Health & Exercise Forum

One of the most common questions I receive from patients is related to the management and care of their cast or splint. Given the fact that one may have to live with a cast or splint for four to six weeks (sometimes less, sometimes more), many people have concerns about hygiene, swelling, pain and function while wearing a cast…

WHY DO YOU NEED TO WEAR A CAST OR SPLINT?

Casts or splints are used to support and protect bones and soft tissues after injury or surgery. A broken bone or severe ankle sprains are two good examples. Consequently, the immobilization provided by a cast or splint protects the injury, allows healing with proper alignment, and reduces pain, swelling and muscle spasm.

WHAT ARE THE DIFFERENT TYPES OF CASTS OR SPLINTS?

Casts, half- casts or splints are made of plaster or fiberglass. A doctor or assistant individually makes them for each person and injury. In addition, custom-made splints are often made by occupational therapists for the hand or physical therapists and certified prosthetists for other body parts such as the trunk or limps. Fiberglass splints are made with Velcro straps and are removable, which could be used for the wrist for carpal tunnel or the foot for ankle sprains.     

Both plaster and fiberglass come in rolls, while fiberglass comes in different colors, which are dipped in water and wrapped around the injured part. It is often necessary to apply the cast to the joint above and below the injury. Then, the material will dry and harden in minutes. The cast must fit the shape of the injured part snuggly, but comfortably. If a cast is applied to a new injury or immediately after surgery, the cast will be too big once the swelling subsides. At this point, a new cast is applied. Padding is used under the cast to protect the skin. Sometimes special padding can be used under fiberglass to allow the cast to get wet in the shower or pool. 

GETTING ALONG WITH YOUR CAST

Most fractures or severe sprains require 4-6 weeks of casting, sometimes less, sometimes more. Often, once the cast is removed, a removable half-cast or splint is applied. This allows the injured part to be washed and exercised several times a day without the splint and then reapplied.

The American Academy of Orthopedic Surgeons offers the following recommendations for cast care and warning signs of cast problems:

Recommendations:

1. Follow your doctors cast instructions carefully
2. Swelling – may occur 48-72 hours after the cast is applied.
   • If the cast feels snug, you can then control swelling by:
     • Elevate the injured arm or leg
     • Move the fingers or toes of the injured arm or leg
     • Ice the cast with a cold pack or ice in a plastic bag
3. Keep Cast Dry - moisture will cause your skin to breakdown; therefore, use two plastic bags with duct tape to keep it dry in the shower
4. Keep Weight Off Cast- unless allowed by your doctor; if allowed, you must wait until the cast is completely dry ( 1 hour for fiberglass and 2-3 days for plaster)
5. Keep Cast Clean – keep dirt, sand and powders from inside of the cast
6. Keep Hangers, Sticks, etc. – out of the inside of the cast. You can irritate or cut your skin and get an infection
7. Inspect the Cast – examine the cast for damage, soft spots and weakness, but do NOT break the edges on your own. Call your doctor
8. Inspect the Skin – if the skin is raw, red or severely irritated/itchy, call your doctor
9. Never remove the cast yourself - Call your doctor 

Warning signs: if the above recommendations fail to provide a reduction in swelling or pain or if you have the following warning signs, contact you doctor:

1. Significant Increase in Pain – with an increase in swelling and tightness in the cast
2. Numbness and Tingling – in the hand or foot of the casted limb which may be caused by pressure on the nerves
3. Burning and Stinging -  which may be cause by too much pressure on the skin
4. Excessive Swelling – below the cast may be due to pressure of the cast slowing blood flow
5. Loss of Active Movement – in the fingers or toes of the casted limb requires urgent action to see your doctor or visit the emergency room

Visit your doctor regularly and listen to your body.     Keep moving, eat healthy foods, and exercise regularly.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

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