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Plaster of Paris–Short History of Casting and Injured Limb Immobilzation



Various materials have been used since ancient times to help immobilise fractures. In this review, we discuss the history and developments of these materials as well as plaster of Paris. There has been a recent trend away from non-operative management of fractures, and skills in the use of plaster of Paris are declining. For the successful treatment of patients, it is important to appreciate how plaster works, how it should be used, and what can go wrong. In this review, we also discuss principles of applications and complications of plaster of Paris.
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The Open Orthopaedics Journal, 2017, 11, 291-296 291
1874-3250/17 2017 Bentham Open
The Open Orthopaedics Journal
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DOI: 10.2174/1874325001711010291
Plaster of Paris–Short History of Casting and Injured Limb
B. Szostakowski, P. Smitham and W.S. Khan*
University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic
Hospital, Stanmore, HA7 4LP, London, UK
Received: February 08, 2017 Revised: March 02, 2017 Accepted: March 09, 2017
Abstract: Various materials have been used since ancient times to help immobilise fractures. In this review, we discuss the history
and developments of these materials as well as plaster of Paris. There has been a recent trend away from non-operative management
of fractures, and skills in the use of plaster of Paris are declining. For the successful treatment of patients, it is important to appreciate
how plaster works, how it should be used, and what can go wrong. In this review, we also discuss principles of applications and
complications of plaster of Paris.
Keywords: Immobilisation, Plaster of Paris, Non-operative management, Fractures, Complications.
Immobilization of injured limbs has been performed for thousands of years. Before contemporary casting materials
became widely used, people used a variety of materials to form rigid casts. Over the centuries immobilization has
evolved from using simple wooden splints and rags to plaster of Paris, fibre and soft casts.
The earliest examples of the active management of fractures in humans were discovered at Naga-ed-Der in 1903
during the Hearst Egyptian Expedition of the University of California lead by Dr. GA Reisner [1, 2]. In a paper
published in the British Medical Journal in 1908, Mr. G. Elliot-Smith describes two sets of splints that were found
during excavations of tombs from the fifth dynasty (2494-2345 BC) [3]. One of the earliest descriptions of casting
material was by Hippocrates in 350 BC. He wrote about wrapping injured limbs in bandages soaked in wax and resin
[1, 4]. According to the earliest known surgical text The Edwin Smith Papyrus (copied circa 1600 BC), the Egyptians
were using self setting bandages, probably derived from those used by the embalmers [1, 4]. Later descriptions of
casting came from the Arab physician Rhazes Athuriscus [1]. El Zahrawi (960-1013 AD), a surgeon born near Córdoba
in Spain, described the use of both clay gum mixtures and flour and egg white as casting materials [1]. Starch based
casts appear to have been the standard treatment with only minor changes until the beginning of the 19th century with
only a few minor changes [5].
Further advances in the choice of materials were made during the wars. In the 18th century, Henri François Le Dran,
who practiced surgery at Hôpital de la Charité in Paris and was a surgeon in Germany Army and consulting surgeon to
the camps and armies of King Louis XV, used to soak his bandages with egg white, vinegar and clay powder or plaster
[1, 6]. A modification to the materials used was introduced by the father of modern military surgery, Baron Dominique
Jean Larrey, a French surgeon in Napoleon’s army. He was surgeon in chief from 1797 till the Battle of Waterloo in
1815 [7]. Larrey’s modification was adopted from Don Eugenio de la Penna who bandaged the fracture with linen that
had first been moistened with Camphor spirit, egg whites and lead-acetate. Unfortunately these were not used on a large
* Address correspondence to this author at the University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National
Orthopaedic Hospital, Stanmore, HA7 4LP, London, UK, Tel: +44 (0) 7791 025554; Fax: +44 (0) 20 8570 3864; E-mails: wasimkhan@doctors.,
292 The Open Orthopaedics Journal, 2017, Volume 11 Szostakowski et al.
scale due to costs [8]. Baron Louis Joseph G Seutin (1793-1862) was a belgian professor and surgeon in chief at the
Universite Libre de Bruxelles. As a chief doctor of the Belgian Army he fought in at Waterloo. He became famous for
inventing starch bandages known as “La Bandage Immobile” or “L’Appareil Amidonnee” that consisted of strips of
linen or bandages and carton splints, soaked in starch and wrapped around the limb [1, 8, 9].
Seutin’s method was popular in England by Joseph Samson Gamgee, the Birmingham surgeon who amongst other
things invented Gamgee tissue. In the first half of the 19th century, it was not popular to reduce fractures until the
swelling of the soft tissue decreased. Following Seutin’s rules Gamgee insisted on immediate reduction and application
of the starched apparatus, and registered spectacular success [10, 11].
Plaster of Paris is produced by removing the impurities from the mined gypsum and then heating it under controlled
conditions to reduce the amount of water of crystallization [12]. Plaster of Paris was well known as a building material
for many centuries before it was introduced as casting material. Egyptians as well as Romans used it for plastering walls
however not more is known on plaster use after the end of Roman occupation. In modern day England, it was widely
excavated in Roman coffins discovered in York, and on the walls in the military barracks of the Second Augustian
Legion excavated at Caerleon in Monmouthshire [4]. In mediaeval times gypsum was used only for alabaster statuary
[4]. There are various accounts describing the origin for the name plaster of Paris. One account mentions King Henry III
who visited Paris in 1254 and was so impressed by fine white walls that he introduced similar plastering in England
where it became known as plaster of Paris.
