Fracture Care and Casting
for Primary Care Physicians
Matt Leiszler, MD
Stephanie Chu, DO
Jack Spittler, MD
University of Colorado Sports Medicine
Goal
Provide an intro to fracture management and
casting for family physicians
Objectives
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Identify common fractures in Primary Care
Proper use of a splint versus a cast
Identify commonly used casting materials and
when to use them
Demonstrate proper cast application and
removal
Describe appropriate patient education with
regards to casting
Introduction
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Orthopedic
problems are over
10% of all primary
care visits
1.6% of all visits to
any physician are
fracture related
16% of all fracture
care is handled by
family physicians
Fractures seen by FPs
Fracture
Finger
Metacarpal
Radius
Toe
Fibula
Metatarsal
Clavicle
Eiff
17%
16
14
9
7
6
5
Hatch
18%
7
10
9
7
5
6
Alcoff
12%
5
16
1
7
4
7
Fractures seen by FPs
4th digit distal
phalanx fracture
4th and 5th
metacarpal
fracture
Distal radius fracture
Fractures seen by FPs
Other Fractures:
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Radius and ulna
Carpal
Ulna
Humerus
Tibia
Tarsal
Casting and
Splinting
Overview
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Mainstay of treatment for most fractures
Joint above and a joint below
Avoid pressure points
– Excessive molding
– Cast indentations

Appropriate padding
– More at bony prominence
– Not too much at fracture site

Consider skin wounds
Splinting
Splinting
Purpose
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Reduce pain
Reduce bleeding and swelling
Prevent further soft tissue damage
Prevent vascular constriction
What to splint
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Fracture
Dislocation
Tendon rupture
Specific splints
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Forearm and wrist
– Ulnar gutter
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Metacarpal
– Thumb spica
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Scaphoid
Ankle
– Posterior splint
– “L and U” or
Sugartong
Casting
Jones Fracture
Supplies
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Stockinette
Padding material
Cast material
– Plaster: cheaper, long shelf life, easier to
work with
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May be fragile, disintegrate in water
– Fiberglass: more durable, lighter, dry quicker,
multiple colors, water tolerant
– Newer synthetic materials
Procedure
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Apply stockinette
– Protect skin and provide smooth edge
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Apply padding
– Protect bony prominence
– Allows for swelling
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Wet the casting material
– Hot water hardens faster
– Squeeze out excess water
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Apply splint or cast
Patient Education
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Keep injured limb elevated and iced
Warning signs
– Numb extremity
– Inability to move extremity
– Discoloration, Cold
– Increased pain
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Avoid getting wet
– Completely with plaster
– May use hair dryer on cool setting if fiberglass
Patient Education
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Keep cast clean
Do not stick objects into cast
Do not pull out the padding
Watch for skin irritation
Do not modify your cast
Watch for cracking and breaking of
cast
Cast Removal
Cast saw
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Vibrates, doesn’t rotate
Biggest concern is burn
Take Home Points
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You will see fractures
Know your comfort level and when to
refer
Splint acutely and with active swelling
Variety of materials
– Know what you have, be comfortable
with it
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Educate your patients
Recommended Resources
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Eiff MP, et al. Fracture management for Primary Care, 2nd
edition. Saunders. 2003.
Honsik K, et al. Sideline splinting, bracing and casting of
extremity injuries. Current sports Medicine Reports.
2003;2:147-154.
Meredith RM, et al. Field splinting of suspected fractures:
preparation, assessment, and application. The Phys and
Sports Med. 1997;25(10).