Preparing light plaster casts (3 pointed plaster casts) for fractures of distal
Forearm (Distal Radius) region.

  
Fractures of distant region of Radius bone are very common. Fractures may be with
Or without displacement, & may be stable or unstable.
Fractures may need reduction. Closed or open reduction.
After finishing the reduction processes, fracture should be fixed by a long or a short plaster cast.

Fixation of stable fractures can be done by splint casts or pipe (Cylinder) casts. Short casts or Long ones.

According to the researches, short casts that are well modeled & well molded, are considered to be sufficient and are preferred.

Typically, to fix the fractures of distal forearm, cylindrical cast are used, by rolling and
Wrapping the plaster layers around the hand & forearm which gets the shape of a pipe.

There is always possibility of appearing swelling & pressure in the plaster cast due to
The fracture or reduction processes. The pressure should be released as soon as possible
To stop the pain and to prevent the appearance of  "compartment syndrome".

Some of the cases come back to the emergency room after a day or more to open or remove the plaster to release the pressure.

Cylindrical casts (Pipe) are not good enough, don’t give perfect fixation, and usually are heavier. It's better to change the plaster to the shape of the "Fish belly" by pressing
The pipe by both hands before it becomes hard, so to prevent the possibility of the moving of fracture parts.

In some emergency rooms, after finishing the fixation by the cast, they wait for 10 to 15 minutes, and then make slots on the two sides of the cast, with slight opening, to prevent
The appearance of pressure in the cast .

In order to prepare a stable fixation, that does not changes and is not pressing, and also
Can be easily removed or released, without the need of using the electric saw, brought
Me preparing light cast named "3 point plaster cast" that is simple to prepare and can be easily applied.

In order to prepare the brace after the fracture is reduced, Hand & forearm are wrapped
With cotton or well band layers. Then measure the distant between the MP joints lines
Down to 2-3 cm before the head of the Radius at Elbow region. Then multiply that length
By 2. Measurement is done by plaster rolls. Typically 6 to 8 layers of plaster are used.

The most convenient width of plaster for this region is 10cm (4inches)

After inserting the brace in the water and removing of extra water by pulling the brace
Between 2 straightened fingers, then grasp the upper Rt. Corner of the plaster and lower
Lt. corner of the plaster, and then gently pull the corners away, to change the shape of
The plaster to the shape of Diamond.

Then place the tip of the diamond shaped plaster cast over the second MP joint, and the
Other corner over the 5'Th MP joint line. Then the plaster is wrapped on the dorsum of the
Hand and forearm toward the Elbow, twisting back over the radial side of the forearm to the
styloid region of Radius bone, continuing to the palm of the hand to the line of distal
Palmar cris.
Then currently wrap the elastic bandage over the cast, from MP region and palm to Elbow,
But not interfering to the Elbow's movement.

This cast is light, strong, easy to work and preparation, and in the case of pressure it can be
Easily released, and applied back again, without the need of the saw. 

                                                                                  Adibi David MD
Orthopedic surgeon

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