Abstract
BackgroundClosed reduction with long leg casting is a widely practiced method of acute management of lower extremity fractures but may be cumbersome and time consuming. To our knowledge, only one method of single practitioner long leg casting has been previously reported. In this report, we describe the novel single-practitioner technique utilized at our institution for acute point-of-care temporizing management of lower extremity fractures.The Boston techniqueThe patient is placed supine at the edge of the hospital bed. The injured extremity is suspended from an intravenous pole in 45° of hip abduction and 30° of hip flexion. Neutral rotation is adequately maintained due to suspension through the great and second toes, without the need for patient participation. A plaster cast is applied in the usual manner and allowed to dry. Once dry, the cast is bivalved per our standard protocol to mitigate the incidence of compartment syndrome and soft-tissue complications.DiscussionThe Boston technique is recommended as a single practitioner method of lower extremity fracture casting in the emergency department, trauma bay or intensive care setting. However, future studies and inclusion of additional comparable novel casting methods are required to validate our empirical findings and to further characterize the benefits and risks of casting via the Boston technique.
Highlights
Closed reduction with long leg casting is a widely practiced method of acute management of lower extremity fractures but may be cumbersome and time consuming
The Boston technique is recommended as a single practitioner method of lower extremity fracture casting in the emergency department, trauma bay or intensive care setting
The Boston technique The Boston technique is performed by a single medical practitioner for acute point-of-care casting and stabilization of lower extremity fractures in the emergency department, trauma bay or intensive care unit
Summary
Long leg casting of lower extremity fractures is routinely performed at trauma centers and community hospitals throughout the United States, and is widely accepted as appropriate initial management of such acute traumatic injuries. With the ever-increasing focus on access-to-care, efficiency and cost-reduction in trauma and urgent-care centers, the Boston technique represents an efficient casting method requiring only a single medical practitioner and limited emergency department resources while demonstrating consistent and reproducible outcomes with regards to quality of care and patient satisfaction [4]. This technique has been valuable in the acute-care setting at our high-volume Level-I trauma institution It can be employed by a single medical practitioner and provides fracture stability, soft-tissue protection, patient comfort and allows for comprehensive clinical compartment pressure management. We recommend the Boston technique as the preferred single practitioner method of lower extremity fracture casting in the emergency department, trauma bay or intensive care setting for acute point-of-care management
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