Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Casts & Plasters & Splints

Casts & Plasters & Splints

Casts & Plasters & Splints

Cast / Plaster is usually used to treat fracture with no dislocation or for soft tissue injury.

GENERAL INFORMATION

Splints and casts support and protect injured bones and soft tissue, reducing pain, swelling, and muscle spasm. In some cases, splints and casts are applied following surgery.

Casts are custom-made and applied by your doctor or an assistant. Casts are often made of plaster or fiberglass. Splints or half casts also can be custom-made, especially if an exact fit is necessary. Other times, a ready-made splint will be used. These off-the-shelf splints are made in a variety of shapes and sizes, and are much easier and faster to use. They have Velcro straps which make the splints easy to adjust, and easier to put on and take off. Unfortunately, splints offer less support and protection than a cast and may not a treatment option in all circumstances.

Fiberglass or plaster materials form the hard supportive layer in splints and casts. Fiberglass is lighter in weight, longer wearing, and “breathes” better than plaster. Both materials come in strips or rolls which are dipped in water and applied over a layer of cotton or synthetic padding covering the injured area. Both fiberglass and plaster splints and casts use padding, usually cotton, as a protective layer next to the skin. When cotton padding, synthetic padding, or plaster is used in the making of a cast, the cast must be kept dry. If these materials become wet significant problems may develop. When a plaster cast gets wet, the cast becomes soft, loses strength, and may no longer adequately immobilize the injured area. As a result, broken bones may heal in the incorrect position if the cast is not replaced. When the cotton or synthetic padding gets wet, it is very difficult to dry. As a result, the wet skin under the wet padding may develop rashes, infections, or become macerated. All of these conditions, require further treatment. To keep these types of casts dry, it is necessary to wear plastic shower bags which are commercially available.

Recently, Gortex cast padding has been developed. This padding is completely waterproof and allows a patient to completely immerse the cast in water without requiring the protection of a plastic bag. With this type of cast padding, coupled with the application of a fiberglass cast, patients may do activities such as showering and swimming without worrying about keeping the injured extremity dry. However, there are some clinical circumstances when this type of cast padding may not be applied.

 

The splint or cast must fit the shape of the injured arm or leg correctly to provide the best possible support. Sometimes, it may be necessary to replace a cast as swelling decreases and the cast “gets too big.” Often as a fracture heals, a splint may be applied again to allow easy removal for therapy.

 

CAST CARE TIPS

If your treatment is to be successful, you must follow your doctor’s instructions carefully. The following information provides general guidelines only, and is not a substitute for your doctor’s advice.

DO’s of CAST CARE

1. Swelling due to your injury may cause pressure in your splint or cast for the first 48 to 72 hours. This may cause your injured arm or leg to feel snug or tight in the splint or cast. To reduce the swelling:

  • Elevate your injured arm or leg above your heart by propping it up on pillows or some other support. You will have to recline if the splint or cast is on your leg. Elevation allows clear fluid and blood to drain “downhill” to your heart.
  • Exercise the fingers or toes to decrease swelling and prevent stiffness and to increase circulation.
  • Apply ice to the splint or cast. Place the ice in a dry plastic bag or ice pack and loosely wrap it around the splint or cast at the level of the injury. Ice that is packed in a rigid container and touches the cast at only one point will not be effective.

2. Keep your cast dry if it has a cotton or synthetic lining or if it is a plaster cast. Use a shower bag for bathing.

3. If you have a Gortex cast, you may shower or swim, but rinse well with tap water afterwards.

4. File down any rough spots with an emery board.

5. To ease any discomfort from itching, you may blow cool air inside the cast with a hair dryer.

6. Check circulation by pressing on the nail bed. The nail should turn pale when pressed, but normal color should return immediately when the pressure on the nail is removed. If this does not happen, contact your physician.

7. Inspect the skin around the cast. If your skin becomes red or raw around the cast, contact your doctor.

8. Inspect the cast regularly. If it becomes cracked or develops soft spots, contact your doctor.

9. Keep dirt, sand, and powder away from the inside of your splint or cast

DON’Ts of CAST CARE

1. Do not get your cast wet, unless you have a Gortex cast.

2. Do not insert any object objects such as coat hangers into the cast to relieve itching. Instead, use the cool setting on a hair dryer to blow air into the cast.

3. Do not apply powders or deodorants to itching skin. If itching persists, contact your doctor.

4. Do not pull out the cast padding. It is there to protect your skin.

5. Do not break or trim the cast edges.

WARNING SIGNS FOLLOWING SPLINT/CAST APPLICATION

After application of a splint or cast, it is very important to elevate your injured arm or leg for 24 to 72 hours. The injured area should be elevated well above the heart. Rest and elevation greatly reduce pain and speed the healing process by minimizing early swelling. If you experience any of the following warning signs, contact your doctor’s office immediately for advice.

  • Increased pain and swelling which is not controlled with ice, elevation, and/or pain medication.
  • A feeling that the splint or cast is too tight.
  • Numbness and tingling in your hand or foot.
  • Burning and stinging.
  • Excessive swelling below the cast.
  • Loss of active movement of toes or fingers, which requires an urgent evaluation by your doctor.
  • A feeling of a blister developing in your cast.
  • A feeling that your calf is becoming swollen, tight and painful inside the cast.
  • You notice any unusual odor coming from inside the cast.
  • If the cast breaks or becomes too loose.
  • If the cast edges are causing skin problems.
  • If a fever develops.

PROPER CAST REMOVAL

Never remove the cast yourself. You may cut your skin or prevent proper healing of your injury. Your doctor will use a cast saw to remove your cast. The saw vibrates, but does not rotate. If the blade of the saw touches the padding inside the hard shell of the cast, the padding will vibrate with the blade.

 

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