The use of gypsum for fractures, gypsum immobilization, the quality of gypsum. Gypsum in orthopedic dentistry: The use of gypsum Medical gypsum characteristics and methods of application

And you say: slipped, fell. Closed fracture! Lost consciousness, woke up - plaster. (film "Diamond Hand")

Since ancient times, various materials have been used to immobilize damaged bone fragments in order to maintain immobility in the fracture area. The very fact that bones grow together much better if they are immobilized relative to each other was obvious even to primitive people. The vast majority of fractures will heal without any need for surgery if the broken bone is properly aligned and fixed (immobilized). Obviously, in that ancient time, immobilization (limitation of mobility) was the standard method of treating fractures. And how in those days, at the dawn of history, you can fix a broken bone? According to an extant text from the papyrus of Edwin Smith (1600 BC), hardening bandages were used, probably derived from bandages used in embalming. Also in the excavation of the tombs of the Fifth Dynasty (2494-2345 BC), Edwin Smith describes two sets of immobilization splints. Before the advent of the first plaster cast was very far ...
Detailed recommendations for the treatment of fractures are given in the Hippocratic Collection. The treatises “On Fractures” and “On Joints” give the technique of repositioning the joints, eliminating limb deformities in fractures, and, of course, immobilization methods. Hardening dressings made from a mixture of wax and resin were used (by the way, the method was very popular not only in Greece), as well as tires made of "thick leather and lead."
Later descriptions of methods for fixing broken limbs, in the 10th century AD A talented surgeon from the Caliphate of Cordoba (the territory of modern Spain) suggested using a mixture of clay, flour and egg white to create a tight fixing bandage. These were materials that, along with starch, were used everywhere until the beginning of the 19th century and technically underwent only minor changes. Another thing is interesting. Why was plaster not used for this? The history of the plaster cast as we know it today is only 150 years old. And gypsum as a building material was used as early as the 3rd millennium BC. Has no one thought to use plaster for immobilization for 5 thousand years? The thing is that to create a plaster cast, you need not just gypsum, but one from which excess moisture has been removed - alabaster. In the Middle Ages, the name "Parisian plaster" was assigned to it.

History of plaster: from the first sculptures to Parisian plaster

Gypsum as a building material was used 5 thousand years ago, and was used everywhere in works of art, buildings of ancient civilizations. The Egyptians, for example, used it to decorate the tombs of the pharaohs in the pyramids. In ancient Greece, gypsum was widely used to create magnificent sculptures. In fact, the Greeks gave the name to this natural material. “Gypros” in Greek means “boiling stone” (obviously, due to its lightness and porous structure). It was also widely used in the works of the ancient Romans.
Historically, the most famous building material was used by the architects of the rest of Europe. Moreover, the manufacture of stucco and sculpture is not the only use of gypsum. It was also used for the manufacture of decorative plaster for processing wooden houses in cities. A huge interest in gypsum plaster arose because of the misfortune that was quite common in those days - fire, namely: the Great Fire of London in 1666. Fires were not uncommon then, but then more than 13 thousand wooden buildings burned out. It turned out that those buildings that were covered with gypsum plaster were much more resistant to fire. Therefore, in France they began to actively use gypsum to protect buildings from fires. An important point: in France there is the largest deposit of gypsum stone - Montmartre. Therefore, the name "Paris plaster" was fixed.

From Parisian plaster to the first plaster cast

If we talk about hardening materials used in the "pre-gypsum" era, then it is worth remembering the famous Ambroise Pare. The French surgeon impregnated the bandages with an egg white composition, as he writes in his ten-volume manual on surgery. It was the 16th century and firearms began to be actively used. Immobilizing dressings were used not only for the treatment of fractures, but also for the treatment of gunshot wounds,. European surgeons then experimented with dextrin, starch, wood glue. Napoleon Bonaparte's personal physician, Jean Dominique Larrey, used bandages impregnated with a mixture of camphor alcohol, lead acetate and egg white. The method, due to the complexity, was not massive.
But who first guessed to use a plaster cast, that is, a fabric soaked in plaster, is unclear. Apparently, it was a Dutch doctor - Anthony Mathyssen, who applied it in 1851. He tried rubbing the dressing with plaster powder, which, after being applied, was moistened with a sponge and water. Moreover, at a meeting of the Belgian Society of Medical Sciences, he was sharply criticized: the surgeons did not like the fact that the plaster stains the doctor's clothes and quickly hardens. Mathyssen's dressings were strips of coarse cotton fabric with a thin layer of Parisian plaster applied. This method of making a plaster cast was used until 1950.
It is worth saying that long before that there is evidence that gypsum was used for immobilization, but in a slightly different way. The leg was placed in a box filled with alabaster - a "dressing projectile". When the gypsum set, such a heavy blank was obtained on the limb. The downside was that it severely limited the patient's mobility. The next breakthrough in immobilization, as usual, was the war. In war, everything should be fast, practical and convenient for mass use. Who in the war will deal with boxes of alabaster? It was our compatriot, Nikolai Ivanovich Pirogov, who first applied a plaster cast in 1852 in one of the military hospitals.

