will   be   managed   by   bed   rest,   immobilization,   and rehabilitation.   Many of the basic concepts of care of the   medical   patient   are   applicable   for   orthopedic patient  care. In  the  military,  the  usual  orthopedic patient  is  fairly  young  and  in  good  general  physical condition.    For  these  patients,  bed  rest  is  prescribed only because other kinds of activity are limited by their condition on admission. Immobilization Rehabilitation is the ultimate goal when planning the orthopedic patient’s total management.    Whether the patient requires surgical or conservative treatment, immobilization is often a part of the overall therapy. Immobilization   may   consist   of   applying   casts   or traction,   or   using   equipment   (such   as   orthopedic frames). During  the  immobilization  phase,  simple basic patient care is extremely important.  Such things as skin care, active-passive exercises, position changes in  bed  (as  permitted),  good  nutrition,  adequate  fluid intake,  regularity  in  elimination,  and  basic  hygiene contribute to both the patient’s physical and psycho- logical well-being. Lengthy  periods  of  immo b i l i z a t i o n    a r e emotionally  stressful  for  patients,  particularly  those who are essentially healthy except for the limitations imposed   by   their   condition. Prolonged   inactivity contributes to boredom that is frequently manifested by various kinds of acting-out behavior. Often,   the   orthopedic   patient   experiences exaggerated   levels   of   pain. Orthopedic   pain   is commonly described as sore and aching.  Because this condition   requires   long   periods   of   treatment   and hospitalization,  the  wise  management  of  pain  is  an important aspect of care.  Constant pain, regardless of severity, is energy consuming.  You should make every effort to assist the patient in conserving this energy. There are times when the patient’s pain can and should be   relieved   by   medications. There   are,   however, numerous occasions when effective pain relief can be provided by basic patient-care measures such as proper body alignment, change of position, use of heat or cold (if permitted by a physician’s orders), back rubs and massages,   and   even   simple   conversation   with   the patient.    Meaningful  activity  also  has  been  found  to help relieve pain.   Whenever possible, a well-planned physical/occupational  therapy  regimen  should  be  an integral part of the total rehabilitation plan. C A S T   FA B R I C AT I O N . — A s   m e n t i o n e d previously, immobilization is often a part of the overall therapy  of  the  orthopedic  patient,  and  casting  is  the most   common   and   well-known   form   of   long-term immobilization.   In some instances, a Corpsman may be required to assist in applying a cast or be directed to apply or change a cast.  In this section, we will discuss the method of applying a short and long arm cast, and a short leg cast. In  applying  any  cast,  the  basic  materials  are  the same:  webril  or  cotton  bunting,  plaster  of  Paris,  a bucket  or  basin  of  tepid  water,  a  water  source  (tap water), protective linen, gloves, a working surface, a cast saw, and seating surfaces for the patient and the Corpsman.   Some specific types of casts may require additional material. SHORT ARM CAST.—A short arm cast extends from the metacarpal-phalangeal joints of the hand to just below the elbow joint.  Depending on the location and type of fracture, the physician may order a specific position for the arm to be casted. Generally, the wrist is in a neutral (straight) position, with the fingers slightly flexed in the position of function. Beginning at the wrist, apply three layers of webril (fig. 2–2A).  Then apply webril to the forearm and the hand, making sure that each layer overlaps the other by a third (as shown in figure 2–2B).  Check for lumps or wrinkles  and  correct  any  by  tearing  the  webril  and smoothing it. Dip   the   plaster   of   Paris   into   the   water   for approximately 5 seconds.   Gently squeeze to remove excess water, but do not wring out.   Beginning at the wrist (fig. 2–2C) wrap the plaster in a spiral motion, overlapping   each   layer   by   one-third   to   one-half. Smooth out the layers with a gentle palmar motion. When applying the plaster, make tucks by grasping the excess  material  and  folding  it  under  as  if  making  a pleat.    Successive layers cover and smooth over this fold.  When the plaster is anchored on the wrist, cover the hand and the palmar surface before continuing up the arm (figs. 2–2D and 2–2E).  Repeat this procedure until   the   cast   is   thick   enough   to   provide   adequate support, generally 4 to 5 layers.    The final step is to remove any rough edges and smooth the cast surface (fig. 2–2F).   Turn the ends of the cast back and cover with the final layer of plaster, and allow the plaster to set  for  approximately  15  minutes.    Trim  with  a  cast saw, as needed. LONG ARM CAST.—The procedure for a long arm cast is basically the same as for a short arm cast, except the elbow is maintained in a 90E  position, the 2-20