Backslabs and plaster casts: which will best accommodate increasing intracompartmental pressures?

Younger, Alastair; Curran, Padraig; McQueen, M. M.

doi:10.1016/0020-1383(90)90091-8

Cited by 35 publications

(14 citation statements)

References 7 publications

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“…Rigid circumferential casts have limited capacity to accommodate ongoing limb swelling and may cause pressure sores, increased tissue pressure and neurovascular compromise. 2,3 For these reasons, many physicians apply circumferential casts and then split one or both sides. This practice is time-consuming and may theoretically compromise the stability of the immobilization.…”

Section: Introductionmentioning

confidence: 99%

A prospective randomized controlled trial comparing circumferential casting and splinting in displaced Colles fractures

Grafstein

Stenstrom

Christenson

et al. 2010

CJEM

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Objective:Our primary objective was to determine the effectiveness of 3 immobilization methods (circumferential casting [CC], volar–dorsal splinting [VDS] and modified sugar-tong [MST] splinting) in maintaining the position of displaced distal radius fractures after successful closed reduction. Our secondary objective was to assess long-term functional outcomes associated with immobilization with fibreglass splinting versus standard CC in patients maintaining initial nonoperative reductions.Methods:We conducted a prospective randomized single-blind controlled trial in patients over 18 years of age who presented to the emergency department with a displaced fracture of the distal radius requiring closed reduction. The primary outcome was loss of reduction (defined as radiologic slippage or the need for surgical fixation during the 3–4 week primary immobilization period after initial successful reduction). Secondary outcomes included DASH (disabilities of the arm, shoulder and hand) score, return to work, activities of daily living, wrist pain, range of motion and grip strength assessed at 8 weeks and 6 months.Results:Thirty participants were randomly assigned to receive MST splinting, 31 to receive VDS and 40 to receive CC. Baseline characteristics were similar among groups. Radiographic loss of reduction occurred in 16% (95% confidence interval [CI] 3.1%–28.9%) of participants in the VDS group, 20% (95% CI 7.6%–32.4%) in the CC group and 30% (95% CI 13.6°%–46.4°%) in the MST splinting group (p= 0.17). Based on multivariate analysis of variance, functional outcomes at 8 weeks were similar among groups (p= 0.89). DASH scores at 8 weeks and 6 months were similar among groups, based on 1-way analysis of variance (p> 0.25).Conclusion:Rates of loss in anatomic position were not statistically significant among the 3 types of dressings used. However, there was a clinically important trend of increased loss of reduction with the use of MST splinting. Functional outcomes at 8 weeks and 6 months were not significantly different between CC, VDS and MDS splinting. Ease of application and familiarity with use should guide clinical decisions when choosing a dressing type for displaced Colles fractures.

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Section: Introductionmentioning

confidence: 99%

A prospective randomized controlled trial comparing circumferential casting and splinting in displaced Colles fractures

Grafstein

Stenstrom

Christenson

et al. 2010

CJEM

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“…It has been shown that split and spread casts are better at accommodating for rises in pressure but arguably cast application is a more complex skill to practice and is not routinely taught to front line clinicians and nurses practicing out with orthopaedics. In their study Younger et al [5] studied the expansibility of full casts, split and spread casts and backslabs as internal pressure was increased. Although backslabs demonstrated least expansibility, it can be argued in the presence of compartment syndrome, predominantly a clinical diagnosis, backslabs are more easily split with scissors and spread by hand than a full cast which makes them more user friendly in a ward environment.…”

Section: Discussionmentioning

confidence: 99%

A novel and effortless technique for application of lower limb backslabs

Rehman

McMillan

Smith

et al. 2015

Injury

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“…Circumferential wraps and casts also have the potential to restrict compartment expansion, decrease venous flow, and result in acute compartment syndrome. 4,23 Age and sex distributions indicated that men in their thirties have the highest likelihood of developing acute compartment syndrome, which may be explained by the relatively larger muscle mass in men within a fixed compartment size after growth is complete. McQueen et al 6 reported that the average annual incidence of compartment syndrome for men was 7.3 per 100,000, with a mean age of 32 years, whereas the average annual incidence for women was 0.7 per 100,000, with a mean age of 44 years.…”

Section: Epidemiology and Etiologymentioning

confidence: 99%

Acute Lower-leg Compartment Syndrome

Mauser¹,

Gissel²,

Henderson³

et al. 2013

Orthopedics

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Acute compartment syndrome remains a challenging problem for orthopedic surgeons because its diagnosis is not always straightforward and it has a high risk of associated limb morbidity if left undiagnosed or untreated. Failure to diagnose and treat acute compartment syndrome is one of the most common causes of successful medical liability claims. The authors review the current literature concerning the diagnosis of acute compartment syndrome and discuss new non-invasive technologies that may allow for earlier and more accurate diagnosis of impending acute compartment syndrome.

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Backslabs and plaster casts: which will best accommodate increasing intracompartmental pressures?

Cited by 35 publications

References 7 publications

A prospective randomized controlled trial comparing circumferential casting and splinting in displaced Colles fractures

A prospective randomized controlled trial comparing circumferential casting and splinting in displaced Colles fractures

A novel and effortless technique for application of lower limb backslabs

Acute Lower-leg Compartment Syndrome

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