Ramalingam Wendy, Lamer Stéphanie
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
J Pediatr Soc North Am. 2025 Jul 3;12:100236. doi: 10.1016/j.jposna.2025.100236. eCollection 2025 Aug.
This chapter will focus on lower extremity casting. Casting is widely recognized as the best treatment for many pediatric lower extremity fractures, unlike those in adults. Due to children's remodeling potential, the displacement threshold for surgery is often higher than that for skeletally mature patients, and immobilization in a cast with proper molding may be the only treatment needed.Lower extremity casts can be used to maintain the alignment of nondisplaced fractures. They are also utilized after closed reduction of a fracture, with appropriate molding to prevent any further displacement. Additionally, casts can provide protection and reinforcement following surgical fixation of lower extremity fractures.Proper casting technique is essential to prevent complications and ensure adequate fracture alignment. Cast treatment is not without risks and should not be considered benign. While it is less invasive than surgery, complications can arise after casting, some of which can be severe, such as compartment syndrome, burns, and significant pressure sores.In this chapter, 4 techniques for casting the lower extremities will be demonstrated: 1. Short leg cast 2. Long leg cast 3. Cylinder cast 4. Patellar tendon-bearing cast.
(1)Mastering casting techniques is crucial to avoiding significant complications.(2)A short leg cast can be used for lower leg and foot fractures.(3)Long leg casts are used to control rotational instability and manage distal femur, patella, and proximal tibia fractures.(4)Any patient's complaint of increased pain with a cast should be taken seriously and investigated.
本章将重点介绍下肢石膏固定。与成人下肢骨折不同,石膏固定被广泛认为是治疗许多儿童下肢骨折的最佳方法。由于儿童具有重塑潜力,手术的移位阈值通常高于骨骼成熟的患者,通过适当塑形的石膏固定可能是唯一所需的治疗方法。下肢石膏可用于维持无移位骨折的对线。在骨折闭合复位后也会使用,通过适当塑形以防止进一步移位。此外,在下肢骨折手术固定后,石膏可提供保护和加固作用。正确的石膏固定技术对于预防并发症和确保骨折充分对线至关重要。石膏治疗并非没有风险,不应被视为无害。虽然它比手术侵入性小,但石膏固定后可能会出现并发症,其中一些可能很严重,如骨筋膜室综合征、烧伤和严重压疮。在本章中,将演示4种下 肢石膏固定技术:1. 短腿石膏 2. 长腿石膏 3. 管型石膏 4. 髌腱承重石膏。
(1)掌握石膏固定技术对于避免严重并发症至关重要。(2)短腿石膏可用于小腿和足部骨折。(3)长腿石膏用于控制旋转不稳定并处理股骨远端、髌骨和胫骨近端骨折。(4)任何患者对石膏固定后疼痛加剧的主诉都应认真对待并进行调查。