When did Viktor Tsoi die? How did Viktor Tsoi die? I am also interested in the issue of the star’s creativity from the legal side...
The creation and fairly widespread use in medical practice of plaster casts for bone fractures is the most important achievement of surgery last century. It was N.I. Pirogov was the first in the whole world to create and put into practice a completely different method of dressing, which was impregnated with liquid plaster. However, it is impossible to say that Pirogov did not try to use gypsum before. Most famous scientists: Arab doctors, the Dutchman Hendrichs, Russian surgeons K. Gibenthal and V. Basova, the Brussels surgeon Setena, the Frenchman Lafarga and others also tried to use a bandage, but it was a solution of plaster, which in some cases was mixed with starch and blotter paper.
A striking example of this is the Basov method, which was proposed in 1842. A person’s broken arm or leg was placed in a special box, which was filled with alabaster solution; the box was then attached to the ceiling using a block. The patient was practically confined to his bed. In 1851, the Dutch physician Matthiessen began using plaster bandages. This scientist rubbed dry plaster onto strips of material, wrapped it around the patient's leg, and then moistened it with the liquid.
To obtain the desired effect, Pirogov tried to use any raw material for the dressing - starch, colloidin and even gutta-percha. However, each of these materials had its drawbacks. N.I. Pirogov decided to create his own plaster cast, which is used in almost the same form today. The famous surgeon was able to realize that gypsum is the best material after visiting the workshop of the then popular sculptor N.A. Stepanova. There he first saw the effect of a gypsum solution on a canvas. He immediately guessed that it could be used in surgery, and immediately applied bandages and strips of canvas, which were soaked in this solution, to a rather complex fracture of the leg. He had a wonderful effect before his eyes. The bandage dried instantly: the oblique fracture, which also had a strong blood leak, healed even without suppuration. Then the scientist realized that this bandage could find wide application in military field practice.
First use of a plaster cast.
Pirogov used a plaster cast for the first time in 1852 in a military hospital. Let's take a closer look at those times when a scientist, under flying bullets, tried to find a way to preserve the limbs of the majority of the wounded. During the first expedition to clear the Salt area from the invasion of enemies, a second one followed, also successful. At this time, some pretty terrible hand-to-hand fighting took place. During military operations, bayonets, sabers and daggers were used. The army managed to maintain its position at a high cost. On the battlefield there were approximately three hundred killed and wounded soldiers of our troops, as well as officers.
Pirogov had already begun to suffer during the battle. He had to work about twelve hours a day, and he even forgot to eat something. Ether anesthesia by a surgeon was widely used in combat situations. During the same period, the brilliant scientist managed to make another amazing discovery. In order to treat bone fractures, instead of linden bast, he began to use a fixed starch bandage. Pieces of canvas soaked in starch were placed layer by layer on a broken leg or arm. The starch began to harden, and in a motionless state the bone began to grow together over time. There was a fairly strong bone callus at the fracture site. Under the whistle of numerous bullets that flew over the hospital tents, Nikolai Ivanovich realized how much benefit a medical scientist could bring to soldiers.
And already at the beginning of 1854, the scientist Pirogov began to understand that it was quite possible to replace the rather convenient starch dressing with plaster. Gypsum, which is calcium sulfate, is a very fine powder that is extremely hygroscopic. If you mix it with water in the required proportions, it begins to harden in about 5-10 minutes. Before this scientist, gypsum began to be used by architects, builders, and sculptors. In medicine, Pirogov widely used a plaster cast to fix and consolidate an injured limb.
Plaster bandages began to be used quite widely during transportation and in the treatment of patients whose limbs were injured. Not without a sense of pride for his nation, N.I. Pirogov recalls that “our nation discovered the benefits of anesthesia and this bandage in military field practice earlier than other nations.” The fairly widespread use of the bone immobilization method he invented made it possible to carry out, as the creator himself claimed, “saving treatment.” Even with fairly extensive bone damage, do not amputate the limbs, but preserve them. Competent treatment of various fractures during the war was the key to preserving the limbs and life of the patient.
Plaster cast today.
Based on the results of numerous observations, the plaster cast has high healing characteristics. Plaster is a kind of protection of the wound from further contamination and infection, helps to destroy the microbes in it, and also allows air to penetrate the wound. And the most important thing is that the necessary rest is created for broken limbs - an arm or a leg. A patient in a cast tolerates even long-term transportation quite calmly.Today, plaster casts are used both in traumatology and surgical clinics all over the world. Scientists today are trying to create various types of such dressings, improving the composition of its components, devices that are designed for applying and removing casts. The method originally created by Pirogov has not changed significantly. The plaster cast has passed one of the most severe tests - the test of time.
The invention and widespread introduction into medical practice of a plaster cast for bone fractures is one of the most important achievements in surgery of the last century. And it was N.I. Pirogov was the first in the world to develop and put into practice a fundamentally new method of dressing impregnated with liquid plaster.
It cannot be said that before Pirogov there were no attempts to use gypsum. The works of Arab doctors, the Dutchman Hendrichs, the Russian surgeons K. Gibenthal and V. Basov, the Brussels surgeon Seten, the Frenchman Lafargue and others are well known. However, they did not use a bandage, but a plaster solution, sometimes mixing it with starch and adding blotting paper to it.
An example of this is the Basov method, proposed in 1842. The patient's broken arm or leg was placed in special box, filled with alabaster solution; the box was then attached to the ceiling through a block. The victim was essentially bedridden.
In 1851, the Dutch doctor Matthiessen already began using a plaster cast. He rubbed strips of cloth with dry plaster, wrapped them around the injured limb, and only then moistened them with water.
To achieve this, Pirogov is trying to use various raw materials for dressings - starch, gutta-percha, colloidin. Convinced of the shortcomings of these materials, N.I. Pirogov proposed his own plaster cast, which is still used almost unchanged today.