The first use of plaster of Paris as a cast for injured limbs took place through a technique known as plâtre coulé that
became popular in Europe at the beginning of 19th century. This technique involved pouring plaster of Paris around
injured limbs encased in a wooden construct. Due to the weight of the construct, the patient was largely confined to bed
during the period of fracture healing. This disadvantage was highlighted by Seutin, but this remained a relatively
popular technique in Europe with some surgeons using it for lower limbs only and some using it for both upper and
lower. Starched and albuminated bandages were also used as a casting method [1].
In 1839, Lafargue of St. Emilion used fresh warm starch paste mixed with plaster of Paris powder applied to layers
of linen strips. That dressing had the advantage of hardening much quicker, reducing setting time down to six hours [8,
13]. The Dutch military surgeon Anthonius Mathijsen while working at the military hospital in Haarlem discovered that
bandages soaked in water and plaster of Paris were becoming hard within minutes providing sufficient casting for
injured limbs. He published his monograph in 1852 in a medical magazine called Repertorium. His plaster bandage was
based on the principles of Seutin, who 10 years earlier introduced starched bandages known as bandage amidonnee [1,
8]. In his paper entitled New Method for Application of Plaster-of-Paris Bandage”, Mathijsen highlighted many
disadvantages of Seutin’s dressings including lack of self-adjustment to the changing conditions of the limb, long
duration of days needed for the casing to become sufficiently solid, carton splints shrinking and becoming shorter when
they dried off adversely affecting fractures, and in cases of suppuration or with small children urinating, dressing
becoming soft and loosen [8]. Mathijsen’s bandages consisted of strips of coarse cotton cloth with finely powdered
plaster rubbed in. This method of preparation was used until 1950.
Nikolay Ivanovich Pirogov, a head of the department of surgery at the St Petersburg Medico-Surgical Academy and
a Russian army surgeon during the Crimean War, conceived his idea to use plaster splints around 1852 while observing
the work of a sculptor who used strips of linen soaked in liquid plaster to make models. Pirogov used coarse cloth,
either in large pieces or in strips that were immersed in a liquid mixture of plaster of Paris immediately before applying
them to limbs protected by stockings and cotton pads. Based on his Crimean experience, Pirogov believed that all
patients with fractures due to missile wounds should not be evacuated from the forward dressing stations until the limb
had been immobilized in a proper dressing of plaster of Paris [14]. After the war he refined his method by cutting coarse
sail cloth to a defined pattern shaped to fit a part of body and soaking it in plaster before application [1, 4].
Use of plaster of Paris bandages for fracture casts became widespread after Mathijsen’s death and replaced most
other forms of splintage [1]. Early plaster bandages used at hospitals were made by nursing staff. They were usually
freshly made from plaster powder kept in air tight containers that was applied on to the woven bandage or strips of
cloths. Care was required while soaking dry bandage in water to prevent the plaster coming off the bandages and
dissolving in water. In the early 1930’s, the first commercially manufactured bandages were available in Germany.
They were made by spreading plaster mixed with minute quantities of volatile liquids on soft cloth.
Plaster of Paris The Open Orthopaedics Journal, 2017, Volume 11 293
Plaster of Paris (2CaSO4.H2O) is calcium sulphate with water. It is prepared by heating gypsum (CaSO4.2H2O) at
120°C to allow partial dehydration. When mixed with water, it gives out heat and quickly sets to a hard porous mass
within 5 to 15 minutes. The first step is called the setting stage with a slight expansion in volume. The second stage is
the hardening stage.
Properties of plaster of Paris bandages have not greatly changed since their first use in the 19th century. Plaster is
still widely popular, it is cheap, non-irritant and easy to apply. As quoted by AJ Steele in his article from 1893 on the
use of plaster of Paris in orthopaedics, “The property of rapidly hardening when once wet, gives to plaster its value.
Additionally it has merit in its cheapnesss and convenience; it is ever ready, is easily prepared, and simple in its
application” [15]. In 1906, Meisenbach published a 24 pages study on plaster of Paris bandages in the American
Journal of Orthopaedic Surgery. He outlined the four essential properties of plaster dressings to include strength, quick
set, light weight and ventilation, summarizing that ideal plaster dressing should be thin and strong [16].
Plaster can be used not only for treatment of fractured bones but also supports sprained ligaments, and inflamed and
infected soft tissues. It usually sets in few minutes, but needs between 36-72 hours to completely dry. Leg plasters are
able to bear weight after 48 hours. Completely dry casts when tapped with knuckles will sound crisp and clear whereas
wet casts emit a dull sound. Cast should only be dried by natural methods. No artificially generated heat is
recommended. Despite its frequent use, allergic reactions to plaster of Paris are extremely uncommon. There are only a
few cases of allergic contact dermatitis from benzalkonium chloride described in the literature [17]; benzalkonium
chloride has been used as an additive in certain brands of plaster of Paris since the 1970’s in order to improve its
binding properties [18]. When plaster of Paris dries off it becomes porous which helps to maintain patient’s skin free
from moisture. It is radiolucent which makes X-ray examination possible. The strength of the plaster cast is determined
by the quality of plaster, water to gypsum ratio, product age and storage conditions [19].
