will be managed by bed rest, immobilization, and
rehabilitation. Many of the basic concepts of care of
the medical patient are applicable for orthopedic
In the military, the usual orthopedic
patient is fairly young and in good general physical
condition. For these patients, bed rest is prescribed
only because other kinds of activity are limited by their
condition on admission.
Rehabilitation is the ultimate goal when planning
the orthopedic patients total management. Whether
the patient requires surgical or conservative treatment,
immobilization is often a part of the overall therapy.
Immobilization may consist of applying casts or
traction, or using equipment (such as orthopedic
During the immobilization phase, simple
basic patient care is extremely important. Such things
as skin care, active-passive exercises, position changes
in bed (as permitted), good nutrition, adequate fluid
intake, regularity in elimination, and basic hygiene
contribute to both the patients physical and psycho-
Lengthy periods of immo b i l i z a t i o n a r e
emotionally stressful for patients, particularly those
who are essentially healthy except for the limitations
imposed by their condition.
contributes to boredom that is frequently manifested
by various kinds of acting-out behavior.
Often, the orthopedic patient experiences
exaggerated levels of pain.
Orthopedic pain is
commonly described as sore and aching. Because this
condition requires long periods of treatment and
hospitalization, the wise management of pain is an
important aspect of care. Constant pain, regardless of
severity, is energy consuming. You should make every
effort to assist the patient in conserving this energy.
There are times when the patients pain can and should
be relieved by medications.
There are, however,
numerous occasions when effective pain relief can be
provided by basic patient-care measures such as proper
body alignment, change of position, use of heat or cold
(if permitted by a physicians orders), back rubs and
massages, and even simple conversation with the
patient. Meaningful activity also has been found to
help relieve pain. Whenever possible, a well-planned
physical/occupational therapy regimen should be an
integral part of the total rehabilitation plan.
C A S T FA B R I C AT I O N . A s m e n t i o n e d
previously, immobilization is often a part of the overall
therapy of the orthopedic patient, and casting is the
most common and well-known form of long-term
immobilization. In some instances, a Corpsman may
be required to assist in applying a cast or be directed to
apply or change a cast. In this section, we will discuss
the method of applying a short and long arm cast, and a
short leg cast.
In applying any cast, the basic materials are the
same: webril or cotton bunting, plaster of Paris, a
bucket or basin of tepid water, a water source (tap
water), protective linen, gloves, a working surface, a
cast saw, and seating surfaces for the patient and the
Corpsman. Some specific types of casts may require
SHORT ARM CAST.A short arm cast extends
from the metacarpal-phalangeal joints of the hand to
just below the elbow joint. Depending on the location
and type of fracture, the physician may order a specific
position for the arm to be casted. Generally, the wrist is
in a neutral (straight) position, with the fingers slightly
flexed in the position of function.
Beginning at the wrist, apply three layers of webril
(fig. 22A). Then apply webril to the forearm and the
hand, making sure that each layer overlaps the other by
a third (as shown in figure 22B). Check for lumps or
wrinkles and correct any by tearing the webril and
Dip the plaster of Paris into the water for
approximately 5 seconds. Gently squeeze to remove
excess water, but do not wring out. Beginning at the
wrist (fig. 22C) wrap the plaster in a spiral motion,
overlapping each layer by one-third to one-half.
Smooth out the layers with a gentle palmar motion.
When applying the plaster, make tucks by grasping the
excess material and folding it under as if making a
pleat. Successive layers cover and smooth over this
fold. When the plaster is anchored on the wrist, cover
the hand and the palmar surface before continuing up
the arm (figs. 22D and 22E). Repeat this procedure
until the cast is thick enough to provide adequate
support, generally 4 to 5 layers. The final step is to
remove any rough edges and smooth the cast surface
(fig. 22F). Turn the ends of the cast back and cover
with the final layer of plaster, and allow the plaster to
set for approximately 15 minutes. Trim with a cast
saw, as needed.
LONG ARM CAST.The procedure for a long
arm cast is basically the same as for a short arm cast,
except the elbow is maintained in a 90E position, the