The fact is that gypsum is precisely the most best material, the great surgeon became convinced after visiting the workshop of the then famous sculptor N.A. Stepanov, where “... for the first time I saw... the effect of a gypsum solution on canvas. I guessed,” writes N.I. Pirogov, “that it could be used in surgery, and immediately applied bandages and strips of canvas soaked in this solution , for a complex fracture of the leg. The success was remarkable. The bandage dried out in a few minutes: an oblique fracture with severe bleeding and perforation of the skin... healed without suppuration... I was convinced that this bandage could find great application in military field practice, and therefore published a description of my method."
Pirogov first used a plaster cast in 1852 in a military hospital, and in 1854 in the field, during the defense of Sevastopol. The widespread use of the bone immobilization method he created made it possible to carry out, as he called, “saving treatment”: even with extensive bone damage, not to amputate, but to save the limbs of many hundreds of wounded people.
Proper treatment of fractures, especially gunshot fractures, during the war, which N.I. Pirogov figuratively called it a “traumatic epidemic,” which was the key to not only preserving a limb, but sometimes even the life of the wounded.
Portrait of N.I. Pirogov by the artist L. Lamm
One of the most important inventions of the brilliant Russian doctor, who was the first to use anesthesia on the battlefield and brought nurses into the army
Imagine an ordinary emergency room - say, somewhere in Moscow. Imagine that you find yourself there not for personal reasons, that is, not with an injury that distracts you from any extraneous observations, but as a random passerby. But - with the opportunity to look into any office. And so, walking along the corridor, you notice a door with the inscription “Gypsum”. And what's behind it? Behind it is a classic medical office, the appearance of which differs only from the low square bathtub in one of the corners.
Yes, yes, this is the very place where, after an initial examination by a traumatologist and an X-ray, a plaster cast will be applied to a broken arm or leg. For what? So that the bones grow together as they should, and not at random. And at the same time, the skin can still breathe. And so as not to disturb the broken limb with a careless movement. And... Why ask! After all, everyone knows: if something is broken, it is necessary to apply a plaster cast.
But this “everyone knows” is at most 160 years old. Because for the first time a plaster cast was used as a means of treatment in 1852 by the great Russian doctor, surgeon Nikolai Pirogov. No one in the world had done anything like this before. Well, after it, it turns out, anyone can do it anywhere. But the “Pirogov” plaster cast is precisely that priority that is not disputed by anyone in the world. Simply because it is impossible to dispute the obvious: the fact that gypsum as a medical remedy is one of the purely Russian inventions.
Portrait of Nikolai Pirogov by artist Ilya Repin, 1881.
War as an engine of progress
By the start of the Crimean War, Russia was largely unprepared. No, not in the sense that she did not know about the coming attack, like the USSR in June 1941. In those distant times, the habit of saying “I’m going to attack you” was still in use, and intelligence and counterintelligence were not yet so developed as to carefully conceal preparations for an attack. The country was not ready in the general, economic and social sense. There was a lack of modern weapons, a modern fleet, railways(and this turned out to be critical!) leading to the theater of military operations...
There were also not enough doctors in the Russian army. By the beginning of the Crimean War, the organization of medical service in the army was in accordance with the manual written a quarter of a century earlier. According to his requirements, after the outbreak of hostilities, the troops should have had more than 2,000 doctors, almost 3,500 paramedics and 350 paramedic students. In reality, there was no one enough: neither doctors (a tenth part), nor paramedics (a twentieth part), and their students were not there at all.
It would seem that there is not such a significant shortage. But nevertheless, as military researcher Ivan Bliokh wrote, “at the beginning of the siege of Sevastopol, there was one doctor for every three hundred wounded people.” To change this ratio, according to historian Nikolai Gübbenet, during the Crimean War more than a thousand doctors were recruited into service, including foreigners and students who received a diploma but did not complete their studies. And almost 4,000 paramedics and their students, half of whom were disabled during the fighting.
In such a situation and taking into account, alas, the rear organized disorder inherent, alas, in the Russian army of that time, the number of wounded who were permanently incapacitated should have reached at least a quarter. But just as the resilience of the defenders of Sevastopol amazed the allies who were preparing for a quick victory, the efforts of the doctors unexpectedly gave a much better result. A result that had several explanations, but one name - Pirogov. After all, it was he who introduced immobilizing plaster casts into the practice of military field surgery.
What did this give the army? First of all, it is an opportunity to return to duty many of those wounded who, a few years earlier, would have simply lost an arm or leg as a result of amputation. After all, before Pirogov this process was arranged very simply. If a person came to the surgeons table with an arm or leg broken by a bullet or shrapnel, he most often faced amputation. For soldiers - according to the decision of doctors, for officers - based on the results of negotiations with doctors. Otherwise, the wounded man would still most likely not return to duty. After all, the unfixed bones grew together haphazardly, and the person remained crippled.
From the workshop to the operating room
As Nikolai Pirogov himself wrote, “war is a traumatic epidemic.” And like any epidemic, a war had to find its own, figuratively speaking, vaccine. This - partly because not all wounds are limited to broken bones - was plaster.
As often happens with brilliant inventions, Dr. Pirogov came up with the idea of making his immobilizing bandage literally from what was lying under his feet. Or rather, at hand. Because the final decision to use plaster of Paris, moistened with water and fixed with a bandage, for the bandage came to him in... the sculptor’s workshop.
In 1852, Nikolai Pirogov, as he himself recalled a decade and a half later, watched the sculptor Nikolai Stepanov work. “For the first time I saw... the effect of a gypsum solution on a canvas,” the doctor wrote. “I guessed that it could be used in surgery, and immediately applied bandages and strips of canvas soaked in this solution to a complex fracture of the tibia. The success was remarkable. The bandage dried in a few minutes: an oblique fracture with strong bleeding and perforation of the skin... healed without suppuration and without any seizures. I was convinced that this bandage could find great application in military field practice.” Which is exactly what happened.