The success of non-operative treatment of fractures relies on a clear understanding of fracture healing and the proper
use of stabilizing techniques. Non-operative management of fractures has been declining in recent years due to
significant advances in operative technology and greater patient expectations of an early return to activity. Younger
surgeons are not as familiar with non-operative treatment of fractures with a plaster cast as their predecessors. This is
due to a lack of experience in application of plaster casts and the subsequent management. Plaster of Paris is unique and
still remains the favoured casting material in many countries. It is cheap, non-toxic, and can easily be moulded to the
desired shapes and contours of the body. Skin irritation and allergy is extremely rare.
Application of plaster of Paris requires good knowledge of anatomy and pathology that we are aiming to treat. It has
to be applied with a great care that is also need in its supervision afterwards. The perfect plaster dressing must retain the
limb under all conditions in the desired position with complete comfort. It must be strong yet light, effective in use but
easily removed when no longer required [20].
Prior to casting, any skin lesions or soft tissue injuries must be carefully noted. It is important to observe and
document neurovascular status of the extremity, and this needs to be repeated following application of plaster. Patients
with neuropathy or neurologic deficits are at greater risk for skin problems with abnormal sensation under the plaster. It
is crucial that plaster bandages are rolled on to the limb and not pulled. Figure of eight turns, creases and ridges have to
be avoided. Rubbing and massaging plaster bandages during application helps to bond layers together creating stronger
and lighter casts. Plaster bandages should be soaked in tepid or slightly warm water. Plaster sets quicker with warm
water compared with cold water. The faster the material sets the greater heat produces and the greater the risk of burns
[21]. Fast setting plasters have increased risk of thermal injury [12, 16]. There is a risk if casts are allowed to dry resting
on pillow. Temperature elevations could be related to the plaster being dipped too briefly and the water being squeezed
too aggressively out of the plaster. The water helps release heat, and if there is not enough, the plaster gets hotter.
Lavalette and Ganaway proposed that pre-existing plaster residue in the water might also play a role in elevating
cast temperature by maintaining the peak temperature for a longer period, therefore water should be clean [12, 14].
Water temperature of 32 degrees Celcius can be high enough to cause burns. Moritz and Henriques showed that 6 hours
at 44 degrees Celcius can cause a third degree burn [12, 14].
A fiberglass cast is a newer synthetic alternative to plaster of Paris. Fiberglass cast is a lightweight and extremely
strong material. Fiberglass, also called glass-reinforced plastic (GRP) or glass fiber reinforced plastic (GFRP) is a fiber
reinforced polymer made of a plastic matrix reinforced by fine glass. As compared to traditional plaster of Paris cast, it
294 The Open Orthopaedics Journal, 2017, Volume 11 Szostakowski et al.
is light in weight and more durable. It is three times stronger and but is only one third in weight. Fiberglass cast is a
lightweight and extremely strong material. Fiberglass cast is used for fracture management but is not applied in the
acute settings because it is less accommodating to swelling and does not allow moulding.
There are risks associated with plaster cast immobilization and patient has to be made aware of these. Patients with
known diabetes or sensory impairment due to spinal cord injury are those who need particular attention at the time of
plaster application and later. Below we discuss some common complications.
1. Deep Vein Thrombosis (DVT)
Prolonged lower limb immobilization in plaster carries the risk of deep vein thrombosis (DVT) that the patient has
to be made aware of. Two independent studies found that adults treated with a lower extremity cast for an average of 3
weeks had an incidence of DVT between 15% and 36%. Low molecular weight heparin did not significantly reduce the
risk of developing DVT [22 - 24]. Although these are more common in the lower limbs, these have also been described
in upper limb immobilisation.
2. Compartment Syndrome
One of the most serious complications to be considered is compartment syndrome. This is a condition in which
increased pressure within a limited space compromises the circulation and function of the tissues within that space.
Compartment syndrome may lead to fatal complications including major loss of limb function and even death [25, 26]
and are more common in lower leg and forearm fractures.
3. Soft Tissue Swelling
Soft tissue swelling associated with the fractured limb will usually subside within 48 hours from the injury leaving
the cast loose. This may lead to displacement of well positioned or reduced fracture, and the reapplication of a new
well-fitted cast may be needed. This is more likely to be an issue with unstable fractures. This is more noticeable in
lower limb injuries where after education and elevation, swelling can reduce significantly. It is vital to ensure sufficient
padding with swelling to prevent complications.
