People who are unfortunate enough to incur a fracture have the belief that their fracture will be treated by the application of a cast leading to the end of their problems. Little do they know that it might be the beginning of a protracted, painful, inconvenient and costly period which may not even ensure healing of the fracture and return of function.
What is a cast?
A cast supports and protects injured bones and soft tissue, reducing pain, swelling, and muscle spasm. It is custom-made and applied by your doctor or an assistant. It is often made of plaster or fibreglass.
Fibreglass or plaster material forms the hard supportive layer in splints and casts. Fibreglass 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 is used in the making of a cast, the cast must be kept dry. If it becomes wet significant problems may develop. 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. To keep these types of casts dry, it is necessary to wear a plastic protection during a shower.
The 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.
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 cast for the first 48 to 72 hours leading to the cast getting tight. To reduce the swelling, elevate the limb above heart level along with icing of the swollen part that is not in the cast. Exercise the fingers or toes to decrease swelling and prevent stiffness and to increase circulation.
2. Keep your cast dry if it has a cotton lining in it. Use a shower bag for bathing.
3. Pad any rough spots with cotton.
4. To ease any discomfort from itching, you may blow cool air inside the cast with a hair dryer.
5. Check circulation by pressing on the nail bed.
6. Inspect the skin around the cast. If your skin becomes red or raw around the cast, contact your doctor.
7. Inspect the cast regularly. If it becomes cracked or develops soft spots, contact your doctor.
8. 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.
2. Do not insert any object 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
A feeling that the cast is too tight
Numbness, tingling or burning sensation
Excessive swelling beyond the cast
Loss of movement of toes or fingers
Blisters developing in your cast
Unusual odour
Breakage
Skin sores
Fever
Drawbacks of cast treatment: Is it obsolete?
Casting is indeed the time-tested modality of fracture treatment but changing times and advances in orthopaedics have rendered it more or less obsolete. The reasons are the several drawbacks of casts in comparison to other modalities of fracture treatment like surgery. The drawbacks are listed below:
1. Inconvenience: the greatest drawback of a cast is its bulk and cumbersome nature. Who likes to drag along a heavy-duty plaster-of-paris contraption wrapped around their limb for three months? It stops you from not only your occupation but also the activities of daily life.
2. Uncertainty of healing: a cast being applied to your fracture does not guarantee healing. As a matter of fact, the chances of healing in a cast are far less than with surgery. Also healing in a cast may lead to deformity and limb shortening as there is no direct control over the fractured ends on the bones.
3. Long recovery: It can range anywhere from between six weeks to three months or more.
4. Stiff joints: Prolonged casting of a limb will stiffen the joints over time.
5. Sores and ulcers: The hard cast surface combined with sweat or water can excoriate the skin.
6. Repeated X rays and cast change: Casts have a tendency to break or loosen requiring repeated X-Rays and changes.
7. Circulation issues and nerve injury: Pressure over nerves and vessels can cause injuries to them
8. Low-cost effectivity: Casts might appear as a cheaper modality of treatment but repeated cast changes, X-rays, absence from work for months, all add up to a much higher financial deficit than the one-time expense of surgery.
To conclude, it can be safely said that with changing times and advances, casts have given way to better and more effective methods. They play a supportive and temporary role in the present era until a definitive action like surgery is undertaken. It is wise to remember that your treatment is not over once the cast is applied. In fact it may be the beginning of a prolonged and inconvenient period which might not even treat your fracture. Making inquiries about newer surgical procedures from your orthopaedic surgeon will ensure fast healing and earlier mobilization.