But Dr. Pirogov’s discovery was not only the result of an accidental insight. Nikolai Ivanovich struggled with the problem of a reliable fixation bandage for many years. By 1852, Pirogov already had experience in using linden splints and starch dressings. The latter was something very similar to a plaster cast. Pieces of canvas soaked in a starch solution were placed layer by layer on the broken limb - just like in the papier-mâché technique. This process was quite long, the starch did not harden immediately, and the dressing turned out to be bulky, heavy and not waterproof. In addition, it did not allow air to pass through well, which negatively affected the wound if the fracture was open.
By the same time, ideas using gypsum were already known. For example, in 1843, thirty-year-old doctor Vasily Basov proposed fixing a broken leg or arm with alabaster poured into a large box - a “dressing projectile.” Then this box was raised on blocks to the ceiling and secured in this position - almost the same way today, if necessary, plastered limbs are secured. But the weight was, of course, prohibitive, and there was no breathability.
And in 1851, the Dutch military doctor Antonius Mathijsen introduced into practice his own method of fixing broken bones using bandages rubbed with plaster, which were applied to the fracture site and moistened with water right there. He wrote about this innovation in February 1852 in the Belgian medical journal Reportorium. So the idea in the full sense of the word was in the air. But only Pirogov was able to fully appreciate it and find the most convenient way plastering. And not just anywhere, but in war.
“Safety benefit” in Pirogov style
Let's return to besieged Sevastopol, during the Crimean War. The already famous surgeon Nikolai Pirogov arrived at it on October 24, 1854, at the very height of the events. It was on this day that the infamous Battle of Inkerman took place, which ended in a major failure for the Russian troops. And here the shortcomings of the organization of medical care in the troops showed themselves to the fullest.
Painting “The Twentieth Infantry Regiment at the Battle of Inkerman” by artist David Rowlands. Source: wikipedia.org
In a letter to his wife Alexandra on November 24, 1854, Pirogov wrote: “Yes, October 24 was not unexpected: it was foreseen, planned and not taken care of. 10 and even 11,000 were out of action, 6,000 were too wounded, and absolutely nothing was prepared for these wounded; They left them like dogs on the ground, on bunks; for whole weeks they were not bandaged or even fed. The British were reproached after Alma for not doing anything in favor of the wounded enemy; We ourselves did nothing on October 24th. Arriving in Sevastopol on November 12, therefore, 18 days after the case, I found too 2000 wounded, crowded together, lying on dirty mattresses, mixed up, and for 10 whole days, almost from morning to evening, I had to operate on those who should have had the operation immediately after battles."
It was in this environment that Dr. Pirogov’s talents fully manifested themselves. Firstly, it was to him that he was credited with introducing into practice the system of sorting the wounded: “I was the first to introduce the sorting of the wounded at the Sevastopol dressing stations and thereby destroyed the chaos that prevailed there,” the great surgeon himself wrote about this. According to Pirogov, each wounded person had to be classified into one of five types. The first is the hopeless and mortally wounded, who no longer need doctors, but comforters: nurses or priests. The second is seriously and dangerously wounded, requiring immediate assistance. The third is the seriously wounded, “who also require immediate, but more protective benefits.” The fourth is "the wounded for whom immediate surgical care is necessary only to make possible transportation." And, finally, the fifth - “slightly wounded, or those for whom the first benefit is limited to applying a light bandage or removing a superficially seated bullet.”
And secondly, it was here, in Sevastopol, that Nikolai Ivanovich began to widely use the plaster cast he had just invented. How much importance he attached to this innovation can be judged by a simple fact. It was for him that Pirogov identified a special type of wounded - those requiring “safety benefits.”
How widely the plaster cast was used in Sevastopol and, in general, in the Crimean War can be judged only by indirect evidence. Alas, even Pirogov, who meticulously described everything that happened to him in Crimea, did not bother to leave to his descendants accurate information on this matter - mostly value judgments. Shortly before his death, in 1879, Pirogov wrote: “I first introduced the plaster cast into military hospital practice in 1852, and into military field practice in 1854, finally... took its toll and became a necessary accessory to field surgical practice. I allow myself to think that my introduction of a plaster cast into field surgery mainly contributed to the spread of cost-saving treatment in field practice.”
Here it is, that very “saving treatment”, it is also a “preventive benefit”! It was for this purpose that what Nikolai Pirogov called “a molded alabaster (plaster) bandage” was used in Sevastopol. And the frequency of its use directly depended on how many wounded the doctor tried to protect from amputation - which means how many soldiers needed to have plaster applied to gunshot fractures of their arms and legs. And apparently they numbered in the hundreds. “We suddenly had up to six hundred wounded in one night, and we performed too many seventy amputations in twelve hours. These stories are repeated incessantly in various sizes,” Pirogov wrote to his wife on April 22, 1855. And according to eyewitnesses, the use of Pirogov’s “stick-on bandage” made it possible to reduce the number of amputations several times. It turns out that only on that terrible day that the surgeon told his wife about, plaster was applied to two or three hundred wounded people!
GYPSUM EQUIPMENT- a series of sequential manipulations and techniques associated with the use of gypsum for medicinal purposes. The ability of moistened plaster to take a given shape during hardening is used in surgery, traumatology and dentistry for fixation and immobilization of bone fragments, as well as for obtaining models of dentition, jaws and face masks. G. t. is used in the treatment of various diseases and injuries of the limbs and spine. For this purpose, various plaster casts, corsets and cribs are used.
Story
Treatment of fractures by fixation of fragments using various hardening agents has been carried out for a long time. So, even Arab doctors used clay to treat fractures. In Europe by the mid-19th century. hardening mixtures of camphor alcohol, lead water and whipped egg white were used (D. Larrey, 1825), starch with gypsum [Lafarque, 1838]; Starch, dextrin, and wood glue were also used.
One of the first successful attempts to use gypsum for these purposes was made by the Russian surgeon Karl Giebenthal (1811). He doused the injured limb with plaster solution, first on one side, and then, lifting it, on the other, and received this. cast of two halves; then, without removing the casts, he attached them to the limb with bandages. Later, Cloquet (J. Cloquet, 1816) proposed placing the limb in a bag of plaster, which was then moistened with water, and V. A. Basov (1843) - in a special box filled with alabaster.
