Name of the Procedure:

Application of Patellar Tendon Bearing (PTB) Cast

Summary

The application of a Patellar Tendon Bearing (PTB) cast involves placing a specialized type of cast around the lower leg to support and partially unload the weight from the affected bones or joints, typically used for fractures or severe soft tissue injuries in the lower leg.

Purpose

The PTB cast is primarily used to stabilize fractures or significant soft tissue injuries by transferring weight from the bones to the patellar tendon area. This allows for improved healing by reducing the stress on the injured area. The goal is to enable the patient to move more comfortably and safely while protecting the injury.

Indications

• Tibial fractures
• Severe soft tissue injuries in the lower leg
• Post-operative support following surgery around the knee or lower leg
• Patients who need to bear weight while minimizing stress on the damaged bone or soft tissue

Preparation

• No specific fasting or medication adjustments are generally required.
• Diagnostic imaging tests, like an X-ray or MRI, may be needed to assess the injury.
• The patient should inform the healthcare team of any allergies or chronic conditions.

Procedure Description

1. The patient is positioned comfortably, usually lying down.
2. The healthcare provider cleans and dries the affected leg.
3. A stockinette and padding are applied to protect the skin.
4. Plaster or fiberglass casting material is wrapped around the lower leg, extending from just below the knee to the ankle.
5. Special attention is given to mold the cast around the patellar tendon area to ensure proper weight distribution.
6. The cast is allowed to set and harden, usually taking around 10-20 minutes.
7. The healthcare provider verifies the fit and comfort of the cast and makes any necessary adjustments.

Tools and Equipment:

• Stockinette
• Cotton or synthetic padding
• Plaster or fiberglass casting material
• Cast scissors and spreaders

Anesthesia or Sedation:

• Typically, no anesthesia or sedation is required for cast application.

Duration

The procedure usually takes about 30-45 minutes from start to finish.

Setting

The procedure is performed in an outpatient clinic or hospital orthopedic department.

Personnel

• Orthopedic surgeon or orthopedic technician
• Nurse or medical assistant

Risks and Complications

• Potential skin irritation or sores due to pressure points
• Cast may become loose or too tight as swelling decreases or increases
• Risk of impaired circulation or nerve compression
• Rarely, compartment syndrome

Benefits

• Enhanced fracture healing by offloading weight from the injured area
• Reduced pain and increased mobility
• Improved ability to perform daily activities with less discomfort

Recovery

• Keep the cast dry and clean.
• Follow specific weight-bearing instructions provided by your doctor.
• Watch for signs of complications (e.g., increased pain, swelling, or numbness) and report them immediately.
• The typical recovery period varies based on the injury, but the cast might be worn for several weeks to a couple of months.
• Follow-up appointments will be scheduled to monitor healing.

Alternatives

• Standard cast without weight-bearing capacity
• Surgical intervention
• Use of a brace or splint
• Each alternative has its pros and cons regarding the level of support and the patient’s ability to move.

Patient Experience

• During the procedure, patients might feel slight pressure while the cast is being molded.
• After the procedure, most patients experience relief from pain due to improved support.
• Minor itching and discomfort can be managed with over-the-counter pain relief and by keeping the cast dry and intact.