The first ever use of a plaster cast

But why is it gypsum? Gypsum is one of the most common minerals in the earth's crust. It is calcium sulfate bound to two water molecules (CaSO4*2H2O). When heated to 100-180 degrees, gypsum begins to lose water. Depending on the temperature, either alabaster (120-180 degrees Celsius) is obtained. This is the same Parisian plaster. At a temperature of 95-100 degrees, low-fired gypsum is obtained, called high-strength gypsum. The latter is just more preferable for sculptural compositions.

He was the first to use the familiar plaster cast. He, like other doctors, tried to use different materials to create a tight bandage: starch, colloidin (a mixture of birch tar, salicylic acid and colloid), gutta-percha (a polymer very similar to rubber). All these funds had a big minus - they dried out very slowly. Blood and pus soaked the bandage and it often broke. The method proposed by Mathyssen was also not perfect. Due to the uneven impregnation of the fabric with gypsum, the bandage crumbled and was fragile.

For immobilization in ancient times, there were attempts to use cement, but the long curing time was also a minus. Try sitting still with a broken leg all day...

As N.I. Pirogov in his "Sevastopol Letters and Memoirs" he saw the action of gypsum on canvas at the workshop of the famous sculptor N.A. Stepanov in those days. The sculptor used thin linen strips soaked in a liquid mixture of Parisian plaster to make models. “I guessed that it could be used in surgery, and immediately put bandages and strips of canvas soaked in this solution on a complex fracture of the lower leg. The success was wonderful. The bandage dried up in a few minutes ... The complex fracture healed without suppuration and any seizures.
During the Crimean War, the method of using plaster casts was widely put into practice. The technique for preparing a plaster cast according to Pirogov looked like this. The injured limb was wrapped in a cloth, and the bone protrusions were additionally wrapped around. A gypsum solution was being prepared and strips from shirts or underpants were immersed in it (in war there is no time for fat). In general, everything was suitable for bandages.

In the presence of a plaster solution, you can turn anything into an immobilizing bandage (from the movie "Gentlemen of Fortune")

The gypsum gruel was distributed over the tissue and applied along the limb. Then the longitudinal stripes were reinforced with transverse stripes. It turned out to be a solid construction. Already after the war, Pirogov improved his method: a piece of tissue was cut out of coarse canvas in advance, corresponding to the size of the injured limb and soaked in a plaster solution before use.

Abroad, the Matissen technique was popular. The fabric was rubbed with dry gypsum powder and applied to the patient's limb. The gypsum composition was stored separately in sealed containers. In the future, bandages sprinkled with the same composition were produced. But they wetted them after bandaging.

Pros and cons of a plaster cast

What are the advantages of a gypsum-based fixing bandage? Convenience and speed of application. The gypsum is hypoallergenic (only one case of contact allergy is remembered). A very important point: the bandage "breathes" due to the porous structure of the mineral. A microclimate is created. This is a definite bonus, unlike modern polymer dressings, which also have a hydrophobic substrate. Of the minuses: not always sufficient strength (although a lot depends on the manufacturing technique). Gypsum crumbles and is very heavy. And for those who have been affected by misfortune and had to turn to a traumatologist, the question is often tormented: how to scratch under a cast? Nevertheless, under a plaster cast, it itches more often than under a polymer one: it dries out the skin (recall the hygroscopicity of gypsum). Various devices made of wires are used. Who faced, he will understand. In a bandage made of plastic, on the contrary, everything “fades”. The substrate is hydrophobic, that is, it does not absorb water. But what about the main bonus of polymer dressings - the ability to take a shower? Of course, here all these disadvantages are devoid of bandages created on a 3D printer. But so far, such bandages are only in development.

Polymer and 3D printer as a means of immobilization

Will the plaster cast become a thing of the past?

