AAHS Annual Meeting
Back to main AAHS site
Annual Meeting Home
Past & Future Meetings


Back to Annual Meeting Abstracts


Skin Surface Pressures under Short Arm Casts
Christian J. Zaino, MD; Melissa S. Arief, MD, MHS; Mukund R. Patel, MD
Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY

Introduction:

  • Closed reduction and three-point casting is used to treat some distal radius fractures; however, post-traumatic edema within a cast may cause pressure-related complications: compartment syndrome, Volkmann's contracture, pressure necrosis of the skin, and complex regional pain syndrome.
  • Significant reductions in pressure can take upwards of three weeks and some patients may develop secondary peaks in pressure shortly after cast application.
  • Only five articles analyze pressure under short arm casts (SACs); none evaluate the effect of cast cutting.
  • No published work evaluates the pressure generated by ace wrapping a bivalved cast.
  • We studied the skin surface pressures under a fiberglass SAC with simulated swelling, cast cutting and ace wrapping.

Materials and Methods:

  • Skin surface pressures were measured on 20 wrists from 10 healthy volunteers (4 male, 6 female, average age 31yrs and range 23-45yrs).
  • An empty 50mL drip bag, placed on the dorsum of a volunteer's wrist with exposed outlet and inlet valves, was incorporated into a SAC.
  • The wrist was casted in neutral position with one 2-inch webril and one 2-inch fiberglass, applied with a stretch-relax technique using room-temperature water.
  • ADinstruments MLT844 Physiological Pressure Transducer was attached to the outlet valve for pressure measurements. A 50cc syringe, with stopcock, was attached to the inlet valve to infuse air for the simulated swelling.
  • Pressures were recorded under six conditions: webril alone (with 10mL of infused air), SAC (10mL), SAC (50mL), ulnar-sided univalve cut (50mL), radial-sided bivalve cut (50mL), and ace wrap with 50% overlap and standard stretching (50mL).

Results:

  • Cast pressure peaked at 93.1mmHg with 50mL of infused air.
  • Univalve pressure decreased by 48.8% (P<0.0001) to 47.7mmHg.
  • Bivavling reduced pressure by an additional 19.5% (P<0.0032), for a total of 68.3% reduction, to 29.5mmHg.
  • Ace wrapping increased pressure by 72.2% (P<0.0333) to 40.9mmHg.

Discussion:

  • Univalved pressure was less than pressure to occlude skin microcirculation (60-75mmHg); but, within the range of pressure to occlude digital arterioles (32-60mmHg).
  • Bivalved pressure was similar to, but just below, minimal pressure to occlude digital arterioles.
  • Ace wrapped pressure was within the range of pressure to occlude arterioles, but less than pressure to occlude skin microcirculation.
  • Application of ace wrap should be conducted with no stretching as to not increase pressure.
  • Additional work investigating cast spreading versus webril cutting is now warranted.



Back to Annual Meeting Abstracts

 

© 2017 American Association for Hand Surgery. Privacy Policy.