Orthopaedic Casts

A plaster cast is a shell constructed from fiberglass or plaster that is built around a limb or other part of the body to hold it in place during repair and until healing is complete. Most frequently casts are used to aid with the healing process after a bone or broken or fractured.

Our team has prepared a number of informational resources on plaster casts which you can read below or download as a handy reference.

Downloadable plaster care care leaflet:  Download PDF

Additional plaster care information is available at our partner organization Marylebone Orthopaedic Casting.

Upper Limb – Cast Care Instructions

Please try to continuously exercise all your joints not covered by your cast: fingers, elbow and shoulder.

Regular exercise will significantly reduce post -injury swelling and joint stiffness. Subsequently, this will reduce pain and discomfort and aid quicker rehabilitation. Additionally, blood supply and muscles tone will also be improved.

Please try to elevate your cast whenever possible.

Elevation with additional exercise will help reduce swelling. This is particularly important in the first 2 weeks post injury.
Swelling is part of the body’s normal inflammatory response to injury or surgery and it is to be expected. However, swelling can be extremely uncomfortable, can put extra tension on surgical wounds and is especially problematic on a casted limb. Elevation aims to reduce swelling by increasing venous return of blood to the systemic circulation. This will result in less oedema which subsequently reduces pain.

Please wear a sling, if provided, as per instruction.

Unless advised otherwise by the clinical team, we suggest you wear the sling fairly religiously for the first 72 hours, only removing the sling for sleeping, bathing and exercise periods.

After 72 hours, please try to limit the use of the sling to occasions when you find yourself in crowded environments, daily commute etc. It is then used as a helpful visual aid to others to make allowances for you.

Over reliance and continuous usage of slings can lead to joint stiffness of the shoulder, elbow and fingers.

Please limit any activity or usage of the affected limb that may be detrimental to healing.

Depending on your injury or surgery, your length of time in cast may vary from anywhere between 2-8 weeks. So, it is important you fully understand your treatment aims and any limitations or restrictions placed upon you in order for optimum healing to take place.

General rules for the casted limb:

  • No loading –using the hand to push yourself up from a sitting position.
  • No stressing- carrying heavy loads, shopping bags etc.
  • Unless advised otherwise, try not to lift anything heavier than a cup of tea in the affected hand.
  • Listen to your pain – Try to limit or reduce any certain activities if they cause you discomfort.
  • Please ensure your cast is kept clean and dry.
  • For obvious hygiene reasons it is advisable to keep the cast clean and dry. You may remove stains or smudges on your cast with a clean, damp cloth.
  • Fingers and exposed areas of the hand and elbow can be cleaned with baby wipes or a damp flannel.

Please inform nursing or medical staff if you plan to fly.

Please inform your Consultant if you have plans to fly- In a minority of cases flying may be detrimental to your treatment due to the higher likelihood of increased swelling.

Your Consultant may advise to “split the cast” which will allow extra room if any swelling occurs.

Airline protocols regarding casts may vary, so we suggest that you contact your airline before travelling.

Please try not to get your cast wet.

The cotton wool padding layer of the cast will act like a sponge if it is allowed to become wet. Consequently, the skin becomes waterlogged (macerated) and can begin to ‘break down’- this is especially serious if you have a surgical wound underneath your cast.
Please consider purchasing a Limbo water-proof cast protector. These may be purchased from our clinical team or directly from the Limbo Company http://www.limboproducts.co.uk/

Please do not wear rings or nail varnish on the casted limb.

If swelling is present, rings may become overly tight, causing restriction or occlusion of normal blood flow to the fingers.
If this pressure is not relieved immediately serious tissue injury can occur. Removing the ring at this stage can be a difficult and painful process.
Subtle colour changes to the nail beds of the fingers can indicate blood supply problems. The wearing of nail varnish masks these early signs so should be avoided if possible.

Please do not place foreign objects (knitting needles, pens, tissues) inside your cast in order to relieve, itching, rubbing or chaffing.

Please try to refrain from using foreign objects such as pens, pen lids, knitting needles etc, in order to alleviate itching under your cast. Even very small scratches are far more prone to infection due to the warm, moist environment under your cast (which is a perfect culture medium for the growth of bacteria). Any early visual signs of infection will go largely unnoticed due to your cast covering the limb. Additionally, it is surprisingly common to find lost objects such as pen lids etc during cast removal- These can often cause pressure sores which can in some severe cases require the need for many weeks of wound care dressings or surgical intervention by plastic surgeons.

