While plaster of Paris is in no way harmful to either garments or
surroundings, both the operator and the assistants should be properly
gowned and the floor covered with newspapers to prevent unnecessary
soiling. It should be borne in mind that if a properly made bandage is
used, which is squeezed to the extent of ridding it of an excess of
water, very few drippings will be scattered and the whole procedure of
the application of the plaster differs in no way from simple roller
bandaging.
The number of bandages intended for use should be taken from the
container and placed in a pan near the pail holding the water, in
which they are to be immersed, in a position in relation to the pail
that will guard against water being splashed upon the dry bandages,
which would render them unfit for subsequent use. Water as hot as the
hand will tolerate, as opposed to cold, facilitates setting. I do not
recommend any chemicals to hasten setting, because a properly made
bandage, prepared as above, of quick setting plaster sets in remarkably
fast time.
The area to be cast should be encased in ordinary absorbent cotton of
the thickness in which it comes rolled, putting an extra pad over all
marked bony prominences, and a roller gauze bandage applied to hold
it in place and snug to the part. Under no consideration do I advise
the use of flannel bandage or the ordinary sheet wadding cotton that
are recommended by some authors, because padding with these materials
is always conducive to applying a cast far too tightly, especially
in fractures where the swelling increases after application thereby
causing constriction of the limb and interference with circulation. The
regular absorbent cotton as padding beneath a cast is always best for
it is almost impossible to apply a cast too tightly when it is used.
The bandage should be completely submerged on its side, and should
remain so until the bubbles cease to come off, which time takes place
most readily in the properly rolled dressing. When the bubbling has
ceased, the bandage is lifted out of the pail and squeezed with the
hands merely to free it of the excessive water, the end is found and
handed to the operator ready to apply. No undue traction should be
made in applying the successive turns of the bandage, though it must
be remembered the cast should fit snugly to the part, and the ordinary
rules of simple roller bandaging followed, except that the reverse
spirals are unnecessary. The assistant should constantly rub the layers
as they are applied by the operator, as this not only helps the cast to
fit more snugly, but also makes the rough edges of the bandage adhere
more firmly to the layer beneath, thereby making a smoother cast.
As a rule there need be no dread of an increased swelling beneath the
bandage because usually several hours have elapsed after the injury
before the physician has arrived and made preparations to apply the
plaster. Indeed, one of the best means of limiting swelling after a
fracture is the prompt application of a plaster of Paris bandage. If
there is any concern that the cast is too tight, while the plaster is
still soft it can be easily cut through the entire length with a knife,
and thus relieve the pressure existing. Also it is a good plan to cut a
window or opening over the sight of injury, which would in no way harm
the object of the cast and would allow a gentle massage to the part. A
neat finish may be given to the edges of a plaster cast by turning over
the ends of the cotton, in cuff-like fashion and held in the grasp of
the last few turns of the plaster at either end.
On clothing you will find it best to allow the plaster to dry before
removing, while on furniture or the hands it is readily removed by
washing off in warm water. The water in which the bandages were
immersed contains, of course, considerable plaster, and under no
circumstances should this be emptied into a sink or waste pipe for
it will certainly demand the services of a plumber. The water may be
poured out on the ground and the paste shaken into a refuse barrel or
ash pile. The best way to remove a cast is to moisten it with water or
vinegar along the path of the knife. I might add that all patients are
in constant fear of being cut either while you are trimming, cutting
windows, or removing the cast, but because of the cotton padding
underneath you will find that it is almost an impossibility. Care, of
course, should be taken that the knife does not slip in any of these
procedures and come in contact with the unprotected parts.
In general, for fractures of the extremities it is best to apply the
plaster with the patient in the recumbent position to secure complete
muscular relaxation, and the part to be cast should be supported by an
assistant. It is also a general rule that in fractures of the shaft
of the long bones, especially of the lower extremities, the plaster
bandage should be applied to include the adjacent articulation and
extend well beyond the joints.