Liu David S, Bauer Andrea S
Harvard Medical School, Boston Children's Hospital, Boston, MA, USA.
J Pediatr Soc North Am. 2025 Jul 3;12:100240. doi: 10.1016/j.jposna.2025.100240. eCollection 2025 Aug.
This chapter aims to provide a comprehensive review of the techniques and challenges associated with applying upper extremity casts in pediatric patients. The chapter, along with its accompanying figures and video clips, serves as an introductory guide to pediatric orthopaedic cast application for trainees. Generally, casts are used to preserve appropriate alignment rather than to create improved alignment. In cases of nondisplaced fractures or those with acceptable alignment, the role of the cast is to maintain that alignment until healing occurs. For fractures with unacceptable alignment, reducing them to an acceptable position is necessary while the cast is utilized to maintain proper alignment. For challenging fractures that are difficult to keep aligned, have displaced intraarticular components, or are length-unstable, surgical intervention is recommended, followed by casting for immobilization after surgery. This chapter reviews the indications, application, techniques, and pitfalls of short arm, thumb spica, mitten, ulnar gutter, long arm, and hanging arm casts.
(1)The cast index is a valuable measure that impacts the rates of loss of reduction in distal radius fractures.(2)Molds are important not only for maintaining fracture reduction but also for keeping the cast in position and preventing slippage.(3)Along with using a cast saw to split fiberglass casts, a cast splitter should be employed to ensure proper bivalving.
本章旨在全面回顾与小儿患者上肢石膏应用相关的技术和挑战。本章及其附带的图表和视频片段，为实习医生提供了小儿骨科石膏应用的入门指南。一般来说，石膏用于保持适当的对线，而非改善对线。在无移位骨折或对线可接受的骨折病例中，石膏的作用是在骨折愈合前维持对线。对于对线不可接受的骨折，在使用石膏维持正确对线的同时，有必要将其复位至可接受的位置。对于难以保持对线、有关节内移位成分或长度不稳定的复杂骨折，建议进行手术干预，术后再使用石膏固定。本章回顾了短臂石膏、拇指人字形石膏、连指手套形石膏、尺侧沟形石膏、长臂石膏和悬垂臂石膏的适应证、应用、技术及陷阱。
（1）石膏指数是一项重要指标，会影响桡骨远端骨折的复位丢失率。（2）模具不仅对维持骨折复位很重要，对保持石膏位置和防止移位也很重要。（3）除了使用石膏锯分割玻璃纤维石膏外，还应使用石膏分离器以确保正确的二分法。