Please do not cut, heat or otherwise interfere with your cast.

Synthetic casting tapes are comprised of an extremely durable material and attempting to trim or cut them without the correct equipment risks personal injury. Additionally, your cast is applied to very strict dimensions governed by anatomical landmarks. Trimming back or altering your cast in anyway may be detrimental to your overall healing.

Please keep in mind that although wearing a cast will restrict you in many ways it should not be uncomfortable to the point of keeping you awake at night or becoming the sole focus of your attention.

If you are experiencing discomfort in your cast please contact a member of the clinical team.

Please do not drive whilst wearing a cast unless instructed it is safe to do so.

Please discuss this issue during your consultation.

It is generally the responsibility of the patient to decide if they are safe to drive a vehicle. You must be able to drive unimpeded during an emergency situation, such as an emergency stop, full steering manoeuvres etc.

If in any doubt, check with your insurer or the DVLA.

Important!

If you experience any of the following, please contact Jason Moores or Sandra Busari at the London Orthopaedic clinic.
Out of hours, please contact either The Princess Grace Urgent Care Centre, the Hospital you were discharged from or your local Accident and Emergency department.

Different or increasing pain

One of the fundamental concepts of plaster immobilization is that once the limb is immobilized pain should be significantly reduced.
Any difference or increase in pain may suggest there is an underlying problem, such as fracture displacement (the fracture has moved into an incorrect position), infection, pressure sores, ischaemia (loss or reduction of blood supply to the tissues). All of the listed examples will require immediate medical attention.

Discolouration of the fingers (other than bruising), or increased swelling that does not improve after elevation or exercise.

Bruising is a normal by- product of injury or surgery and subtle colour differences to the casted and unaffected limb are fairly common due to an increase in blood supply to the injured area. However, if you notice colour changes, especially with associated pain, this may be a sign that the blood supply has become compromised or restricted in some way. This can be caused by excessive swelling, an overly tight cast or a mixture of both.
Elevate and exercise immediately- If symptoms have not improved after 30 minutes you will need to seek urgent medical attention

Numbness or pins and needles in fingers.

Parathesia (pins and needles) is a common complaint post injury. Often this is caused by swelling compressing the sensory nerves. Elevate and exercise will often alleviate the problem. Less commonly, the pins and needles may be caused by nerve injury as a consequence to the initial injury or surgery or by an overly tight cast or bandage being applied. If after 30 minutes of elevation the problem still persists please contact the clinical team or seek urgent medical advice.

Inability or difficulty in moving any joints not immobilized within the cast.

Please contact a member of the clinical team if you are experiencing problems moving any joints not included within your cast. This may happen due to pain or swelling limiting movement or simply by the cast restricting normal movement ranges. Either way, your Consultant will need to be informed as adequate analgesia (pain killers) can be prescribed or our nursing team can adjust or replace your cast if needed. Movement of all joints not included in your cast is actively encouraged. This helps improve blood supply and muscles tone and will reduce consequent swelling and joints stiffness.

Blister-like pain, chaffing or rubbing.

This problem is unlikely to resolve itself and will often increase in severity. For all the major advantages of modern synthetic casting tapes the one huge drawback is it is a very unforgiving material and is very abrasive.
Incidents have been reported of pressure areas caused by casts breaking the skin and extending all the way down to bone. Once the superficial skin nerves have been eroded away, patients often feel very little pain. These incidences are fortunately extremely rare but it does demonstrate the need to never ignore or ‘put up’ with chaffing problems caused casting.

Visible staining, wetness or any offensive odours that may originate from an enclosed wound.

The above signs are often an indication that there is a wound problem or skin breakdown has occurred. It is hugely beneficial for Infection or heavily macerated wounds to be seen and treated as early as possible.

Foreign body inside your cast; such as a pen or a coin.

Please see section- Please do not place foreign objects inside your cast.

The cast has become wet or soiled.

For hygiene purposes, your cast will most likely need to be replaced if it has become wet or heavily soiled, especially so if you have wounds under your cast.