Essentially, all of these methods did not use plaster casts, but plaster molds.
For the first time, the Dutch surgeon Mathysen (A. Mathysen, 1851) began to use bandages made of fabric previously rubbed with dry plaster for the treatment of fractures. After applying a continuous bandage, it was moistened with a sponge. Subsequently, Van de Loo (J. Van de Loo, 1853) improved this method by suggesting that a cloth rubbed with plaster be moistened with water before applying a bandage. The Royal Academy of Medicine of Belgium recognized Mathijsen and Van de Loo as the authors of the plaster cast.
However, the invention of the plaster cast - the prototype of the modern one, its widespread use for the treatment of patients with bone fractures belongs to N. I. Pirogov, who described it in a special brochure and book “Ghirurgische Hospitalklinik” in 1851-1852. The book “Mapped alabaster plaster cast in the treatment of simple and complex fractures and for transporting the wounded on the battlefield” (1854) published by Pirogov is a work that summarizes previous information about the method, indications and technique of using a plaster cast. Pirogov believed that with Matheisen’s method, alabaster impregnates the canvas unevenly, does not hold tightly, easily breaks and crumbles. Pirogov’s method was as follows: the limb was wrapped in rags, additional rags were placed on the bony protrusions; dry gypsum was poured into water and a solution was prepared; shirt sleeves, long johns or stockings were folded into 2-4 layers and lowered into the solution, then stretched “on the fly”, smeared with hands on both sides of each strip. Strips (splints) were applied to the damaged limb and reinforced with transverse strips, applied so that one covered half of the other. Thus, Pirogov, who first proposed the application of plaster casts impregnated with liquid gypsum, is the creator of both circular and splint plaster casts. The promoter and defender of the plaster cast was the professor of the University of Dorpat, Yu. K. Shimanovsky, who in 1857 published the monograph “The plaster cast, especially for the use of military surgery.” Adelman and Szymanowski proposed an unlined plaster cast (1854).
Over time, the technology for making plaster casts has improved. IN modern conditions Preferably, factory-packaged plaster bandages of certain sizes are used (length - 3 m, width - 10, 15, 20 cm), less often - such bandages are made manually.
Indications and contraindications
Indications. Plaster casts are widely used for peacetime and wartime injuries and in the treatment of various diseases of the musculoskeletal system, when immobilization of the limb, torso, neck, and head is necessary (see Immobilization).
Contraindications: circulatory disorders due to ligation of large vessels, gangrene of the limb, anaerobic infection; purulent streaks, phlegmon. The imposition of G. p. is also inappropriate for persons old age with severe somatic disorders.
Equipment and tools
Plastering is usually carried out in specially designated rooms (plaster room, dressing room). They are equipped with special equipment (tables for preparing material and plastering, pelvis, back and leg holders, a frame for hanging the patient when applying a corset bandage with a loop for traction, etc.), instruments, basins for wetting bandages. To apply and remove a plaster cast, you must have the following tools (Fig. 1): scissors various designs- straight, angular, button-shaped; plaster expanders; tongs for bending the edge of the bandage; saws - semicircular, sheet, round.
Basic rules for applying plaster casts
The patient is given a position in which free access to the damaged part of the body is easily achieved. Bone protrusions and parts of the body at the edge of the bandage are covered with cotton wool to prevent bedsores. When casting, it is necessary to comply with the requirement for a certain arrangement of personnel: the surgeon holds the limb in correct position, and an assistant or plaster technician applies a bandage. Bandaging rules must be strictly followed. The first rounds of the bandage covering the area intended for plaster casting are not applied tightly, the subsequent rounds are applied more tightly; the bandage is moved spirally with moderate tension, applying each subsequent move to 1/3-1/2 of the surface of the previous one; The bandage is constantly smoothed to avoid the formation of constrictions, kinks and depressions. To ensure a uniform fit of the bandage to the body, after applying the third layer, modeling of the bandage begins, crimping the bandage according to the contours of the body. The bandage should have a uniform number of plaster layers (6-12), be somewhat thicker in places subject to fracture (in the joint area, in fracture sites); as a rule, it should cover two adjacent joints.
After applying the bandage, the limb must be elevated to reduce swelling; For this purpose, metal tires, pillows, functional bed. Beds for patients with hip bandages and corsets should be equipped with shields. A properly applied plaster cast should not cause pain, tingling or numbness; for control, the toes and hands should be left unplastered. Cyanosis and swelling of the fingers indicate a violation of venous outflow; their pallor and coldness indicate cessation of arterial circulation; lack of movement indicates paresis or nerve paralysis. When these symptoms appear, the bandage is immediately cut along its entire length, and the edges are folded to the sides. If blood circulation is restored, the bandage is secured with a circular plaster bandage, otherwise it must be removed and replaced with a new one. If local pain occurs, most often in the area of bone protrusions, a “window” should be made in this place to avoid the formation of bedsores. With long-term use of plaster casts, muscle atrophy and limitation of joint movements may occur. In these cases, exercise therapy and massage are recommended after removing the bandage.
Types of plaster casts
The main types of plaster casts: 1) circular, circular, blind (unlined and lining); 2) fenestrated; 3) bridge-like; 4) staged; 5) open (splint, splint); 6) combined (with twist, hinged); 7) corsets; 8) cribs.
A circular bandage (Fig. 2) is a blind plaster bandage applied directly to the body (unlined) or to a body previously covered with cotton-gauze bandages or a knitted stocking (lined). A lining plaster cast is used after orthopedic operations and for patients with joint diseases (bone tuberculosis).
The fenestrated plaster cast (Fig. 3) is also a circular cast with a “window” cut out over the wound; It is advisable if it is necessary to inspect the wound and change dressings.
