Application of Short Leg, Patellar Tendon Bearing, or Rigid Total Contact Leg Casts

What is Application of Short Leg, Patellar Tendon Bearing, or Rigid Total Contact Leg Casts: Overview, Benefits, and Expected Results

Definition & Overview

The application of casts is a key part of treatment for broken bones or fractures. Casts help promote proper bone healing during the recovery period. They work by keeping the injured part of the body straight and without motion. Casts come in different types, such as short leg casts, patellar tendon bearing casts, and rigid total contact leg cast, among others. To prevent potential complications, casts should be worn only for the correct amount of time, which depends on the severity of the injury.

Who Should Undergo and Expected Results

The application of short leg, patellar tendon bearing, and rigid total contact leg casts is helpful for patients recovering from musculoskeletal conditions, such as:

• Fractures
• Sprains
• Reduced joint dislocations
• Severe soft tissue injuries

They can be used on almost any body part, including the arms, legs, elbows, ankles, and even the fingers.

Casts keep bones from moving while they are healing and support the injured limb during the recovery period. They also stabilize reduced, displaced, or unstable fractures before the patient seek further treatment.

Using casts offers the following benefits:

• Promote proper healing
• Keep the injured limb from unnecessary stress
• Shorten the patient’s recovery time
• Help reduce pain and swelling

Casts are made of either plaster of Paris or fiberglass. Fiberglass is a type of mouldable plastic used to make cooler and more lightweight casts than the traditionally used plaster casts.

Casts come in many different types, including:

• Short leg casts. These are appropriate for patients who suffer from lower leg, ankle, and foot injuries, such as non-displaced metatarsal or fibular fractures. The cast is applied at the metatarsal heads until 2 inches away from the fibular head. The bony parts, such as the fibular head and malleoli, are covered with additional padding. If it is the ankle, it is flexed to a neutral 90-degree position.
• Patellar tendon bearing casts. Patellar tendon bearing casts are below-knee total contact casts first developed in 1967. They are appropriate for injuries affecting the patellar and its soft tissues, such as patellar fracture, patellar dislocation, and patellar tendon rupture. They are modified versions of the short leg cast. The top of the cast has a wing-like addition that supports the knee’s medial and lateral side. The back of the cast is then cut in the back to allow the leg to flex at the crease of the patellar. These modifications were made to allow the knee to move but to keep it from rotating and worsening the injury. This cast is used by patients who are ready to begin bearing weight. It is usually worn after coming out of a long leg cast.
• Rigid total contact leg casts. A total contact cast is the primary type of cast used for diabetic patients who suffer from foot ulcers. For diabetic patients, it is important to keep the pressure on the foot ulcer low. Studies show that a rigid total contact cast put the lowest peak plantar pressure in ambulatory patients. These casts are ideal for diabetic patients with foot ulcers as long as the patient:

1. Is not infected
2. Has sufficient arterial flow
3. Does not have pain or significant oedema
4. Has a stable gait
5. Does not have safety hazards and compliance issues
6. Has Wagner 1 or 2 ulcers

Patients who have an active infection or compromised arterial flow are reconsidered for a total contact cast only if they have received treatment for the infection or have undergone vascular surgery.

The selection of the right cast to use depends on the following factors:

• The body part being treated
• The type of injury
• The extent of the injury
• The stability of the injury

How is the Procedure Performed?

Doctors generally follow the same steps during the application of different casts, which include short leg, patellar tendon bearing, and rigid total contact leg casts.

• The doctor first wraps the injured area with several layers of soft cotton or, in the case of a total contact cast, foam dressing. This makes up the inner layer of the cast. Sometimes, patients are also given a stockinette or a strip of felt.
• The outer layer of the cast, which is made from plaster of Paris or fibreglass, is soaked in water.
• The material is then wrapped around the injured area and the inner layer of the cast. It normally feels wet at first, but the cast will quickly harden.
• The cast is trimmed to the right size.
• Doctors may make tiny cuts on the sides of the cast to accommodate any swelling.
• A rubber or plywood walking heel is attached to the bottom of the patient’s foot.
• After the cast is applied, patients are not allowed to bear any weight for around 15 minutes or until the cast is cool and hard.

