Ayzenberg Mark, Narvaez Michael, Raphael James
Einstein Medical Center, Philadelphia, PA, USA.
Orthop Rev (Pavia). 2018 Mar 29;10(1):7314. doi: 10.4081/or.2018.7314.
Casting is routinely used for acute and post-operative immobilization and remains a cornerstone in the non-operative management of fractures and deformities. The application of a properly fitted and wellmolded cast, especially for a trainee, can be challenging. We present a simple method of prolonging cure time of fiberglass cast - placing ice in the dip water. Eight-ply, fiveinch fiberglass cast was circumferentially applied to an aluminum-wrapped cardboard cylinder. An electronic, 2-channel temperature sensor (TR-71wf Temp Logger, T&D Corporation, Matsumoto, Japan), accurate to 0.1ºC and accurate to ±0.3ºC, was placed between the fourth and fifth layers of fiberglass. Thirty total casts were tested using 9±1ºC (cold), 22±1ºC (ambient), and 36±1ºC (warm) dip water. Room temperature was maintained at 24±1ºC. Cast temperatures were measured during the exothermic reaction generated by the cast curing. Peak temperatures and cure times were recorded. Cure time was defined as the point of downward deflection on the timetemperature curve immediately after peak. Cure and peak temperatures were compared among groups using analysis of variance. Mean cure time was 3.5±0.1 minutes for warm water, 5.0±0.4 minutes for ambient water and 7.0±0.5 minutes for cold water. Peak temperature, measured between layers 4 and 5 of the cast material, was 36.6±0.8ºC for warm water, 31.1±1.4ºC for ambient water and 25.2±0.5ºC for cold water. Cold afforded, on average, an additional 2 minutes (40% increase) in cure time compared to ambient water and an additional 3.5 minutes (100% increase) compared to warm water. Cure time differences were significant (P<0.001) for all groups, as were peak temperature differences (P<0.001). Temperatures concerning for development of burns were never reached. Utilizing iced dip water when casting is a simple and effective method to prolong the time available for cast application. Orthopedic residents and trainees may find this useful in learning to fabricate a high quality cast. For the experienced orthopedic surgeon, this method eliminates the need to bridge longlimb casts and facilitates the application of complex casts.
石膏固定常用于急性损伤和术后制动,至今仍是骨折与畸形非手术治疗的基石。然而,正确地应用并塑形石膏,对于新手而言颇具挑战。我们介绍一种简单的方法——在浸液中加入冰块,来延长玻璃纤维石膏的固化时间。将八层、五英寸的玻璃纤维石膏环绕包裹在铝箔纸包裹的硬纸板圆筒上。在玻璃纤维的第四层和第五层之间放置一个精度为0.1ºC、误差为±0.3ºC的电子双通道温度传感器(TR - 71wf温度记录仪,日本松本市的T&D公司)。总共测试了30个石膏,浸液温度分别为9±1ºC(冷)、22±1ºC(常温)和36±1ºC(热)。室温保持在24±1ºC。在石膏固化产生的放热反应过程中测量石膏温度,记录峰值温度和固化时间。固化时间定义为温度 - 时间曲线上峰值后立即向下偏转的点。使用方差分析比较各组的固化温度和峰值温度。热水组的平均固化时间为3.5±0.1分钟,常温组为5.0±0.4分钟,冷水组为7.0±0.5分钟。在石膏材料的第四层和第五层之间测量的峰值温度,热水组为36.6±0.8ºC,常温组为31.1±1.4ºC,冷水组为25.2±0.5ºC。与常温浸液相比,冷水平均使固化时间延长2分钟(增加40%);与热水浸液相比,延长3.5分钟(增加100%)。所有组的固化时间差异显著(P<0.001),峰值温度差异也显著(P<0.001)。从未达到可能导致烧伤的温度。在打石膏时使用冰浸液是延长石膏应用时间的一种简单有效的方法。骨科住院医师和实习生可能会发现这对学习制作高质量石膏很有用。对于经验丰富的骨科医生来说,这种方法无需连接长腿石膏,便于应用复杂的石膏。