Your cast becomes very loose, overly tight or otherwise uncomfortable.

You may find that your cast becomes loose over time as the initial swelling subsides and your muscle bulk diminishes due to the effects of immobilization.
A loose cast will give only limited splintage and increases the likelihood of chaffing/rubbing problems.

An overly tight cast can be caused by excessive swelling or by poor cast application. If after exercise and elevation the problem persists please contact a member of the clinical team or seek urgent medical attention. Serious vascular (blood supply) problems can be caused by overly tight casts or bandaging and must be rectified immediately.

Areas of your cast become soft or cracked.

Your cast can become cracked or soften in areas over time. This is especially common, but not exclusive to, Plaster of Paris casts. This often occurs in your cast at points overlying joints such as the hand, wrist or elbow or along lines where the cast is in contact with resting areas- such as the point of the elbow ( in above elbow casts) or along the inside of the forearm.

If the cast is showing signs of wear it must be replaced or reinforced otherwise splintage will be reduced and pressure sores can develop.

If you experience an unexplained fever

A high temperature can be an indication of infection. Consequently, this must be investigated by clinical staff.

If you notice any skin irritation or rash

Some dry skin is a normal reaction to being in cast. The dry area near the fingers can often be relieved by careful moisturising of the skin or by the use of baby wipes etc

Rarely, some patients experience rashes, caused either by a sensitivity or allergy to cleaning fluids, dressings or other materials used in the construction of your cast. Often, symptoms are mild and can be relieved by the use of simple antihistamines, such as Piriton. If, however, you are experiencing a wide spread rash extending to the trunk, neck or face you will need to seek urgent medical attention.
Additionally, If the itching or rash is in close proximity to an underlying wound please inform a member of our clinical team who will advise you the best course of action.

 

Lower Limb – Cast Care Instructions

Please continuously exercise all your joints not covered by your cast: Hip, knee and toes.

Regular exercise will significantly reduce post-injury swelling and joint stiffness. Subsequently, this will reduce pain and discomfort and aid quicker rehabilitation. Additionally, blood supply and muscles tone will also be improved.

Please do elevate your cast whenever possible.

Elevation with additional exercise will help reduce swelling. This is particularly important in the first 2 weeks post injury.
Swelling is part of the body’s normal inflammatory response to injury or surgery and it is to be expected. However, swelling can be extremely uncomfortable, can put extra tension on surgical wounds and is especially problematic on a casted limb. Elevation aims to reduce swelling by increasing venous return of blood to the systemic circulation. This will result in less oedema which subsequently reduces pain.
Due to gravity, the lower limb is especially prone to excessive swelling. It is not uncommon to experience residual swelling for many months after injury.

Please do limit any activity or usage of the affected limb that may be detrimental to healing.

You will be given clear guidance as to your weight- bearing status before leaving your consultation. It is important you fully understand your treatment aims and any limitations or restrictions placed upon you in order for optimum healing to take place. You will be given instructions by your consultant regarding your weight-bearing status.

For clarification these will be either:

  • Non weight bearing- the affected foot must not at any stage touch the floor.
  • Partial weight bearing- if walking unaided, usually no more than touching the affected foot to the floor for balance.If you are walking with crutches, the foot strikes the floor simultaneously with your two crutches- this ‘offloads’ 2/3 of your body weight on to your arms.
  • Full weight bearing- you may walk unaided as comfort allows.

Please do use walking aids such as sticks or crutches as instructed.

If you are struggling using your crutches please contact a member of our clinical team.
Before leaving your consultation, we will advice you on the correct usage of your walking aids. If you have any problems please contact us for further advise. It is common for patients to struggle using crutches, especially if you have been instructed to be non weight-bearing. Sometimes just a simple change of technique or crutch height can make things a little easier. However, if problems persist there are other options that can be considered. Knee walkers- such as the StrideOn are light weight knee trolleys that will help you mobilise far easier than conventional crutches.
Please see www.strideon.co.uk for more information.

Please do ensure your cast is kept clean and dry.

For obvious hygiene reasons it is advisable to keep the cast clean and dry.

Please do inform nursing or medical staff if you plan to fly.