Modern capabilities of a 3D printer in the creation of fixation dressings

Undoubtedly. But I don't think it will be very soon. Rapidly developing modern technologies, new materials will still take their toll. The plaster bandage still has a very important advantage. Very low price. And, although new polymeric materials are emerging, the immobilizing bandage of which is much lighter and stronger (by the way, it is much more difficult to remove such a bandage than a regular plaster one), fixing bandages of the “external skeleton” type (printed on a 3D printer), the history of the plaster bandage is not over yet.

Palamarchuk Vyacheslav

If you find a typo in the text, please let me know. Highlight a piece of text and click Ctrl+Enter.

A fracture is associated in the vast majority of Russian patients who survived it with a heavy cast, painful itching and a long rehabilitation of muscles that have forgotten how to move. But the world is changing. Inconvenient bulky gypsum has been replaced by new technologies. We already have them in our clinics - sometimes just knowing about it is enough to get a comfortable, breathable, lightweight bandage with an ideal shape. MedAboutMe found out how the methods of external immobilization have changed and what doctors prefer to use now.

The fact that broken bones need to be securely fixed for some time and deprived of the opportunity to move, that is, to be immobilized, humanity guessed a long time ago. In ancient times, the most amazing combinations were used:

planks wrapped in linen and smeared with clay;
canvas ribbons soaked in a mixture of egg whites and various plants (Africa);
impregnation of tapes with resin (ancient Egypt);
the use of boiled rice (India) or gutta-percha (Malaysia) as a fixative;
freshly torn skin of a ram with wool inside (Caucasian peoples), etc.

But before Hippocrates, the use of external immobilization was more an accident than a rule. It was only thanks to the ancient Greeks and Romans that this method gradually took its place in medicine. Over time, rough splints were replaced by individual dressings moistened with starch. To prevent them from bending, they were reinforced with wood shavings. Which, however, did not save the history of medicine from unusual methods of immobilization. In the work of a German physician of the 19th century, there is evidence of an Arab who buried a broken shin in the ground and thus waited for the bones to grow together.

Napoleon's army doctors declared external immobilization a key element of first aid to injured soldiers - it turned out that then their fractures heal faster. This has intensified the search for options to replace splints with bandages that can be impregnated with a fast-curing agent. The first evidence of the use of gypsum dates back to 1795 - again in a situation of hostilities. Initially, the method seemed too dirty to the doctors, and the plaster dries too quickly. But the famous Russian surgeon N.I. Pirogov, he received full support and soon became the most common method of external immobilization. Among the variations of plaster casts were:

tires made of hemp rope immersed in gypsum porridge;
paper pants (tights) coated with plaster;
splints made of plaster bandages, which were wound around the limb, and then stroked to give the desired shape, etc.

Classical medical plaster lasted almost until the end of the 20th century. Among the materials that at different points in time were proposed to be used instead of gypsum for fracture immobilization were: cottage cheese, glass, inflatable tires, celluloid - until mankind discovered modern low-temperature plastics.

In the 1970s, one of the world leaders in dressings and immobilization, Johnson & Johnson developed an isoprene-based plastic that was modified into an orthoplastic. The polymer product had to be heated to 70°C, the limb was fixed, and after half an hour it solidified in the desired shape. From that moment began the general transition from gypsum to modern plastics. At the moment, more than 200 varieties of thermoplastics are known.

Today, the whole world is gradually starting to use new materials for immobilization. Russia is also doing this, but rather slowly. A proven cheap cast with cotton bandages is still the most common method of fixing fractures in the vast majority of Russian cities. But in large metropolitan areas, trauma centers already have a choice: instead of the traditional free gypsum, modern plastic can be applied - for a separate price.

We add that the materials from which modern tires for emergency immobilization are made have also changed: these are metal, cork, rattan, synthetics, plastic, etc.

gypsum is a very cheap material;
a cast can be found in any, the most underfunded traumatology department in the most remote village in Russia.

It is very difficult to move around with plaster. Need crutches or help from other people. In addition, gypsum often leads to the formation of edema and impaired blood circulation in tissues;
when gypsum dries, strong bonds are formed between silicon ions. As a result, the plaster bandage is impermeable to air, which is fraught with the development of diaper rash, bedsores, abrasions, conflicts (blood blisters) and ulcers on the skin under the bandage;
patients complain of unbearable itching, which is caused by plaster chips or hairs adhering to the plaster;
as the plaster dries out and muscle atrophy develops, immobilization inside the bandage sometimes worsens and the plaster literally hangs on the limb;
you can’t take a bath with plaster, moisture is harmful to the bandage;
not always plaster allows you to get a high-quality x-ray of the injury site without removing the bandage;
in the presence of gypsum, hygiene of the damaged area is impossible;
finally, the degree of immobilization with plaster is such that a large amount of healthy muscles and ligaments are also bound by the bandage. As a result, the patient requires long-term rehabilitation after the fracture has healed.

