My Orthopedic Surgery

AONA posting of the AO Classification of Long Bone Fractures

Casting: Introducing the "Gumby" Technique Have your usual casting supplies ready plus an eight-inch length of two-inch stockinette. That’s it. Just an extra five cents’ worth of product will change your casting life! The “Gumby” Technique Prepare the additional eight-inch length of two-inch stockinette by cutting four-inch “legs” through both sides of the stockinette lengthwise. This now makes the stockinette (Figure 1) look like the animation character, Gumby. Make an additional cut on one side of the legs to allow for the difference in width between the hand and the wrist. (If Gumby had legs, this cut would be in the crotch.) Apply stockinette in the normal fashion. Then, apply the Gumby piece over the thumb (Figure 2) with the longer crotch cut out over the web space and the legs hanging on either side of the hand/wrist area. There should be no crinkles or folds in the thumb-index finger web space. If the legs are too long, they can be trimmed back or just folded smooth around the wrist area. The top of Gumby should reach over the distal tip of the thumb. Up to one inch of stockinette past the tip of the thumb is best. Trim more than that. Apply cast padding (Figure 3), as you usually do, covering the legs of Gumby on either side (palmar and dorsum) of the wrist. This anchors Gumby to the arm. Start folding Gumby (Figure 3) making the first fold down the thumb to the DIP joint. Then make a second fold (Figure 4) spreading the stockinette out around the base of the thumb. Be sure to spread it out as far as possible smoothing it as you go. You should have two layers of stockinette covering the cast padding all around the base of the thumb reaching almost to the midline of the anterior and posterior aspect (Figure 5) of the hand and wrist. Cast as you usually do, being sure to incorporate the Gumby folds around the base of the thumb (Figures 6 and 7) under your casting material. If you have followed the instructions correctly, you have a cast where no padding is accessible to the patient around the base of the thumb. It is completely covered by stockinette. You now have a beautiful finished edge around the thumb.

The distal radius section of the AO Surgery Reference. The whole surgical management described, including decision-making support, approaches, and surgical procedures.

Casting Technique Jan 2006 THE MODIFIED GUMBY TECHNIQUE Charles Barocas, ROT, CO Cut a 6- to 8-inch length of stockinette depending on the size of your patient. Cut a 2- to 3-inch slit down a side of the stockinette. Start the cut 1 inch from an end of the stockinette. Place this piece of stockinette on the patient. The four fingers and the hand go into the stockinette and out the 2- to 3-inch cut. The thumb stays inside the uncut portion of the stockinette. A 2-inch stockinette is OK for most patients. Just make sure the stockinette is not too tight around the hand. Place your regular stockinette on the patient. Fold down the stockinette covering the thumb to the distal PIP. You could also apply your regular stockinette first and then apply the modified Gumby. No set rule here. Pad the arm as you usually do. Then fold the thumb piece down again toward the base of the thumb, covering the padding. The second fold should go as far down the palm and posterior aspect of the hand as possible. Cast the arm as you usually do, being sure to incorporate the base of the Gumby under the casting material. The stockinette now covers the padding at the base of the thumb. Patients can no longer pick the padding out

A classification for extraarticular distal radius fractures and indications for treatment.

Archive Copy: Advances in Distal Radius Fracture Management

Wheeless' Textbook of Orthopaedics

Wheeless' Textbook of Orthopaedics

Archive Copy 2004

The indication to perform closed reduction could be a definitive treatment for an uncomplicated Colles wrist fracture. Closed reduction may be applied to more complicated fractures followed by a post-reduction re-assessment of the fracture configuration to decide if the fracture needs further treatment.

There are several different types of external fixation. There is the transarticular external fixator with pins in the second metacarpal and pins in the radius. It can be either static or dynamic i.e. a locking ball-joint system which permits wrist mobilization midway through the treatment). There is also periarticular or non-bridging external fixation which joins pins inserted into both the distal and proximal radial fracture fragments while permitting complete motion of the wrist.

when will cast treatment will most likely fail, when percutaneous pinning is sufficient alone, when percutaneous pinning requires supplementary external fixation, what kind of post-treatment function can patients expect.