4. Pressure Sores
Plaster pressure sores can occur as a result of poor plastering technique associated with inadequate skeletal
protection or failure to trim the extremities of the cast correctly. Foreign bodies especially with young children can be
easily misplaced in the cast and exert pressure on the skin that can lead to a break in the skin. Every patient should be
warned about dangers of scratching beneath the cast with different sharp implements as this can cause infection. Cutting
windows in plasters and leaving them unprotected may lead to oedema developing within the window area that will lead
to soreness of the skin at the margins. Bivalving casts can be considered as an alternative to enable inspection.
5. Venous Congestion
Swelling or blue discoloration of the extremities suggests impaired venous return due to tightness of the plaster. The
blue discoloration of venous congestion must be differentiated from bruising.
There are a number of other complications that relate to long periods of immobilization and include joint stiffness,
muscle atrophy, cartilage degradation, ligament weakening, and osteoporosis. Some risks can be minimized with correct
casting technique [23]. It is important to make patients aware of what can potentially go wrong with a plaster cast.
Our review article shows that plaster of Paris has stood the test of time and is still commonly used. Although there
have been developments with the use of the lighter, stronger and more durable synthetic fiberglass of Paris, plaster of
Paris is still more widely used as it can be used in the acute setting and allows moulding. It is important to appreciate
the complications and how these can be avoided to ensure we continue to use it safely.
The author confirms that this article content has no conflict of interest.
Plaster of Paris The Open Orthopaedics Journal, 2017, Volume 11 295
Declared none.
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© 2017 Szostakowski et al.
This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a
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... Hippocrates had documented the importance of splinting and use of bandages stiffened with wax, lard or resin and multiple bandage layers for fracture care. It is manuscripted that linen glued together with plaster and splints made of bamboo were in use from 600 BCE to 600AD [9,15]. ...
... Three months later, upon the removal of the dressing, the residual limb had healed. This concluded that the rigid dressing immobilization accelerated fracture healing [14][15][16]18]. With the acceptance of limb immobilization for fracture healing, the first use of Plaster of Paris as a cast was carried out at the beginning of the 19th century in Europe. ...
... They poured Plaster of Paris around fractured limbs encased in a wooden construct, which was known as plâtre coulé. The technique of plâtre coulé has refined patients to one place during the entire healing process due to the weight of the cast [14,15]. The first Plaster of Paris bandage was invented in 1852 by A. Mathijsen, a medical officer of the Dutch army. ...
Full-text available
Immobilization material has slowly revolutionized since 3000 BCE from traditional plaster to modern day synthetic casting tape, including other sustainable immobilization material. This revolution is driven by the search for superior casting material that possesses excellent mechanical and load-bearing properties, non-toxicity, excellent healing rates, patient satisfaction and eco friendliness. Even though the new materials have been evolved, the traditional plaster still remains a material of choice owing to its excellent skin conformability, low cost and availability. This paper aims to present a comprehensive review on the technique of immobilization, existing orthopedic immobilization (casting and splinting) materials and complications associated with immobilization (mainly casting) which aimed to assist the medical practitioners and researchers in casting material improvements and selection. Nine immobilization materials are comprehensively discussed for their desirable properties, drawbacks and the required improvements to the composition, along with the most common cast complications ranging from superficial pressure sores to compartment syndrome and Deep Vein Thrombosis. . This paper identifies that among the existing material, plaster casts are still highly used due to their cost benefit and the ability to fit patients into full body casts, while synthetic material is too rigid and has a higher probability of causing complications such as compartment syndrome and deep vein thrombosis. Patients show a higher preference in using synthetic casts for short term and body extremity casting as they are comparatively more comfortable. New materials such as Woodcast shows good promise but their mechanical characteristics and comfort are yet to be critically analyzed. However, there exists an imminent requirement to upgrade existing material as well as to introduce novel promising sustainable material for long term immobilization.
... However, healing of the fracture will be impaired and patient comfort and safety will be jeopardized if the cast is not properly applied and managed (Meeson et al., 2011;Nguyen et al., 2016). The heat generated during the drying of the cast, improper care and maintenance of the cast, prolonged immobility of the limb in the cast, tightness of the cast, and increased pressure inside the cast are among the other factors that make the limb in the cast prone to complications (Boyd et al., 2009;Szostakowski et al., 2017). Identifying cast-related complications, their incidence, and factors affecting their occurrence can help plan for the prevention of complications. ...
... Deep vein thrombosis (DVT), venous thromboembolism (VTE), swelling, impaired sensation, thermal injury, compartment syndrome (Boyd et al., 2009;Ekwall et al., 2018), pressure injury, and infection (Szostakowski et al., 2017) are among the complications of casting and splinting. Some other complications such as joint stiffness, muscle atrophy, cartilage degradation, ligament weakening, and osteoporosis may also occur due to prolonged immobilization (Szostakowski et al., 2017). ...
... Deep vein thrombosis (DVT), venous thromboembolism (VTE), swelling, impaired sensation, thermal injury, compartment syndrome (Boyd et al., 2009;Ekwall et al., 2018), pressure injury, and infection (Szostakowski et al., 2017) are among the complications of casting and splinting. Some other complications such as joint stiffness, muscle atrophy, cartilage degradation, ligament weakening, and osteoporosis may also occur due to prolonged immobilization (Szostakowski et al., 2017). VTE may occur in 4.3-40% of patients with leg injuries who have been immobilized in a cast or splint for at least 1 week but received no prophylaxis (Mehta et al., 2014). ...