For the same purposes, a bridge bandage is used (Fig. 4), when it is necessary to leave at least 2/3 of the circumference of the limb open in any area. It consists of two sleeves fastened together by one or more “bridges” plastered together.
A staged plaster cast is used to eliminate contractures and deformities. Apply a circular bandage with a slight possible elimination deformation, and after 7-10 days it is cut into 1/2 of the circle in the area of deformation and the position of the limb is corrected again; a wooden or cork spacer is inserted into the resulting space and the achieved correction is fixed with a circular plaster bandage. The next stage plaster casts are made after 7-10 days.
An open splint cast (Fig. 5) is usually applied to the posterior surface of the limb. It can be made according to pre-taken measurements from plaster bandages or splints, or the bandages can be rolled out directly on the patient’s body. You can turn a circular cast into a splint cast by cutting out 1/3 of its front part.
A plaster cast with a twist is used to eliminate persistent contractures. It consists of two sleeves connected to each other by rope loops. By rotating the twist stick, they tighten the cord and bring its attachment points closer together.
An articulated plaster cast is used to treat bone fractures when it is necessary to combine fixation of the damaged area with partial preservation of the function of the nearby joint. It consists of two sleeves connected to each other by metal tires with hinges. The axis of the hinge must coincide with the axis of the joint.
A corset is a circular plaster cast applied to the torso and pelvic girdle for diseases of the spine. A special type of removable plaster cast used to immobilize the spine is a plaster crib.
Method of applying plaster casts
Plaster casts on the pelvic girdle and thigh. The Whitman-Thurner unlined circumferential hip cast is used for fractures of the femoral neck. Length traction is performed, the leg is retracted outward and rotated inward. Wide splints are placed around the body at the level of the nipples and at the level of the navel, two others are placed on the pelvis and thigh, and the bandage is secured to the body and in the hip joint with a plaster bandage, followed by plaster casting of the entire limb. After a few days, the walking stirrup is cast (Fig. 6). Due to the successful results of surgical treatment of this type of injury, the Whitman-Thurner bandage is used extremely rarely.
A hip circular plaster cast is applied after orthopedic surgery on the hip joint and for a fracture of the femoral diaphysis. It can be with a corset (half-corset), a belt, with or without a foot; the level of application depends on the nature of the disease and damage. A padded hip circular bandage with an additional “trouser leg” on the other leg and a wooden spacer (Fig. 7) is indicated after surgery on the hip joint, for example, after open reduction of a congenital hip dislocation. A Lorenz plaster cast (Fig. 8) is applied after bloodless reduction of congenital dislocation of the hips. Hip bandages are applied on a Holi-type orthopedic table (Fig. 9).
Plaster casts on the lower limb. For diseases knee joint(tuberculosis, infectious arthritis, osteomyelitis, arthropathy) and in some cases of damage to the knee joint and shin bones, as well as after orthopedic surgery on the shin (bone grafting, osteotomy, muscle tendon transplantation) various types plaster casts depending on the nature, location and extent of the disease and damage. They can be up to the ischial fold, up to the upper third of the thigh, with or without a foot, circular and splint.
At various diseases and fractures of the bones of the foot and ankle joint, various types of plaster casts are used, applied up to the knee joint. 1. Plaster boot - a circular plaster cast with an additional splint of 5-6 layers on the sole (Fig. 10). When treating congenital clubfoot, when a boot is applied, the bandage should go from the fifth toe through the back of the foot to the first toe and then to the sole. Tightening the bandage reduces the deformation. In case of hallux valgus, a boot is also applied, but the bandage is applied in the opposite direction. 2. Splint bandage various depths. When applying it, it is more convenient to place the patient on his stomach, bend the knee at a right angle; the doctor holds the foot in the desired position. 3. Longuet bandage: measure the lower leg (from the inner condyle of the tibia along the inside through the heel area of the sole and then along the outer side of the lower leg to the head of the fibula) and roll out a splint of the appropriate size in 4-6 layers on the table; another splint equal to the length of the foot is attached to it. The application of a plaster cast is carried out with outside through the foot, then along inner surface. To avoid swelling, the splint is secured with a soft bandage, and after 8-10 days it is secured with a plaster bandage, while the heel or stirrup can be plastered for walking.
Plaster cast on the upper limb. Due to anatomical and topographical features, the application of plaster casts to the upper limb is associated with a greater possibility of compression of blood vessels and nerves compared to the lower limb. Therefore, fixation of the upper limb in most cases is carried out with a plaster splint. Its size varies. So, for example, after reducing a dislocated shoulder, a posterior dorsal plaster splint is applied (from the healthy shoulder blade to the metacarpophalangeal joint of the affected arm).
Plaster cast for dislocation of the acromial end of the clavicle - a belt-belt consisting of an annular plaster belt, by means of which the forearm with the elbow joint bent at a right angle is fixed along the front and anterolateral surface of the chest, and a half ring thrown over the damaged shoulder girdle in the form of a belt-belt attached to a plaster belt in a state of tension (Fig. 11).
After surgical interventions on the shoulder joint and in some cases after a fracture of the diaphysis of the humerus, a thoracobrachial plaster cast is applied, consisting of a corset, a plaster cast on the arm and a wooden spacer between them (Fig. 12).
Immobilization of the elbow joint after open reduction of intra- and periarticular fractures, after operations on tendons, vessels and nerves is carried out with a posterior plaster splint (from the metacarpophalangeal joint to the upper third of the shoulder). If both bones of the forearm are fractured, two splints can be used: the first is placed on the extensor surface from the metacarpophalangeal joint to the upper third of the shoulder, the second is placed along the flexor surface from the middle of the palm to the elbow joint. After repositioning the fracture of the forearm bones, a deep dorsal plaster splint is applied in a typical place (from the metacarpophalangeal joint to the upper third of the forearm) and a narrow one is applied along the palmar surface. Children are recommended to use only splint plaster casts, since circular ones often lead to ischemic contractures. Adults sometimes have to use circular plaster casts. In this case, as a rule, the arm is bent at the elbow joint at a right angle and the forearm is placed in a position intermediate between pronation and supination; According to indications, the angle in the elbow joint can be acute or obtuse. The bandages are rolled out circularly, starting from the hand, and directed in the proximal direction; on the hand, the bandage should pass through the first interdigital space, with the first finger remaining free. The hand is placed in a position of slight extension - 160° and ulnar deviation - 170° (Fig. 13). A circular plaster cast from the metacarpophalangeal joint to the upper third of the forearm is indicated for fractures of the hand bones.