What options for a traditional plaster cast does modern medicine offer?

Instead of a cotton bandage, polymer bandages use a fiberglass or polymer mesh impregnated with polyurethane resin. Polymer gypsum can be in the form of a bandage (activated by water) or sheets-blanks (activated by temperature change) of different sizes.

Advantages of polymer gypsum:

during the polymerization reaction, the distance between the fibers does not change. Thus, a “breathable” dressing is obtained, through which air freely penetrates;
the bandage stretches in 6 directions, so you can easily model the bandage for any body contours, and this improves the degree of immobilization;
due to the cellular mesh structure, the bandage made of polymer bandage is 2-5 times lighter than plaster bandage;
you can take a bath with a bandage, and after that you can simply dry it with a hairdryer;
polymer gypsum is resiliently elastic, that is, it reduces the risk of muscular dystrophy, which is so characteristic of ordinary medical gypsum;
completely permeable to x-rays;
the resulting base of polymer gypsum can be used as you recover to create a removable orthosis or splint.

The main disadvantages of polymer plastering:

polymer gypsum is not a free material. The cost of applying it can range from 1.5 to 3 thousand rubles, and in cases of fractures of large bones and the use of thermoplastic - up to 10 thousand rubles;
the imposition of a polymer bandage is carried out according to a certain technology. And this is a new material for Russian clinics, which is not a mandatory immobilization method for them, so there is no certainty that the emergency room nurse is a professional in applying a polymer bandage;
Removing polymer plaster is also a paid pleasure, as it requires the use of a special saw. The process will cost about 1000 rubles.

Types of polymer gypsum

This is the toughest version of modern polymer gypsum. It is activated by water and is 4-5 times stronger than conventional medical. Like any other polymer gypsum, it is very light, non-toxic, hypoallergenic, breathable and not afraid of moisture. The main disadvantage: with prolonged wear leads to muscle atrophy.

Unfortunately, people quite often break something due to an unforeseen event or in winter, falling on ice. At the same time, the properties of gypsum and its correct application become an integral part of the fracture treatment.

As a rule, a plaster cast is applied in the first hour after the accident. Therefore, medical plaster plays an important role both in treatment and in medicine in general.

How to get medical plaster

Medical plaster does not immediately look like most people imagine it.

Before we see it as a free-flowing powder, it goes through several stages.

So, initially it is a simple gypsum stone, which is heated in a special oven, but the temperature should not exceed 130-140 ° C.

After that, the stone loses all moisture and becomes very brittle. This is done in order to turn the stone into a fine powder.

The properties of gypsum and its quality depend on several factors, but the main thing is the residence time in the oven and the correct exposure. It is very important to store such gypsum in a dry room so that it does not absorb moisture.

What should be the gypsum

The properties of gypsum are very simple, since it must be white, soft, well sifted, harden quickly, and most importantly, not have lumps.

When gypsum is applied, it is imperative to observe the proportions, as a rule, these are 2 parts of gypsum per part of water. If the proportion is not observed, then the plaster will not harden, and the treatment will not begin on time.

What to do if the quality of gypsum has deteriorated

Often, hospitals do not use all the cast on time, and it begins to become damp, but this is not a tragedy.

It happens that not the best cast is used, but you can always make sure that patients feel quality services.

To do this, you need to take gypsum, pour it onto an iron layer, and send it to the oven (the temperature should not exceed 120 ° C), so the gypsum will lose moisture.

If in doubt, then you need to take a mirror, bring it over the plaster, and if it fogs up, then moisture is still present, if not, then everything is in order.

Gypsum is most often applied to the lower leg, hand, forearm and foot. Applying a cast requires different sizes of bandages and appropriate tools.

So, having considered the properties of gypsum and its features, everyone realizes that it is not easy to get gypsum and you need to make an effort, and also make sure that it does not deteriorate.

But it's better that you just know about it, and never come across it on your body.

In the treatment of fractures, a plaster cast is most often used, which is applied by an average medical worker alone or together with a doctor.

Medical plaster obtained from gypsum stone (lime sulphate), calcining it in special furnaces at a temperature not exceeding 130 ° C. As a result, the gypsum stone loses water, becomes brittle and is easily ground into a fine white powder. The quality of gypsum depends on a number of conditions, in particular, on the residence time in the oven, the calcination temperature, and the mesh size of the screening sieves. Gypsum must be stored in a dry place, as the degree of its humidity depends on it.