Background Casting is a common procedure in the treatment of extremity fractures, but it can lead to serious complications if applied improperly. However, there are few studies on the prevalence of cast-related complications. Purpose To assess the frequency of cast-related complications and influencing factors in patients referred to medical centers affiliated with a University of Medical Sciences. Methods A descriptive study was conducted on 120 patients with limb fractures in need of casting. The study was conducted from November 1, 2020, to June 1, 2021. A checklist was used to assess complications, and complications were monitored by regular telephone contact. Each patient was followed up for 3 months. Descriptive and inferential statistics were used to analyze the data. Results Pain, impaired mobility, numbness, swelling, and a burning sensation inside the cast were the most common complications in the first week after cast application and occurred in 94.2%, 72.5%, 60.8%, 60%, and 54.2% of patients, respectively. Patients whose casts were applied by a nurse experienced more pain (p = 0.002), numbness (p = 0.02), and swelling (p = 0.05). The incidence of numbness was significantly higher in patients who were more active during convalescence (p = 0.04). Conclusions Due to the importance of the cast-related complications, in-service training programs for casting staff are needed. Furthermore, patient education and follow-up should be taken more seriously.
... Failure to observe the principles of casting and provide cast care may predispose patients to a number of complications that can be divided into systemic such as deep venous thrombosis (DVT) or local complications affects limb where plaster cast has been applied and can be further classified into immediate and delayed complications such as severe pain, edema, compartment syndrome, tissue necrosis, pressure ulcer, and contracture (Szostakowski et al., 2017) [22] . A study in Sweden reported that 25% of patients with plaster cast experienced cast complications (Ekwall et al., 2018) [9] . ...
... Failure to observe the principles of casting and provide cast care may predispose patients to a number of complications that can be divided into systemic such as deep venous thrombosis (DVT) or local complications affects limb where plaster cast has been applied and can be further classified into immediate and delayed complications such as severe pain, edema, compartment syndrome, tissue necrosis, pressure ulcer, and contracture (Szostakowski et al., 2017) [22] . A study in Sweden reported that 25% of patients with plaster cast experienced cast complications (Ekwall et al., 2018) [9] . ...
Full-text available
Orthopedic casting is a routine procedure used for managing fractures in all age groups. Patient counseling is considered as the most valuable tool to ensure proper cast maintenance and improve patient outcomes. Aim of the study: To investigate the effect of self-care nursing instructions on reducing specific potential local complications among patients with limbs plaster cast. Research design: Quazi experimental research design (pre-posttest) was utilized. Setting: Orthopedic clinic and department of Minia university hospital, Egypt. Sample: The purposive sample technique was used to select 60 patients with a newly applied upper or lower limb plaster cast. Tools: Three tools were utilized for collecting data of this study. First tool: A structured interview questionnaire was developed and filled by the researchers to assess sociodemographic, medical data and cast patient's knowledge and practice about cast care. Second tool: Pain numerical rating Scale. The third tool: Was a Post-applied cast assessment tool used to assess the incidence of any signs and symptoms of potential local complications. Results: There was a highly statistically significant improvement of the patients' knowledge and self-care practices about cast care which consequently leads to a low incidence of specific potential cast complications among them. Conclusion: Implementation of self-care nursing instructions was effective in improving knowledge and practice about cast care as well as reflected low incidence of potential local complications among patients with limb plaster casts. Recommendations: Applying nursing interventions regarding cast care on a large sample and other different types and locations of the orthopedic cast and measuring the effect of nursing intervention on reducing both local and systemic complications. Designing and implementing an educational training program for orthopedic nurses to improve the quality of care before, during, and after casting.
... Plaster of Paris (POP) has been a well-known building material for many centuries and has been used by the Egyptians and Romans for plastering walls (Szostakowski et al., 2017). Plaster of Paris is composed of calcium sulphate and water. ...
... It is made by partially dehydrating gypsum by heating it to 120 °C. When mixed with water, it emits heat and hardens to a porous mass in 5 to 15 minutes (Szostakowski et al., 2017). Plaster of Paris can be harmful because it has impurities like silica and asbestos, which can damage the lungs and cause other health problems (Helmenstine, 2019). ...
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Construction workers are found to use Personal Protective Equipment (PPE) infrequently, although workplace accidents are common and strongly associated with safety education. In Ho, Ghana, this study examines POP installers' awareness of occupational hazards and the use of PPEs. The study's motivation and contribution are in its analysis of the perceived obstacles and driving forces behind PPE use by POP installers in the construction industry, which is yet unknown in Ghana. Between May 15 and June 30, 2022, 149 POP installers in Ho Municipality filled out a crosssectional questionnaire using a purposive sampling method, and the data were analysed using the Statistical Package for Social Science (SPSS) v.20. The outcome variables were determined using logistic regression with a 0.05 p value, the relative importance index (RII), and correlation analysis. There is a lack of awareness of knowledge, PPE use, and workplace safety among the participants. Once again, respondents cited discomfort as a reason for not wearing PPE during POP installation. Furthermore, knowledge of occupational hazards among POP workers negatively predicts PPE usage (B = 0.207, p < 0.05). The study's findings provide critical information for contractors' associations to collaborate with relevant health and safety professionals to regularly organise safety awareness training for members to increase worker knowledge and reduce risk-taking behaviour. This study is unique because it is the first to access and provides an in-depth analysis of the purported barriers and driving motivations for PPE compliance and non-compliance from the perspective of an under-researched group of construction workers in Ghana.
