Plasters in the ED

BACKGROUND Poor plaster application technique thereby leading to the loss of reduction in a plaster cast has been considered to be the most important causative factor in delayed fracture healing. Anecdotally, there is an impression that plasters applied in the emergency department are relatively poor in quality and often need to be revised. There are no reliable and validated objective radiological measurements to differentiate a well-applied plaster cast from a poorly padded and moulded cast. The Cast Index and Padding Index has been proposed with a combination of the two termed the Canterbury Index but are rarely used. The quality of plasters in the clinical setting continues to be judged by subjective clinician opinion. AIM The aim of this study was to identify the quality of plasters applied in the ED. METHODS Study design: Literature review: We will review the literature on quality of plasters and methods to evaluate quality. Prospective observational study: Using a convenience sample, we will recruit patients and follow up in fracture clinic over a 8-week period. Patients: Any patients who had a circumferential plaster or splint applied in the ED and had a planned follow up in the fracture clinic would be included. Informed consent to be obtained from patient in ED. Data: Type of fracture, plaster cast and clinician details will be collected in ED. Orthopaedic opinion of the plaster together with data on the principles of plaster immobilization will be collected in pre-determined abstraction forms. ANALYSIS AND FOLLOW-UP Data will be analysed for common, reversible deficiencies in the practice of plaster application in the ED. Following analysis, education of ED personnel on plaster application will be repeated with emphasis on pitfalls identified in Phase 1. In Phase 2 (Optional for BMedSc), the methodology of Phase 1 will be repeated to identify any improvements in plaster application.