Lesson 1Balancing stability, function and complication risk: how to trade immobilization rigidity for early mobilityExplains how to balance rigidity and early motion, using functional bracing, cast windows, and staged immobilization to reduce stiffness, thrombosis, and muscle loss while preserving fracture stability and patient safety.
Risks of over-immobilization and stiffnessWhen to allow early joint motionFunctional bracing and removable devicesStaged cast modification and wedgingMonitoring for instability during mobilizationLesson 2Duration of immobilization: evidence-based timelines for paediatric distal radius, adult ankle fractures, vertebral compression fracturesSummarises evidence-based immobilization durations for common fractures, focusing on paediatric distal radius, adult ankle, and vertebral compression fractures, and discusses modifying timelines based on healing, imaging, pain, and functional recovery.
Bone healing phases and timelinesPediatric distal radius immobilizationAdult ankle fracture immobilizationVertebral compression fracture bracingCriteria for safe cast or brace removalLesson 3Documentation and informed consent specifics for immobilization choicesDetails how to document immobilization plans, explain options, and obtain informed consent, emphasizing shared decision-making, risk disclosure, medico-legal protection, and clear communication tailored to patient literacy and cultural context.
Essential elements of cast documentationRecording clinical indications and goalsExplaining risks, benefits, and alternativesDocumenting patient questions and teachingLegal and ethical aspects of consentLesson 4Selection criteria: fracture pattern, patient age, soft-tissue status, comorbidities (osteoporosis, neuropathy)Defines how fracture pattern, age, soft-tissue status, and comorbidities such as osteoporosis and neuropathy guide selection of cast type, splint, or brace, emphasizing individualised, risk-adjusted immobilization strategies.
Classifying fracture patterns for planningAge-related healing and immobilization needsSoft-tissue swelling and skin conditionImpact of osteoporosis on construct choiceNeuropathy and sensory risk managementLesson 5Properties of casting materials: plaster of Paris, fiberglass, thermoplastics, padding materials, waterproof linersReviews physical and handling properties of plaster, fiberglass, and thermoplastics, plus padding and waterproof liners, highlighting setting times, strength, radiolucency, weight, contouring ability, and implications for patient comfort and skin safety.
Plaster of Paris: setting and strengthFiberglass: advantages and limitationsThermoplastics and custom splintsPadding types and pressure protectionWaterproof liners: use and caveatsLesson 6Joint positioning and functional alignment: acceptable angulation/rotation for distal radius, ankle, and spine fracturesCovers functional joint positioning for distal radius, ankle, and spine fractures, including acceptable angulation and rotation, and how alignment choices affect function, pain, long-term deformity, and risk of post-traumatic arthritis.
Functional position of the hand and wristAcceptable distal radius angulation and tiltAnkle neutral alignment and rotation limitsSpinal alignment in compression fracturesConsequences of malalignment on functionLesson 7Cost, availability, and resource-limited alternatives for casting materials and removable devicesAnalyses cost and availability of casting supplies and removable devices, with strategies for choosing affordable, safe options in resource-limited settings, including reuse policies, local fabrication, and prioritisation of high-value materials.
Cost drivers in casting materialsChoosing between cast and removable braceLow-cost splinting and casting optionsReuse, recycling, and safety limitsTriage of premium materials in scarcityLesson 8Infection control and sterile technique considerations when skin integrity compromisedOutlines infection control when skin is compromised, including pre-cast wound care, sterile technique, dressing selection, cast windows, and follow-up checks to detect odour, drainage, or necrosis beneath immobilization.
Assessing wounds before immobilizationSterile technique for open injuriesChoosing dressings under casts or splintsCast windows and wound inspection plansWarning signs of infection under a castLesson 9Biomechanics of fracture stabilization: loads, splints vs circumferential casts, role of moldingExplores how forces act on fractures, comparing splints and circumferential casts, and explains how three-point molding, interosseous pressure, and cast index influence reduction maintenance and prevention of displacement under load.
Types of mechanical loads on fracturesSplints versus circumferential castsPrinciples of three-point moldingCast index and sagittal-coronal balanceAvoiding loss of reduction under load