... In addition, in 1970 Mayan skulls were discovered with replaced teeth by nacre substitutes [4]. In the twentieth century, the plaster of Paris was known as bioceramic material due to many factors as the invention of antiseptics and using them in surgeries [1,5]. ...
... (4) Biodegradability: this property also depends on the application as quantity, but as quality, the scaffolds must have the ability to be degraded in the biological environment and fluid sooner or later to leave space for new growth [13,14]. (5) Proliferation and cell attachment: the scaffolds must be bioactive with the cells. Cell adhesion could occur and having blood from other tissues is essential [15,16]. ...
The nanocomposites (NCs) contain a hybrid matrix and reinforcing material that could improve the physicochemical and biological properties of individual compounds. Hydroxyapatite (HAP), cuprous oxide (Cu2O), and graphene oxide (GO) were prepared separately and combined to fabricate nanocomposite (NCs). The hexagonal symmetry of HAP and the cubic symmetry of Cu2O were confirmed using XRD analysis. The different scanning techniques detected HAP with nanorod shape. The length decreased from 50 to 27 nm. The maximum roughness valley depth (Rv) reached 208.4 nm. The effect of the ternary nanocomposite (TNC) against S. aureus and E. coli reached 14.1 ± 1.1 and 13.2 ± 1.2 mm, respectively. Furthermore, the cell viability towards the human cell line was around 103 ± 4%. The enhancement in antibacterial behavior and cell viability indicates the biocompatibility of the TNC to be encouraged for use in biomedical applications such as bone regeneration.
... and low cost. However, these materials are correlated to clinical complications, such as microbial activity on the dermis, with occurrence of skin irritation, deep vein thrombosis, and compartment syndrome due to the increased pressure in the region and difficulty in defining fixation points for fracture stabilization [7,8]. Thus, some advanced materials have been proposed in order to avoid these problems and ensure the customization of orthoses. ...
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Background: The occurrence of bone fractures is increasing worldwide, mainly due to the health problems that follow the aging population. The use of additive manufacturing and electrical stimulators can be applied for bioactive achievements in bone healing. However, such technologies are difficult to be transferred to medical practice. This work aims to develop an orthosis with a combined magnetic field (CFM) electrostimulator that demonstrates concepts and design aspects that facilitate its use in a real scenario. Methods: A 3D-printed orthosis made of two meshes was manufactured using PLA for outer mechanical stabilization mesh and TPU for inner fixation mesh to avoid mobilization. A CFM stimulator of reduced dimension controlled by a mobile application was coupled onto the orthosis. The design concepts were evaluated by health professionals and their resistance to chemical agents commonly used in daily activities were tested. Their thermal, chemical and electrical properties were also characterized. Results: No degradation was observed after exposure to chemical agents. The CMF achieved proper intensity (20–40 µT). The thermal analysis indicated its appropriate use for being modelled during clinical assessment. Conclusion: An orthosis with a coupled electrostimulator that works with a combined magnetic field and is controlled by mobile application was developed, and it has advantageous characteristics when compared to traditional techniques for application in real medical environments.
... However, if plaster casts are incorrectly applied or not properly taken care of by the patient, healing may be delayed and patient safety is threatened. Failure to comply with plaster casting and cast care principles can cause patients a range of immediate and delayed complications, including severe pain, edema, compartment syndrome, tissue necrosis, malunion, delayed union, nonunion, contracture, neurological problems, paralysis, and pressure sores (Adib-Hajbaghery & Mokhtari, 2018;Szostakowski et al., 2017). Orthopaedic patients, and especially those with plaster casts, are susceptible to the side effects arising from immobility. ...
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Plaster casts have been used in the treatment of fractures since 1850, and they play an important role in the healing of extremity injuries and operative repairs. Despite the high incidence of fractures and the widespread use of plaster casts in patients with fractures, the quality of counseling in patients with plaster casts has been neglected. There are few studies on the quality of this patient advisement and the nonmedical experiences of patients with plaster casts. We believe that understanding the feelings, thoughts, and experiences of patients who have had plaster casts will contribute to holistic patient care and will guide the planning of such care. The aim of this study was to describe some of the nonmedical experiences of being in a plaster cast and to illustrate these difficulties through patient quotes. This qualitative research study used a qualitative, descriptive approach guided by phenomenology to explore and describe the subjective experiences of patients with plaster casts. Participants consisted of 10 patients with lower extremity fractures, all of whom had been in a plaster cast for at least 6 weeks. Data were collected through in-depth individual interviews using semistructured questionnaires. The content analysis method was used to analyze the data. COREQ (Consolidated Criteria for Reporting Qualitative Research) was used in structuring and reporting the study. Six themes that described the experiences of patients with a plaster cast were determined in the study. These themes were the basic physiological and functional concern, self-image challenges, social roles, dependence/independence, emotions, and the experience of being in a plaster cast. We determined that many aspects of the lives of patients had been affected by being in a plaster cast and that they had experienced not only physiological issues but also psychological, social, emotional, and aesthetic issues. In addition, all the participants stated that they sought solutions to these issues by requesting support from a person or persons around them. Understanding the experiences of individuals with a plaster cast will contribute to the holistic healthcare of individuals who suffer fractures, allowing it to be more patient-centered. This understanding will also support the planning and implementation of patient-centered counseling and education.
