Non-surgical management of fractures

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The management of long bone fractures using casts and splints pre-dates other means of repair. With appropriate case selection, the results achieved by rigid bandaging, otherwise known as external coaptation, can be excellent. However, it should be appreciated that, with the advent of more sophisticated fixation techniques, optimal fracture management is now likely to involve primary coaptation. This chapter looks at cast biomechanics, indications for casting, cast construction, cast maintenance, cast removal, complications, splinted bandages, other bandages, external coaptation in fractures of the skull and spine, non-surgical management without support.

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16.1 (a–h) Cast application (see text for details).
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16.2 (a–c) Cast removal (see text for details).
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16.3 (a) Greenstick fracture of the left distal radial diaphysis and minimally displaced complete oblique fracture of the distal ulnar diaphysis in a 6-month-old Labrador Retriever. (b) After 3 weeks of coaptation in a splinted bandage there is bridging periosteal callus formation about the radial fracture plane. (c) Immediately after splint removal there is carpal and digital hyperextension affecting the left forelimb associated with disuse atrophy. Restoration of normal posture should be expected within 2 to 3 weeks.
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16.4 Pressure sore over the medial aspect of the distal metatarsus in a 4-year-old Border Collie. Bone is exposed in the wound. A cast had been applied to manage an isolated, mid-diaphyseal fracture of the fifth metatarsal bone. The wound eventually healed, but required several weeks of ongoing management with dressings.
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