Please inform your Consultant if you have plans to fly- In a minority of cases flying may be detrimental to your treatment due to the higher likelihood of increased swelling.
Your Consultant may advise to “split the cast” which will allow extra room if any swelling occurs.
Airline protocols regarding casts may vary, so we suggest that you contact your airline before travelling.

Please do not get your cast wet.

The cotton wool padding layer of the cast will act like a sponge if it is allowed to become wet. Consequently, the skin becomes waterlogged (macerated) and can over time begin to ‘break down’- this is especially serious if you have a surgical wound underneath your cast.
Please consider purchasing a Limbo water-proof cast protector. These may be purchased from our clinical team or directly from the Limbo Company 

Please do not wear toe rings or nail varnish on the casted limb

If swelling is present, rings may become overly tight, causing restriction or occlusion of normal blood flow to the toes.
If this pressure is not relieved immediately serious tissue injury can occur. Removing the ring at this stage can be a difficult and painful process.
Subtle colour changes to the nail beds of the toes can indicate blood supply problems. Obviously, wearing nail varnish masks these early signs so should be avoided if possible.

Please do not place foreign objects (knitting needles, pens, tissues) inside your cast in order to relieve, itching, rubbing or chaffing.

Please try to refrain from using foreign objects such as pens, pen lids, knitting needles etc, in order to alleviate itching under your cast. Even very small scratches are far more prone to infection due to the warm, moist environment under your cast (which is a perfect culture medium for the growth of bacteria). Any early visual signs of infection will go largely unnoticed due to your cast covering the limb. Additionally, it is surprisingly common to find lost objects such as pen lids etc in the interior of casts, during cast removal- These can often cause pressure sores which can require the need for many weeks of wound care dressings or in severe cases surgical intervention by plastic surgeons.

Please do not cut, heat or otherwise interfere with your cast.

Synthetic casting tapes are comprised of an extremely durable material and attempting to trim or cut them without the correct equipment risks personal injury. Additionally, your cast is applied to very strict dimensions governed by anatomical landmarks. Trimming back or altering your cast in anyway may be detrimental to your overall healing.

Please keep in mind that although wearing a cast will restrict you in many ways it should not be uncomfortable to the point of keeping you awake at night or becoming the sole focus of your attention.

Please do not drive whilst wearing a cast unless instructed it is safe to do so.

Please discuss this issue with your Consultant.
It is generally the responsibility of the patient to decide if they are safe to drive a vehicle. You must be able to drive unimpeded during an emergency situation, such as an emergency stop, full steering manoeuvres etc.
If in any doubt, check with your insurer or the DVLA.

Important!

If you experience any of the following, please contact Jason Moores or Sandra Busari at the London Orthopaedic clinic.
Out of hours, please contact either The Princess Grace Hospital, the Hospital you were discharged from or your local Accident and Emergency department

Different or increasing pain

One of the fundamental concepts of plaster immobilization is that once the limb is immobilized pain should be significantly reduced.
Any difference or increase in pain may suggest there is an underlying problem, such as fracture displacement (the fracture has moved into an incorrect position), infection, pressure sores, ischaemia (loss or reduction of blood supply to the tissues). All of the listed examples will require immediate medical attention.

Shortness of breath

If you experience any pain or discomfort in your calf whilst wearing your cast or any unexplained shortness of breath, please inform one of our clinical team immediately. By far, the most common cause of calf pain in cast is simple muscle cramps- although painful these cramps will pass. However, calf pain can also be an indication of Deep vein thrombosis (DVT). DVT is a blood clot which usually occurs in a deep leg vein. It can cause pain and swelling in the leg and may lead to complications such as a pulmonary embolism. Pulmonary emboli occur when a portion of blood clot breaks off, travels through the bloodstream and subsequently blocks one of the blood vessels in the lungs. This is a life threatening condition.

Who is at risk?

Each year, 1 in every 1,000 people in the UK is affected by DVT.
Anyone can develop DVT, but it becomes more common with age. As well as age, risk factors include:
• previous venous thromboembolism
• a family history of blood clots
• medical conditions such as cancer and heart failure
• inactivity – for example, after an operation, casting of the lower limb
• being overweight or obese
• Pregnancy
• The contraceptive pill and HRT

Discolouration of the fingers (other than bruising), or increased swelling that does not improve after elevation or exercise.