Plaster casts for the treatment of spinal diseases. To unload and fix the spine in case of fractures, inflammatory and dystrophic lesions, congenital defects and curvatures, a variety of plaster corsets are applied, which differ from each other depending on the area of the lesion, stage and nature of the disease. Thus, if the lower cervical and thoracic vertebrae are affected up to the Th 10 level, a corset with a head holder is indicated; if Th 10-12 is affected - a corset with hangers; if necessary, fix the lumbar region - a corset without hangers (Fig. 14). The corset is applied with the patient standing in a wooden frame or on the Engelmann apparatus (Fig. 15). Traction behind the head is carried out with a Glisson loop or gauze strips until the patient can touch the floor with his heels, the pelvis is fixed with a belt. The corset can also be applied with the patient lying down (usually after surgery) on an orthopedic table. For compression fractures of the lower thoracic and lumbar vertebrae, during simultaneous reduction, a corset is applied between two tables that have different heights; during staged reclination according to Kaplan, a plaster corset is applied in a hanging position from the lower back.
To apply a corset, wide plaster bandages are used, which are carried out mainly in circular or spiral movements. Tight coverage of bone support points (ridges iliac bones, pubic area, costal arches, back of the head) helps relieve the heaviness of the corset. To do this, modeling begins after the first round of bandaging. Head holder - a circular plaster cast covering the chin, neck, back of the head, shoulder girdle and top part chest, indicated for lesions of the three upper cervical vertebrae. After surgery for congenital muscular torticollis, a plaster cast is applied with a certain installation: tilting the head to the healthy side, with the face and chin turned to the painful side (Fig. 16).
Various corsets have been used for scoliosis. The Sayra corset, applied in an extended position, eliminates the deformity only temporarily. The removable Goffa detorsion corset aims to correct both the lateral displacement of the torso and the rotation of the torso relative to the pelvis when the spine is elongated. Due to the use of surgical intervention, Sayre and Goffa corsets are rarely used.
A unique redressing technique was proposed by Abbott (E. G, Abbott), who recommended applying a very tight corset that compresses the chest. After the plaster hardened, a “window” was cut out from behind on the concave side of the curvature; with each breath, the ribs of the compressed convex side pushed the spine to the concave side, i.e., towards the cut “window”, which ensured a slow correction. The Abbott corset is sometimes used as one of the stages of spinal deformity correction.
Risser's corset (Fig. 17) consists of two halves connected to each other by a hinge; the upper half is a short corset with a collar, the lower half is a wide belt with a trouser leg on the thigh on the side of the convexity of the curvature; between the walls of the corset along the concave side of the curvature is strengthened screw fixture type of jack, with the help of which the patient is gradually tilted towards the convexity of the curvature, thereby correcting the main curvature. The Risser corset is used for preoperative correction of deformity.
A plaster bed is used for diseases and injuries of the spine; it is intended for long-term lying. An example is the Lorenz crib (Fig. 18): the patient is placed on his stomach, his legs are extended and slightly spread, his back is covered with a piece of gauze; the bandages are rolled out on the patient and modeled well; splints or gauze sheets soaked in gypsum paste can be used. After production, the crib is removed, trimmed, dried for several days, after which the patient can use it.
Plaster technology in dentistry
Gypsum in dentistry is used to take casts (impressions), obtain models of dentition and jaws (Fig. 19-20), as well as face masks. It is used for the manufacture of rigid headbands (plaster helmets), fixing equipment for extraoral traction during orthodontic treatment, for jaw injuries and splinting devices. In therapeutic dentistry, gypsum can be used as temporary fillings. In addition, gypsum is included in some masses for casting and soldering dentures, and also as a molding material for the polymerization of plastic in the manufacture of removable and fixed dentures.
Taking impressions of the dentition and jaws begins with the selection of a standard spoon if teeth are present, or the manufacture of an individual spoon for a toothless jaw. 100 ml of water is poured into a rubber cup and 3-4 g of sodium chloride is added to accelerate the hardening of the gypsum, then plaster is poured into the water in small portions so that the pile of gypsum is above the water level; Excess water is drained and the gypsum is stirred until the consistency of thick sour cream. The resulting mass is placed in a spoon, inserted into the mouth and pressed on the spoon so that the plaster mass covers the entire prosthetic field. The edges of the cast are processed so that their thickness does not exceed 3-4 mm; excess plaster is removed. After the plaster has hardened (as determined by the brittleness of the remaining plaster in the rubber cup), the impression in the mouth is cut into individual fragments. Incisions are made from the vestibular surface: vertical along the existing teeth and horizontal - on the chewing surface in the area of the dentition defect. Plaster fragments are removed from the mouth, cleaned of crumbs, placed in a spoon and glued together in the spoon using hot wax. To cast the model, place the tray with the impression for 10 minutes. in water so that the cast is better separated from the model, after which it is poured liquid gypsum, and after hardening, the model is opened by separating the impression plaster from the model.
Taking a plaster cast of toothless jaws is extremely rare. In these cases, plaster is replaced with more advanced impression materials - silicone and thermoplastic masses (see Impression materials).
When removing the mask, the patient is placed in a horizontal position. The face, especially its hairy areas, is lubricated with Vaseline oil; Rubber or paper tubes are inserted into the nasal passages for breathing, and the borders of the cast on the face are covered with cotton rolls. The entire face is covered with an even layer of plaster, approx. 10 mm. After the plaster has hardened, the impression can be easily removed. The mask is cast after the impression is placed for 10 minutes. into the water. To cast a mask, you need liquid plaster; to avoid the formation of air bubbles, it must be evenly distributed over the surface of the cast and shaken frequently with your hands or using a vibrator. The hardened model with the cast is placed in boiling water for 5 minutes, after which the impression plaster is chipped from the model using a plaster knife.