Additive manufacturing is an advanced layer-based manufacturing process that fabricates customized prosthesis and orthosis to patient requirements directly from computer aided design data without using part depending tools. In this article, basic information on the elements, materials, and methodology of prosthesis and orthosis is described. Now a days in the rehabilitation field, the use of additive manufacturing processes has been shown to accelerate, facilitate and improve the quality of personalized products. This article discusses the AFO design and development process in detail using advanced manufacturing processes. The AFO part is printed with PLA Material in an FDM machine. It takes less than 6.5 h to manufacture a single 3D printed personal device. The entire process is completed in less than 7 h, plus the average actual working time is only 10–15 min, that is the very short amount of time it takes to create an orthosis device for a patient using 3D printing compared to traditional methods.
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Objectives: This study aims to assess, through a questionnaire, the functionality, and efficacy of using three-dimensional (3D) printed medical casts. Patients and methods: Between February 2017 and March 2019, a total of 24 patients (14 males, 10 females; mean age: 33.1±9.4 years, range, 12 to 62 years) with upper extremity fracture who were applied 3D printed medical cast were included. Patient satisfaction was evaluated using the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 (QUEST 2.0). Each item is scored on a five-point scale. Results: The mean follow-up was 14 (range, 6 to 18) months. All fractures healed within four to six weeks without any complications. In all cases, there was no loss of reduction. The total mean QUEST 2.0 satisfaction score for the participants was 4.7. The ratings on each scale ranged from 4.5 to 4.9. Conclusion: Almost all patients with upper extremity fractures were satisfied with the 3D printed medical cast. The patients found the 3D printed medical cast to be comfortable, safe, easy-to-apply, lightweight, and effective.
Flue Gas Desulfurization (FGD) is a waste incineration process commonly used to eliminate sulfur dioxide (SO 2 ) from flue gas power plants. FGD by-product recorded a rich gypsum content, also known as calcium sulfate dehydrate (CaSO 4 •2H 2 O), which has promising practical applications in plaster mould production. Plaster of Paris (POP) with a chemical composition of calcium sulfate hemihydrate (CaSO 4 •0.5H 2 O) is widely used in plaster mould production because of its quick setting and hardening upon moistened. Naturally, gypsum with 2 molecules of crystalline water can change to 1.5 molecules via the dehydration process. Various dehydration methods were conducted to transform FGD gypsum to hemihydrate. After undergoing different autoclave processes, the phase transition of FGD by-products was identified by X-ray diffraction (XRD) mode and compared with commercial POP. Chemical composition of FGD sludge contains a high amount of calcium oxide (CaO), sulfur trioxide (SO 3 ) and boron trioxide (B 2 O 3 ), as well as other impurities such as fluorine (F), chlorine (Cl), and magnesium oxide (MgO). Based on phase analysis, sample H1 to H5 show the percentage of hemihdyrate is 1.5%, 19.7%, 2.8%, 1.2%, and 46.1%, respectively, after different dehydration methods.
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Plaster of Paris (PoP) impregnated bandages have been used to maintain the position of bones and joints for over a century. Classically, wool dressing is applied to the limb before the PoP, which can then be moulded to the desired shape. A modification of this practice is to wrap the PoP bandages circumferentially in cotton before wetting and applying to the patient in an attempt to reduce inhalation of plaster dust and reduce mess. However, this may affect the water content of the cast and therefore also its setting properties and strength. This study compared the setting properties of PoP casts when used with and without cotton wrapping. Sixty specimens, compliant with the American Society for Testing and Materials standards for three-point bending tests, were prepared, with thirty wrapped in cotton. All were weighed before and after water immersion, and wrapped around a plastic cylinder to mimic limb application. Bending stiffness and yield strength was measured on a servohydraulic materials testing machine at 2, 6, 12, 24, 48 and 72 hours. The water content of cotton-wrapped plaster was significantly higher (50%) than that of standard plaster. It had significantly lower strength up to 24 hours and significantly lower stiffness up to 72 hours. The initial decrease in strength and stiffness of the cast wrapped in cotton may comprise the ability of the backslab to hold the joint or bone in an optimal position. Any modification of the standard plaster slab application technique should allow for the potential adverse effects on the plaster setting properties.
