Everything you do to an immobilised limb either helps the blood get in or stops it. Elevation and ice are correct for ordinary post-fracture swelling and wrong the moment you suspect compartment syndrome — so set the limb for both patients and watch the delta pressure move. Then sort the cast findings you teach from the ones you report, and repair a traction rig without once lifting the weights.
Which patient?
Where do you put the limb?
The rest of your choices
Cast round, 24 hours after applicationNine things you find or are told on your round. Each one is either normal and a teaching moment, or a finding you report immediately. Decide, and the rule lands on the right.
Finding
Which traction?
Hang how much weight?
0 lb8 lb (3.6 kg)35 lb
Five things are wrong with this rig. Fix them.
The limb, and what the pressures are doing
Compartment pressure · normal 0 to 8 mmHg
—
Diastolic pressure reaching the limb
—
Delta pressure · fasciotomy if under 30 mmHg
—
The rule behind the call
0 correct of 9
Make a call on the leftEvery cast finding sorts into two piles, and the reason lives here.
Cast basics. Plaster is heavy, moulds beautifully and takes 24 to 72 hours to dry fully; fibreglass is lighter, water-resistant and sets in about 30 minutes. Handle a wet cast with the palms only — fingertips leave indentations that become pressure points. Leave it uncovered to air-dry, support it on a cloth-covered pillow, elevate above heart level for the first 24 to 48 hours, and ice over (not under) the fracture site 20 minutes at a time.
The rig
Pin sites. Assess at least every shift. Expected: serous crusting. Abnormal and reportable: purulent drainage, erythema spreading beyond the pin, tenderness, loosening or fever. Standard care is once-daily cleansing with chlorhexidine solution after the first 48 to 72 hours, following facility protocol.