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Background 背景
Plaster of Paris or Fiberglass are hard materials that are mouldable when wet and once they are set, they would be stony hard permanently. They are made in form of a slab or a complete wrap around cast.
After application, the cast or slab will immobilise the injured body part, to facilitate bone and soft tissue healing.
石膏或玻璃纖維都是堅硬的材料。在弄濕時可以塑型，一旦凝固，它們將永久變硬。它們可以是托板 (slab) 或完全包裹的殼 (full cast)。
套用後，石膏或玻璃纖維板將固定受傷部位，以促進骨骼和軟組織的癒合。
Indication 適應症
Immobilisation should be considered in 在以下情況應考慮使用固定
- Fracture 骨折
- Major soft tissue injury 嚴重軟組織受損
- Torn ligament 韌帶斷裂
- After surgery 手術後
- Contracted soft tissue 軟組織收縮
Preparation 預備
- Relax and listen to the instruction
- 放鬆，聆聽指示並合作
Risk 風險
While all medical and nursing professionals endeavor to provide best and safest practice, complications still would occur.
General risks including compression causing skin ulceration, circulation impairment and nerve palsy, and deep vein thrombosis are possibly encountered but very rare. Limb loss is a remote possibility.
Joint stiffness, muscle weakness and wasting, related to prolonged immobilisation are commonly seen and require an extended period of rehabilitation.
Persistent swelling, pain, stiffness and redness related to reflex sympathetic dystrophy, is the complication related to the injury rather than complication of the immobilisation.
儘管醫生和護士都會盡最大努力提供最佳和最安全的治療，但併發症仍會發生。
可能會遇到的風險，包括因受壓而導致的皮膚損傷，血液循環受損，神經受損（肢體觸感受損以及乏力），以及靜脈栓塞，都是罕見但可能的風險。嚴重情況可能需截肢。
關節僵硬，肌肉乏力或萎縮，可能在長時間固定後出現，通常需一段時間康復訓練。
關於區域性神經紊亂相關的患肢持續性紅腫僵硬疼痛等，屬受傷的自然進程，不屬併發症。
Budget Estimation 預算費用
CPT code and RVU is as follows
- 29065 upper limb cast application, RVU 0.87
- 29700 removal of upper limb cast, RVU 0.57
- 27780 lower limb cast application, RVU 2.83
- 29710 removal of lower limb cast, RVU 1.34
CPT碼和RVU如下
- 29065 上肢石膏應用，RVU 0.87
- 29700去除上肢石膏，RVU 0.57
- 27780 下肢石膏應用，RVU 2.83
- 29710去除下肢石膏，RVU 1.34
Estimation based in 8-2020, application cum removal
- Surgeon fee $8,040 (upper limb long cast), $5,760 (upper limb short cast); $16,680 (lower limb long cast) $8,340 (lower limb short cast)
- Consultation fee $1,200
- Facility cost $2,100 (upper limb short cast); $5,200 (long leg cast)
Total $9,060 (short arm cast); $23,080 (long leg cast) around
根據於2020年8月進行的估算，打石膏連拆
- 外科醫生費$ 8,040（上肢長石膏) ,$ 5,760（上肢短石膏）; $ 16,680（下肢長石膏）$ 8,340（下肢短石膏）
- 診金$ 1,200
- 物料費$ 2,100（上肢短石膏）; $ 5,200（下肢長石膏）
總計$ 9,060 (短上肢石膏); $23,080 (長下肢石膏) 約數
Post-casting care 固定後料理
- Put a waterproof bag to avoid the cast getting wet.
- Elevate the injured body part above chest. You might have to lie down on floor and put the legs on chair in case your leg is cast.
- Take anti-inflammatory drug to avoid the injured part swell up.
- Gently move the unconstrained body part through whole range. For example, if your ankle is cast, move toes and your knee.
- Do not put force across the cast part. If your ankle is cast, do not walk unless specified by your doctor.
- 把打了石膏的肢體放入防水袋才淋浴。
- 將受傷的患肢抬高於胸口。您可能需要躺在地板上，然後將腿放在椅子上，以防患肢腫脹。
- 服用消炎藥，避免受傷部位腫脹。
- 把不受約束的關節作全幅度活動。 例如，如果腳踝打了石膏，則多移動腳趾和膝蓋。
- 請勿在打了石膏的患肢上施力。 如果腳踝打了石膏，除非醫生特別確認，否則請勿用患肢受力步行。
Early Post-immobilisation Complication 固定後早期併發症
Notify surgeon in case you have
- Persistent fever of more than 37.5 Celcius
- Chills and rigor
- Pain inside cast despite rest and elevation
- Numbness
- Progressive swelling
- Calf pain
- Ankle swelling, progressive
- Sudden onset of shortness of breath
- Chest pain
如發現以下情況，要立即通知醫生
- 持續高燒（口探高於攝氏37.5度）
- 發冷打顫
- 即使抬高及休息，石膏內肢體痛楚都持續增加
- 麻痺
- 越來越腫脹
- 小腿愈見痛楚
- 小腿、腳踝和腿部腫脹持續增加
- 突發性的氣促
- 胸口突然疼痛
After casting 固定後
- Attend clinic follow-up as instructed
- 依照指示覆診
Rehabilitation after 6 weeks 固定後6週復健
Range of Motion Exercise:
- Continue full range of motion exercise, gradual stretching to gain additional range.
Strengthening:
- Gradual increase in weight and number of repetition.
活動範圍運動:
- 全幅度活動，並逐漸拉伸，增加活動範圍。
肌力訓練：
- 逐漸增加重量及重複次數
Reference 參考資料
- Anne SB, Holly JB, Chad A. Principles of Casting and Splinting. Am Fam Physician. 2009 Jan 1; 79(1):16-22 https://pubmed.ncbi.nlm.nih.gov/19145960/