Pressure sores
Compartment syndrome → Volkmann’s ischemia
Peripheral nerve injury
Due to Improper Application:
Joint stiffness
Malposition
Plaster blisters
Due to Allergy:
Allergic contact dermatitis
Allergen: Benzalkonium Chloride
Disuse Atrophy:
Muscle atrophy → functional loss
Cast loosening
Osteopenia
X-ray: speckled, washed-out bone
Fracture Disease:
Pain, swelling, edema
Protein exudate becomes gelatinous scar → joint stiffness, tendon adhesion
May cause Reflex Sympathetic Dystrophy
Cast Syndrome:
Occurs with hip spica
Duodenal compression
Symptoms: nausea, fullness, regurgitation
Due to excessive cast over abdomen/lordosis
Avoid tight abdominal casts
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FIBERGLASS CAST
Synthetic, lighter alternative
Cotton or waterproof padding + knitted fiberglass with resin
Advantages:
Sets quickly
Allows weight-bearing
Strong, light
Radiolucent
Moisture-wicking
Disadvantages:
Costly
Not for wet wounds
Sharp edges
Less moldable
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Properties of an Ideal Cast:
Direct application
Easily moldable
Non-toxic
Waterproof
X-ray transparent
Quick setting
Breathable
Strong & lightweight
Non-flammable
Mess-free
Long shelf life
Cost-effective
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Introduction to Splint
A splint should be defined as an object or body part used to support
or immobilize an injured limb or other body part.
A splint can be pre-manufactured or custom-fabricated with materials
that are rigid or semi-rigid in design and have some sort of softer
padding in their construction. This padding acts as a barrier between
the skin and splint to prevent further injury, chafing, or other
discomfort.
Purpose of Splinting
To provide immobilization to the injured area
To protect the injured area
To prevent further injury
To help reduce pain
To provide a means for the injury to have room for swelling
To offer a sense of security
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Pre-Splinting Requirements
1.Introduce Yourself to the Patient: Try to build a rapport. This
helps in easing the patient's anxiety.
2.Inspect Circulation:
Check for neurovascular continuity.
Use the 5 P’s to assess vascular health:
Pain
Pallor
Pulse
Paresthesia
Paralysis
3.Treat Wounds and Bleeding: Manage any wounds and slow or
stop any bleeding.
4.Remove Jewelry: Prevent constriction that could occur
due to swelling.
5. Ideally, Immobilize Joints: If the injury is an acute
fracture, immobilize the joint proximal to the injury and
the joint distal to the injury (if possible).
6. Gather Materials: Collect all necessary materials
before starting the splinting process.
Don't leave your patient alone to go get more items.
7. Explain the Process: Give the patient a brief
description of the process and what to expect. This helps
manage anxiety and avoids panic.
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Orthopedic Splinting Material
Rigid Dressing
Materials
1.Plaster of Paris
2. Fiberglass
3.Pre-Cut Splinting
Slabs
Soft Underpadding
4.Synthetic Cast
Padding
5.Cotton Webril
6. Stockinette
Overwrap
7. Bias-Cut
Stockinette
8.ACE Bandage
9.CoBan Wrap
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Common Splints
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most common
orthopedic splint
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Selecting the Appropriate Splint
Upper Extremity Splints
1. Volar Splint:
2. Thumb Spica Splint:
3. Short Arm Sugar Tong Splint:
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4. Long Arm Double Sugar Tong Splint:
5. Long Arm Posterior Splint:
6. The Coaptation Splint:
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Lower Extremity Splints
1. The Short Leg Posterior Splint:
2. The Short Leg Posterior with Sugar Tong Splint:
3. The Long Leg Posterior Splint:
4. The Long Leg Posterior Splint with Medial and Lateral Slabs:
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What to watch out for
when applying any splint?
1. Check Circulation: Before and after every splint,
verify distal circulation. All rings and bracelets
should be removed from the affected limb.
2. Treat Skin Compromises: Ensure wounds, rashes,
and other skin compromises are treated before
splinting.
3. Joint-to-Joint Coverage: Ensure the splint goes
from joint to joint around the epicenter of the injury.
4. Padding and Wrinkles: Secure an appropriate
amount of padding to prevent rub and pad extra over
bony prominences. Avoid wrinkles in padding or
splint material as they can irritate.
5. Smooth Edges: Ensure all rough and sharp edges of
the splint are well-padded.
6. Avoid Finger Impressions: Do not use fingers to
mold any part of the splint, as this leaves unwanted
impressions that may irritate the skin.
7. Inter-Digit Padding: Ensure that if fingers or toes
are secured together, there is padding placed between
them before securing.
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8. Moistening the Plaster: Ensure the plaster is properly
moistened before application.
9.Avoid Overworking: Overworking the plaster weakens its
structure.
10.Layering Rules:
Upper Extremities: Typically 10–15 layers.
Lower Extremities: Typically 11–25 layers.
11. Water Temperature: Use warm water (about 70-
75°F) to mix plaster.
12. Exothermic Reactions: Avoid extremely hot water, as it
increases the exothermic reaction, which can burn the
patient.
13.Change Water: Change the water between applications to
avoid increased set time due to residual salts.
14.Ventilation: Allow adequate ventilation around the drying
splint to avoid the buildup of heat and moisture. Materials
like terry cloth towels are ideal for cooling.
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References
1.Maheshwari J. Essential Orthopaedics. 6th ed. New Delhi: Jaypee Brothers
Medical Publishers; 2021.
2.Kulkarni GS. Textbook of Orthopaedics and Trauma. 4th ed. New Delhi:
Jaypee Brothers Medical Publishers; 2016.
3.Appley AG, Solomon L, Warwick D, Nayagam S. Apley's System of
Orthopaedics and Fractures. 10th ed. Boca Raton: CRC Press; 2018.
4.Turek SL. Orthopaedics: Principles and Their Application. 6th ed.
Philadelphia: Lippincott Williams & Wilkins; 2005.
5.Campbell WC, Canale ST, Beaty JH. Campbell's Operative Orthopaedics.
13th ed. Philadelphia: Elsevier; 2017.
6.Thompson SR, Zlotolow DA. Handbook of Splinting and Casting: Mobile
Medicine Series. Philadelphia: Lippincott Williams & Wilkins; 2012. 300 p.
7.Lee S, Kim J. Splinting Techniques. J Orthop Surg. 2018; 26(2): 12-20.
8.Lee S, Kim J. Splinting Techniques. J Orthop Surg [Internet]. 2018 [cited
2020 Jan 10]; 26(2): 12-20. Available from: http://example.com/splinting.
9.American Academy of Orthopaedic Surgeons. Splinting and Casting.
Rosemont, IL: AAOS; 2020 [cited 2022 Mar 15]. Available from:
https://orthoinfo.org/en/staying-healthy/splinting-and-casting
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