Bruising is a normal by- product of injury or surgery and subtle colour differences to the casted and unaffected limb are fairly common due to an increase in blood supply to the injured area. However, if you notice colour changes, especially with associated pain, this may be a sign that the blood supply has become compromised or restricted in some way. This can be caused by excessive swelling, an overly tight cast or a mixture of both.
Elevate and exercise immediately- If symptoms have not improved after 30 minutes you will need to seek urgent medical attention.

Numbness or pins and needles.

Paraesthesia (pins and needles) is a common complaint post injury. Often this is caused by swelling compressing the sensory nerves. Elevate and exercise will often alleviate the problem. Less commonly, the pins and needles may be caused by nerve injury as a consequence to the initial injury or surgery or by an overly tight cast or bandage being applied. If after 30 minutes of elevation, the problem still persists please contact the clinical team or seek urgent medical advice.

Inability or difficulty in moving any joints not immobilized within the cast.

Please contact a member of the clinical team if you are experiencing problems moving any joints not included within your cast. This may happen due to pain or swelling limiting movement or simply by the cast restricting normal movement ranges. Either way, your consultant will need to be informed as adequate analgesia (pain killers) can be prescribed or our nursing team can adjust or replace your cast if needed. Movement of all joints not included in your cast is actively encouraged. This helps improve blood supply and muscles tone and will reduce consequent swelling and joints stiffness.

Blister-like pain, chaffing or rubbing.

This problem is unlikely to resolve itself and will often increase in severity. For all the major advantages of modern synthetic casting tapes the one huge drawback is it is a very unforgiving material and is very abrasive.
Incidents have been reported of pressure areas caused by casts breaking the skin and extending all the way down to bone. Once the superficial skin nerves have been eroded away, patients often feel very little pain. These incidences are fortunately extremely rare but it does demonstrate the need to never ignore or ‘put up’ with chaffing problems caused casting.

Visible staining, wetness or any offensive odours that may originate from an enclosed wounds.

The above signs are often an indication that there is a wound problem or skin breakdown has occurred. It is hugely beneficial for Infection or heavily macerated wounds to be seen and treated as early as possible.

Foreign body inside your cast; such as a pen or a coin

Please see section- please DO NOT place foreign objects inside your cast.

The cast has become wet or soiled

For hygiene purposes, your cast will most likely need to be replaced if it has become wet or heavily soiled, especially so if you have wounds under your cast.

Your cast becomes very loose, overly tight or otherwise uncomfortable

You may find that your cast becomes loose over time as the initial swelling subsides and your muscle bulk diminishes due to the effects of immobilization.
A loose cast will give only limited splintage and increases the likelihood of chaffing/rubbing problems.

An overly tight cast can be caused by excessive swelling or by poor cast application. If after exercise and elevation the problem persists please contact a member of the clinical team or seek urgent medical attention. Serious vascular (blood supply) problems can be caused by overly tight casts or bandaging and must be rectified immediately.

Areas of your cast become soft or cracked.

Your cast can become cracked or soften in areas over time. This is especially common, but not exclusive to, Plaster of Paris casts. This often occurs in your cast at points overlying joints such as the ankle or knee or along lines where the cast is in contact with resting areas- such as the calf, heel or the base of the toes.
If the cast is showing signs of wear it must be replaced or reinforced otherwise splintage will be reduced and pressure sores can develop.

If you experience an unexplained fever

A high temperature can be an indication of infection. Consequently, this must be investigated by clinical staff.

If you notice any skin irritation or rash

Some dry skin (most frequently noticed around the toes, the ball of the foot and the heel) is a normal reaction to being in cast. The dry area near the toes can often be relieved by careful moisturising of the skin or by the use of baby wipes etc

Rarely, some patients experience rashes, caused either by a sensitivity or allergy to cleaning fluids, dressings or other materials used in the construction of your cast. Often, symptoms are mild and can be relieved by the use of simple antihistamines, such as Piriton. If, however, you are experiencing a wide spread rash extending to the trunk, neck or face you will need to seek urgent medical attention.
Additionally, If the itching or rash is in close proximity to an underlying wound please inform a member of our clinical team who will advise you the best course of action.

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