Bricolage IS WRITTEN by Jeff Cable and is based in the United Kingdom.

This blog aspires to provide COHERENT and relevant Material for all cast TECHNICIANS. 

What Do We Know?

This may seems like an odd question but, having undertaken the update course to my original BCC certificate, I am acutely aware that a body of theoretical knowledge for cast technicians does not exist. Yes; I can find mention of a particular approach to a specific orthopaedic problem but cast technicians have been reluctant to commit their practices to paper.

There are a few papers (contentious) which promote methods that are not exactly science but more a statement of belief. This situation has caused me to examine what I actually know and how have I come to understand what I do know.

The job of a cast technician encompasses a complex and wide range of tasks which include applying and removing casts for fractures, constructing or applying functional splints and braces of many different kinds to injuries which are healing.

Applying serial casts for congenital conditions and supporting orthopaedic surgical interventions with specialised casts. The provision of walking aids and instructions in their use and dealing with patients who have returned with cast problems, wound infections and pressure injuries. 

Specialist casting techniques such as total contact casting for diabetic ulcers and Charcot joints are common. The patients may need casts bivalving prior to travelling by air or have their metalwork (K wires or external fixators) removed. Wounds need to be dressed and clips or sutures are often removed in the plaster room.

Early reporting of complications such as CRPS or flexion contractures is also an expected norm. All of the foregoing requires a depth of knowledge but our casting courses are short and have not taught any of the advanced skills which are required.

To be adequately prepared for the job of cast technician we need to gain a deep knowledge of anatomy and physiology, surface anatomy, bony anatomy, radiological anatomy for adults and children, basic neurology and a comprehensive knowledge of the musculature and biomechanics. 

Physiotherapeutic principles would be a useful addition to our knowledge base as would some basic orthotic knowledge when we are required to make functional cast braces such as those which are common with knee injuries.

A knowledge of available materials and techniques would help us to make clinical cases for using certain materials and methods of practice. This would short-circuit the NHS supply chain requirement to specify what you will use in your work; without any reference as to how it is used. 

Much of my basic knowledge was in place because I had worked in the field of trauma and orthopaedics as a nurse. Since I began working full time in the arena of the cast technician, I have used my previous work experiences to underpin my work.

I always ask relevant questions of the prescribing clinicians if I do not understand their approach to a particular condition. Where a novel approach looks to be both beneficial and applicable to the general case, I will always ask for permission to test it.  

Only by asking when we are unsure (as to the rationale behind a treatment) can we begin to improve our understanding. I am frequently prompted to read articles for myself when I wish to understand more about the work I do and when I have seen a new type of case presented in the clinic. Attending trauma meetings helped to raise my own awareness of potential issues and pitfalls with particular patients.

I have attended an excellent and intensive module on functional cast bracing and improved my own radiological interpretation skills. I have attended a non-operative fracture treatment course arranged by AO and derived huge benefits from the course.  

Nowhere do we find any clear statement of the knowledge and skills that we need to have and to develop if we are to provide excellence in casting care. I started by asking What Do We Know? I am not sure how many cast technicians could write down what they do actually know. I would be very interested to see what they would write when asked the question; Why Do We Think We Know What We Do?

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