Plaster, Fibreglass and Splints

Previously on LITFL I’ve sourced the help of Simon Green, plaster nurse supremo from the Children’s hospital in Perth to show us how to do paediatric splints and boots as well as Spaso Miljesic. Spaso finally agreed to show the world how to do his shoulder reduction technique properly and his take on plaster splints based from his practise in Melbourne.

Today we expand the plaster library further with Dan Smith who works in Vancouver and their practise is different in that they prefer full plaster casts. Interestingly I’ve never seen one patient come back to have them split but that maybe because he gives a 10 minute lecture on elevating the limb and also does not use any additional wraps that he states constricts the cast. Dan kindly agreed to show me his technique for plaster, fibreglass and how to put on a Thomas splint properly.

Thomas Splint

  • Femur fractures
Thomas Splint

Aircast / moon boot application

  • Weber A and occasionally stable weber B fractures (distal fibular fractures)
  • Metatarsal fractures
Aircast Application Video

Below Knee Backslab

  • Multiple metatarsal fractures
  • Base of 5th fractures that are not avulsion fractures
  • Weber A+B ankle fractures
  • Bi / Tri-malleolar fractures
  • Calcaneal, Tarsal, cuboid, cuneiform fractures
Below Knee Plaster Application Video
Below knee Fibreglass application video

Above Elbow Fibreglass and sling

  • Supracondylar Fractures
Above Elbow Fibreglass Application Video
Sling application video

Thumb Spica

  • 1st Metacarpal fracture
  • Scaphoid fracture (in some shops)
Thumb Spica Application Video
Thumb Spica Application Video (Fibreglass)

Below Elbow Cast / Colles / Smith fracture

  • Scaphoid fracture (in some centres)
  • Buckle fracture involving the volar surface
  • Distal radius fracture (Colles and Smith)
Below Elbow Plaster Application Video
Below Elbow Plaster Application Video (Fibreglass)

Cast Removal, Bi-valve, cleaning and Critique

  • Changing casts
  • Bi-valve for pain or flights
  • Cleaning off fibreglass
  • Dan gets mad at a poorly placed fibreglass casts
Removing an above elbow cast
Removing and below knee cast
How to bi-valve a cast
Cleaning up the patient
What we get wrong with fibreglass

Additional Resources
Vimeo showcase
Further reading

Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Kelowna hospital, British Columbia. Loves the misery of alpine climbing and working in austere environments (namely tertiary trauma centres). Supporter of FOAMed, lifelong education and trying to find that elusive peak performance.

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