Some special considerations are depending on the type of cast being used. For the patellar tendon bearing cast, it should be applied in segments and over minimal padding. During the application, the patient is asked to flex the knee to a right angle. The doctor then molds the cast over the upper calf. This creates a triangular cross-section. The cast is then molded around the patella with a special indentation around the tendon.

For the application of a rigid total contact leg cast, the patient should be in a prone position, and the leg should be flexed at the knee. The foot should also be in a neutral position with the ankle.

Patients are given instructions on the care of the cast before being discharged.

Possible Risks and Complications

Patients who have a short leg, patellar tendon bearing, or rigid total contact leg cast placed are prone to the following symptoms or complications:

• Chronic pain
• Joint stiffness
• Muscle atrophy
• Heat injury
• Pressure sores
• Skin breakdown
• Infection
• Dermatitis
• Complex regional pain syndrome

To avoid such complications, the casts are only worn for a limited amount of time. Patients are also carefully monitored.

References:

• Boyd AS, Benjamin HJ, Asplund C. “Splints and casts: Indications and methods.” Am Fam Physician. 2009 Sep 1;80(5): 491-499. http://www.aafp.org/afp/2009/0901/p491.html
• H. Svend-Hansen, V. Bremerskov & P. Ostri (1979) Fracture-Suspending Effect of the Patellar-Tendon-Bearing Cast, Acta Orthopaedica Scandinavica, 50:2, 237-239, DOI: 10.3109/17453677908989761

/trp_language]

**Question: ⁣What are the different types of⁣ leg‍ casts and their applications?**



**Answer:** There are various types​ of leg casts used for different purposes, ⁤including:



* **Short Leg Cast:**



⁣ * **Application:** Covers from below⁣ the knee to the ‍toes.

‌⁣ * **Purpose:** Immobilizes the‍ ankle, foot, or toes for injuries like sprains, fractures, or post-surgical recovery.



* **Patellar Tendon Bearing⁣ Cast:**



* **Application:** Extends from the top ⁢of the thigh to the‍ toes, with a cutout for the patella (kneecap).

* ⁤**Purpose:** Supports and immobilizes the entire leg, the patella takes⁣ most of the weight,⁤ allowing walking. Used for fractures or ligament injuries of‌ the knee⁣ or leg.



* **Rigid Total Contact Leg Cast:**



* **Application:** Encases the entire leg⁤ from the hip to the ⁢toes, with a foam or felt liner for ⁤cushioning.

* **Purpose:** Provides complete immobilization and support for complex fractures, severe injuries, or post-operative care. Requires non-weight bearing on the⁤ affected leg.



**Question: What are the advantages and disadvantages of each type of cast?**



**Answer:**



**Short Leg Cast:**



* **Advantages:**

⁢ * Shorter, ​less​ cumbersome

⁤ * Allows some ⁢mobility

* **Disadvantages:**

⁢ * Limited‍ immobilization of the knee



**Patellar Tendon Bearing Cast:**



* **Advantages:**

​ * Allows walking with support

* Immobilizes the knee

* **Disadvantages:**

* Can be bulky and heavy

* May‍ not be suitable ⁣for severe injuries



**Rigid Total Contact Leg Cast:**



* **Advantages:**

* Excellent⁣ immobilization and support

⁤ * Can‌ prevent complications

* **Disadvantages:**

⁤ * Requires non-weight bearing

* Can be challenging to manage



**Question: Which⁣ factors should be considered when choosing the appropriate leg cast?**



**Answer:**



Choosing⁤ the right cast depends on several factors, including:



* **Type and severity of the injury**

* **Patient’s ⁤age and mobility**

* ‍**Desired level of⁢ immobilization**

* **Expected duration of use**

* **Patient’s comfort and preferences**



**Question: What are the key considerations ‌for⁣ proper cast care and maintenance?**



**Answer:**



*⁣ Keep the cast dry ‌and​ protected from moisture.

* Elevate the casted ‌leg to reduce swelling.

* Apply ice packs to reduce pain and inflammation.

* Inspect the cast regularly for any signs of damage or discomfort.

* Keep the skin around the cast clean and dry.

* Follow the doctor’s instructions for ​cast maintenance and removal.



**Additional Keywords:**



* Below-knee cast

* Above-knee cast

* Non-weight bearing cast

* Plaster⁣ cast

* ​Fiberglass cast