To make a rigid plaster headband, a scarf made of several layers of gauze or nylon is placed on the patient’s head and a plaster bandage is placed on it around the head, with a bandage placed between the layers. metal rods for fixing equipment. The plaster cast should cover the frontal and occipital tubercles. A nylon or gauze scarf makes it easy to remove and put on a plaster cast, which improves hygiene. conditions for tissues under a rigid plaster cast.
Plaster technique in military field surgery
Plaster equipment in military field surgery (MFS) is used for treatment. and transport and treatment. immobilization. The priority of introducing a plaster cast into the arsenal of VHS means belongs to N. I. Pirogov. The effectiveness and advantage of plaster casts compared to other means of immobilization in war were proven by him during the Crimean campaign (1854-1856) and at the theater of military operations in Bulgaria (1877-1878). As E.I. Smirnov pointed out, the widespread use of plaster casts for the treatment of wounded in military field conditions ensured the progress of domestic military-technical treatment and played a great role in the future, especially during the Great Patriotic War. Patriotic War. In combat conditions, plaster casts provide reliable transport immobilization of the injured limb, facilitate and improve care for the wounded, and create opportunities for further evacuation of the majority of victims in the coming days after surgical treatment; The hygroscopicity of the dressing promotes good outflow of wound fluid and creates favorable conditions for wound cleansing and repair processes. However, when using plaster casts, secondary displacement of fragments and the formation of contractures and muscle atrophy are possible.
In military field conditions, splint, circular and splint-circular plaster casts are used. Indications: treat. immobilization for open gunshot and closed fractures of limb bones, damage to great vessels and nerves, as well as extensive soft tissue damage, superficial burns, frostbite of the extremities. The application of a blind plaster cast is contraindicated in cases of developing anaerobic infection (or suspicion of it), insufficiently thorough surgical treatment of the wound, in early dates after operations on the great vessels (due to the possibility of developing gangrene of the limb), in the presence of unopened purulent leaks and phlegmon, extensive frostbite or extensive deep burns of the limb.
The use of plaster casts in modern war conditions is possible in institutions that provide qualified and specialized care.
In SMEs, gypsum technology can be used ch. arr. in order to strengthen the transport splint for immobilization of the lower extremities (application of three plaster rings) and the application of splints. In exceptional cases, under favorable medical and tactical conditions, blind plaster casts can be used.
In medical work conditions. GO services plaster casts can be used in hospital facilities (see).
Equipment: field orthopedic table, improved ZUG-device (Behler type), plaster in hermetically sealed boxes or bags, ready-made non-shedding plaster bandages in cellophane packaging, tools for cutting and removing plaster bandages.
When working in military field conditions, it is necessary to ensure the application of a large number of plaster casts in a short time. For this purpose, in specialized surgical hospitals and specialized medical centers with a surgical profile, a plaster room and a room for drying applied plaster bandages (room, tent), located near the operating room and dressing room, are deployed. Marking the circular plaster cast facilitates the organization of observation of the wounded and triage during the evacuation stages; it is usually done in a visible place on the wet dressing. The date of injury, surgical treatment, application of a plaster cast is indicated, and a schematic drawing of bone fragments and the contours of the wound are applied. During the first 24 hours after applying a plaster cast, monitoring the condition of the wounded person and the limb is required. Changes in normal color, temperature, sensitivity and active mobility of areas of the limb exposed to inspection (fingers) indicate certain deficiencies in the technique of applying a plaster cast, which must be immediately eliminated.
Bibliography: Bazilevskaya 3. V. Gypsum equipment, Saratov, 1948, bibliogr.; Bohm G. S. and Chernavsky V. A. Plaster cast in orthopedics and traumatology, M., 1966, bibliogr.; Vishnevsky A. A. and Shreiber M. I. Military field surgery, M., 1975; K a p l and N A. V. Closed injuries of bones and joints, M., 1967, bibliogr.; KutushevF. X. id r. The doctrine of bandages, L., 1974; P e with l I to I. P. and Drozdov A. S. Fixing bandages in traumatology and orthopedics, Minsk, 1972, bibliogr.; Pirogov N.I. Molded alabaster bandage in the treatment of simple and complex fractures and for transporting the wounded to the battlefield, St. Petersburg, 1854; H e h 1 R. Der Gipsverband, Ther. Umsch., Bd 29, S. 428, 1972.
N. A. Gradyushko; A. B. Rusakov (military), V. D. Shorin (ostomy).
97. Plaster and plaster casts. Plaster bandages, splints. Basic types and rules for applying plaster casts.
Plaster casts are widely used in traumatology and orthopedics and are used to hold fragments of bones and joints in their given position.
Medical gypsum is a semi-aqueous calcium sulfate salt, available in powder form. When combined with water, the hardening process of the gypsum begins after 5–7 minutes and ends after 10–15 minutes. The plaster gains full strength after the entire bandage has dried.
Using various additives you can speed up or, conversely, slow down the hardening process of gypsum. If the plaster does not harden well, it must be soaked in warm water (35–40 °C). You can add aluminum alum to the water at the rate of 5–10 g per 1 liter or table salt (1 tablespoon per 1 liter). A 3% starch solution and glycerin delay the setting of gypsum.
Since gypsum is very hygroscopic, it is stored in a dry, warm place.
Plaster bandages are made from ordinary gauze. To do this, the bandage is gradually unwound and a thin layer of gypsum powder is applied to it, after which the bandage is again loosely rolled into a roll.
Ready-made non-shedding plaster bandages are very convenient for use. The plaster cast is intended to perform the following manipulations: pain relief for fractures, manual reposition of bone fragments and reposition using traction devices, application of adhesive traction, plaster and adhesive dressings. In some cases, it is permissible to apply skeletal traction.
