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Chapter 2 Index
A. Evaluation by system B. Other categories of illnesses:
1. Metabolic and Endocrine
2. Collagen-Vascular Illnesses
3. Chromosomal Abnormalities
4. Generalized
5. Sexual Abuse
6. Hematology 7.
Trauma and Surgery
--Surgery in
Pediatrics: Timing and Indications for Procedures
--Fractures in Children
--Evaluation of Ankle Injuries |
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Splinting and Casting
Chip Iwinski, MD
Introduction: Pediatricians should be comfortable with
splinting and casting. Dr. Iwinski gave us a workshop, which taught us how
to do this.
It is assumed that the pediatrician will see the child first, and
determine whether x-rays need to be done, whether referral needs to be
immediate or the next day, etc.
When a Pediatrician Should Splint or Cast a Fracture:
- Uncomplicated fracture of radius- including greenstick fracture
- Uncomplicated fracture of finger or toe
- Clavicle fracture (probably best to not treat with figure of 8, but
just have child wear a sling.)
- Uncomplicated metatarsus fractures sometimes.
- Uncomplicated fibula fractures sometimes.
Preparation of material for casting:
- Plaster is the most inexpensive and easiest to use material available
for treating fractures. (The pre-made material that needs to be dampened
and then applied is not as easy to use)
- For forearm fractures, the arm and hand always need to be held in the
position of function.
- When possible splints are made to treat forearm fractures. This
allows child to remove the splint for bathing, etc.
- The arm is first wrapped in a soft gauze, the plaster then fitted to
the under forearm, wet, and then wrapped. About 5-6 layers of plaster are
used. Another group of plaster is then applied to the top part of the
forearm and then wrapped.
Finger Fractures:
Rarely need to use a splint for this type of fracture. Treatment is
by putting soft gauze between fractured finger and the one next to it; the
fingers are then wrapped with adhesive.
SUMMARY: In this managed care environment, you the pediatrician will
need to know how to splint and cast minor sprains and fractures.
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