Medical plaster should be white in color, finely ground, soft to the touch, free of lumps, should harden quickly and be durable in products.

When performing plaster work, you need to take two parts by weight of gypsum to one part of water. With an excess of water, the hardening of gypsum slows down. Gypsum hardens faster at high temperatures, slower at low temperatures. In some cases, for faster hardening of gypsum, alum is added to the water (20 g per bucket of water).

Plaster test. Upon receipt of a cast or before applying a cast, check the quality of the cast using the following steps.

1. Prepare a two- or three-layer splint and impose it on the forearm or hand. If the gypsum is benign, then it hardens in 5-7 minutes, the removed splint retains its shape and does not crumble.

2. Prepare a gypsum gruel (consistency of liquid sour cream) and smear it with a thin layer on a saucer or tray. Good gypsum hardens in 5-6 minutes. If you press on the hardened mass with your finger, then it is not crushed and moisture does not appear on its surface. A piece of such gypsum will not warm up, but break. A bad cast will loosen up.

How to improve the quality of gypsum. Sometimes you have to use not quite benign gypsum. In such cases, you can try to improve its quality. If the gypsum is damp and contains an excessive amount of moisture, then it can be dried. To do this, gypsum is poured in a not very thick layer on an iron sheet, which is placed for several minutes in a heated oven, oven, or simply on a stove. It is necessary to ensure that drying is carried out at a temperature not exceeding 120 ° C. After drying, warm gypsum should not release moisture. This is checked as follows. A mirror is held over the plaster for several minutes. If the mirror fogs up, then moisture is released and the plaster is still wet. Insufficiently well ground gypsum, in which there are lumps, should be sifted through a fine sieve.

In clinics and emergency rooms, plaster bandages are applied in the dressing room. In polyclinics and emergency rooms, bandages are often applied to the lower leg, foot, forearm, and hand. A paramedic or nurse working in the dressing room of a polyclinic or emergency room should ensure that it has everything necessary for applying a plaster cast, including a sufficient number of plaster bandages of various sizes and a set of special tools for processing and removing a plaster bandage (Fig. 126). Dressing staff should be trained in dressing procedures.

Rice. 126. Tools for circumcision and removal of plaster bandages.

Dubrov Ya.G. Outpatient traumatology, 1986

Medical gypsum does not differ in chemical composition from ordinary gypsum. This is calcium sulfate dihydrate, which is formed after ordinary water is added to calcium sulfate hydrate. Hydrate is the initial friable material in the form of a white or slightly yellowish powder, which hardens for a certain time after mixing it with water. The setting time of medical plaster and the permissible dilution consistency are of decisive importance in medicine, since medical plaster is used for making hard bandages, splints, plaster beds, as well as in dentistry for taking dental casts and modeling prostheses.

Medical gypsum is usually divided into the following types: ordinary calcined medical gypsum, model gypsum and super gypsum. All of them have a different production technology and certain places of application in medicine.

Burnt medical plaster obtained by calcining calcium sulfate dihydrate in an open container. When heated to a temperature above 130 degrees, the dihydrate turns into a hemihydrate, which is the usual medical plaster. An important difference between this material and other types of gypsum is that it has very large porous particles of uneven shape, which strongly absorb water. Therefore, for mixing medical calcined gypsum, it is necessary to take water in a ratio of 2: 1 (two parts of gypsum one part of water). The setting start time of this type of medical plaster is from 6 minutes after dilution, and the end time of setting is about 12 minutes after dilution. The main application is plaster bandages.

Model plaster obtained by heating calcium sulfate dihydrate in an autoclave under pressure. In this case, hemihydrate particles of the correct form are obtained with practically no pores. This type of medical plaster is otherwise called alpha hemihydrate. More uniform particles allow you to get denser structures with less water to mix the powder. At the same time, the prints obtained when using model plaster are more accurate. What is especially important when taking impressions of teeth in dentistry. To dilute model gypsum, twenty milliliters of water per 100 grams of powder is needed.

Supergypsum received in two steps. First, the dihydrate is boiled in the presence of calcium and magnesium chlorides, and then heated in an autoclave. Chlorides in this process are deflocculants that prevent flocculation and agglomeration of small gypsum particles into larger granules. Thus, the structure of supergypsum is even thinner and denser than that of model gypsum. Therefore, it is used to take impressions from individual teeth and obtain casts for the manufacture of root inlays for prosthetics.