Plaster bandages are immersed in cold or slightly warmed water, and air bubbles that are released when the bandages get wet are clearly visible. At this point, you should not press on the bandages, as part of the bandage may not be saturated with water. After 2–3 minutes, the bandages are ready for use. They are taken out, lightly wrung out and rolled out on a plaster table, or the damaged part of the patient’s body is directly bandaged. To make the bandage strong enough, you need at least 5 layers of bandage. When applying large plaster casts, you should not soak all the bandages at once, otherwise the nurse will not have time to use some of the bandages within 10 minutes, they will harden and will be unsuitable for further use.
Rules for applying bandages:
– before rolling out the plaster, measure the length of the applied bandage along the healthy limb;
– in most cases, the bandage is applied with the patient lying down. The part of the body on which the bandage is applied is raised above the table level using various devices;
– the plaster cast should prevent the formation of stiffness in the joints in a functionally unfavorable (vicious) position. To do this, the foot is placed at a right angle to the axis of the shin, the shin is in a position of slight flexion (165°) at the knee joint, the thigh is in a position of extension in the hip joint. Even with the formation of contracture in the joints, the lower limb in this case will be supporting, and the patient will be able to walk. On the upper limb, the fingers are placed in a position of slight palmar flexion with the first finger opposed, the hand is in a position of dorsal extension at an angle of 45° in the wrist joint, the flexor forearm is at an angle of 90-100° in the elbow joint, the shoulder is abducted from the body at an angle of 15– 20° using a cotton-gauze roll placed in the armpit. For some diseases and injuries, as directed by a traumatologist, a bandage may be applied in the so-called vicious position for a period of no more than one and a half to two months. After 3–4 weeks, when initial consolidation of the fragments appears, the bandage is removed, the limb is placed in the correct position and fixed with a plaster;
– plaster bandages should lie evenly, without folds or kinks. Anyone who does not know desmurgy techniques should not apply plaster casts;
– areas subject to the greatest load are additionally strengthened (joint area, sole of the foot, etc.);
– the peripheral part of the limb (toes, hands) is left open and accessible for observation in order to notice the symptoms of compression of the limb in time and cut the bandage;
– before the plaster hardens, the bandage must be well modeled. By stroking the bandage, the body part is shaped. The bandage must be an exact cast of this part of the body with all its protrusions and depressions;
– after applying the bandage, it is marked, i.e., the diagram of the fracture, the date of the fracture, the date of application of the bandage, the date of removal of the bandage, and the name of the doctor are applied to it.
Methods of applying plaster casts. According to the method of application, plaster casts are divided into lined and unlined. With padding, a limb or other part of the body is first wrapped in a thin layer of cotton wool, then plaster bandages are placed on top of the cotton wool. Unlined dressings are applied directly to the skin. Pre-bone protrusions (area of the ankles, femoral condyles, iliac spines, etc.) are isolated with a thin layer of cotton wool. The first bandages do not compress the limb and do not cause bedsores from the plaster, but they do not fix bone fragments firmly enough, so when they are applied, secondary displacement of the fragments often occurs. Unlined bandages, if not carefully observed, can cause compression of the limb to the point of necrosis and pressure sores on the skin.
According to their structure, plaster casts are divided into longitudinal and circular. A circular plaster cast covers the damaged part of the body on all sides, while a splint cast covers only one part. A variety of circular dressings are fenestrated and bridge-like dressings. A windowed bandage is a circular bandage in which a window is cut out over a wound, fistula, drainage, etc. Care must be taken that the edges of the plaster in the area of the window do not cut into the skin, otherwise the soft tissues will swell when walking, which will worsen the wound healing conditions. Protrusion of soft tissues can be prevented by covering the window with a plaster flap each time after dressing.
A bridge bandage is indicated in cases where the wound is located throughout the entire circumference of the limb. First, circular bandages are applied proximally and distally to the wound, then both bandages are connected to each other with U-shaped curved metal stirrups. When connected only with plaster bandages, the bridge is fragile and breaks due to the weight of the peripheral part of the bandage.
Bandages applied to various parts of the body have their own names, for example, corset-coxite bandage, “boot”, etc. A bandage that fixes only one joint is called a splint. All other bandages must ensure immobility of at least 2 adjacent joints, and the hip bandage - three.
A plaster cast on the forearm is most often applied to fractures of the radius in a typical location. The bandages are laid out evenly along the entire length of the forearm from the elbow joint to the base of the fingers. A plaster splint for the ankle joint is indicated for fractures of the lateral ankle without displacement of the fragment and ruptures of the ankle ligaments. Plaster bandages are rolled out with gradual expansion at the top of the bandage. The length of the patient’s foot is measured and, accordingly, 2 cuts are made on the splint in the transverse direction at the bend of the bandage. The splint is modeled and strengthened with a soft bandage. Splints are very easy to turn into circular bandages. To do this, it is enough to strengthen them on the limb not with gauze, but with 4–5 layers of plaster bandage.
A lining circular plaster cast is applied after orthopedic operations and in cases where bone fragments are welded together by callus and cannot move. First, the limb is wrapped in a thin layer of cotton wool, for which they take gray cotton wool rolled into a roll. It is impossible to cover it with separate pieces of cotton wool of different thicknesses, since the cotton wool will become matted and the bandage will cause a lot of inconvenience to the patient when wearing it. After this, a circular bandage in 5–6 layers is applied over the cotton wool with plaster bandages.
Removing the plaster cast. The bandage is removed using plaster scissors, a file, plaster forceps and a metal spatula. If the bandage is loose, you can immediately use plaster scissors to remove it. In other cases, you must first insert a spatula under the bandage in order to protect the skin from cuts from the scissors. The bandages are cut on the side where there is more soft tissue. For example, a circular bandage up to the middle third of the thigh - along the posterior outer surface, a corset - on the back, etc. To remove the splint, it is enough to cut the soft bandage.