Abstract Background Most cast materials mature and harden via an exothermic reaction. Although rare, thermal injuries secondary to casting can occur. The purpose of this study was to evaluate factors that contribute to the elevated temperature beneath a cast and, more specifically, evaluate the differences of modern casting materials including fiberglass and prefabricated splints. Methods The temperature beneath various types (plaster, fiberglass, and fiberglass splints), brands, and thickness of cast material were measured after they were applied over thermometer which was on the surface of a single diameter and thickness PVC tube. A single layer of cotton stockinette with variable layers and types of cast padding were placed prior to application of the cast. Serial temperature measurements were made as the cast matured and reached peak temperature. Time to peak, duration of peak, and peak temperature were noted. Additional tests included varying the dip water temperature and assessing external insulating factors. Ambient temperature, ambient humidity and dip water freshness were controlled. Results Outcomes revealed that material type, cast thickness, and dip water temperature played key roles regarding the temperature beneath the cast. Faster setting plasters achieved peak temperature quicker and at a higher level than slower setting plasters. Thicker fiberglass and plaster casts led to greater peak temperature levels. Likewise increasing dip-water temperature led to elevated temperatures. The thickness and type of cast padding had less of an effect for all materials. With a definition of thermal injury risk of skin injury being greater than 49 degrees Celsius, we found that thick casts of extra fast setting plaster consistently approached dangerous levels (greater than 49 degrees for an extended period). Indeed a cast of extra-fast setting plaster, 20 layers thick, placed on a pillow during maturation maintained temperatures over 50 degrees of Celsius for over 20 minutes. Conclusion Clinicians should be cautious when applying thick casts with warm dip water. Fast setting plasters have increased risk of thermal injury while brand does not appear to play a significant role. Prefabricated fiberglass splints appear to be safer than circumferential casts. The greatest risk of thermal injury occurs when thick casts are allowed to mature while resting on pillow.
Acute compartment syndrome is a life and limb threatening condition. Clinical assessment is the diagnostic cornerstone of compartment syndrome but pressure monitoring also has a role in equivocal cases, in unconscious or uncooperative patients, and in patients with nerve blocks and other forms of regional and epidural anesthesia. A high degree of suspicion and early decompression of all compartments at risk are important for a satisfactory outcome.
The ability to properly apply casts and splints is a technical skill easily mastered with practice and an understanding of basic principles. The initial approach to casting and splinting requires a thorough assessment of the injured extremity for proper diagnosis. Once the need for immobilization is ascertained, casting and splinting start with application of stockinette, followed by padding. Splinting involves subsequent application of a noncircumferential support held in place by an elastic bandage. Splints are faster and easier to apply; allow for the natural swelling that occurs during the acute inflammatory phase of an injury; are easily removed for inspection of the injury site; and are often the preferred tool for immobilization in the acute care setting. Disadvantages of splinting include lack of patient compliance and increased motion at the injury site. Casting involves circumferential application of plaster or fiberglass. As such, casts provide superior immobilization, but they are more technically difficult to apply and less forgiving during the acute inflammatory stage; they also carry a higher risk of complications. Compartment syndrome, thermal injuries, pressure sores, skin infection and dermatitis, and joint stiffness are possible complications of splinting and casting. Patient education regarding swelling, signs of vascular compromise, and recommendations for follow-up is crucial after cast or splint application.
Because the compartmental syndrome occurs under such a wide variety of circumstances and because early diagnosis is vital, it is essential that all physicians be familiar with this condition. Results of relatively simple clinical tests permit the diagnosis in most instances. Ancillary diagnostic techniques may prove helpful in questionable instances. Prompt, complete decompression of the affected compartments can preserve function and minimize complications.
A compartmental syndrome is defined as a condition in which increased pressure within a space compromises the circulation to the contents of that space. Any cause of increased intracompartmental pressure may result in a compartmental syndrome. The diagnosis should be suspected in any case of pain or neuromuscular deficit in an extremity and may be confirmed by signs of circulatory disturbance of nerve and muscle in association with increased pressure in the compartment. Generous opening of any dressings covering the extremity permits a proper examination and rules out a compartmental syndrome caused by the dressing itself. Immediate decompression is indicated in all cases of compartmental syndrome unless the risk of complications exceeds the possible gains from improvement in circulation. Elevation of an extremity afflicted with a compartmental syndrome is contraindicated. Myoglobinuria and renal failure may complicate severe cases.
There is no question that Baron Larrey was the first modern military surgeon. The high morale of Napolean's troops, which contributed to the success of his armies, was in a major way dependent on Larrey's superb medical care of the wounded. It was Napoleon's brilliance to recognize this and to give Larrey free rein. Beginning in the Civil War, when ambulances first brought in the wounded to receive surgical care at the Battle of Antietam (1862), down to World War II and the Vietnam War, his principles were increasingly followed by the U.S. Army Medical Corps. In Vietnam a true "flying ambulance," the medical helicopter, was obviously the final perfection of Larrey's ambulance volante. Perhaps his dedicated humanism in the care of the wounded soldier was his best characteristic and the one that should be followed most carefully today. Even in this era of great ethical concerns for the sick and wounded, Larrey's principles set the highest of standards for all.