Orthopedic surgery covers a vast spectrum of conditions ranging from mild ailments to life threat— ending diseases, all of which involve the locomotors system, viz the limbs and spine. The effectiveness of this skeletal system depends on the integrity of rigid poles, i.e. the hones and the mobility of the joints. An’ loss of normal integrity, therefore, requires efficient external support, to allow healing to occur. Splinting with the aim of external support and immobilization of the joints, therefore, becomes mandatory. Whoever finds an effective means of splinting without disturbing the ultimate of the skeletal system, becomes the master.
It might still be appropriate to consider hone setter the father of modern orthopedic surgeons. The bone-setter was the master who started and developed effective means of splinting: splinting to support fractured bones and to rest painful joints. The bone setter relied totally on his manual technique and creative ideas. He must do an excellent job on conditions that normally underwent a natural process of healing. He could not, however, help effectively on serious conditions that threatened life and required more specific scientific treatment. At this point, the orthopedic surgeon comes in. The orthopedic surgeon takes over those areas that the bone setter is obviously incapable of. He prescribes specific treatment, administers even more effective means of splinting, removes pathological lesions, and reconstructs damaged parts. The advances achieved under the leadership of orthopedic surgeons have been tremendous in the past century. All bone setters should be amazed at the solutions currently offered to conditions in which they never dreamt of any possible means of treatment. The role of the bone setter, therefore, apparently declined.
Is this the true picture?
Orthopedic surgeons do think this way because according to them, hospital practice has little to do with hone settering. They are only partly right. operating room practice has little to do with hone settering, hut splinting technique, i.e. casting technique, is still the bone-setter's expertise. Orthopedic surgeons’ operating room practice has misled him to a total denial of hone—setter’s skill, as well as to ignore the value of casting. Orthopedic surgeons forget that only the special patients require their special attention, whereas the majority of patients suffering from locomotors disturbances all occupy the other end of the spectrum i.e. they require treatment for ailment only, not complicated management. An orthopedic surgeon should take care of the whole spectrum, the ailments as well as the serious conditions. L1nfortunatelv, the current tendency is to give up the ailments. The majority of victims of accidents and injuries suffer from sprains and simple fractures
which do not require hospital treatment. These patients keep our bone—setters busy. Our orthopedic surgeons are more skillful at the basic techniques of pain relief and splinting the with contributing more towards this vast, non—hospital group of patients.
With this background, the volume that you are going to read: “Casting materials and their clinical applications” obviously becomes very important. It should serve as an important reminder to the orthopedic surgeons about the old-time technique and justifications. It should sensitize them once more to the conventional options of splinting and casting which so often, have been chucked to a dark corner of “last resort”. Surgeon readers should learn to keep an open mind in choosing the ideal option of treatment: casting or otherwise, carefully weigh the different merits arising from different options before committing to the best choice.
Surgeons of my age with thirty years of working experience have witnessed different eras when casting techniques were over-used, abused, and underused. Twenty-five years ago, nearly all patients with fractures, irrespective of their sites and nature, were treated with casting alone. That was an era of overuse and abuse. Nowadays, we see the hairline fracture of the tibia being nailed. This is over-used of operative means and under-used of casting technique. Surgeons should refrain from either extreme. This volume should offer them support and help.
Without the knowledge of the casting material being used and without the understanding of basic biomechanical principles, thermoplastic splints cannot be properly applied. Apprenticeship alone is not the best solution to A thermoplastic splints application. Functional A thermoplastic splints s advocated by Sarmiento and functional components incorporated in A thermoplastic splints s like hinges and reinforcements are good examples of applying biomechanics in clinical practice. Such technical points are discussed in this volume and will form useful references and provide technical guidance.
Scientific and technological advances in medicine suffer unnecessary conflicts between conventional and current practices. Unlike non-medical fields where the conventional ideas and practices are usually incorporated in the newer options, new techniques in medicine tend to be exclusive against their precursors. While we welcome and rejoice over advances, we could refrain from being over-receptive. An open mind gives better judgment. The best treatment for a hone fracture is the one that gives the best healing with the shortest time of functional loss and the most guaranteed outcome in the surgeon’s hands. Above all, no harm should be done to the patient.